I've been mulling this over for a few days, finally deciding to write
about it. There was an article in the NYT on 13 January 2010
about an NEJM article:
Doctors have long hoped to discover a "morning-after pill"
to blunt the often disabling emotional fallout from traumatic
experiences. Now it appears that they have had one on hand all along:
morphine...In a large study of combat casualties in Iraq, Navy
researchers reported Wednesday that prompt treatment with morphine cut
in half the chances that troops would develop symptoms of
post-traumatic stress later on...The new study, appearing in The New
England Journal of Medicine, supports the standard practice in settings
like the battlefield and emergency rooms, where morphine is often used
readily. But experts say it may have implications for the timing of
treatment and for a wider variety of traumas, like those resulting from
rape or muggings.
Overall, the NYT article is reasonably good, complete with the
necessary disclaimers about how limited the study is. One odd
thing about it: Carey's articles usually exhibit a noticeable bias
against the use of psychotropic medication. I did not notice any
such bias this time. The reason this is notable, is that often
the medications he disparages often are drugs that have undergone
multiple placebo-controlled, double-blind clinical trials. There
have been no such studies on the use of morphine for PTSD.
Indeed, this is an area in which it would be exceptionally difficult to
design a really good prospective study. After all, you cannot
randomly select people to be traumatized. And it would be
difficult to justify randomizing people to receive placebo, if they
have been traumatized in such a way that morphine ordinarily would be
As it stands, the study really does not have any direct clinical
application. (Few single studies do, of course.) One reason
it is interesting, is that it provides some comfort that the morphine
does not makes things worse for the patient, in terms of the
psychological aftermath. The other reason it is interesting, is
that it would be really nice to know how this works on a molecular
level. That remains highly speculative.
I do wonder why Carey is less critical of the morphine idea. Perhaps it is because he consideres PTSD so far from common experience, that he is suggesting that a compromise is necessary. I find this a real problem, both in understanding trauma, and in the process of discovering new treatments. At what point is an experience one that should be clouded, blocked, or erased? I am in general a proponent of medication for all types of psychological issues. I also don't judge anyone for trying whatever they can find to hide from the harsh realities of major trauma. It would be a shame though if morphine is considered the best solution in my opinion. It is like drinking vodka to get over stress. In a limited study, I think you will find some benefit. Long term, it can be destructive. If depression, general anxiety disorder and even schizophrenia can be medicated safely, and routinely, certainly PTSD can. The search needs to continue, and if Morphine is the best shot, then that is fine.