GG and Prescriptions

[kimmoor@mindspring.com (Kristen Immoor)]

Hi all,
        I'm toying with the idea of writing a paper charting the known
contraindication factors and side effects of GG's prescription drugs at the
time they were prescribed as compared to the contraindication factors or
side effects recognized for said drugs today. Anyway, I came across a very
interesting paper titled the Canadian Government Commision of Inquiry (Feb
18, 1997). It gives a wide range of information on prescription, use, and
physiological/psychological side effects of barbituates in Canada, and
after reading it all it's no wonder to me that Gould gave up Nembutal. The
wide range of emotional mood swings and 'dry intoxication' effect of the
barbituates were probably loathsome to Gould, who professed a hatred of
losing self-control. The information becomes of even greater interest when
considered in context with all of the other prescriptions GG was taking,
esp. Valium and Trifluoperazine, which are contraindicated for barb. users.
(Though he was by no means a 'chronic' user and did not develop the high
tolerance or dependence, it is interesting to note that apparently the
withdrawal symptoms after heavy long-term use are reportedly stronger than
those of heroin withdrawal.) I also wonder whether the Fiorinal GG was
taking was a Fiorinal/codeine mixture or Fiorinal without (both are
available and prescribed frequently for migraines.) Fiorinal without
codeine is basically made up of butalbital(50mg), aspirin(325mg),
caffeine(40mg), and it is my understanding that butalbital is a
short-acting barbituate. GG must have been mixing himself quite a
pharmacological cocktail at his point of greatest dependency, I think I
remember reading a snippet from his journal that read something like
"...just how many Fiorinal can you take?"
        Anyway, here are some interesting points raised in the Canadian
paper, in case anyone else is interested in this pharmaceutical-type stuff:

"47. It has been frequently said that in Canada, the supply of barbiturates
lawfully manufactured or imported greatly exceeds the requirements of
legitimate medical use. It appears that many current non-medical users were
initiated into barbiturate use for medical reasons. Numerous medical users
develop dependence and continue use long after the original medical purpose
or prescription is absent, and there are indications that most chronic
barbiturate users obtain the drugs through legitimate channels."

"Psychological dependence also occurs in some users, and anxious or tense
individuals may become dependent on even small doses in order to function
in a manner which they consider satisfactory. Many persons depend upon the
hypnotic effects of the barbiturates and can not sleep without a pill. In
other individuals, the drug may be depended upon for a variety of
subjective effects which the user considers essential to his well-being.
The problem of psychological and behavioural dependence on barbiturates has
not been adequately explored, however, and remains in the area of clinical
impression and conjecture. "

"Although high doses invariably produce behavioural sedation, drowsiness,
and sleep, the effects of mailer quantities may be quite unpredictable. As
with alcohol and other sedatives, barbiturates may initially produce
behavioural excitation, stimulation and lack of inhibition (especially at
low doses), rather than sedation, depending on the situation and the
individual. In certain persons, sedation is not produced until a
considerable quantity has been administered, whereas other psychological
and behavioural effects may be quite pronounced. The user may become happy,
pleasant, euphoric or 'mellow' on one extreme, or possibly hostile,
suspicious, aggressive and violent on the other. Emotional depression,
self-pity, and withdrawal are also not uncommon, and barbiturate-related
suicides are frequently reported. Although low-dose effects are often
erratic, moderate to high doses generally slow down reaction time, impair
complicated mental functions, and produce a lessening of inhibition, a
reduction in emotional control, and an impairment of physical co-ordination
as well as a variety of other effects resembling alcohol inebriation. Acute
toxic psychoses are rare. The extreme variability in response, even within
the same individual over a short period of time, is illustrated by Wikler's
report.243 "

"52. Although it appears certain that driving skills would be diminished by
barbiturate intoxication, little direct investigation has been conducted.
Related behavioural studies do suggest such an effect. Low therapeutic
doses may not reduce driving ability, however, if the drug is not taken in
conjunction with other sedatives such as alcohol.72 "  (We all know what a
great driver Gould was...)

"54. The short-term effect of moderate to high doses of barbiturates is a
general depression of neural and muscular activity. As with psychological
and behavioural effects, the response to low dose is much more variable.
Initially, the electroencephalogram (EEG) may suggest cortical activation,
although this pattern is usually soon replaced by signs of drowsiness or
sleep. The sleep induced by hypnotic doses generally resembles normal sleep
with the exception of a marked reduction in the rapid eye movement (REM)
stage, the significance of which is only beginning to be understood.
Drowsiness or 'hangover' symptoms may follow acute intoxication or
drug-induced sleep. Although the sedative action of the barbiturates has
frequently been attributed to their effects on the reticular activating
system of the brain, little is known of the specific details, and this
action might occur through a variety of different pharmacological
mechanisms. "

"Although barbiturates were not recognized as 'addictive' drugs for decades
after their general medical acceptance and usage, in chronic users,
physical dependence may develop along with tolerance. Barbiturate
dependence is in some respects similar to opiate narcotic dependence,
although barbiturate (and alcohol) withdrawal symptoms are frequently more
severe and are more likely to result in death. The abstinence syndrome
following withdrawal of the drug in chronic heavy users may begin with a
reduction in intoxication and an apparent improvement in condition. Within
a few hours, however, general physical weakness, dizziness, anxiety,
tremors, hyperactivity, nausea, abdominal cramps and vomiting may occur.
These may be followed after one-and-one-half to five days by muscle spasms
and grand mal (epileptic) seizures. Between the third and seventh day,
delusions and hallucinations may appear; this psychosis may last for days
or even months although recovery usually occurs within a week or two. Death
during the convulsive phase occasionally occurs. 111, 89 "

"1.Barbiturates are often used in conjunction with amphetamines. Dexamyl*,
for example, is a combination of dextroamphetamine and amobarbital which
supposedly produces stimulation without certain of the irritation or
tension-producing effects of the amphetamines. More important clinically,
is the frequently noted alternating cycle of sedation and stimulation which
many medical and non-medical drug users demonstrate. A stimulant may be
used to overcome the drowsy hangover the day after a hypnotic dose of
barbiturate. By evening, another sedative dose may be necessary to overcome
the insomnia potentiated by the day's amphetamine. This continuing cycle is
apparently not at all uncommon among otherwise socially respectable drug
users."

        Sorry to have bored anyone... I think this stuff is fascinating. I
wouldn't mind if Ostwald delved into this in his book (which I have to wait
until the symposium to read,) because it sheds new light on symptoms and
disorders which GG was very public about his suffering from, and which at
the time were quite mysterious to him as well as the doctors who saw him
(who may or may not have had a full picture of the number of medications
Gould was taking at once.) If anyone on the list has searched along similar
lines of study and would like to compare notes, mail me, we'll chat
chemicals.

Going to bed now...
Kristen

PS- Kill the Rach thread!

___________________________________________________________________________

"...you can never say no to a stewardess in a dream."

                                                              -Glenn Gould