Is there a ceiling for heroin use? Apparently so…

‘K, this isn’t a post about the virtues of tax-funded “harm reduction”, so please humour me and allow me a little diatribe…

~rant/on~

I’m one of those right/libertarian meanies who likes watching people in wheelchairs being forced to park at the outside edge of the Walmart parking lot and wheel in and out of traffic to get to the handicapped-unfriendly, normal-people-doors and wants the state out of his life if he hasn’t committed violence or theft. But with liberty and freedom comes self-responsibility; you want drug programs? Not with my cash. Get your grubby hands out of my pockets and take care of your own business if you’ve acquired an addiction…

…and don’t give me shit about “harm reduction” saving legal and medical resources. There would be less harm if the government would look at the whole picture and study why the drug war is futile, why organised crime is so powerful, why state methadone programs are not very successful, why the police-budget and resources are stretched, why health-care costs are higher than they need to be… then get the hell out and stop making such a fucking mess of it…

…now that would be “harm reduction”.

The point is, all drugs should be legal and taken out of the black market and allowed in the open market, and social programs for the drug-addled squished underfoot. This would radically lower drug prices for the under-class, save as much money as any fucking soul-crushing welfare program and justly disallow positive rights for parasites who otherwise develop a sense of entitlement to my hard-earned money.

~rant/off~

…Thank you for your patience.   ;D    Maybe I should have saved that rodomontade for another post but, well, I just had to get it out of m’system.

~Junkies die in the streets. Lots ‘n lots of them. Why? I have an idea why, and when I think of it, I become pretty fucking angry; angry at the tsk tsking Immaculate who cannot stand the thought of people doing things they wouldn’t do, for fear of some mythical “breakdown of society” that would leave all and sundry raving and slavering in the streets, eyeing wives and daughters and productive mens’ wallets while businesses, houses and government buildings burn to the ground. This is the demographic that could, with a collective word, tell the politicians, “enough is enough”, and free the markets just a little more and allow a product in that should never have been taken out

…I don’t blame the pols, the cops, or Big Pharma; the blame, and the power, lie completely with the Conservative Immaculate.

You see, there’s something that’s been going on for a few years concerning drug legalisation; The Swiss heroin experiments allow users to buy unlimited amounts of clean product. “What?”, you gasp. “These junkies are going to die in a twisted carnival-land of smack! They’re gonna wind up, one on every street corner, swaying and nodding in unison, knocking their heads on newspaper stands and light poles!”

Sorry to burst your righteous bubble, Moses. You probably don’t want to hear this, but apparently there’s a limit to how much heroin a junky craves. And when the junk is clean and free of contaminants, properly inexpensive and legally accessible, the junky not only doesn’t crave more and more, but tends to find employment, become a social member of society and uh… not die…

…you see, when drugs are legal and in the markets, people just like you and me who haven’t necessarily hurt anyone, who were once stigmatised as criminals and sub-humans scurrying about, like cockroaches, searching for drugs in and out of the cracks of the surface-world and the under-world… suddenly aren’t criminals.

Suddenly, these people are allowed to breathe, to pause, to take their bearing, to walk out of the night and out of the cracks in the concrete with dignity, to watch the sunrise while walking out their homes rather than wearily stumbling into them, to make a plan and carry it through… because society has finally let these isolated ones know that one who takes a drug isn’t necessarily a thief or a thug; just a person like everyone else.

~The evidence from the Swiss Heroin Program suggests that when a user isn’t stressed by everything surrounding the illegality of the drug and he feels safe, secure and included within his society, there is an upper limit to his drug use; when he can see over his once-smoggy horizon, and into better, fertile lands, the evidence suggests that he is more likely to be inspired and motivated to change his priorities, make better and life-affirming plans, look less favourably on his past and the drug that fueled it and start taking less and less of it…

…we don’t need social programs to make this happen… we just need the will, wit and wisdom to let it happen…

…legalise it.

Is there a case for tramadol?

Tramadol is a mild opioid analgesic with weak agonist actions at the μ receptor; it also releases serotonin and inhibits the reuptake of noradrenaline. It’s scripted for moderate pain, restless legs syndrome and fibromyalgia.

