No, this isn’t a confessional in which I disclose that I am under the influence of drugs, something that my liberal detractors figure must surely explain all of my wrong-headed views. But it does address the issue of social and political influences in regulating drugs.
I was paging through the January 2023 AARP Bulletin, a publication targeted at geezers like myself, and between ads for Jitterbug large print phones, adult mobility scooters, and easy access bathtubs, I came upon a piece bemoaning the use of psychotropic drugs in nursing home settings that mentioned a lawsuit filed by the AARP Foundation against nursing homes for the overuse of such drugs. These drugs, which AARP describes as “chemical straight jackets” used to control agitated patients include anti-anxiety drugs and antidepressants.
The thought of further governmental intervention in this area scares the hell out of me.
My concern is this: If I ever find myself a resident of a nursing home, spending 12 hours a day slumped over in a wheelchair parked in front of daytime TV, watching channels selected by indifferent aides and afflicted with the various painful infirmities of old age, I am likely to be depressed and agitated. It would be greatly appreciated if the staff kept me pumped up on whatever drugs it took to make me feel better. In other words, if I am forced to watch MSNBC all day, I will probably be frustrated and agitated by my failed attempts to telepathically explode Rachel Maddow’s head, and it would be merciful to keep me high enough to forget my predicament. Sing-alongs, crafts, or an extra pudding cup at dinner won’t be of much help.
Of course abuses occur, and I have seen them. But as many of us recognize, politics and government are blunt instruments poorly suited for addressing complicated, nuanced problems, especially where there is an emotional “hot button” issue. And, in the case of both drugs and end-of-life care, there are sensitive issues involved in which emotion and belief may overwhelm reason and distort the process. If government decides to inject itself further, it can only make my preferred care less accessible and hasten my death by cerebral aneurism after being forced to binge watch CNN unmedicated.
I am always wary of those who would volunteer others to “tough it out” for “their own good.” For example, those who would prohibit assisted suicide, and force those with a painful terminal illness to endure the full course of their disease. Now, I sympathize with the religious and recognize that they might be right, but the effect on the patient is very real and tangible, not just conjectural. The decision should be made by them if competent. While assisted suicide has very real issues, primarily related to coercion and voluntariness, it shouldn’t be prohibited for just the spiritual concerns of others. They’re not the ones suffering.
A personal anecdote: As an estate planning attorney, I prepared many hundreds of advance health dare directives. These allow you to select your desired end-of-life care. Out of all the directives I prepared, not one client ever chose the “keep me going” option, and most selected “pull the plug.” People tend to focus a lot more clearly when their own life is involved.
The same goes with medically prescribed drugs. If politicians, under the goading of the 22-year-old interns who seem to write much of the content of today’s media, decide that “something needs to be done” about these drugs that supposedly turn Grandma into a zombie, it is likely to make things worse by further restricting access to those who need them.
These public panics over prescription drugs are nothing new. Recall the earlier days of the “opioid crisis,” which was then blamed on overprescribing by doctors. After massive lawsuits and new regulations, many patients who are suffering serious pain are now unable to obtain sufficiently strong pain relievers because their doctors are afraid of discipline for overprescribing them, and pharmacies are wary of liability for filling the prescriptions.
The pharmaceutical companies’ role in creating the epidemic, and the role of legal prescriptions in creating the crisis, turned out to be overstated. While undeniably some doctors ran “pill mills,” and some manufacturers appear to have concealed or misrepresented the addictiveness of their products, the current crisis of smuggled fentanyl shows that the main problem is that a lot of people just like to get high. Remember, we previously had the “meth crisis,” the “crack crisis,” and the “cocaine crisis.” The drugs change from time to time, while addiction and the desire to get high endure.
For my sake, and for your own sake in the future, please resist the exhortations that you must call upon the government to immediately “do something” about the “problem” of psychotropic drugs in nursing homes. If there is excess, it should be handled with a defter, more sensitive and informed touch than politicians have. Δ
John Donegan is a retired attorney in Pismo Beach, who is too cranky to do arts and crafts or sing alongs. Send a letter to the editor in response by emailing letters@newtimesslo.com.
This article appears in Feb 16-26, 2023.
I would like to offer my support of Mr. Donegan’s request. Yes, it is time to prescribe psychotropics and antipsychotics because, as we have seen, he is prone to seeing straw men and trying to strike them down. His paranoid delusions have him envisioning big scary governments (think “black helicopters!”) that aim to deprive him of his right to cook on a gas stove, to own a firearm, to practice his faith. It’s sad, really. He has graduated to violent ideation, imagining that he could do great harm to a television personality by wishing it to be. I hope his family members will do the right thing, and help Mr. Donegan transition to a more peaceful place, through the miracle of modern medicine.
I thank Mr. Tsankswi for his heartfelt concerns. In the spirit of pharmaceutical reciprocity, allow me to recommend that he try Aricept, a drug for Alzheimer’s. Forgetting prior stances is quite telling, such as his enthusiasm for defunding the police until it proved so disastrous, or his enthusiasm for rioting, until the right did it. Trying to wrap the moral mantle of the civil rights movement around himself, despite the fact that it occurred 60 years ago, shows that he is living in the past, as is trying to find equivalency between his pet causes, like CRT and reparations, and more morally compelling concerns like equal opportunity and integration. I am not sure what antipsychotic drug would help him with his ideation on Trump. Like a lunatic taking a Rorschach test, his shrill response of “Trump!” to everything which annoys him, shows an unhealthy fixation. Lastly, I recommend diazepam for his periodic panics on whatever the media tells him he should panic about. Living with that level of anxiety is neither pleasant nor healthy.
Personally, I intend to turn to psychedelic drugs after some catastrophic diagnosis. Researchers say that psilocybin has shown positive mental and emotional results for end of life patients.
I took both mushrooms and acid in the 70’s and loved them. Far more fulfilling than pot, cocaine or alcohol.
Anyway, I found nothing to disagree with in Mr. Donegan’s article. I think he’s mostly right. Though I do believe that the government only has a say in medication if a patient is receiving government aid while residing in a convalescent home.