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From: ((Steven B. Harris))
Subject: Re: Needle exchange program needs syringe supplier
Date: 21 May 1995

In <3plckh$> (Michael Ellner) writes:

>:                                             Steve Harris, M.D.
>:    (Who's been supporting the idea of needle exchange in principle since
>: he thought of it independently in 1985).
>Great idea doc, why not give
>them free drugs too?  It
>would kill those undesirable
>junkies even faster.

  Actually, you're wrong.  Most junkies die from infections (due to
unsterile technique and product) or from accidental overdose, due to
uneven product quality.  When supplied with pure and sterile drug,
junkies may live decades with no medical complications (hell, they
don't even get scars on their arms).  They may even live productive
lives, as did the great surgeon Halstead, who spent the last 20 years of
his life as a morphine addict, all while advancing the field of surgery
a great deal.

   In addition, junkies supplied with pure drug (which is very cheap)
don't have to commit violent or property crimes upon you and me to get
it, which is nice.  And there is no money funneled into organized crime,
which runs the drug trade when the government doesn't.  Remember when
they used to have drive-by machine-un shootings and gang wars over the
right to distribute illegal **ethanol**?  Guess when that stopped?  Yep,
1933.  And you know what we did to MAKE it stop, don't you?  We
legalised ethanol.  Now we have the same gang warfare over other drugs.
Duh.  Need I comment on our stupidity for not seeing the obvious answer

   With regard to other drugs (many much less socially damaging than
ethanol) I don't have to argue these points theoretically-- the English
have had programs which supply drugs to the addicted for years, and they
do work. The only reason we don't have them here in America (excepting
some methadone programs) is our basic puritanism.  Not because we really
care more about junkies.  Generally, we don't give a damn about junkies.

                                              Steve Harris, M.D.

From: (Steven B. Harris )
Subject: Re: Legal Cocaine Analog !!!
Date: 26 Aug 1995
Newsgroups: rec.drugs.misc,,,

In <41lj0p$> (Raefer
Gabriel) writes:

>In article <41j2pa$>,
> (Benjamin R. Ginter) wrote:
>>That's nice, but the company that sells this product is probably
>>breaking federal drug laws. In the mid-1980s, Congress passed a law that
>>made analogues of drugs on the US Drug Schedule the same as the drug
>>(legally). The reason was that people were making analogues of cocaine,
>>LSD (tons of those.. DOET, etc..), and other drugs and selling them
>>Unless this has a totally unique chemical structure or isn't one of the
>>chemicals that the body metabolizes the cocaine into, the drug is
>>probably illegal for any use outside of medical.
>Well now, I wouldn't bet on this interpretation of the law. I mean, I
>agree with your facts here: indeed as I remember Congress did pass such a
>measure. But does this apply to living organisms that may _contain_ these
>analogues? I don't know as I don't have the wording here in front of me
>nor I am a lawyer (thank God). It very well might cover this area to
>prevent new strains of certain illegal plants or the like. However this
>particular law may not cover a bacteria that contains a cocaine analogue
>(assuming I understood the original message in that the Superfood drink
>contains this bacteria and not the extracted cocaine analogue).
>Raefer Gabriel

  You are sneaking up here on something that WILL be a real problem in
a couple of decades, even if it isn't now.  Many plant based illegal
drugs like morphine, cocaine, psylocybin, etc, are just products of
enzymic reactions in leaves.  These enzymes can potentially be cloned
to yeast with a bit of genetic engineering, which would then make these
drugs in simple culture the way yeast now make alcohol.  That would
make these drugs about as hard to interdict as homemade beer, which is
(of course) exactly what they'd wind up in.  That will be the effective
end of the "war on drugs."  I've suggested to various fed types, and
also my political representatives, that they'd better find more
creative ways to deal with addiction before we reach this inevitable
world, but nobody listens to me.  So, as usual, we'll go into the
future blind, and when we hit the genetic engineered drug Wall,
everybody in the government will look at each other and say (in
unison):  "Who could have imagined it would come to this...?"
Duhhh....   "What do we do now....?"

                                         Steve, Harris, M.D.
                                         Cassandra of the Drug Wars

From: (Steven B. Harris )
Subject: Re: Narcotic Painkillers
Date: 10 Sep 1995

In <> (Steve Work) writes:

>D Stephen Heersink ( wrote:
>> Add the co-conspiracy of the FDA, FTC, and other governmental watch
>> dogs and their hounding and pounding of physicians who prescribed these
>> narcotic medications in good conscience, the fact that the drug
>> companies themselves participated in the conspiracy is hardly shocking,
>> but no less disgusting. Again, our government is often not in our best
>> interests.
>What exactly scares doctors so much about prescribing narcotics?
>Supposing that a patient gets addicted is the doctor somehow afoul of the
>law? Or are they subject to lawsuits? Is it true that some "big brother"
>monitors every narcotic prescription and comes after the doctors who
>prescribe them too "liberally"?

   Yep.  Once in L.A. I had Big Brother pay a visit to my office, in
the form of an investigator from the then California Board of Medical
Quality Assurance (now just called the CMB) on just such an expedition.
He didn't get anything he could use on me, but the very same guy did
nail Liz Taylor's doctors a while later.  They got into real hot water
for prescribing Ms. Taylor some heavy stuff, which she then proceeded
to go to the Betty Ford Center for, and blame the docs for (you see, it
doesn't count as much when you get addicted to "prescription
painkillers," as it does when you buy it from the local druggie; ah,
the benefits of being famous, rich, etc).  So the short answer to your
question is: yes, indeed.  You have to keep careful records of all your
patient drug transactions and your reasoning for them, and if your
local medical board doesn't like your reasoning in retrospect, you get
warned, then (eventually) nailed (lose your DEA licence).

>I remember responding to a post a few weeks back about a doctor who
>clearly prescribing narcotics inappropriately. He was writing
>prescriptions for some morphine-like painkiller (Levo-Dromoran) for a
>patient who was seeking treatment for obesity. Either he was trying to
>take advantage of anorexia which is a side-effect of this drug, or he was
>deliberately trying to get the patient addicted. I believe that the
>poster said the doctor was willing to give refills, but charged a stiff
>fee (i.e. $50) for each refill he wrote. Which gives the impression the
>doctor was trying to addict the patient in order to make money.
>Supposing the doctor was indeed doing the above, would he be guilty of a
>criminal offense, or is this a civil matter (i.e. malpractice)?

Probably both.  Malpractice requires that the patient bring suit and
prove harm.  Criminal matters here would be on the administrative side,
and would probably only result in licence suspension.  After all, it's
a pretty heavy hit to lose the result of years of schooling and work.
Sort of like retroactive prison, if you think about it-- a piece of
life taken.

>Recently, I had a tooth extracted, and I could sense that the dentist was
>reluctant to prescribe any type of narcotic painkiller. The first
>prescription was for ketoprofen, an NSAID, 75mg, 4-6 times daily. This is
>quite a high dose, and it made me both drowsy and nauseous. He did give
>me some Vicodin (which is, I believe, one of the weaker narcotics).

  It's moderately strong, actually, especially in the higher dose

>  But he was quite stingy (ten pills).  I did, however, get him to
>call in one refill but was reluctant to ask for more.  This was both a
>better painkiller and had fewer side effects.  From what I read, it
>takes months at a high dose to develop addiction to codeine-type drugs
>like this.  Yet, I sense unnecessary paranoia even with a minor
>ailment like this.

Yep.  Your local boards would probably want to know why a tooth
extraction hurt for more than a couple of days, and if it did, why it
wasn't re-examined.  They don't want refill after refill ordered
without that return visit for that re-exam, you see.  Not terribly
unreasonable.  Not that I want to give the idea that one offence like
this would like result in much problem, but a pattern of such
prescribing could definately make a dentist's life hard.  He doesn't
need the hastle.  It is a little known fact that some pharmacists feel
it to be their god-given duty to report physicians who seem to be too
"free" with narcotic refills.  Ain't the world a nice place?

>And I often wonder how to deal with the situation (I hope it never
>happens) where me or a relative really needs painkilling drugs and is
>not getting them in an adequate dose.  Is it the right thing to do to
>find another doctor (i.e. vote with your feet)?  Or to complain?  If
>so, who would be appropriate to complain to?