Tramadol has been prescribed for refractory depression for years, overtly in the US as a last-line drug for depression and somewhat otherwise to trusted patients by intelligent doctors in other countries. Lurking around the internet however, one finds there isn’t as much love for this drug as for its opiate cousins. Because of its unusual actions, some are fairly content to use it with a few reservations, a very few love it (maybe because they have uncommon genuine serotonin issues), and most become disillusioned with it after a time (maybe because, like so many depressives, they don’t have serotonin issues); and tolerance is kind of an issue because of potential serotonin poisoning (god, I have a hate-on for serotonin), so in my opinion long-term use is not advised…

…but, and here’s the kicker, because of lack of knowledge patients who are scripted on-label for pain get caught in a trap of dependence and withdrawal hell. The net is filled with stories like these… …be aware.

Tramadol acts as a μ-opioid receptor agonist, serotonin releasing agent, norepinephrine reuptake inhibitor, NMDA receptor antagonist, 5-HT2C receptor antagonist, (α7)5 nicotinic acetylcholine receptor antagonist, TRPV1 receptor agonist, and M1 and M3 muscarinic acetylcholine receptor antagonist. This is one hell of a mechanism of action, and the very reason I’m wary of this drug. Calling it a “mild opiate” is like calling someone the world’s tallest midget… “like, so what?” Opiate withdrawal and PAWS are bad enough; now let’s combine O withdrawal with a SNRI-type withdrawal (Effexor discontinuation syndrome, anyone?), and fun and happy-happy joy times are right around the corner (I can see the balloons, confetti and flying ribbons already). I’ve been through SNRI discontinuation syndrome, and I cannot imagine dealing with, both at once, O withdrawal and SNRI withdrawal.  If one must abruptly discontinue for any reason (there are many…) and is into this stuff up to his neck, one had better get ready to take some time off work and possibly check into a medical facility; there ain’t no staying in bed with the Thomas Recipe, benzo’s and classical guitar cd’s with this stuff.

People are more and more advocating tramadol as a possibility for refractory depression, but I wonder if they’ve done their homework or don’t take seriously the potential for pain caused by this drug. Again, I have experience with these side effects and have no problem with the thought of saying “uhh… no.” Consider too, possible seizures for some, and tramadol starts to sound like not so much fun anymore. Indeed, a growing awareness regarding seizures appears to be another of tramadol’s bad raps…

…so, if one thinks combining tramadol with most mainstream antidepressants to increase efficacy might be the ticket, I would be inclined to put that thought away; maybe I’m wrong, but possible serotonin complications make this idea hard to defend.

~If your doctor is willing to script tramadol (imo, stacked with no other ADs), and you’ve done your homework and are aware of the negatives, you might be presented with an opportunity because it’s a “mild opiate” and maybe not so stigmatised by patronising (or just simply worried about a patient) doctors; maybe it is worth trying. As long as the supply doesn’t get abruptly cut off, you don’t develop a scary tolerance and this funny little opioid works as well as other “normal” opiates for refrac-depression, maybe try it out. There is evidence that tramadol binds to kappa receptors, but no evidence of wretched κ effects; so this is a big point in its favour. Just be careful and don’t beat a dead horse if it doesn’t work the way you want it to in the long-term…

…a blog-mate recently wrote that she takes a very small dose every few days to excellent effect. Maybe this is the way to go with this stuff. Little to no tolerance is built, and the potential for bad side effects is reduced big time.

I might look more into tramadol later, if my interest is piqued; but I can’t help feeling like a bit of an opie-snob with this stuff. Because of its obscure actions, this drug may be the holy grail for someone with an obscure kind of depression, but probably not much fun for most. I just don’t know if it comes close to “real” opiates for a person with EDS/refrac-depression…

…personally, I’d try LDN before tramadol.

Addiction & dependence are not the same

I don’t crave opium. I know it sounds like delusion and denial, but it’s true. I don’t seek the euphoria, and when I feel the wd’s coming on, I don’t crave O. Whenever I have to taper off for some reason, I just taper off. Yes, there’s that PAWS “hole” in my life for a while that users talk about that’s hard to fill with something else, but otherwise, no; I just spend more time mountain climbing and backpacking, my favourite hobbies, and being with my valued people. If there ever came a time when I was forced to go cold turkey and, say, some kind of benzodiazepine or tranquilizer was available to deal with the anxiety and a pain-killer for the aches, cramps and kicks, I would feel no pull toward opiates.

