The Patron Saint of America’s Opioid Crisis

Before there was an opioid crisis in America, before our national struggles with Valium, heroin, and laudanum, there was a 29-year-old dentist in Hartford, Connecticut, theorizing about nitrous oxide—laughing gas—and surgical pain.

He suffered then from an aching molar and needed it pulled. Extraction, though, would be its own agony, because this happened on December 11, 1844. Anesthesia wasn’t yet a thing. Those in need of surgery faced a choice: pain from an affliction versus the pain of what would relieve it–scalpel or saw or tooth key.

Testing his theory, that young dentist inhaled nitrous oxide to the point of insensibility. A colleague then yanked the molar. When Horace Wells regained his wits, he said he’d felt nothing and declared “a new era in tooth pulling.” Soon after, Wells reasoned that his discovery could be applied to amputations and other surgeries. He’d come upon a world-changing technology.

But this moment—widely credited as history’s first recorded painless surgery—also led Wells to scandal, financial ruin, and a madness that now looks like addiction. Within four years he was dead: a suicide.

Pain relief then, as now with prescription opioids, promised miracles—until unforeseen complications arose. Personal, cultural, and market forces that have shaped our current trouble with pain relief have parallels and origins in the dentist’s story. Deemed the Father of Surgical Anesthesia 100 years after his death by the American Dental Association, Wells could also rightly be called the Patron Saint of America’s Opioid Crisis.

For several years I worked on a novel about Wells, immersing myself in 19th-century pain and his work to eradicate it, while also applying a fiction writer’s imagination to supply what history doesn’t reveal. What we know now about the opioid crisis helped me understand what happened then. Wells’s story carries a warning: to be wary of pain-free promises and to be skeptical of pain-relieving miracles, which are always likely to carry costs. Yet almost 175 years after that tooth pull, we still court fresh suffering when we try to relieve pain.

At their starts, both nitrous oxide and Oxycontin were hailed as miracles. When Purdue Pharma introduced its drug in 1996, the company’s press release promised “New Hope for Millions of Americans.” The phrase echoed the 19th-century utopian ideal of “painless surgery” and an 1848 newspaper description of Wells’s work: “the most wonderful discovery in human history.”

That wasn’t hyperbole. Before Wells, pain was a birth-to-death everyday proposition. Clove oil, opium tinctures, and even hypnosis offered limited relief. No one expected a “pain-free” life. Such a state wasn’t even considered desirable. As UCLA historian Marcia L. Meldrum notes in her 2003 JAMA article, “A Capsule History of Pain,” when pain couldn’t be erased, it had to be explained, given meaning. Christianity, with a crucifixion as its central event, considered pain to be a purifying force. This belief was so strong that Wells’s religious leaders impeded widespread use of general anesthesia. They “called anesthesia a violation of God’s law,” Meldrum writes. Pain was meant “to strengthen faith.”

Today that concept might seem alien, even cruel. Yet it mirrors contemporary attitudes that also impede relief, especially for people who endure the chronic pain opioids are meant to numb. Consider T-shirt slogans such as “No pain, no gain” or “Pain is weakness leaving the body.” Replace “weakness” with “sin” and you’ve got the 19th-century take.

Americans have long wanted to believe that fighting through pain leads to personal growth. But people who can’t win that struggle might actually suffer more because of well-meaning scorn: “Why do you need those pills? You’ll feel better if you get up and do something.” In her JAMA article, Meldrum points to theories that pain has physical and psychological components. Emotional pain, she writes, like physical pain, can be “compounded with social, spiritual, and emotional concerns.”

The opioid crisis and its overdose deaths—likely more than 59,000 in 2016 per a New York Times report—should tell us that pain is a slippery thing. It evades efforts to jaw-clench through it, to drug it, to destroy it.

Wells confronted that fact, too. Weeks after he made his discovery, he demonstrated its use before faculty and students of Harvard’s medical school by pulling a patient’s tooth. But the patient groaned—no one’s sure what went wrong—and Wells was laughed out of the city.

The failure devastated him. He quit dentistry. Later, he wrote that he’d suffered “a debilitating illness” that lasted several months. A 1987 British Journal of Anesthesia editorial says that Wells’s actions might have indicated “the first outward sign of a major depressive illness.”

Other erratic behavior followed. He started dentistry again, quit, started. Always short of money, he imported French paintings but took a tremendous financial loss. He peddled an “improved shower bath” of his invention, which also failed. All the while, he inhaled vapors from chloroform and ether as well as nitrous oxide gas. Self-experimentation was accepted scientific practice, but for Wells it may also have masked a dependency that evened out his mood swings and volatility, especially after a betrayal by a former student led to that student receiving popular credit for “painless surgery.”

Amid patent arguments and promises of wealth, Wells fought his former student’s claim, writing letters to newspaper editors and politicians and also crossing the Atlantic to press his case before French medical and scientific societies.

All of this wrecked him. When Wells met with newspaper editors from New Haven the summer before his suicide, he told them the controversies caused him “extreme pain,” describing his emotional suffering in physical terms. Science now tells us this isn’t surprising. Meldrum writes in her JAMA article about 20th-century theories that pain often involves physical and psychological components, either one leading to the other. “The same nervous system that reacts to pain is the same nervous system that reacts to anxiety and distress,” she told me recently. The New Haven editors seemed to have a nascent understanding of that holistic concept. They wrote that Wells “was subject to some great mental depression, amounting to almost a disease.”

Through the years since, pharmaceutical efforts toward relief have often sought large-scale, marketable, one-drug fits-all solutions. But significant and especially chronic pain is experienced in idiosyncratic ways. Wells’s patient in Boston groaned, though Wells had successfully used nitrous oxide in prior surgeries. Some users have become addicted to Oxycontin; others haven’t. Significant and especially chronic pain is experienced in idiosyncratic ways, and there might not ever be a single wonder-drug fix.

In early 1848, less than four years after his discovery, Wells moved to Manhattan to open a new dental practice. He touted himself in a newspaper advertisement as “the discoverer of the wonderful effects of ether and various stimulating gases in annulling pain.” The sensation brought on by the anesthetics, he told readers, “is highly pleasurable.”

But one night, likely delusional from huffing chloroform fumes, he tossed sulfuric acid into the faces of prostitutes he’d met on Broadway. Arrested and imprisoned, he convinced authorities to let him return to his quarters, in the company of a guard, to fetch his Bible. He also smuggled a bottle of chloroform and a straight razor back to his cell.

America’s first chapter in its complicated history with pain relief was about to end.

After Wells’s death, donors dedicated a stained glass window to him in Hartford’s Center Church, where Wells and his family had worshipped. The window remains, still catching light and displaying part of a verse from The Revelation of Saint John the Divine, Chapter 21. “Neither shall there be any more pain, for the former things are passed away.”

Those familiar with the verse know that the promise is only realized when there is a “new heaven and a new earth.” The opioid crisis shows us that when it comes to pain and its relief, we are nearer to Wells and his struggles than to any utopian hope.

The post The Patron Saint of America’s Opioid Crisis appeared first on The Millions.

from The Millions https://ift.tt/2OYKbfm