All of the above.   I'm assuming its a problem for which there aren't
clear medical guidelines (or else a simple change of doctors will
usually fix it).   For marginal cases you can complain directly to the
professional licencing board in your state, and your local DEA office,
that you have a fine doctor who feels crimped by the state drug laws in
a particular case, and is paranoid.  Let them know you're having a
problem with a suffering family member, and start yelling and
screaming.  Politicos and bureaucrats just hate that.   As long as
everything is out in the open, and everybody knows about your case,
you'll likely find your doctor much more willing to prescribe whatever
it takes.  Doctors know they only get stand to get hastled for marginal
prescribing that looks hidden, and that DEA offices and state boards
find out about, after the fact, and not from the doctor.  Them's the
rules of kissing up to bureaucracies.  The one mortal sin in law and
government, as in all religious institutions, is failure to bow to and
acknowledge authority.  Remember this and all else follows.

                                            Steve Harris, M.D.

From: (Steven B. Harris )
Subject: Re: Narcotic Painkillers
Date: 11 Sep 1995

In <4325dq$> (AlWeissman)

>In article <42u9qo$>,
>(Steven B. Harris ) writes:
>>It is a little known fact that some pharmacists feel
>>it to be their god-given duty to report physicians who seem to be too
>>"free" with narcotic refills.  Ain't the world a nice place?
>Dr. Harris, are you familiar with the phrase "corresponding liability?"
>4. Patients have successfully sued _both_ the physician and the
>pharmacist after becoming addicted to controlled substances, even when
>the pharmacist has verified the prescripitons with the MD.

   This I didn't know.  If true it explains a lot.  Okay, I'll give up
blaming pharmacists and blame lawyers and tort juries, who I've always

>The goal of making the patient comfortable is hampered by politics and
>fear. Our UK brothers can testify to the efficacy of diacetyl morphine,
>which crosses the blood-brain barrier ten times more readily than
>morphine SO4. Unfortunately, it would be too big a political bombshell
>for our FDA to allow the use of heroin for terminal pain.

   This is another subject, but one where I differ again.  Heroin is
only twice as potent as an analgesic, milligram for milligram, as
morphine.  It may be 10 times as good at crossing the blood-brain
barrier, but this is only important to a junkie who wants an IV rush.
You can't tell the difference between equi-analgesis doses of the two,
when given IM, SQ, or PO.  Even experienced drug abusers can't
(although, again, they CAN tell the difference IV).   And the doubled
potency is paid for with doubled side effect, so there's really no
reason not to just give twice as much morphine, when you're talking
about pain control.  Or dilaudid or fentanyl if the doses are getting
large and you want small injection volumes.

    The British are horribly snooty and superior about their medical
heroin, but they really don't have anything better than we do in the
U.S. (sorry).  The people who kept heroin illegal in the US had a good
scientifically valid reason to do it, if you agree with their moral
stand on drug abuse.  Which I don't.  But I have admit the science was

                                            Steve Harris, M.D.

From: B. Harris)
Subject: Re: STOP DESTROYING LIVES, Doctors----
Date: 28 May 1997

In <>
(LaTexana) writes:

>My husband, married 25 years, father of four, has been battling an
>addiction to hydrocodone for several years. These pills are TOO EASY to
>get from doctors who scribble whatever an addict wants with minimal
>actual medical investigation. One of his doctors realized he was an
>addict (after I found the prescription and informed her). Used Clonidine
>to get him off. TWO MONTHS LATER, without notice to his loved ones, she
>prescribed 300 pills/per month hydrocodone to him AGAIN, in full
>knowledge of his addiction. The doctor's excuse? "He is so persuasive. He
>won't get any more out of me." Husband has several other doctors who give
>him prescriptions of about 100 each per month, on his claims of bad back
>How does the medical profession explain a man on 900 pills per month? Is
>there no cohesiveness of any kind here? Are these sick people dying
>because the medical profession doesn't really give a damn? Too easy to
>write scrips without proper testing? Why are these pain meds not on
>triplicate, state-reported prescription forms? How many lives and
>families have to be destroyed before "doctors" take more general
>responsibility here? Addicts are very ill. So is the medical profession.
>I sincerely doubt many doctors will have the intestinal fortitude to
>answer and comment on this subject.

   He's not taking 900 hydrocodone pills a month, or at 10 grams per
day chronically he'd have long since been dead of acute Tylenol
poisoning.  Actually, this is the worst danger he's in presently, and
far outweighs danger from the narcotic, sad to say.  This, because your
wise FDA has used APAP (Tylenol) as a sort of denaturing agent, to make
sure that schedule III narcotics can't be abused to any huge extent
(since the abuser dies of liver failure if this is tried).  Boy,
that'll teach abusers...

   Doctors are in a tough situation vis a vis chonic pain, as we in
general get more critisism for undertreating it than overtreating it.
Nor is there anything about back pain which makes it any less real or
nasty than any other type.

   If you want to put the fear of God into any doctor you think is
overprescribing pain meds, you just give a call to your local state
medical board about the situation.  It'll stop.  Of course, on your
conscience then will be the many poor schlubs who will get undertreated
by this now-paranoid doctor in the future.  And whose families will
write in here to complain about it (I'll refer them to your email

   The bottom line is that there really aren't very many good answers
to chronic, intractable pain, if you're not willing to give enough
narcotic to treat it.  There are lots of other tricks and drugs to try
(and I use them all in my own practice), but sometimes nothing works,
or works without at least some narcotic.  The only thing you can do is
get your husband to a pain specialty group, which will give him all the
other treatments, and minimize his narcotic consumption.  And get him
at least off the Tylenol.

                                       Steve Harris, M.D.

From: B. Harris)
Subject: Legalization (was: Alchohol and Violence)
Date: 04 Jun 1997
Newsgroups: alt.drugs,alt.drugs.culture,alt.drugs.hard,alt.drugs.chemistry,

>Ryan Maves <> was, like, :
>>I think a lot of the people on both sides of this issue are quite naive,
>>though. Alcohol is perfectly legal, but its abuse destroys lives quite
>>nicely. Why would this not happen with heroin?

   The short answer is that use of medically pure opiates over long
periods of time does no damage to organs.  Whereas alcohol eventually
rots and atrophies people's livers, brains, bones, and all kinds of
other things.

   There are all kinds of drug users/addicts.  Some lead perfectly
controlled lives, and are quite functional.  This may even be true for
alcohol.  The difference is that alcohol used this way still leads to
long term health problems.  Pharmaceutical grade opiates and
benzodiazepines don't.  Of course, it's possible with any drug to "ruin
your life" by giving yourself an overdose, or by chronically using so
much of the drug you can't function in any other capacity.  But this
kind of extreme abuse of drugs is at one end of a spectrum, and is a
minority pattern.  Even people who do go through this kind of phase, if
they survive, quite often "burn out" after a decade or two, and want to
get on with a productive life.   With lower doses of drug, they often
can.  In fact, many hard drug users even quit entirely after they
"mature" through the heavy abuse years.  Again, of course, given that
they survive them.  Legalization would be a great help in that regard.

                                            Steve Harris, M.D.

From: B. Harris)
Subject: Re: Legalization (was: Alchohol and Violence)
Date: 05 Jun 1997
Newsgroups: alt.drugs,alt.drugs.culture,alt.drugs.hard,alt.drugs.chemistry,

In <5n4r9o$9j9$> (Jonathan
Fox) writes:

>But intravenous administration of even pure opiates does have risks such
>as skin infections, endocarditis, and transmission of HIV and hepatitis B
>through shared needles. None of these would be solved completely even
>with the most aggressive needle-exchange programs.

   But there would be mostly solved with a program in which new
syringes were available freely without exchange.  Junkies don't WANT to
destroy their veins and give themselves AIDS, and studies show that
they don't if given half a chance (of course, a few people insist on
suicide in any group, but why count them?)