I think I can understand people with big gaping holes in their lives who just simply crave an altered state. I’ve seen them. We all long for beauty, don’t we? I know I do, and when I see the way some others live, where they live and their circumstances, whether in a semi-derelict state in a rented apartment/hovel or middle class but painfully empty state in a moneyed situation, I think they have an unusual “need” to fill these big gaping holes of “ugly” any way they can. Do they lack an imagination, or capacity for just filling the gaping hole with beautiful things and edifying activities and experiences instead of drugs?…

…or is there something biological that compels them to seek drugs? Maybe, but I’m not so sure about this.

Then we have ones for whom drugs have little appeal. These are people who acquire scripts for pain, or have tried opies and other drugs recreationally and find no inspiration in them. They are many. I’m one. If it was not for O’s incredible efficacy for my particular depression, I wouldn’t use it. I know a guy at work who was on a ten-year morphine run for back pain at inhumanly high doses, until he got sick of it, took a year off and used that time to taper off. He never craves, and “good riddance.”

We’re not the only ones who know that the whole “addiction” thing is pure bullshit. There is a difference between addiction and physical dependence, and you will never hear this from anyone in a position of governmental authority or with a “drugs-are-scary” agenda.

[all block quotes from Wikipedia]

~”severely distressed animals, like severely distressed people, will relieve their distress pharmacologically if they can.”

And this is absolutely correct… and, know what? Any rational person would. Why in hell, in this age of relief, would man or mouse not under the spell of phony machismic or masochistic convictions “man up” and crawl through the devil’s rat-cage of pain instead? Explain the dignity in this, please. The above quote is from Canadian psychologist Bruce K. Alexander, referring to Rat Park, a happy little place wherein once lived a happy little colony of lab rats, about which an experiment was carried out to test his own suspicions and find out if the disease hypothesis of drug addiction was a load of rat poop.

To test his hypothesis, Alexander built Rat Park, an 8.8 m2 (95 sq ft) housing colony, 200 times the square footage of a standard laboratory cage. There were 16–20 rats of both sexes in residence, an abundance of food, balls and wheels for play, and enough space for mating and raising litters. The results of the experiment appeared to support his hypothesis. Rats who had been forced to consume morphine hydrochloride for 57 consecutive days were brought to Rat Park and given a choice between plain tap water and water laced with morphine. For the most part, they chose the plain water. “Nothing that we tried,” Alexander wrote, “… produced anything that looked like addiction in rats that were housed in a reasonably normal environment.” Control groups of rats isolated in small cages consumed much more morphine in this and several subsequent experiments.

Rats are valued for research because we share an almost identical genetic compatibility. This gives us some measure of confidence despite that rats have no conscious sense of purpose, aesthetics, values, goals, self-esteem or other human traits that might set motives for drug use and abuse. Doctors in the UK with experience scripting heroin feel little trepidation regarding most patient’s motives because, well, most patients aren’t at risk to divert from their purpose; so, apparently we and rats share many of the same attitudes toward drugs.

According to Alexander, the disease model makes either of two claims:

  • Claim A: All or most people who use heroin or cocaine beyond a certain minimum amount become addicted.
  • Claim B: No matter what proportion of the users of heroin and cocaine become addicted, their addiction is caused by exposure to the drug.

Several decades of animal studies have been seen as supporting these claims. Avram Goldstein wrote in 1979: “If a monkey is provided with a lever, which he can press to self-inject heroin, he establishes a regular pattern of heroin use — a true addiction — that takes priority over the normal activities of his life … Since this behavior is seen in several other animal species (primarily rats), I have to infer that if heroin were easily available to everyone, and if there were no social pressure of any kind to discourage heroin use, a very large number of people would become heroin addicts.

