MEDICATIONS - Medicine for Mountaineering and Other Wilderness Activities - page 512

The major hazard associated with strong painrelieving drugs is cerebral depression that
impairs respiration. No one with a known or suspected head injury or neurologic illness
that impairs consciousness should be given strong pain medications.
Addiction is not a major hazard of these agents—possibly not even a significant hazard
for individuals receiving analgesics for legitimate reasons. Almost everyone who under-
goes major surgery—thousands of people every day—receives strong analgesics postoper-
atively to control pain. Subsequent addiction is vanishingly rare. Many of the drugs that
relieve severe pain also produce euphoria, which is clearly beneficial for someone who has
suffered a major accident or undergone major surgery. Addiction results when these drugs
are taken for euphoria alone.
Codeine and the strong analgesics (and other agents) are classified as controlled sub-
stances in the United States, and the Drug Enforcement Agency, an arm of the U.S. Treas-
ury Department, not the Public Health Service, regulates their distribution. They are diffi-
cult to obtain for anyone who is not a licensed physician (or a habitual drug user). Prob-
lems with regulatory agencies, particularly for individuals who are not physicians, can be
lessened by precise records that detail the total amount of such agents on hand, where they
are stored, the security of that location, persons authorized to remove the agents from stor-
age, the names ofindividuals treated, and the time, place, quantity,and reason foradminis-
tering the drugs.
To minimize the risk of addiction, the following precautions should be observed:
◆ Stronganalgesicsshouldnotbeadministeredexceptwhenclearlyneededfortherelief
of pain.
◆ A less potent analgesic should be substituted for a strong agent as soon as pain has
diminished to a level at which the milder drugs can provide relief.
◆ Strong analgesic administration should not be continued for more than twelve to four-
teen days except in extraordinary circumstances, but such circumstances could occur
in the wilderness. Evacuation of a person with a painful fracture from a remote area
such as the Himalaya could take more than two weeks. Failure to provide analgesia,
even if addiction resulted, could be devastating.
If a potent analgesic is needed, one should be used, and it should be given in adequate
quantities to relieve pain. A person with severe pain desperately needs the rest and relief
these drugs alone can provide. Halfway measures, such as inadequate doses or inadequate
drugs, are of almost no value.
Aspirin
Aspirin (acetylsalicylic acid) is best known as a mild analgesic. Willow bark, which
contains salicin, a precursor of aspirin, is reported to have been recommended for pain
relief by Hippocrates in approximately BC 400. Powdered acetylsalicylic acid, which was
made from purified salicin, was first widely distributed in 1899. Tablets became available