>Furthermore, I don't think he meant alcohol abuse destroys lives just in
>a physical sense. The psychosocial aspect of alcoholism is often the most

    No doubt.  But the psychosocial effects of narcotics and
benzodiazepines are not nearly as bad as those of alcohol, either.
People function fine on Xanax.  They don't beat their wives, commit
crimes, kill people on the highway, lose their jobs, etc, etc, etc.
Getting them off alcohol and onto Xanax is usually a blessing, though
they remain (of course) chemically dependent.  To a lesser extent the
same is true of narcotics.  Many a cancer patient has lived a pretty
full life on huge doses of morphine or fentenyl or methadone.

   The biggest problems in legalization involve amphetamine and cocaine
(ab)use.   The nasty uppers.  There are people who use these in
controlled fashion, but the potential for dropping off the end and
becoming totally dysfunctional and crazy is much more of a problem here
than for any other class of drugs, save perhaps alcohol.

                                           Steve Harris, M.D.

From: B. Harris)
Subject: Re: Little respect for doctors
Date: 19 Jun 1997
Newsgroups: bionet.general,bionet.cellbiol,,,,

In <> (ORAC) writes:

>In article <>,
>>if you think its about helping people and the "hippocratic oath crap
>>  your on the very drugs you withold from your chronic pain clients
>>  (to cover your ass)
>Then you'll probably conclude that I'm on those drugs, because I DO
>believe that that's what it's about, for the most part.
>As for "covering our asses" by not giving adequate pain medication, I
>wouldn't necessarily blame the doctors exclusively for that. Blame the
>anti-drug hysteria in this country, too. A doctor who gives prescriptions
>for lots of narcotics to his patients soon finds the DEA looking *very*
>closely at his practice. If that doctor persists, pretty soon he'll face
>threats of having his license revoked. That's a lot of pressure to bear.
>A doctor who resists that pressure soon faces the loss of his ability to
>make a living if he doesn't surrender.
>If you're a pain patient, I'm sure you're aware of the case of this one
>doctor who is an advocate of giving as much narcotics as it takes to
>control a patient's pain. (I don't remember his name, but I think he's in
>Virginia, although my memory could be faulty there.) He was featured on
>60 MINUTES in a rather sympathetic portrait not too long ago. What
>happened to him? The DEA prosecuted him and the pharmacist who filled his
>prescriptions, and the state medical board stripped him of his license to
>practice medicine.

    Yep.  I haven't been able to decide whether we get more "doctors
are monsters because they won't treat my pain" messages, or "doctors
are monsters because they got me (or my husband or other family member)
addicted to pain pills" messages.  We ought to have a service that
sends one crowd the other's email addresses.

    It's be nice if we'd just legalize opioids and be done with it.
Let adults treat their own pain and take their own responsibility for
it.  Pain is too damned subjective to require some other person of
authority to be in the loop.  It's bound to be cruel no matter what you
do.   Let doctors continue to control antibiotics, which are really far
more dangerous to the public safety.  You should need a triplicate from
a doctor to buy amoxicillin, but as an adult you should be able to buy
morphine at the liquor store on your own, no questions (but your age)

   My 2 cents.

                                         Steve Harris, M.D.

              (Who's given a hell of a lot of narcotics to patients in
pain, and has a suspicion it still wasn't enough).

From: B. Harris)
Subject: Re: Trauma anesthesia demand
Date: 27 Dec 1997 20:24:48 GMT

In <68376l$> Matthew O'Neil
<> writes:

>Even fractures are reduced in the ER with sedation and pain meds. We try
>to avoid ' putting anyone to sleep' unless absolutely necessary. 90 year
>old ladies get IV's every day, buck up about it. No one ever died from

    I'm not an ER certified doc, but I'm an internist who's moonlighted
in many ER and Urgent care situations over the years, and who has seen
a lot.  It's my opinion (and that of many learned bodies as well) that
pain meds are vastly underused in ERs.  Excellent results happen when
people in significant pain get significant narcotics.  The person who
is nearly comatose from "shock" from the pain of that fractured leg or
jaw, will turn into a pleasant, cooperative, normal human being again
after 10 mg of MS IM.   I've seen it more times than I can care to say.
I've also seen people with significant trauma who would not have any
real contraindication to IM morphine go hours without decent pain
relief in ERs.  Or get inadequate treatment, like one Lortab for a
couple of fractured ribs.

   In nearly every ER you've find one patient who can hardly talk or
function because of the pain.  And he won't be getting what he needs.
Welcome to the "War on Drugs," which resembles, quite a bit, a war on
people.  Strange to tell.

                                      Steve Harris, M.D.

From: B. Harris)
Subject: Re: Trauma anesthesia demand
Date: 27 Dec 1997 23:22:32 GMT

In <683rb4$> Matthew O'Neil
<> writes:

>In our hospital most docs always use pain meds unless specifically
>contraindicated or refused (occasionally they are refused) . I see no
>need to let a patient sit in pain and disturb everyone around them when
>they can have effective pain control. I am of the ' 1 mg short of apnea'
>school of thought for severe injuries and I prefer to give pain meds
>around the clock rather than prn at least for the immediate post
>traumatic period. I can't create an opiate dependency in the few hours a
>pt is in the er. Let the admittings create and resolve those problems.

Bravo.  And it's amazing how rare narcotic apnea is.  I can't say as
I've ever really seen it at standard MS pain control doses.  Certainly
the GI guys get away with much larger doses of stuff in (often) pretty
frail people.  And that's just for colonoscopy, which has to hurt a lot
less than a lot of trauma you see in ERs.


From: B. Harris)
Subject: Re: Trauma anesthesia demand
Date: 28 Dec 1997 21:56:05 GMT

In <> Carey Gregory <>

>Serious trauma patients coming into an ER often have internal injuries
>that are not readily apparent. They also come in with unknown medical
>histories, unknown prescriptions for other conditions, and unknown drug
>allergies. They may also have alcohol or other drugs on board that will
>interact with the pain control meds. The wise ER doc proceeds carefully
>when all the facts aren't yet known.

   There's a lot of mythology to battle, here, though.  It used to be
that narcotics were not given to people with abdominal problems, for
fear of "masking" the pain.  When somebody finally got around to doing
the study, it was found that narcotics were actually helpful in
abdominal pain, as they mask secondary guarding and allow better
localization of pain to the site of the primary problem. Fancy that.

>Even more importantly, a patient's level of consciousness is often the
>most sensitive indicator of serious injuries, especially head injuries.
>Nearly all pain control drugs affect one's level of consciousness,
>thereby making it difficult to distinguish between the drug's effects and
>physiological signs of injury. Is the patient lethargic because of the
>morphine? Or is it because of head injury, shock, etc? These questions
>have to be answered FIRST.

   Again, rarely.  Narcotics given to people in pain in appropriate
doses DO NOT cause grogginess.  Pain itself is quite an effective
antedote, here.

   Second, level of consciousness is not just grogginess-- it is also
delirium, which includes difficulty in focusing attention and
difficulting cooperating.  Delerious patients aren't always the heavy
lidded sleepy types-- that's the popular misconception.  More often
than not patients in delerium are wide awake, but not with you in any
meaningful way.  Pain is a primo cause of delirium in trama patients,
and it goes away magically with pain control.  As I said in previous
post, groaning injured people who aren't much more than animals so far
as rational thought goes, will turn into thoughtful cooperative
patients when the morphine hits the pain they're having from all those

>Paramedics with my ambulance service routinely administer pain control
>for painful injuries long before the patient even reaches the ER.
>However, this is done only when we can rule out head injury, impending
>shock, drug allergies, and that the patient has taken other drugs or
>alcohol that will interact with the pain control drugs.  I've never seen
>any ER doc withhold pain control frivolously.

    I have the feeling that a lot of your "possibly head injured"
patients are suffering unnecessarily.   Geez, just about anybody in a
bad accident has minor or possible head injuries.   I don't think that
any of them are going to be harmed by a 5 or 10 mg of morphine, if they
are in real pain, and I doubt it is going to make a whit of different
on their GCS's (there must be a study about this...).

                                   Steve Harris, M.D.

From: B. Harris)
Subject: Re: Ritalin in ADD uses & dangers??
Date: 30 Dec 1997 21:25:11 GMT

In <68b94m$> (Peter Cash)

>Your comments are, as always astute. However, you give the impression
>that this situation is exclusively the fault of patients who clamor for
>"legitimate" drugs, and you neglect the role of the medical profession in
>perpetrating this legal/street drug fiction. Exactly what has the medical
>profession done, other than to jealously safeguard its right to be the
>pharmaceutical gatekeeper of our world?