Against this, Alexander argues that the main evidence for the belief in drug-induced addiction comes from “the testimonials of some addicted people who believe that exposure to a drug caused them to ‘lose control’,” and from some “highly technical research on laboratory animals”. He argues that this weak evidence has been embellished in the news media to the point where it has acquired the status of an unassailable fact, whereas the great bulk of historical and clinical evidence, he says, runs against it. He writes that, although the use of opiates in the United States and England during the 19th century was greater than it is now, the incidence of dependence and addiction never reached one percent of the population and was declining at the end of the century. In Britain, he writes that heroin has been widely used in medication for coughs, diarrhea, and chronic pain until the present day; in 1972, British doctors prescribed 29 kilograms of heroin to patients, which he writes amounts to millions of doses, yet a 1982 study of the statistics on iatrogenic addiction in the UK showed a “virtual absence” of such addicts. Recent research confirms that many people use heroin regularly for years, for either recreational or medical purposes, without becoming addicted.

I have refractory depression and must supplement with opiates, understanding that they facilitate the things I enjoy and value and motivate me to partake in them.

Opiates don’t addict people. Attitudes addict people. Also, withdrawal is a nasty business, but is not addiction. If one has an addiction problem, one must do his best to change his financial/social circumstances, environment, and most of all, head space…

…find instead beauty in the world and in life, not in a drug. The drug is for enhancement of these, not an end in its self.

The dragon chaser

Years ago some mates and I were hanging around Gastown in Vancouver one warm, drizzly afternoon. Walking along the old cobblestone, we passed by an ancient chowder house and went in for a bowl. This place was renowned for its cheap but delicious fare, so attracted an eclectic bunch, from blue-collars to businessmen to bums. We walked in, sat at the bar bench, ordered, and waited in impatient anticipation. I started people-watching and noticed this bedraggled guy, long disheveled hair sticking out from under an abused weathered toque, sitting in apparent religious meditation over his nutriment. After a minute, looking lost in the aether, he promptly plunked down face-first into his bowl of seafood chowder, then shot back up, bobbled a bit, twitched once or twice, eyelashes blinking chowder, clams and squid easing their way down his face and back into the bowl… and proceeded to chow down with absolutely zero self-consciousness…

…yeah …you know those toy glass birds that you saw in old Bugs Bunny cartoons? They sort of filled up with water while “drinking”, their heads down in the drinking glass on the rim of which they were perched; then when filled with water, gravity popped them back up, drained the water, then dunked their heads back down into the glass again. Kinda genius actually…

…anyway, this guy sorta looked like one of those birds… but a broken one.    ;D

~This floating in and out of consciousness is called “nodding” or going “on the nod”. This state is the junky’s ideal, the ultimate in escape, the dreaming back into mother’s womb… and one that you want to avoid if your motive is simply relief from refractory chronic depression.

This is important to consider, because when naive people talk about the “living hell” that is addiction, they are innocently referring to the aforementioned state. People don’t understand that, though daily dosing with any amount will leave one with a pet monkey, there is a profound difference between someone taking O for depression therapy and a “dragon chaser”, one who tries to recapture a coveted state from back in time when an addict first met the Poppy Goddess, the siren who let him ride her serpent to heaven…

…sadly, brain chemistry and biomechanics dictate that an addict’s first flight to paradise is his last… this must be accepted gracefully, yet despite that over time the euphoria will be less and less with each subsequent dose, people are stubborn. Overdose in livingrooms and on urine-soaked mattresses in back alleys is achieved in two ways: either by mixing substances, or taking ever higher doses of one substance, one day being roasted chasing a winged ophidian that deep inside the junky knows would never again be caught.

~From my experience, the difference between a user searching for answers and a dragon chaser is not levels of addiction, nor even the dependence/addiction attitudes, but one of head space… a user’s therapeutic intentions are good because he is desperately clinging to life and doing what he perceives as truly the best thing for his life in this particular case, as in every other, while a dragon chaser is conscious of what he’s doing, riding a one way train to that filthy back alley, yet paradoxically in a state of hopeful denial. The therapeutic user maintains his life as his highest value, so his life remains his reference point if he is forced to kick the habit or make a painful change. The dragon chaser is irrational, makes the drug a value higher than self, and gives up on self the moment he makes his choice and takes that first hit.

