Palliative medicine and drugs: pros and cons
Educational program. Drugs for the terminally ill
Olga Grigorchuk, MednovostiThe phenomenon
The vast majority of patients with incurable diseases need relief from pain and other painful symptoms accompanying the last days of life.
Narcotic drugs are used all over the world to improve the condition of terminal (dying) patients. The list of these drugs is limited, but research is constantly being conducted, according to the results of which other drugs may appear in medical practice.
However, this field somewhat discredited itself in the middle of the last century, when there was a boom in research on hallucinogens. More effects were attributed to these substances than they should have, and many of these works, as it turned out later, could hardly be called scientific.
The topic of drugs in medicine has another aspect. If in some states of America and European countries it is allowed to use marijuana as prescribed by a doctor, then in Russia there are problems even with a more important category of drugs – opioids. Palliative medicine is a fairly new concept for our country, although the problem of helping patients with incurable diseases that limit life expectancy has always existed. Only in 2011, this problem was raised at the legislative level in our country. And there are still great difficulties with prescribing and obtaining narcotic drugs at the pharmacy, which significantly complicates the lives of patients and their relatives. However, the state bodies that support such an order have their own arguments.
ProOpioids
The main narcotic substances used in palliative medicine and officially permitted in Russia are opioid analgesics.
For many centuries, opium was extracted from the dried milky juice of immature boxes of sleeping poppies. In 1803, the German pharmacist Friedrich Zerturner isolated morphine from opium. It is this substance that determines the basic properties of opium. To date, morphine has been used as one of the best medications that eliminate pain in injuries, myocardial infarction, and cancer patients. Studies of its analogues are still being conducted in order to identify the most "successful" versions of this drug. In particular, the World Health Organization now recognizes short-acting morphine in tablets as the gold standard for terminal patients.
CannabioidsIn some countries, drugs based on cannabioids are used to improve the condition of patients in need of palliative care (Denmark, Germany, Canada, some US states).
Cannabis-based drugs are used to relieve chronic pain, improve appetite, and relieve feelings of nausea.
Cannabis has been used for medical purposes for hundreds of years – to eliminate various types of pain, including colic, menstrual pain, migraine. Studies have shown that cannabioid preparations used in capsules are able to relieve chronic pain, but are not very effective in acute pain (for example, operating rooms).
It has also been shown that cannabioids can enhance the analgesic effect of opioids, but this effect has not yet been used in medical practice.
In addition to chronic pain, the problem of terminal patients is often nausea and vomiting caused by the underlying disease or ongoing treatment. Many researchers have noticed that drugs based on cannabioids have a more pronounced antiemetic effect compared to classical drugs.
LSDIn the 1950s, studies of the effects of LSD (lysergic acid diethylamide) on human consciousness received a wide public response.
In an article published in 1964, Eric Kast and Vincent Collins described the results of a study in which the alleged analgesic properties of LSD were compared with two recognized and powerful drugs. The study was conducted on a group of 50 patients suffering from severe physical pain. The results showed that the analgesic effect of LSD in comparison with other analgesics does not develop as quickly, but significantly exceeds their effect in time. In addition to relieving pain, Kast and Collins noticed that some patients demonstrate a striking disregard for the severity of the situation they are in.
In later studies, Kast studied not only the analgesic effect of LSD, but also the effect of the drug on changing emotions, sleep, and the attitude of patients to illness and death. In many subjects, two to three hours after the administration of 100 mcg of the drug, pain decreased sharply for an average of twelve hours. The intensity of pain in many patients was reduced by three weeks, there was an improvement in sleep and a decrease in anxiety about illness and death.