   Well, the AMA and every other major medical organization I know of,
has been publically for drug decriminalization for years.  Our critics
say we're just trying to "medicalize" one more problem.  Go figure.

>Instead of resorting to invective, you might suggest an alternative
>public policy on drugs. For example, should we do away with the entire
>concept of drugs-by-prescription? Should everyone be free to buy
>whatever pharmaceuticals they want?

    Yes, except for antibiotics, which truly are a public health
problem.  You can use mind altering drugs in your living room or
bedroom until you pass out, and it doesn't affect me much.  But you
breed antibiotic resistant bugs in the privacy of your own home, and
it's sort of like breeding rats in the garbage in your back yard.

>If that's what you think, be careful--the medical high priests will
>squash you like a bug, for nothing would be more ruinous to their
>incomes than this. After all, why go to the doctor if I can buy
>morphine and antibiotics OTC?

   You'll soon find out.  You go to the doctor for information.  If you
can get the same from a book, more power to you.  But methinks you'll
soon find that, although in theory there's no difference between theory
and practice, in practice, there is (thanks to Yogi Bera for that

>In truth, one could make arguments _for_ the prescription system; I'm not
>really advocating its utter abolition.

    I am.  Except for antibiotics.  And third party payers will
obviously want to use it to keep track of what they'll pay for.  But
that's not quite the same thing.  You can buy without Rx for more money
is not the same as not being able to buy at all.

>I'm not sure just what the answer is, but I do know that this country
>(the USA) is totally bonkers on the subject of drugs, and that we need to
>go a loooong way toward tolerance and deregulation.

    Agree, of course.

>I would like to hear some suggestions from a medical professional like
>you who's evidently concerned about this problem.

    There's a start.

                                    Steve Harris, M.D.

From: B. Harris)
Subject: Re: hydrocodone
Date: 12 Jan 1998 00:34:36 GMT

In <>
(Liza57) writes:

>In article <69664m$>,
>B. Harris) writes:
>> A lot of chonic pain is due to inflammation and swelling. NSAIDS are a
>> significant adjunct to narcotics in these cases. You can get a lot of
>> extra pain control for only a bit of drug. Classic example is a cancer
>> patient with bone metastases, which cause pressure in the periosteum
>> due to swelling and inflammation. NSAIDS or aspirin added here to
>> morphine works great.
>FWIW, after a C-section I was given 1-2 Tylox (oxycodone/apap 5/500)
>every 3 hours as needed. A day later, the doctor added Motrin 600mg
>(ibuprofen) every 6 hours. The pain relief I had with the combination of
>Tylox and Motrin was far superior to Demerol 50mg IM or 2 capsules of
>Tylox. I always justified it by the theory that NSAIDS were more
>effective for peripheral pain (as well as for inflammation) while
>narcotics were more effective for deep-seated pain. It seems totally
>logical to me that the addition of _therapeutic_ amounts of NSAIDS would
>improve pain management in _all_ types of pain, regardless of whether or
>not inflammation is a problem.

   I'm sure you're right.  The only reason why combinations of NSAIDS
and narcotics, or for that matter, NSAIDS and APAP (acetominophen)
aren't out there, is that the combos have to be tested all over again
to get FDA approval.  Nobody has the money to do that for off patent

                                  Steve Harris, M.D.

From: B. Harris)
Subject: Re: Fiorinal/Fioricet
Date: 28 Jan 1998 20:29:49 GMT

In <>
(Piller61) writes:

>Does anyone know why Fioricet is non-controlled whereas Fiorinal is a
>scheduled drug? I know the only difference between them is Fioricet
>contains APAP and Fiorinal contains ASA. I've discussed this with other
>pharmacists with no specific answer given. I was asked this question by a
>nurse practicioner the other day and was unable to answer so would
>appreciate your help. Thanks in advance.
>                  R.Dyer, RPh

The cruel reason is that the FDA uses APAP for narcotics (including
barbiturates) in much the same way methanol is used for ethanol.  To
wit: as a toxic "denaturation" agent to make sure you don't, or can't,
take too much before your liver rots or your kidneys quit.  The APAP
therefore makes the difference between a lot of schedule II and III
drugs.  FDA's reasoning is that these drugs *can't* be greatly abused
for very long, or the user will be dead or disabled, which is a
perfectly fine outcome in the war on drugs (see "war on people").

Now, if you accused the FDA of this deliberate policity, it would deny
it.  Since of course there are an awful lot of former Darvon abusers on
chronic renal dialysis.  But that's the way it is.

                                           Steve Harris, M.D.

From: B. Harris)
Subject: Re: HIV 10 times more active in the USA
Date: 24 Apr 1998 04:57:07 GMT

In <6hms9m$8uk$>
lb@ariel.ucs.unimelb.EDU.AU (Lindsay Berge) writes:

>As for not having sex, you obviously have never met any real-life heroin
>addicts, have you?
>Best regards, Lindsay Berge

    I have, and they one and all said they weren't much interested in
sex-- that part's correct.  Narcotics are even better than SSRIs for
turning off your sex drive and ability to reach orgasm.   Which is not
to say there aren't heroin addicts who aren't prostitutes.  But that
has nothing to do with interest in sex, of course.

                                   Steve Harris, M.D.

From: B. Harris)
Newsgroups: alt.current-events.clinton.whitewater,,,
Subject: The End of the Drug War:  Not With a Bang But a Belch
Date: 8 May 1998 10:28:32 GMT

In <6itt88$> Tommy the Terrorist
<> writes:

>While it's not very certain to guess their priorities, it appears that
>one case is that trashing black neighborhoods is useful to them for
>real estate, social control, and demonstrative punitive purposes.


   Oh, give us all a break.  No CIA plot is needed for this.   Black
neighborhoods got "trashed" when the black middle class moved out (as
soon as they could) and left everybody else.  That escape was a result
of LBJ's civil rights legislation, pushed really hard by every liberal
and every US black leader everywhere.  Nobody saw the consequences, and
had they forseen them, they'd have done it anyway.  What was the

    Yes, the drug war is a class war, and nobody really cares too much
about the 1.1 million people in jail, since only 20% of them are white.
But I don't think anybody planned it.  It's just that nobody's really
very interested in doing anything to stop it.


   However, note that the situation is not a stable one, because
technology is upon us.  Cocaine and morphine (the basis drugs for crack
and heroin) are plant products.  As, for that matter, is also
ephedrine, which can be turned into methamphetamine (and is, illegally,
in basement labs by the ton). Cocaine and morphine are very difficult
to make artificially, which is why they are still smuggled.  But that
is about to change.

   What produces these chemicals in the leaves of the plants that make
them-- the coca bush and the opium poppy?  Enzyme systems.  Protein
catalysts with exquisite selectivity.  No human chemist could hope to
match the feat which plants do with the utmost ease.

   But why keep these enzymes in plants, where they are difficult to
grow and feed?   Today, the genes of living organisms are removable,
and with modern techniques, a living organism can be thought of as not
a book of genetic instructions, but more a looseleaf, from which pages
can be borrowed at will.  Cocaine and morphine are products of a few
enzymes, the genes for which should be entirely transferable from plant
to yeast, using the modern techniques of genetic engineering.
Pharmaceutical companies now manufacture proteins like human growth
hormones in yeasts, in this way.  One day, they will manufacture not
only proteins, but proteins that are enzymes, and which are tailored to
make other chemicals we want.

   When such a yeast strain has been prepared with drug-manufacturing
enzymes from the appropriate plants (coca, poppy, canabis), it will be
possible to brew morphine, cocaine and marijuana alkaloids at home,
with about the same level of difficulty as making alcohol in
home-brewed beer.  Indeed, with genetically altered yeast, the process
will be exactly the same.  It will, however, be beer with a very
different kind of kick.

