「醫生,你開了一個月的安眠藥給我,不怕我一次吃光會死掉嗎?」
偶爾就是會遇到這類患者,喜歡測試醫師有沒有關心他。
「喔!抱歉,現在的安眠藥太安全,就算半年、一年的藥一次吃下去,頂多只會讓你睡上幾天。醒來什麼事都沒有,連洗胃都不用。你只會失望,不會失去性命,但是你確實可能因為神智不清、跌倒撞到頭而死,或被自己的嘔吐物噎死,所以還是不要啦!」
(註:有非常非常少數致死的病例,一般致死原因是癲癇,不能說絕對安全,若過量服用還是留在醫院觀察為宜。)
即使面對精神科患者,醫師也要展現幽默感。所謂言教不如身教,在遭受測試的壓力下,醫師越是輕鬆以對,患者對自己的病情反而更能正向看待。
有的安眠藥,健保價甚至只有兩塊錢,真的比糖果還便宜。現在隨便吃個自助餐就要一百多塊,算起來,一整個月的安眠藥還比較便宜。而安眠藥除了便宜、醫師隨便開、不怕健保核刪之外,政府跟醫師不怕你終身吃藥的另一個原因是「太安全」。在1940年之前的安眠藥都是巴比妥酸鹽類,有肌肉鬆弛跟抑制呼吸的作用,要是藥物過量再加上喝酒就很容易致死。不過,巴比妥酸鹽後來只能用在手術或檢查時的麻醉,之後發展出來的安眠藥幾乎都沒有致死劑量,意思是「吃再多也不會死」,也不會造成器官功能的傷害,包括大家最怕的肝跟腎。
一旦病人已經長期依賴安眠藥,指「半年以上每天都要靠吃安眠藥入睡,不吃更是完全睡不著」,醫師要花多大的力氣才能讓他們願意重新思考「不吃安眠藥的可能性」?並且願意跟醫師好好討論呢?
要是已經吃了好幾年,而且是天天吃,不吃完全睡不著的病人,單單是讓他們考慮「不要依賴安眠藥睡覺」這檔事,可能就要花上十幾分鐘解說。仔細詢問可能影響睡眠的工作跟生活狀態,又要再花上至少20分鐘。更不用說探討可能造成失眠的壓力源、負面情緒則需耗時更久。而這一切對治療失眠都很重要,但是習慣只吃安眠藥解決問題的病人,他們可不願意頻繁回診,有時連討論都嫌煩。像是一週一次的「認知行為治療」,每次要花上半個小時以上,整個療程則需要至少六至八週,這時病人寧可藥拿一拿趕快走人。而健保署基於費用控管,基本上不太支持像認知行為這種心理治療的項目,甚至動輒刪減、罰錢,從不在意病人被養成藥罐子。他們只看到眼前的總預算,關切一個病人是不是花太多錢。
所有安眠藥的使用說明都建議只能短期服用。美國據說規定更嚴格,不可以服用超過三個月或半年。但是因為安眠藥太便宜、太安全,臨床上又看到很多病人一吃幾十年,活到七十多歲也都沒事。醫師看診最容易的就是只要說:「拿藥喔?照舊?」不到一分鐘就看完了!頭都不用抬起來進行望聞問切,病人也高高興興地拎了一袋子的藥回家,這個月不用再擔心睡不著。這樣的結果,就是不知不覺把病人養成藥罐子。
你是安眠藥的藥罐子嗎?即使你不是,身邊的親友也很有可能是,只是大家都不說而已。
有一次我到老年大學演講,在座的都是七、八十歲的老人家,加起來有能有五千歲。
「你們有吃安眠藥的請舉手。」
零零星星慢慢舉起的手,剛好湊足五根手指頭。怎麼可能,我心想至少會有20位舉手才對。
等到演講結束,那可精彩了,只見大家神秘兮兮地從包包裡拿出安眠藥,都問我同一個問題:「黃醫師,我一定要吃這個才能入睡。已經這樣很久了,有沒有關係啊?」
眼見想上前詢問的人越來越多,早過了中午12點,肚子也越來越餓的我只好尿遁,結果一路被追問到廁所門口。還得故意在裡面多待一會兒,偷瞄了一下,眼看外面沒人,機不可失趕快閃。
失眠的問題跟安眠藥的使用,會因年紀變老而增加。
隨著人口老化,臺灣人每年吃的安眠藥很快就會超過四億顆,但也只不過花個十來億就可以讓一、兩百萬人免於失眠之苦,聽起來好像還不賴?
