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 Quality Care Close To Home

Central  South  Dakota  Medical News
The Clinical View
by Phillip Hoffsten,M.D.28 April 2004

HOW DO YOU KNOW “SOMETHING IS WRONG”?

     It was that wonderful time after supper when the dishes were done, the kids were either doing homework or already in bed.  Mom sat down in her favorite chair to go through the day’s mail.  But as she was doing this, she noticed that she was very, very warm.  “Something was wrong”.  She got up, checked the thermostat and found that granny had turned it up again.  Mom turned the thermostat back where she thought it belonged, opened a window a little bit to cool off and went on reading the mail.  What had told her “something was wrong”?

     In another home, dad sat down in his favorite easy chair after an unusually hard day.  He had strained his back with calving.  He was aching so much that he could not concentrate on what he was trying to read.  “Something was wrong.”  He stretched, took several Tylenol and charmed his daughter into rubbing some Ben-Gay on his back.  Soon he felt better and was able to sleep through the night.  How had he known that “something was wrong”?

     In another home, a 17-year-old young lady was hoping that she would be asked to go to the prom by a certain boy.  But, “Something was wrong.”  It appeared that he had been paying more attention to another girl lately.  How did the 17 year-old young lady know that “something was wrong”?

     The answer for all of the above three people is more or less the same.  In the human brain is a system of chemicals with the amazing job of telling us that everything is OK or “something is wrong”.  That system takes information from all of our senses and from our thinking.  After that system analyzes all the information, it tells us that we can relax because everything is OK or alternatively it tells us “something is wrong” and we need to do something. That something we do can range from resetting the thermostat, getting a back rub, or figuring out how to charm a boyfriend.  Alternatively we can choose destructive responses such as anger, or spitefulness, or learned helplessness, etc. etc.  How a person responds to “something is wrong” is an individual choice.

     This column is written to point out that there are chemicals that stimulate our pleasure centers to tell us that “something is wrong” or that everything is OK.  That system is called the opiate system named after the drug opium that comes from poppies.  More than 2000 years ago it was known that there was something in those pretty poppy flowers that made you feel really good if you ate it.  I don’t know who the first person hungry enough to eat flowers was but somehow or other somebody tried it and pretty soon we had an extract from the poppy plant and we called it opium.  Opium is a crude mixture of at least 20 different ingredients.  Two thousand years later in the 1800’s chemists were able to separate the components of opium and identify the drug called morphine.  They also found codeine among the many components of the poppy plant.  Morphine is used as the major pain control agent in medicine.  When a person is hurting so bad that they cannot sleep or function, morphine stops the pain and tells the person that everything is OK.  Everything may not be OK.  In fact, the person can have a late stage cancer or terrible injuries from an accident or a gunshot wound and things are certainly not OK.  But morphine will tell the person that things are OK so that the person can relax, rest, and have some comfort even if the disease process or injury cannot be fixed.  Morphine is truly one of nature’s most wonderful gifts to mankind.

     It wasn’t until the 1970’s, that people got smart enough to start asking what it was that morphine did to comfort a person who was suffering.  It was then that a series of scientific experiments were carried out demonstrating that there were receptors in the brain that morphine attached to.  When these receptors were activated with morphine, the person’s sensation of well-being was re-established.  In the 1970’s the second question asked was, “What activates these receptors when a person doesn’t have externally administered morphine?”  It was in the 1970’s that a family of natural hormones called enkephalins, endorphins, and dynorphins were discovered. These three chemicals were our natural hormones in our brains that activate opiate receptors and tell us that everything is OK.  When these opiate receptors are not stimulated by the naturally-occurring hormones, we recognize that “something is wrong” and it is through this system that we know that “something is wrong”.

     It is an incalculable tragedy that this opioid system has created one of humankind’s most disastrous social problems.  Specifically, the opioid system provides us with the basis for narcotic addiction and all of the social structures that we have to combat that.  Some people find it easier to use morphine or its sister drug heroin to make themselves feel good.  Success makes a person feel good but it doesn’t come easy to everyone.  Loving and being loved makes a person feel good but doesn’t happen to everyone.  Security, warmth and enough to eat make us feel good but it doesn’t come to everyone.  When these more natural methods of making us feel good are not available or perhaps too hard to obtain, morphine provides an alternative.  Morphine will stimulate our opioid system and tell us that we are OK even if we are hurting or hungry or cold or frustrated.  Then sometimes people just get lazy and turn to morphine and narcotics because they are easier to obtain, available at the push of a syringe, and provide immediate gratification.  When a person turns to this method of achieving comfort, they don’t get a whole lot of other things done.  Pretty soon their entire effort is devoted to obtaining that drug that makes them feel good.  Society’s values and work ethic are not satisfied and the drug addiction is the problem.

     The stimulus to write this column came from an individual who said that narcotics were a scourge on the earth and instead of a war on terrorism, we should have war on narcotics, the root of all evil.  I pointed out to him that as bad as our war on terrorism is going, there is already a war on narcotics and it is not doing any better.  Nature has built into our brains the opioid system which is essential to our keeping track of when things are OK and when “something is wrong”.  Humankind’s inexhaustible capability to corrupt nature’s gifts has lead to the problems of narcotics, their addiction, and all of the law enforcement effort that goes into combating drug abuse.  But morphine itself is neither good nor bad anymore than a gun or a knife or a spoon or pencil is good or bad.  It all depends on how you use it.  Nature’s use of our opiate system is essential to our well being.  The components of the opium poppy getting in the way was a problematic accident of nature that we have yet to solve.