On June 26, pop music king Michael Jackson died in Los Angeles. Jackson’s death in Los Angeles was reported by the media at home and abroad, and the cause of his death became a mystery that people were eager to solve. All kinds of reports and reports flooded the media. There is news that Jackson was suffering from a malady, there is the problem of addiction to painkillers, probably because of the overuse of strong painkillers such as dulcolax and other seven drugs mixed into the “pain cocktail”, coupled with the preparation of the concert exhaustion, triggering a heart attack death. It was also reported that Jackson’s home was searched for the powerful sedative Deprenylma. The article points out that Deprenyl is usually only used in hospitals and can have serious cardiovascular complications, among other things. Whether “painkiller abuse” or “private use of Desprisal” was ultimately the “culprit” or the “scapegoat” for Jackson’s death Whether “painkiller abuse” or “private use of Depo-Provera” was ultimately the “culprit” or the “scapegoat” for Jackson’s death, we need to begin to take a serious look at the abuse of painkillers and sedatives and to properly evaluate both types of drugs. Who needs to take painkillers Patients with chronic pain often need to take analgesic drugs to relieve pain and improve their quality of life. This includes pain caused by chronic soft tissue diseases, neuropathic pain, and cancer pain. Especially for oncology patients, WHO statistics show that 50% of cancer patients treated have different degrees of pain, cancer pain is the main symptom in 70% of advanced cancer patients, and 30% of cancer patients have unbearable and severe pain. Fifty percent of pain patients have moderate or high depression, 30% have more severe anxiety, and 59% have thought about suicide. The most important cause of significant psychological disorders and even suicidal thoughts is the long lasting and unbearable cancer pain. Since the 1980s, the World Health Organization has proposed the “three-step therapy” for the treatment of pain. In 2001, domestic experts in oncology, pain and drug dependence discussed and put forward the concept of “standardized pain management” for the first time in China. The standardized pain management is the summary of the development practice of three-step therapy. From stepwise administration of drugs to the selection of drugs that can achieve maximum analgesic effect and minimum side effects according to pain intensity, disease type and pathophysiological characteristics of pain, from oral administration to non-invasive administration, from scheduled administration to the use of controlled and slow-release drugs for cancer pain and chronic pain, from individualized administration to individualized and multi-modal administration, cancer pain and chronic pain treatment has made great progress. According to the current treatment measures, more than 70% of cancer pain patients can have pain relief If it is true as reported, Michael? Jackson suffered from chronic pain and severe insomnia, the use of analgesic drugs and sedative medication was unjustifiable, even necessary, and could have worked well to help the musical giant create more classics. But the problem is abuse – both in the absence of standardized pain treatment. Abuse of painkillers and sedatives with high side effects Abuse of painkillers refers to the casual use of painkillers without following medical advice or drug instructions, for long periods of time, in excessive doses, or without a strict grasp of indications. This may bring various hazards to the body due to some side effects of the painkillers themselves. First of all, let’s not talk about Michael Jackson. Jackson’s death was caused by analgesia or excessive sedation, but only to talk about the dangers of painkiller abuse. We note that Jackson used Dulcolax (Demerol), a synthetic narcotic drug with effects and mechanisms similar to those of morphine. In the past, patients and their families treated Dulcolax as a panacea for cancer pain, which is actually a misconception. This is actually a misconception because Dulcolax has low analgesic efficacy, short pain relief time and poor oral administration effect. Its metabolite, desmethyl dulcolax, can cause central nervous excitation, which can lead to tremors and seizures. As early as 1996, the Ministry of Health of China explicitly prohibited the use of dulcolax in cancer pain treatment. According to the MOH document, Dulcolax can only be used for short term acute pain such as fracture, trauma, visceral colic, myocardial infarction, etc. From the pharmacological point of view, drugs for the treatment of pain are divided into 3 major categories: (1) non-opioid drugs, which are used for mild to moderate pain; (2) opioid drugs, divided into 2 types, weak and strong, which are used to relieve moderate to severe pain, respectively, with morphine as its representative drug; (3) adjuvant drugs, including antidepressants, anxiolytics, anticonvulsants and other drugs such as corticosteroids, which are effective for specific types.WHO has developed The first step is to apply non-opioid drugs such as paracetamol, aspirin or other NSAIDs for mild to moderate pain; the second step is to increase (not replace) weak opioids, such as cocaine, if the pain persists or worsens; for patients with persistent pain or pain of moderate to severe onset, strong opioids such as morphine, fentanyl or methadone should be chosen In patients with