摘自黃偉俐醫師新書《失眠勿擾》

懷疑你怎麼當上醫生的?你知道我妻子因為長期安眠藥導致夢遊,焦慮,恍惚,戒斷症候群嗎?有這種醫生,發這種沒有水準的文章,害死一堆病人
現在很多醫生為了賺錢,就算病人變成藥罐子,他們依然可以昧著良心亂開藥,安眠藥的日期還沒到不能開,就給你開鎮定劑,反正他們只要有錢可以賺,根本不在乎病人藥物依賴變成多嚴重
洪凱駖藥師~ Solving a long-standing mystery about the desert’s rock art canvas Petroglyphs are carved in a material called rock varnish, the origins of which have been debated for years. Now, scientists argue it’s the result of bacteria and an adaptation that protects them from the desert sun’s harsh rays. By Nathan Collins 5923141600_1bc3f25867_k.jpg Rock art featuring human and animal forms and handprints Petroglyphs at Mesa Verde National Park, Colorado (Christine Fry & Peter Russo) Wander around a desert most anywhere in the world, and eventually you’ll notice dark-stained rocks, especially where the sun shines most brightly and water trickles down or dew gathers. In some spots, if you’re lucky, you might stumble upon ancient art – petroglyphs – carved into the stain. For years, however, researchers have understood more about the petroglyphs than the mysterious dark stain, called rock varnish, in which they were drawn. In particular, science has yet to come to a conclusion about where rock varnish, which is unusually rich in manganese, comes from. Now, scientists at the California Institute of Technology, the Department of Energy’s SLAC National Accelerator Laboratory and elsewhere think they have an answer. According to a recent paper in Proceedings of the National Academy of Sciences, rock varnish is left behind by microbial communities that use manganese to defend against the punishing desert sun. The mystery of rock varnish is old, said Usha Lingappa, a graduate student at Caltech and the study’s lead author. “Charles Darwin wrote about it, Alexander von Humboldt wrote about it,” she said, and there is a long-standing debate about whether it has a biological or inorganic origin. But, Lingappa said, she and her colleagues didn’t actually set out to understand where rock varnish comes from. Instead, they were interested in how microbial ecosystems in the desert interact with rock varnish. To do so, they deployed as many techniques as they could come up with: DNA sequencing, mineralogical analyses, electron microscopy, and – aided by Stanford Synchroton Radiation Lightsource (SSRL) scientist Samuel Webb – advanced X-ray spectroscopy methods that could map different kinds of manganese and other elements within samples of rock varnish. “By combining these different perspectives, maybe we could draw a picture of this ecosystem and understand it in new ways,” Lingappa said. “That’s where we started, and then we just stumbled into this hypothesis” for rock varnish formation. Among the team’s key observations was that, while manganese in desert dust is usually in particle form, it was deposited in more continuous layers in varnish, a fact revealed by X-ray spectroscopy methods at SSRL that can tell not only what chemical compounds make up a sample but also how they are distributed, on a microscopic scale, throughout the sample. That same analysis showed that the kinds of manganese compounds in varnish were the result of ongoing chemical cycles, rather than being left out in the sun for millennia. That information, combined with the prevalence of bacteria called Chroococcidiopsis that use manganese to combat the oxidative effects of the harsh desert sun, led Lingappa and her team to conclude that rock varnish was left behind by those bacteria. For his part, Webb said that he always enjoys a manganese project – “I’ve been a mangaphile for a while now” – and that this project arrived at the perfect time, given advances in X-ray spectroscopy at SSRL. Improvements in X-ray beam size allowed the researchers to get a finer-grained picture of rock varnish, he said, and other improvements ensured that they could get a good look at their samples without the risk of damaging them. “We’re always tinkering and fine-tuning things, and I think it was the right time for a project that maybe 5 or 10 years ago wouldn’t really have been feasible.” The research was supported by the National Science Foundation, the National Institutes of Health and the National Aeronautics and Space Administration. SSRL is a DOE Office of Science user facility. Citation: Usha F. Lingappa et al., Proceedings of the National Academy of Sciences, 22 June 2021 (10.1073/pnas.2025188118) For questions or comments, contact the SLAC Office of Communications at communications@slac.stanford.edu. SLAC is a vibrant multiprogram laboratory that explores how the universe works at the biggest, smallest and fastest scales and invents powerful tools used by scientists around the globe. With research spanning particle physics, astrophysics and cosmology, materials, chemistry, bio- and energy sciences and scientific computing, we help solve real-world problems and advance the interests of the nation. SLAC is operated by Stanford University for the U.S. Department of Energy’s Office of Science. The Office of Science is the single largest supporter of basic research in the physical sciences in the United States and is working to address some of the most pressing challenges of our time. X-ray Science X-ray Spectroscopy Stanford Synchrotron Radiation Lightsource (SSRL) 陳宜斌 ~GOTOBED NOTGOTOHELL