The reasons for being rational about this are obvious; there is no need to make a list. But we should always keep in mind that the body is in a state of homeostasis. It is always trying to maintain equilibrium, so it’s in our best interest as users to keep tolerance as low as possible, understanding that it is imperative to keep unnatural synaptic plasticity and other forced biological states to a minimum. The rational user knows that the nod, even an almost unnoticeable nod at lunchtime, is not a normal state and anything that feels this good can’t be good for us. If we don’t educate ourselves and try to understand as much as possible about what we’re doing to our brain chemistry, biomechanics and bodies in general, and do our best through diet, motion and stress reduction to mitigate potential harm to our shrines, we may find ourselves in much the same predicament as the dragon chaser; maybe not on a urine-soaked mattress in an alley, but on a sweat-soaked mattress in a hospital.

Moral authority

Folks talk glibly and cheerily about what’s considered “success” when someone with EDS manages to quit opiates.

I suppose… Let’s say I take their good advice. I’m sad and tired. I awake every morning in the rusted-iron grip of existential despair. I spend each day at work wearing myself out trying not to feel and act like an outsider. I try to keep my moods on an even keel so people don’t have to guess where I’m coming from. I go home and simply want to disappear. My ambition and thoughts for the future vanish… but I’m, y’ know, “clean”.

…and yet, all that garbage could completely disappear within minutes; all the pain and abnormality, all the pointless depression, with one small non-euphoric dose of an exogenous chemical that mimics an endogenous chemical that my brain should have enough of within it… but does not.

I would rather be a drug-dependent “loser” who has the drive, energy and joy in living to earn a six figure wage and actually wants to be with the people he values than to be “clean” with an urge to drop out of sight.

Do-gooders and moralists, you don’t have the authority to take my happiness away from me. In your urge to control those who are not like you, cerebrate on what you’re doing to people…

…think about others for once.

Are you sure you want to do this? A list of cons

There is a price to pay for opiate therapy. Opiates are not like other drugs. Yes, pharma antidepressants have uncomfortable withdrawal symptoms if stopped abruptly, SNRIs like Effexor being exceptionally nasty little bastards; but not much compares to opiate withdrawal. There may be a special temporary hell waiting for you if you go travelling and forget or lose your medicine.

…which brings me to my Special List of Questions for those contemplating O dependence.

~Do you have experience with withdrawals? Do you understand exactly what you’re getting into if you succumb and build a difficult tolerance? heh… virgin. Just wait…

~Are you aware of and prepared for the pain of dope sickness if circumstances don’t allow you access to opiates (eg. lack of access to product, loss while travelling)?

~Will you always be able to afford your habit?

~If carrying contraband, how will you deal with border crossings into other countries with draconian laws? Are you prepared to take dangerous chances? Will having to cancel your plans because of a physical dependence on drugs disgust you?

~When travelling around, will the fact that you’re (possibly) inevitably carrying illegal product weigh on your mind and detract from a positive experience?

~Are you the type who can’t stop at your alloted daily “lifting” dose, and obsesses into euphoric doses?

~ are you ready and willing to possibly entangle yourself with a drug?

~Have you thought about the social stigma around opiate use? Will you have to hide your use from the people around you; your family/significant other/friends/work mates? If so, how will you work out the logistics, or worse, your guilty conscience?

~Does your occupation require occasional drug testing, understanding that it can take four months or more to taper off?

~Have you educated yourself about and understand the possibly very serious post-acute withdrawal syndrome (PAWS)? If you must stop therapy, are you aware that PAWS can leave you much more depressed than you were before you started opiates, and can keep a very few in its grip for years?

These are a few queries that require contemplation before embarking on this opiated journey.

Ponder them well. Make your choice with eyes wide open.

Check your motive

Life is a funny thing. I know the statement sounds trite, and writing about something so big might provoke fish-eyed stares and tongues in cheeks, but think about it; the universe is all about entropy and decay, yet here we are, products of reproduction, built up from conception to grown bodies.  Every cell vibrating, nervous, seeming to understand that it’s existence should never have been, but is unwillingly wrenched out of nothing and coerced, being driven by something. Perhaps we are unwitting slaves to genes that are more desperate to carry on a legacy than even we. Life is improbable, and being so, a fight; a fight to carry on, to constantly tip the balance toward existence.

It can’t last though. Eventually, time and universal law take their disinterested toll and ensure that we exhaust our amazing and impossible energies.