   At that point, we must realize, the drug war, as we know it, will be
over.  Even during Prohibition in the roaring 20's, the feds didn't try
to control microbrewing of beer.  It would have been impossible.  In
home brewing of beer there's nothing to smuggle.  There's nothing to
distil.  There are no power requirements.  The starting stuff is yeast
(which can be kept like a sourdough start) and food items like sugar.
The yeast itself can be dried, and mailed on postage stamps.  Ladies
and Gentlemen, that's the end of laws against such drugs with any
effectiveness.  Genetic engineering is about to do to the illegal drug
industry what the cheap video camera did to the porn industry.
Everybody will soon be into the act.

   When is this going to happen?  It's anyone's guess, but it could
come any time between next year and 20 years from now.  One thing is
for certain-- barring some kind of global disaster which stops
technology in its tracks and starts a new dark age, genetic engineering
of yeast to provide illegal home brew narcotics WILL certainly happen.
There is no way it cannot happen.  Genetic engineering is too easy, and
too many people are doing it.  Nature has already shown us the way to
the chemicals which people want.  It's the basis for the pharmaceutical
industry of tomorrow.  Trying to stop it would be about as impossible
as trying to suppress computers.   We're long past that possibility.
Genetic engineering is being done today in high school science fairs.

    What can we do?  One immediate conclusion is obvious.  Eventually,
and not before another generation is up, our society will finally need
to learn to live with the new high potency drugs, in the same way that
Europeans finally learned to live with alcohol down through the
centuries.  This will come uneasily.  However, I believe it will come
also with reasonable sucess, because we are more medically
sophisticated, and also, (as in the case of alcohol) we have had no
choice.  We learned to live with alcohol successfully partly because it
was out in the open where we could deal with it and learn from our
mistakes (which we have not been able to do with the other drugs).  But
all of the other drugs are soon to follow the example of alcohol.

    It's time to start preparing for this NOW.  We had better start
letting addicts and sellers out of prison, and start spending money on
drug rehabilitation and addiction research like there was no tomorrow.
For soon, these will be the only option our society has left in this
battle, and if we do not begin to understand the mechanisms of
addiction of the human brain at a fundamental level, there may BE no
tomorrow for us.

    Prohibition is soon to be over, and it's time we learned how to be
adults again.  Here's the warning bell.  The ship is sinking, and there
aren't enough life boats.  But this time, if we start now, we may just
have time to build enough by the time we need them.  Let's get on with

                               Steven B. Harris, M.D.
                               May 8, 1998

From: B. Harris)
Subject: Re: Wellbutrin
Date: 1 Jul 1998 04:17:46 GMT

In <6nc1jj$qe9$> "Asper Oggus"
<> writes:

> > I personally feel that dopamine has been overlooked by researchers
>It's not an accident. Dopamine has been deliberately overlooked. The
>reason is that a DA reuptake inhibitor would actually make you feel good.
>On the one hand, that's what an antidepressant =should= do, but on the
>other hand, that sounds suspiciously like "abuse potential" (what an
>unscientific, indeed imbecilic, concept).
>We're in a tough bind. We need to develop drugs that make depressed
>people feel better, while making them feel shitty at the same time. We
>need drugs that make people want to be alive, but which no one in their
>right mind would consider taking.


   But which no one in their right mind would abuse to feel euphoric,
you mean.  Yeah, big problem.

   Never fear about the dopamine receptors, though.  With enough
congitive dysonance, we can still stimulate the dopamine receptors
directly or indirectly, and pretend the euphoria is a different and
much more legal and puritanical kind than experienced by the nasty
speed freaks and meth-heads.  Antidepressant "augmentation" therapy
with T3 and Ritalin are alive and well.  If you call it mere
"augmentation," they can't accuse you of being Dr. Feelgood.  Language
is important.

    With (just a little) more seriousness, I have wondered why they
haven't tried more of this with Sinemet, though.  Should work.  Right?
For that matter, Sinemet should work a little bit on smoking, if
Wellbutrin does.  I believe there are reports of prosexual effects of
Sinemet which remind me a lot of the Wellbutrin and cocaine and speed

                                         Steve Harris, M.D.

From: B. Harris)
Subject: Drug Abuse Dangers (was: Re: Wellbutrin)
Date: 2 Jul 1998 10:03:44 GMT

In <> Shelly & Maria <> writes:

>Steven B. Harris wrote:
>> In <> Shelly & Maria <> writes:
>> >Steven B. Harris wrote:
>> >>  I believe there are reports of prosexual effects of
>> >> Sinemet which remind me a lot of the Wellbutrin and cocaine and speed
>> >> experiences.
>> >>
>> >       We've never used drugs Steven.  Are we missing out on some important
>> >life experiences?  If so, what drugs should we try?
>> >
>> >                S&M
>> How would I know?  I'm just a stodgy doc.  Ask the folks on
>> alt.drugs.recreational.
>	We don't care what those bozos think Steven...we want the opinion of
>medical renegade-libertarian with an expanded mind.   We don't want to
>put you on the spot, so will ask you a purely hypothetical question,
>based on several assumptions that are beyond your control, but which you
>must work with.
>	Here are the assumptions: (1) you have 22 year old daughter; (2) she is
>going to experiment with drugs for the intended purpose of having a mind
>expanding experience (remember Steven, you can't change the
>assumptions--she is going to do this); (3) you care about your
>daughter's welfare and want her to have the most mind expanding
>experience reasonably possible, while minimizing any dangers of "bad
>trips" or permanent damage (assume she is a medical student with huge
>student loans so she can't afford to fry her brain); and (4) she has
>access to both prescription drugs and "street" drugs.
>	Now, given these assumptions, list the five drugs (or combinations of
>drugs) you would hope she would take, starting with the "best" (or
>perhaps from your perspective, the "least worse").   Again, this is a
>purely hypothetical question, based on the premise that your position as
>a stodgy doc is that you would not recommend that anyone experiment with
>drugs, but have been placed in this imaginary quandary.
>		Love,
>                                                 Shelly & Maria

   Well, that's a toughie, since the answer to "what's the best drug if
you just *have* to experiment with mind-altering drugs" depends on who
you are (ie, what your brain chemistry is, probably due to what your
genes are).  Andrew Weil, M.D. is not out to lunch when he says there
are no bad drugs, only bad combinations of certain people and certain
drugs.  He's talking about pure drugs, of course, and not stuff cut
with junk.

   A few things can be said statistically, I suppose, to guide those
bent on experimenting at any cost.

   Based on pure statistics, the physically safest addictive and mind
altering drugs are probably the benzodiazepines.  Alprazolam/Xanax is
probably the purest example.   Next in safety is probably GHB--- the
dose it takes to alter your mind is very far from anything it takes to
stop your respirations.  But make sure you're in a safe place with a
sober guardian.  The prescription drug Neurontin/gabapentin is quite
similar to GHB, and also fairly safe.  Of course, as with all
"downers"-- some people it just puts to sleep.   Alcohol, quaaludes,
and babiturates are all major respiratory depressants, and are best
left out of experimentation entirely (alcohol can be used, but
generally should be used entirely alone, or possibly with marijuana).

   LSD in appropriate doses 100-200 mcg is fairly safe, so long as
somebody sober and physically strong watches over the experiment, and
has a lot of Xanax handy.  Other psychodelics, such as those in "magic
mushrooms" are weaker, and even more benign.  Extasy/MDMA is an
extremely interesting drug for mental effects (so says the literature),
and also apparently *relatively* benign, unless used very often (more
than once a month or so).  There is indirect evidence that it is
neurotoxic, but nobody knows what the limits are.  Used too often it
also loses effect.

   Nearly all of the above drugs (not counting the respiratory
depressants mentioned) can be combined with reasonable safety, so long
as this is done sequentially, with due titration (no more than small
changes--one drug--- in each new combo).  Marijuana can be added to
this list, also.

   Pure stimulants such as methamphetamine and Ritalin are dangerous in
proportion to dose only.   In standard medical doses of 5 or 10 mg,
orally, they're really not very dangerous for a young person in good
health.  In larger doses, or by injection, they become quite dangerous.

