SLEEP DEPRIVATION

As we often say at Medical Examiner world headquarters here in Augusta — you probably say it too — abusus non tollit usum. As we all know, in the Latin-free version that’s “Abuse does not take away use.” In other words, the misuse of something is not an argument against its proper use. The gentleman above would probably quote that Latin maxim often if he was still alive, and so would millions of patients around the world. But countless others would beg to differ, and do so quite loudly.

You see, the man in the photo is Dr. Paul Janssen, the founder of Janssen Pharmaceutica. You might recognize that name if you’ve already read this issue’s edition of “This Is Your Brain” on page 8. There it notes that Dr. Janssen is the inventor of fentanyl, which was approved for use in the US in 1968. The drug gets plenty of bad press these days as the #1 cause of drug overdose deaths in the US. For 2021 alone that number stood well north of 71,000. That is an appalling toll.

Of course, we can’t forget abusus non tollit usum. Fentanyl’s deadly ways are largely from illicit drugs manufactured and sold on the street. But in legitimate medical applications fentanyl racks up more than a million prescriptions annually in the Unites States alone, and it’s listed on the World Health Organization’s “List of Essential Medicines.”

What is it good for? Fentanyl is a potent painkiller, some 50 to 100 times more powerful than morphine, making it very useful for cancer patients and people suffering from painful after-effects of surgery and other medical interventions. In a perfect world, fentanyl’s potency would be a godsend, because even a tiny amount of it is effective. That’s what you want in drugs: minimal amounts that are maximally effective.

Fentanyl is an opioid, but significantly it’s a synthetic opioid. The roots of the word opioid can be traced back to opium. That may call to mind images of acres of poppies under cultivation to extract the plant’s active ingredient for use in making all kinds of pain killers: morphine, oxycodone, codeine, heroin and more. In the case of a synthetic opioid like fentanyl, however, those acres of farmland are not required. Its ease of manufacture in somebody’s garage makes it a readily distributed and abused drug, and its incredible potency makes casual use incredibly risky.

Even so, we still keep coming back to abusus non tollit usum. Dr. Janssen created a useful and effective drug; if its abuse caused it to be taken off the market, several groups of patients would feel the pain — literally. Fentanyl is an effective treatment for chronic pain, often using transdermal patches. The dosage can be controlled by the size of the patch.

Fentanyl is used in fields as diverse as obstetrics and combat medicine. It’s useful for epidurals because of its rapid effectiveness coupled with the speedy disappearance of its effects soon after administration. Combat medics sometimes use a fentanyl lollipop taped to the finger of a wounded soldier with the lozenge portion placed in his mouth. When enough fentanyl has been absorbed, its sedating effect generally results in the patient letting their hand drop, taking the fentanyl lollipop with it. It’s a simple but effective way to reduce the likelihood of getting too much fentanyl, even in a chaotic field setting.

Dr. Paul Janssen, incidentally, was born in Belgium in 1936, and died in Rome in 2003 at age 77.

It was widely reported last week that actor Don Johnson, due a hectic filming schedule at the height of the popularity of Miami Vice, did not sleep for five years.

Not “did not sleep well.” Not “had trouble sleeping.” Not “didn’t spend much time in the sack.” No. Quote: “I didn’t sleep for five years..” Period. Five whole years. Could someone actually go that long without sleeping?

The short answer is no. And so is the long answer. It is physically impossible to pull off a feat like that and stay sane, let alone stay alive. Most people have a hard time staying awake for a single day. In a 1989 study of rats, lack of sleep killed them dead in at most one month, and often within 10 days or so.

There is a scarcity of research on extended sleeplessness in humans because it’s considered unethical to deliberately deprive people of sleep. In fact, deliberately keeping someone awake for an extended period of time is used as a torture technique. There are a number of records, some considered legit and others not verifiable, which sprang from a fad in the early 1960s: radio DJs, most often, pulled these publicity stunts, staying on the air for ridiculous lengths of time, sometimes using a public place like a department store window as their temporary studio. an esophagoscopy in which a scope with a light is used to examine the esophageal lining, a biopsy (removing cells for examination under a microscope), and brush cytology or balloon cytology in which a brush or a balloon device captures esophageal cells for examination.3

One of the longest sleepless stints that’s considered verifiable was the 1964 experiment by California high school student Randy Gardner. As a science project he managed to stay awake for...five years? no...four? ...a full year? Not hardly. He lasted 264 hours, which is 11 days. He was monitored by a doctor during the experiment.

Miami Vice may have been an exciting show back in the day, but there’s no way it kept anyone awake for five years.

Augusta University Health offers a noninvasive esophageal DNA test to check for abnormal cells. Using an EsoGuard, the patient swallows a tiny balloon-like device, about one-half the size of a multi-vitamin, attached to a thin tube that collects cells as it slides up the esophagus while being extracted.5

If cancerous cells are detected, the patients’ physician or the patient is contacted, and appropriate referrals are made. A multidisciplinary team of cancer specialists at the Georgia Cancer Center provides gastrointestinal cancer care and supportive services using a patient- and family-centered care approach.

“The C Word” is a newsbrief of the Georgia Cancer Center at Augusta University. For cancer information, visit: augusta.edu/cancer/ community. To request exhibits or speaking engagements, contact Christine O’Meara at comeara@augusta.edu or 706-721-8353.

Sources:

1. American Cancer Society (ACS) cancer.org/cancer/ esophagus-cancer/causes-risks-prevention/risk-factors. html

2. American Cancer Society (ACS) Key statistics for esophageal cancer. cancer.org/cancer/esophagus-cancer/ augusta.edu/cancer/community about/keystatistics. html#:~:text=The%20American%20Cancer%20Society’s%20estimates,men%20and%203%2C200%20 in%20women)

3. National Cancer Institute (NCI) Esophageal Cancer Screening (PDQ) – Patient Version. General Information about Esophageal Cancer. cancer.gov/types/esophageal/ patient/esophageal-screening-pdq#_19

4. National Cancer Institute (NCI) Esophageal Cancer Prevention )PDQ) – Patient Version. cancer.gov/types/esophageal/patient/esophageal-prevention-pdq#_80

5. Kaylor L. New, non-invasive DNA test focuses on early detection of esophageal cancer. Augusta University Health News. March 2022. news.augustahealth.org/2022/03/30/new-non-invasive-dna-testfocuses-on-early-detection-of-esophageal-cancer