Because it’s so hard to build something, especially life, and so much more natural it seems, to deconstruct, life means pain; the pain of growing, working and surviving, loving and hating; the pain of dealing with other subjective human beings as objects; the pain of fighting off predators and parasites large and small who want the fruits of our energy without expending their own… and the pain of disease and death.

I’m not trying to be a downer here. I’m simply making a point. Life can be wonderful when circumstances are right. When everything is as it should be, when we are free from want, we forget ourselves. We are no longer aware of our bodies and minds; they cease to become that strange “other”. The world is not filtered through our problems. But when the universe lets its innocently cruel storms batter our lives, we want to escape. Some escape into their work; some head to the golf course; some go to the clubs to escape in hilarity and sex, while others go to places of worship and fill their heads with promises of a future without pain or limits; some go jogging or climb mountains; some read chronically, empty themselves into the X-Box or stare at the tv screen; and some escape into the always welcoming arms of Mother Opium.

Very few feel quite right all the time. Even boredom, a fairly innocuous state, can lead our thoughts to filling the interminable void with something to take us out of ourselves. I defy anyone to tell me that he never feels the void and the urge to feel differently through some activity or substance…

~Antidepressants are not of much use for anything for many (I submit, most) of us; but most of them, besides some on and off label dopaminergics, don’t have a capacity for abuse. On the other hand, O definitely does. There’s nothing quite like it. You either love it or hate it. One never has a bad “trip” on O (unless one has taken too much. If so, one might be in big trouble), so if you hate it, it’s because you either don’t need it, or because some people simply have a bad reaction to it, like any food or drug…

…however, If you need it because your endorphins are all fucked up, or you don’t have a bad reaction to it, O feels like god is giving you a little hug and telling you that everything is going to be okay. One doesn’t trip on O. Rather, one feels a profound relief from a pain he never realised he had when taking it for the first time: the pain of existence. These powerful effects conspire to make this little flower an addictive bitch goddess.

If you are getting ready to submit to her spell, you must be aware of her ability to screw with you in order to lull you into getting more of that which she makes you crave. Think about it: every plant has a strategy for seed dispersal. We eat colourful fruit because we love sweet and (sometimes) fat. We get a reward for consuming and the plant potentially spreads its seeds far and wide. The bitch goddess does things a little differently. She has developed an awesome strategy for seed dispersal. By developing alkaloids that mimick almost perfectly some of our endogenous and pleasure-giving chemicals, she ensures that an otherwise foul tasting fruit is consumed (there are some very happy ruminants in Tasmania these days because of Big Pharma’s fields of glorious poppies). So your subconscious can easily fool you if you don’t keep meticulous daily dosing records for pharma opies, or a digital gram scale that measures down to the 10ths for dode. Do it. Don’t not do it. Did I make myself clear? You will be physically addicted or habituated (there is a difference) by the end of the first week, so in order to build up tolerance as slowly as possible, you must understand the difference between being lifted out of depression for that day, and euphoria. It’s tempting to go for euphoria, especially when you know you’re going to have a rough day at work, but don’t do it. take your “lifting” dose in the morning, under the knowledge that within the hour you’ll be all right.

Grapefruit, some say, potentiates or prolongs the effect. I use dode, so wake up 45 minutes before I would normally, down the foul swill in a glass of water (yechh!) that I keep beside my bed, eat my grapefruit and other fruit that I usually have for breakfast, and lie around until its time to get up. By this time I’m ready to take on the world.

Check your motive. Why are you doing this? If you spend each day in an opiate nod, do you really think that you’re going to deal with problems that could have been fixed by gently lifting yourself instead? Do you understand the despair and disaster that will burn you if you start chasing the dragon? Do you realise that the depression you experienced before opiates will pale beside the living hell you will go through if you lose your head?

We all fill that void with something. Its a part of us; what makes us human. Let us accept it… but let us sate our natural desire rationally. Don’t be a junkie. Don’t be “that guy”. I think that if you’re desperate enough in your depression to consider doing something you wouldn’t in normal circumstances and go down the poppy strewn road, you’re probably smart enough to avoid the giant potholes that consume others. Because of this, I don’t think you’re a natural drug seeker. But be aware that opiates are different. If your diligence slips, you will be surprised when a cliff you didn’t notice takes you into that void.