   Much the same is true of narcotics (opioids).  In prescription
strength pills, one pill is unlikely to harm a young and healthy
person, even when combined with one dose of stuff in the list above
(excluding alcohol, barbs, quaaludes, etc).  But again, nobody should
try any combo which differs by more than one pill from something he or
she's not tried before several times.  Naturally, drugs which aren't
pharmaceuticals should be avoided, unless there is no choice (schedule
I drugs such as MDMA, LSD, marijuana).  Heroin and cocaine should be
avoided, even as sniffing powders, due to powerful effects, uneven
quality, and physiological derangements (cocaine, for instance, can
cause a nasty cerebral vasculitis.   Heroin is usually not pure, and
when it is, can cause real problems in dosing for people used to
getting it cut).  Injected drugs in any form should be avoided at all
costs, due to a raft of problems which puts them all in a whole other
danger category.

   So there you are-- the straight stuff about "drugs" which they
certainly won't tell you in high school.  Don't say where you heard
this theoretical discussion.  Last, I need to add the standard
disclaimer that there's no way to really experiment with mind altering
drugs *really* safely, any more than there's a *really* safe way to
climb Mt. Everest.  You're going into mighty thin air, except you're
doing it in a non "socially-acceptable" way.   If you lose your life or
your fingers on drugs, they'll react very differently than if you do it
on a mountain.

    But whether on Everest or with drugs, it makes sense, if you're
going to do it, not to do the really dumbest stuff.  John Belushi and
Chris Farley didn't die because they took a Xanax AND a Ritalin AND a
Percocet.  That's Valley of the Dolls scare-mongering.  By and large,
people die from drugs by doing the really bad and way-out-of-proportion
things with them.  Everybody else, at worst, gets drug-dependent, or
gets into trouble with the law, or runs into danger by doing something
complicated they aren't supposed to-- like swim, shoot, or drive, while
mentally impaired.  Exactly as with alcohol.

                                   Doc Harris
 (An yes, DO try it at home, if you MUST try it.  No place else is
safe, that's for sure)

From: B. Harris)
Subject: Re: Opiates for suidicidal depression
Date: 11 Oct 1998 11:13:09 GMT

In <smi-1110980643050001@> smi@sch.tiac (Samson) writes:

>In article <>,
>(Gorieth) wrote:
>> On 10 Oct 1998 19:26:11 GMT, smi@sch.tiac (Samson) wrote:
>> >Opiates as first-line therapy for depression? I think not. Managing
>> >the dose is a pain in the ass.
>> When you say managing the dose is a pain in the ass I take it you're
>> talking about tolerance. How about DXM(dextromethorphan) for
>> preventing the tolerance, is this a viable way to be able to manage
>> depression successfully?
>I don't know. At the dose of DXM found to significantly "reverse
>tolerance"* in animals (20+ mg/kg), you'd be pretty loopy to say the
>least (if not *dead*).

   Sick as a dog is what you'd be.  When DXM has been used as a
possible stroke "prevention" (amelioration) agent, people felt so bad
on large doses they had to stop.  These people say it's very dysphoric
and not at all pleasant.

>More what I'm talking about is titrating down when you opt for a
>different approach. If you're going to go for chronic opioid
>therapy -- be it for addiction maintenance, pain or depression --
>you're in it for the long haul. If opiates are to be used for
>depression, they should be the last option. But they *should*
>be an option.
>(* - I'm skeptical about the use of the term "tolerance reversal"
>here. All the studies I've read coadministered DXM and morphine, so
>there's no way I can see to distinguish "tolerance reversal" from
>"augmentation", and by Ockham's Razor I prefer the latter.)
>I should also say that I do have a friend who was suicidally
>depressed/OCD/bipolar/whatever-the-diagnosis-du-jour happened to
>be -- and severely anorectic, and at her wits' end with all the
>lithium, Depakote, SSRIs, fluphenazine, TCAs she could swallow.
>All for naught. She had a psychiatrist who was willing to prescribe
>methadone, and it really did bring her back from the edge of death.
>She has been on 10-20mg/day for over 3 years now, and it still works
>at that relatively low dose.
>I don't expect this sort of thing to become common practice,
>nor do I think it should, necessarily, but opiates have demonstrated
>their effectiveness in affective illness for hundreds of years,
>and it is high time the psychiatric community as a whole
>[re]recognizes their utility in refractory cases.

   Interesting that I had this same thought about opioids and depression
a few years ago, and dismissed it as heretical.  And it certainly would
be dangerous to a doctor's license.  The psych guy you talked about
only got away with it because nobody brought it to the attention of the
medical board in his state.  These days, even though laws do not
specify this, the defacto position of most medical boards is that you
only get to prescribe chronic methadone to non-terminal patients if
you're a pain management specialist, or you run a methadone clinic
under all the correct auspices and licences.  Try it with your run of
the mill medical patients (except of course the hospice patients) and
you're cruising to get nailed by the establishment.  That's reality in
the War on Drugs.

From: B. Harris)
Subject: Re: Opiates for suidicidal depression
Date: 5 Nov 1998 02:42:29 GMT

In <71qouf$9tr$> writes:

>I've been following your posts with great interest. I have suffered from
>long- standing dysthymia for 18 years. I am looking for a health care
>provider in the U.S. who is willing to use opioids as a treatment
>protocol for depression (if there exists such an animal).
>I know from previous experiences that opioids do alleviate my
>depression---in fact, this is about the only time I have felt "normal".
>A "normal" person who takes opioids for pain is alleviated from the pain
>and may perhaps become drowsy. In a depressed individual, the opioids
>simply make him/her feel "clear-headed" enough to do the things that the
>"normal" person would do "normally".
>Do I stand a fathom of a chance of receiving this mode of treatment? Any
>information you could provide would be greatly appreciated. I am
>collecting research articles/other information to "plead my case" before
>yet another psychiatrist.

   You might have better luck getting one to prescribe you naltrexone,
which is an orally active opiate blocker, used for narcotics addicts to
keep them straight.  This may make you feel WORSE while under the
effect, but the idea is to take it at bedtime, perhaps with a sleeping
pill to keep you from the full effect.  By the time you get to morning
it will have mostly worn off, and your opioid receptors will be more
sensitive through the day for it.  It should be sort of like the
withdrawal depression from opiates, but in reverse.   And you won't
have any problem getting anyone to let you try it, because the stuff is
not controlled (for obvious reasons). The bad dreams may be worth the
daytime highs.  You won't know till you try.

From: B. Harris)
Subject: Re: Opiates for suidicidal depression
Date: 14 Nov 1998 08:41:03 GMT

In <72hgo8$5qg$>

>In article <72gb0r$7g3$>,
> wrote:
>> My understanding is that one could take morphine
>> all of one's life and not experience any serious health effects.
>You have been misinformed.

    Not really.  See the life of surgeon William Halsted.
Pharmaceutical grade opiates such as morphine have no common long term
serious deletarious health effects, and in that sense are quit
different from the legal drugs tobacco and ethanol.  Many a chronic
pain patient has been on morphine for decades at fairly high doses.

From: B. Harris)
Subject: Re: Opiates for suidicidal depression
Date: 23 Nov 1998 11:07:55 GMT

In <> Rev Chuck
<> writes:

>> Substance P is not an antagonist for opiates PER SE. What has happened
>> in some cases is that endorphins will suppress the release of Substance
>> P in some systems in the brain. I don't know what all these systems are
>> - or whether one of such systems is the one that involves anxiety or
>> depression.
>If you've ever had Demerol, you'd understand perfectly.

   Not necessarily.  Demerol, for instance, makes me feel dysphoric and
nauseated.  I cannot imagine why anybody in their right mind would
abuse it.  But I suppose it makes some people feel like they've had a
shot of Fentenyl, the One True Opiate (but short lived, and only
anaesthesiologists seem to have sufficient access to get addicted).

    Response to narcotics is actually highly individual.  Most of them
don't just activate the mu receptor, but other opioid receptors as
well, some of them not so nice.  And what they activate differs from
person to person.  Cats go into a horrible paniced frenzy if you give
them morphine.  A few people do also.

                                          Steve Harris, M.D.

From: B. Harris)
Subject: Re: Opiates for suidicidal depression
Date: 25 Nov 1998 07:08:01 GMT

In <> Rev Chuck
<> writes:

>IV fentanyl does the job splendidly. I still remember my conversation
>with the anaestheologist when I had an ankle fracture repaired.
>"Okay, this is fentanyl to put you out. It should take a few moments."
>"Fentanyl? I hear there's a... street version... 3-methyl fent... a...
>nyl... stronger than her... "
>Next memory is waking up three hours later with my foot in a cast.

