If there is one form of suffering that almost creatures, apart from masochists, wish to escape from, it is pain. As humans, it is a universal, primal reaction to snatch our hand out of fire, to reflexively shield the vulnerable parts of our body - our face, for example, if we are under attack. The simple act of blinking is a pain avoidance mechanism.
There are a small - a very small - minority of people who have such control over their thoughts and their mind's interpretation of pain that they can sublimate these terrible signals to a higher plateau - above the range of sensation, through meditation and disciplined thought control.
When I had a stroke in 2005 and was briefly on an assessment ward before being moved to the Neurology Unit, there was a very elderly gentleman who was in the late stages of terminal bone cancer. Unfortunately, certain forms of bone cancer are known to be one of the most painful of cancers to endure. I watched silently as he repeatedly refused Diacetylmorphine (Heroin) or Morphine, offered on seemingly countless occasions by nurses, doctors and consultants. I heard him explain to a doctor that he didn't need pain relief as he had studied meditation for forty years, and he could merely think the pain away. The doctor, and the other medical staff were completely dumbfounded. He was completely at rest. I have never seen this before or since, and have seen people die of both AIDS related illness and cancer in abject pain.
A cruel juxtaposition of this can be read in Christopher Hitchens, "The Missionary Position". This searingly honest, and merciless book concerning Mother Teresa, paints this woman in a rather different light to the radiant, saint-like woman of kind heart that the Catholic Church sold to the world. In one horrendous excerpt, an inspector had gone to one of her Homes for The Dying, and had observed Mother Teresa tending to a man in his last agonising hours. They had an unspoken, but clear policy of not administering drugs such as morphine, and only basic over the counter medication, such as Ibuprofen was given. In a gut wrenching exchange, a dying man implored Mother Teresa for his pain to cease, to which she replied, "Ah, the pain you feel is Jesus kissing your body". He said in response, "Well, will you please ask him to stop".
As Britons, we are possibly the most fortunate country in the world with regard to our approach to pain relief. Much of this stems from the Palliative Care Movement, which was pioneered in the UK, and spread to other countries from here. And from Palliative Care, many of the drugs that were once reserved for the dying are now common place medications in treating acute and chronic pain conditions. Whilst for some of the older population, drugs such as Morphine still retain a stigma: that of hastening death, which is an untruth based on the principle of "double effect" seen in patients at the very end of their life. The basic concept being that extremely high doses of Morphine or Diamorphine (Heroin) and sedatives are needed to relieve end of life suffering, without the intention of hastening death, even though the chance of hastening death may remain a small possibility. However, overall evidence suggests that because tolerance has developed to such an extent by this stage to these high doses of drugs, the doctrine of double effect is extremely rarely invoked. One could say, in patients who are in great pain and psychic distress in these very final hours, that, quietly, a certain amount of clinical discretion is brought into practice.
Compared to France, who have always had an almost sadistically tight-fisted approach to pain-relief, or America, a country that relies almost exclusively on synthetic opiates compounded with Ibuprofen or Paracetamol (to deter abuse, apart from Fentanyl and OxyContin - both slow release drugs administered in different ways, the latter a tablet which, when abused is crushed and snorted), because of their infamous "War On Drugs" that wiped out almost all natural and semi-synthetic opiates and made them completely illegal, apart from Morphine, Britain has an extremely docile attitude towards Opiates and Opioids. It is one of only a few countries in the world that uses Diamorphine (Heroin) for non-terminal illness.
What makes Opioids (a catch-all term for all opiates) such interesting drugs is that they have only a couple of physiological effects on the body. The first, and most obvious is they slow down what's called peristalsis, or the movement of the intestines. The net result of this is constipation. The other effect is more profound but when taken medicinally, not problematic usually - they depress your respiratory system. They also give you a dry mouth and pin prick pupils. But they don't work on a physiological level when it comes to killing pain. Paracetamol does, by it's inhibition of COX, Aspirin does, by thinning the blood, Ibuprofen does by means of it's anti-inflammatory action.
Opioids, like Cannabis, Alcohol, Cocaine, Ecstasy, Amphetamine, and so on, works due to it's psychoactive properties. In other words, it's all in the head. And that gives away a clue as to why it is not only rather good at killing physical pain, but psychic and emotional pain too. Opioids work by sleight of hand. In a nutshell, and to put it quite crudely, they work by making you feel high. This is the good side and, and at exactly the same time, the bad side of Opioids. I've had recourse over the last seven years to take Dihydrocodeine, the next drug down in the pain ladder pain relief scale from Morphine. In fact, I've been on it more than off it. At one point I became horrendously addicted to it. I'm having to take it again now, whilst I await my operation on my teeth and jaw, and for a while after whilst it heals. Thankfully, I got the message, and I don't want to do another Cold Turkey again. They are horrible.
Because opioids, especially moderately strong, or strong ones, such as Dihydrocodeine and above, relieve pain, relieve anxiety, make you relaxed, make you feel warm, make all your arms and legs and tummy feel warm and fuzzy, as well as your head, they take away all your horrible worry loops and neuroses, when you are suddenly deprived of them, you get all the reverse symptoms to the above. And that's just Dihydrocodeine. I wouldn't have got through the last two weeks without them, because, most people can't stick toothache for more than a few days. I've had severe toothache in three teeth since last August.
I thank God that he invented the Opium Poppy. There would be so much terrible suffering in the world without it. Ask Mother Teresa. But it's also caused untold misery, and thousands and thousands of thousands of deaths. People chewing their Fentanyl Patches to get high, people dying from paracetamol toxicity because they're addicted to the small amount of Hydrocodone in the tablet. People dying from septicaemia through using dirty needles, or gangrene because they are riddled with with thrombosis' because they've run out of places to stick a needle. People dying from anaphylactic shock because they've tried to inject a very innocent drug called codeine.
But I can understand the allure, and I thank God that I've never known or been in that orbit of people who take Heroin. Because then they usually end up on Methadone, which is even worse. I don't look down my nose on anyone. I've made far too many blunders in my life to give me any right to do that. It's just the world of Heroin is a place of abject desperation, a place of chasing an ever receding rainbow, of ever diminishing returns. And a horrendously hard scrabble back up the hill to normality. But I can understand how people get there. And it is much easier than you might imagine.
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