persistent pain or pain of moderate to severe onset, strong opioids such as morphine, fentanyl or methadone should be used or the dose of opioids should be increased, i.e. the third step. There are five key points in the WHO recommended medication: oral, timely, stepwise, individualized, and attention to specific details. Therefore, the “analgesic cocktail” of several drugs is not appalling, but the key is how to mix the cocktail. Deprenyl is an intravenous class of general anesthetic emulsion, with good sedative-hypnotic effect, usually used for induction of general anesthesia and maintenance of sedation when the patient receives mechanical ventilation in intensive care. Deprenyl can only be administered by trained anesthesiologists or intensive care unit physicians, and must be used with artificial ventilation and oxygenation equipment to maintain a clear airway, because the patient may experience transient respiratory arrest during the administration of the drug. Deprenyl should be used with caution in patients with cardiac, respiratory, hepatic or renal impairment, circulating hypovolemia, and in debilitated patients. Opioids are the basic medication of the “three-step approach”. Many patients and family members, and even health care providers, are fearful that taking opioids will lead to addiction. This is a very misconception. The chance of addiction is less than 4 in 10,000 if used regularly and under the guidance of a physician. That is, for every 10,000 cases of long-term opioid pain medication use, there are less than four addicts. The purpose of opioid use in pain patients is for pain relief, and when the drug exerts a powerful analgesic effect, its euphoric (addictive) effect takes a back seat. When opioids are used by “normal” people without pain, the blood concentration increases rapidly, resulting in “euphoria” and addiction, which is a kind of mental dependence. Some patients with cancer pain have increased tolerance to opioid painkillers after long-term use, which is a normal pharmacological phenomenon and belongs to physiological dependence, not addiction. Although some painkillers do have side effects such as nausea and vomiting, these side effects are tolerable compared with severe pain. In addition, although morphine-based drugs have physical dependence, the possibility of psychological addiction is reduced by reducing the dosage once the pain is resolved. There is no need to talk about the tiger and take care of life with the right medication So, how can we better avoid pain medication abuse while relieving pain? The American pain society (APS) guidelines for pain management in 2005 recommended abandoning the use of the WHO analgesic ladder in favor of a step-by-step (algorithm-based) approach to pain management, based on a detailed assessment of After a detailed assessment of pain intensity, pain treatment is initiated based on the patient’s self-reported pain intensity. The new APS guidelines have the same tenets as our proposed standardized pain management and are clinically better implementable than the three-step approach. The use of morphine extended-release and controlled-release tablets mainly treats moderate and severe pain. The drug is more effective for bone pain, visceral pain, and pain due to soft tissue infiltration, and less effective for neuropathic pain, with common side effects such as constipation and nausea. The latter is a potent agonist of morphine receptors and is very easy to use because it is suitable for transdermal administration. The side effects of this drug are similar to morphine, but constipation, nausea, vomiting and other side effects are significantly reduced than morphine. In recent years, the research and development of analgesic drugs has focused on the innovation of opioid dosage forms and routes of administration in order to achieve a more practical, safer and less risky analgesic treatment. The new formulations not only maintain the potent analgesic effect of opioids, but also are more convenient and safer to administer and have lower risk of abuse. The new dosage forms are: new fentanyl transdermal patch D-TRANS, patient-controlled iontophoretic fentanyl delivery transdermal patch, morphine sulfate 24h controlled release capsule, fentanyl transmucosal oral agent, hydromorphone 24h controlled release tablet, oxycodone hydrochloride controlled release tablet, etc. The combined use of opioid and non-opioid drugs in the treatment of cancer pain can reduce the side effects of drugs, enhance the analgesic effect and improve safety. Sedative drugs with long duration of action and low impact on respiratory circulation, such as Valium, are chosen instead of Desprimir, which is used by Jackson. It is worth mentioning that Deprenyl is not as terrible as one might think, it is a fast-acting, short-acting general anesthetic, and can be considered one of the most commonly used drugs in anesthesia. Because of the white liquid, doctors are commonly known as “milk”. As the name implies, it is a drug that provides effective sedation while being safe if used properly. Because of its short-acting nature, it has allowed tests and treatments that many people used to fear to be performed under outpatient anesthesia, such as gastroscopies and abortions and curettage procedures. Michael? Jackson once conquered the world with his unparalleled artistic achievements, and perhaps the consequences of the pain medication abuse he experienced will give the world more of a wake up call.