   ROFL.  I was a medical student, so for knee surgery they told me
what I was getting.  "This is a little curarie".  Great, now my eyes
are permanently crossed.  "This is fentenyl."  Oooh, warm feeling in
chest like geting kissed on neck and ears by the high school
chearleading squad; AND I'd just won the lottery.  "And this is a short
acting barbiturate called thiamylal."  Hmmm, I don't feel anything

   I'll bet they don't do Tim McVeigh that way.  Way too much fun.

From: B. Harris)
Subject: Re: Opiates for suidicidal depression
Date: 28 Nov 1998 10:06:19 GMT

In <> Rev Chuck
<> writes:

>Curare?  Gotta try that one.  I've often wondered how a monkey feels
>when an Indian shoots it with a blowgun dart.

   Crappy, since it usually falls on its head, and curare is NOT an
anaesthetic.  And then there's the problem that you want to breathe,
but can't. Yech.

>Speaking of Timmy's upcoming, all-expense-paid trip to the great
>beyond, has anyone else chuckled at the irony of the lethal injection
>gurney looking exactly like a crucifix?

   No, but I'm reminded of Lenny Bruce's comment that if the ancient
Romans had used electrocution for capital punishment, Catholic churches
would now all have silver electric chairs over the altars.   Lenny
stole that from somebody, but I can't remember who.



"Yes, we Jews killed Christ.  I admit it! What can I say?
It was a party.  It got out of hand.

                  -- Lenny Bruce


From: B. Harris)
Subject: Re: heroin
Date: 2 Dec 1998 22:54:10 GMT

In <> Happy Dog <>

>"Steven B. Harris" wrote:
>> In <>
>> writes:
>> >1898. They were trying to develop a "heroic" pain reliever, and they
>> >did. Heroin is still the best pain reliever in the world, although
>> >U.S. law denies it to anyone in a medical setting, even amputees in
>> >chronic agony and the dying.
>> That's because Heroin is no better as a pain reliever than morphine or
>> Dilaudid. It's more potent per milligram than morphine (it's two or
>> three times better), and it's not as potent as Dilaudid. [It's
>> delightful, it's delicious, it's Dilaudid--- Lenny Bruce]. But
>> milligram potency is meaningless, because respiratory depression scales
>> along with it. So you can just give two or three times more morphine,
>> or a fifth as much Dilaudid.
>Why is Dilaudid not commonly found on the street?

   Because it's hard to synthesize, and they can't grow it in huge
poppy fields in East Asia and the middle East.

From: B. Harris)
Subject: Re: heroin
Date: 3 Dec 1998 18:53:47 GMT

In <> aaron <> writes:

>Also, users usually really can't tell a morphine high from a heroin high
>from a dilaudid high from a fentanyl high.

   But they can tell heroin from morphine if given IV.  Heroin gets
into the brain faster and gives more of a "rush" (acute opioid
endorphine action).  None of this is relevent to pain control, since
the drugs aren't given IV push for that.

From: B. Harris)
Subject: Re: Morphine and its effects
Date: 4 Jan 1999 08:02:46 GMT

In <76ltes$6o9$>

>In article <>,
>  "Charles Stuart" <> wrote:
>> On Tuesday I had a minor operation. In the recovery room, I complained
>> of pain and the doctor decided to administer morphine. After the first
>> dose of 4ml I stated that it had not had any effect. The doctor gave me
>> another 3ml, followed by a third dose of 3ml with no effect on the
>> pain. Furthermore, the morphine had no other effects on me, no sedative
>> effects and no hallucinogenic effects. I told the nurse who was looking
>> after me that the pain was still there and she said that the doctor had
>> given me the maximum permissable dose of morphine but that I could have
>> something else once I was back in my room. Back in my room I was given
>> Tylex, a proprietary brand of paracetamol (acetomenophen) with codeine.
>> This had a significant effect on the pain quite quickly.
>> Why did morphine have no effect on me?
>A sad possibility is that the health care providers have been subsituting
>saline for the morphine and using the morphine on themselves. I've known
>2 cases of this happening during my practice. The one was an
>anesthesiologist who was thrown out of medicine, and the other was a ward
>nurse, who was discharged from his service.


    Particularly since codeine probably has no analgesic properties of
its own, but works entirely by being metabolized to morphine.  And to a
smaller dose than you got (which I assume was 10 mg-- incidentally far
from the max dose, and you were being B.S.ed if they told you it was).
In any case, if a good dose of morphine wasn't doing you any good, it
would have been silly to give you codeine, except as placebo.

    The other possibility is that you got Tylox (big red capsule), not
Tylex.  Tylox has acetaminophen and oxycodone, a potent direct-acting
narcotic much like morphine, but one which occassionally works better
on a few people (nobody knows why-- this is true of all narcotics: each
has a few people it's far and away best for, and a few that it makes
deathy ill or crazy).

    Another possibility is related to the fact that pain is a pretty
good antidote to narcotic effects, and some people seem to have a
threshold for effect.  They get nothing much in the way of relief until
they reach that threshold, and then not a lot more does a great deal.
Nobody understands this, either.

   Lastly: it could be that it's rather comforting to be back in one's
room and know the trauma of minor surgery is over, is it not?
Everybody (in a sense) understands THIS.

                                    Steve Harris, M.D.

From: B. Harris)
Subject: Re: Morphine and its effects
Date: 6 Jan 1999 03:25:58 GMT

In <> (Terri)

>>Harris Comment:
>>    Particularly since codeine probably has no analgesic properties of
>>its own, but works entirely by being metabolized to morphine. And to a
>>smaller dose than you got (which I assume was 10 mg-- incidentally far
>>from the max dose, and you were being B.S.ed if they told you it was).
>Since the morphine was administered in the Recovery room and by a
>doctor (some places still don't allow nurses to administer IV bolus
>narcotics even in critical care areas) I assume that it was given IV,
>in which case 10mg is very close to the maximum dose over a short
>period of time i.e. the hour or so post op in Recovery. In general the
>people who don't respond *at all*  to that dose of morphine are
>habituated to drugs or alcohol,

    In many (perhaps most) cases.  But there exist people who simply
have an intrinsic high tolerance to morphine and other narcotics.
Perhaps fewer endorphin receptors, or receptors of a different kind.
You see them ocassionally among people you know very well are not
narcotics addicts, like kids with trauma.

  And secondly, the dose of morphine needs to be titrated to pain,
vitals like respiratory rate, and mental status.  I've seen 60 mg given
over half an hour for acute MI, and nearly that much for a dislocated
knee.  It's simply bad medicine to say, in effect: "Well, 10 mg of
morphine didn't help your pain, so tough.  That's all you're getting,
because that's the max."  It's not even close to the max.  There is no
good number for a max, and that especially applies to post op and
recovery.  Any pain specialist would look at your post above, and start
screaming.  It makes me want to start screaming.  I'm sure it will make
a lot of post-surgical patients with stories to tell start screaming.
I want them all the scream at you, not me.

>I agree that it is highly likely that the patient never got the
>morphine that was signed out to him.

    It's a possibility.  But only one of them.

                            Steve Harris, M.D.

From: B. Harris)
Subject: Re: Morphine
Date: 6 Jan 1999 03:56:13 GMT

In <> (Terri)

>The remark that codeine works by being metabolized to morphine is
>interesting. I can take codeine (in small doses - up to 30mg) orally
>with little difficulty. During a recent hospitalization I was given
>2mg of morphine IV. My b/p  dropped to 60/? and heart rate dropped to
>32 within less than 2 minutes. I was also intensely nauseated. Narcan
>IV fixed the hypotension and bradycardia which makes it clear that it
>was the morphine that caused the problem. Can anyone explain the
>severe reaction to morphine, when oral codeine causes no problem at

   You're probably not making MUCH morphine, and you're doing it over a
much longer period of time.  Blood levels make a difference, and many
people have a clear theshold for the nastier narcotic side effects.

From: B. Harris)
Subject: Re: Morphine and its effects
Date: 6 Jan 1999 08:15:30 GMT

In <> (Terri)

>2mg almost killed me, but it didn't do a damn thing for the pain. The
>point being that one can have all kinds of adverse effects from
>morphine and still not get rid of the pain you're giving it for.