Stanislav Grof, a researcher from the Czech Republic, was also actively interested in this topic. He received a scholarship from the American Psychiatric Research Foundation in the USA and for many years has been engaged with colleagues in psychedelic therapy of terminal patients. LSD was taken under the supervision of researchers in specially created conditions. Before using the drug, conversations were held, the purpose of which was to establish a trusting relationship with the patient and his family. In a special conversation, immediately before the session, the patient received specific information about the nature of the psychedelic experience, the range of unusual mental states arising from taking LSD. The patient was located in a separate room, which they tried to make as cozy as possible. Relatives brought fresh flowers, fruits, family albums. As soon as the patient began to feel the effect of the drug, he was asked to lie down, cover his eyes with a blindfold and put on headphones in which music was playing. It was supposed to be a single dose of the drug. Only occasionally, if the result was not completely effective or if the disease progressed, the use of LSD was repeated.
Stanislav Grof wrote: "Specially designed sessions of taking LSD, conducted in simple and protective conditions, are sharply different from "spreading". For a person who has taken LSD in a difficult social situation, external stimuli and what comes out of his subconscious are intertwined in incredible combinations. The LSD experience that occurs in such conditions usually results in an incomprehensible confusion of perception of the external world and experiences from the inner world. As a result, the situation is not very conducive to a deep exploration of one's self."
PsilocybinCurrently, some scientists continue to investigate the effect of psychedelic drugs on the emotional state of terminal patients.
American psychiatrist Charles Grob studies the effect of psilocybin (a substance contained in mushrooms of the genus Psilocybe) on the well-being of patients in the last stages of cancer. As a result of such treatment, the researcher notes a decrease in anxiety, an improvement in mood, which greatly facilitates the last days of severe patients.
Around the world, only a few of Charles Coffin's colleagues are doing the same. For example, British doctors tried to explain this effect of the drug by using magnetic resonance imaging. The fact is that the change in consciousness against the background of taking psilocybin is associated with the deactivation of those areas of the brain that are responsible for our feelings and our perception of ourselves. In people who are depressed, one of these areas (the anterior cingulate cortex) is hyperactive. Psilocybin can change that.
A similar effect of the drug can be explained as follows: the patients who participated in the study received psilocybin regularly, and probably the fact that they experienced positive emotions from time to time when reproducing memories made this effect stable.
ContraWithout a doubt, the abnormal use of narcotic drugs can lead to severe addiction.
Therefore, the release of such drugs from pharmacies is under strict control. But doctors urge to distinguish between the negative long-term effect of taking drugs by healthy people and providing assistance to terminal patients. Dying patients can no longer develop severe addiction, which will lead to antisocial actions and self-destruction. And the concentration of cannabioids in the blood, leading to a pronounced analgesic effect, in the studied patients was lower than in people who smoke marijuana. This dosage did not lead to side effects: confusion and sedation.
But some experts also fear that if hallucinogenic drugs are regularly prescribed by doctors, this will lead to an expansion of indications and a downward movement. As a result, such substances will be legally taken, for example, by people who are prone to unreasonably bad mood. But psychiatrist Charles Grob believes that nothing like this will happen: hallucinogens will be prescribed only to those who have no alternatives, because even without drugs there are many means that can relieve depression or other problems.
FinallyDespite the fact that opioids are recognized as the only group of drugs capable of relieving terminal patients from severe chronic pain, access to them is extremely difficult in Russia.
One of the most important problems of palliative medicine in our country is a complex procedure for accounting and trafficking of narcotic drugs. According to the Federal Drug Control Service, this reduces the level of drug addiction and prevents such drugs from illegal trafficking. However, this leads to the fact that terminal patients do not receive anesthesia on time, receive it in insufficient quantities or do not receive it at all. Relatives of such patients repeatedly have to bypass specialists of different levels who give permission to receive the drug. Doctors, in turn, fill out a large number of documents.
Meanwhile, in a world where opioids are available to everyone in need, research continues on various groups of narcotic drugs that are likely to help patients in the terminal stages of the disease. Perhaps hallucinogens will soon appear in the wide medical practice in the West.
Portal "Eternal youth" http://vechnayamolodost.ru11.02.2014