    Not unless it almost killed by some allergic reaction.  Certain
things happen in sequence in medicine.  Morphine titrated in 2 mg doses
(or 5 mg doses, if 2's have having little efffect) every few minutes,
does not kill patients unless long after (and much drug is given after)
their blood pressure and breathing rate drop preciptously.  There's a
lot of mythology about morphine, but those of us familiar with it know
that it gives lots of warning.

    These poor effects on vital signs and consciousness occasionally
(and I mean VERY occasionally) happen without full pain control in
hospice patients, but (needless to say) not at 2 mg.  In the last
lecture I heard by probably the formost hospice guy in the country
he said he'd had to give full anaesthesia to control pain adequately
only a couple of times in many thousands of patients.

    Valium, BTW, is a crumby pain drug.  After you've reached the level
of dose which fixes whatever component of the patient's anxiety which
is contributing to his pain, further doses of Valium do nothing but
depress his consciousness and respiration, without having any further
effect on pain.  And Valium has such a long duration of action that if
you decide you've gone over that threshold, it takes forever to fix.
And during that time you're sitting there sweating, pushing short
acting antagonists, and wishing you'd used Versed or simply more
morphine.  I can well imagine that if you practiced pain control in the
way you say, you had reason to be anxious yourself.  But that was just
because you were doing it wrong.  We now know better ways.

                                    Steve Harris, M.D.

From: B. Harris)
Subject: Re: Morphine
Date: 6 Jan 1999 08:27:57 GMT

In <> (Terri)

>>   You're probably not making MUCH morphine, and you're doing it over a
>>much longer period of time.  Blood levels make a difference, and many
>>people have a clear theshold for the nastier narcotic side effects.

    You're welcome, but don't imagine that by nastier narcotic side
effects I was talking about the deadly ones.  I was talking about
nausea, dysphoria, confusion, restlessness, and the like.  You don't go
from fine with good vitals to dead at some theshold.  As I said, that
kind of effect has lots of warning, with slowly increasing narcotic

    In the real world, the only people who manage to kill themselves
with narcotics are addicts who shoot up a huge and unknown amount of
heroin, in search of a rush, and therefore essentially all at once.  No
titration, by definition.  By contrast, people who try to kill
themselves with opiates in more medical settings are often surprised by
how hard it is to do.  I know many, many depressive OD and hospice
stories, some of them funny and some of them not so funny.  But there's
a very good reason that Final Exit and the various Suicide Advice clubs
recommend barbiturates and not opiates.  And don't even suggest relying
on barbiturates.

                                Steve Harris, M.D.

From: B. Harris)
Subject: Re: Opiates
Date: 16 May 1999 22:58:50 GMT

In <>
shapere@aol.comicrelief (Shapere) writes:

>In article <7hn8mc$>,
> B. Harris) writes:
>>Heroin is acetylated morphine, and most is metabolized TO morphine by
>>the time it gets to the urine. You might get a trace of heroin.
>>Dilaudid is somewhat similar to morphine and heroine, but is not turned
>>into them, and is clearly distinguishable by itself, as what it is.
>This brings to mind something I've been wondering about - would
>buprenorphine show up on a standard tox screen? What about the kappa

   No good answer.  It entirely depends on what they look for.  These
things don't show up as classes of molecules or by classes of receptor
binding, since they are not assayed by affinity or by RIA, but rather
by high performance liquid chromatography (sometimes backed up by mass
spectroscopy for the very best labs).  Chemically they may be very
different and yet work essentially the same way (eg, morphine and
meperidine/Demerol).  Whether anybody bothers to look for schedule III
and VI drugs depends on how much money they have, and what their
suspicions are.  There is, as you may guess, no such thing as a
"standard tox screen."  There are just various tox screens from
different labs, that different places use.

From: B. Harris)
Subject: Re: "Legalize" Narcan?
Date: 26 May 1999 05:31:47 GMT

In <> writes:

>Perhaps more important, Narcan can precipitate acute withdrawl which
>can be fatal in itself.

    Nonsense.  Opiate withdrawal is not a dangerous thing,
preciptitated by narcan or not.  It's about as uncomfortable as bad GI
"flu" with chills, which it resembles.  I suppose it could stress a
heart patient enough to have an MI, but then so can a cold bath.

    By contrast, "cold turkey" withdrawal from alcohol or barbiturates
really is dangerous (though the "cold turkey" phrase comes from the
plucked bird skin goosebumps of opiate withdrawal, of course).

From: B. Harris)
Subject: Re: "Legalize" Narcan?
Date: 26 May 1999 21:09:01 GMT

In <> writes:

>In article <7ig103$>,
> B. Harris) wrote:
>> In <>
>> writes:
>> >Perhaps more important, Narcan can precipitate acute withdrawl which
>> >can be fatal in itself.
>>     Nonsense.  Opiate withdrawal is not a dangerous thing,
>The last acute opiate withdrawl precipitated by naloxone was accompanied
>by heart rates over 160 and pulmonary edema.  Both required emergent
>therapy (the hypoiemia from the PE combined with the HR caused multifocal
>PVC's and was contributing to the failure.

   You can always find somebody so sick from something that the
additional stress of drug withdrawal will kill them.  Heck, you can
always find somebody so sick with something that saying "boo" will kill

   Neither opiate withdrawal nor a HR of 160 will a reasonably healthy
person pulmonary edema.  Ergo, your patient had some other severe
problem, such as a pneumonia that hadn't shown up, endotoxic shock from
a hypoxic gut and malnutrition, a very low albumen from the same, etc,
etc.  Lung damage from long shooting up crud.  Perhaps cocaine on board
causing extra systemic hypertension (which tends to squeeze stuff out
in the lungs when it gets too large-- I've seen this a time or two with
accidental overdoses of 1:1000 epi which were thought to be 1:10,000
epi).  I don't know.  What I do know is the assumption that the problem
was chiefly due to withdrawal is not a good one, since it may tend to
inhibit what should be a continued search for the additional causes of
the problem you're seeing.  Which almost certainly exist.

From: "Steve Harris" <>
Subject: Re: Narcotics, pain-killers, and questions.....
Date: Mon, 21 Apr 2003 20:38:37 -0700
Message-ID: <b82dft$h69$>

"Joe Peters" <> wrote in message
> What is the difference between morphine and Demerol??? I've been given
> both at some time or another during a few surgeries I've had. Both seem
> to be quite powerful. What is the difference???

Morphine comes from poppies and has a difficult to make 3
ring stucture; whereas Demerol is a synthetic substance
which fits the same receptor and has many of the same
properties. It's easier to make.

> Also, could someone please give a clear definition of a "narcotic".

There really isn't one, except as a broad class of sleep
inducing agents. Legally, "narcotics" are addictive "downer"
type, and has included even things like barbiturates and
marjuana. A better term for the small class of pain killers
that work like morphine and demerol and heroin is "opiates".

> I know that morphine, Demerol, and heroin are all considered narcotics,
> but why is it that only heroin is seen on the street, and yet never in
> the hospital???

Heroin actually is used in hospitals in the UK. It's illegal
in the US because it is morphine modified in such a way as
to get rapidly across the blood brain barrier, thus
producing a "rush" or all-at-once pleasure effect when
injected IV. Morphine doesn't do that nearly as well, so
isn't as likely to be abused IV. When given IM or orally,
even addicts cannot tell the difference between heroin and
an equi-analgesic dose of morphine. When given IV, they
can-- but the difference has nothing to do with pain

>Can heroin kill pain??? I am confused about what is
> considered a narcotic, and what is the difference between them.

Heroin kills pain 2 or 3 times as well as morphine, but also
has 2 to 3 times the effect on respiration. Thus, if you're
not after the IV-rush, there's no reason why you can't just
use 2 or 3 times as much morphine to get the same
*painkilling* effect as heroin. This is the argument for why
heroin has no particular reason to be legal. There are legal
drugs which are many times more potent than heroin as
painkillers (Dilaudid, Fentenyl, etc). However, they aren't
any more USEFUL than morphine, since they are also just as
many times more potent at inducing sleep and apnea (death).

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