Tuesday, May 21, 2019

15 Years Dirty (An Ode to Opiates)

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Am I an oddity?  An outlier?

2019 marks the 15th year I've used opioids to self-medicate social anxiety, depression, autism spectrum disorder & various other medical issues mostly without a doctor's prescription or knowledge.  In that time I've never overdosed, gone to jail, stolen or pawned anything, prostituted myself, spent money I didn't have or doctor shopped to obtain drugs.  My dose & frequency of use have not increased--I still get the same amazingly euphoric effects from the same low doses of substances like hydrocodone or oxycodone.  One pill is great; two is better.  Any more & I start to get nauseated.  And nausea is intolerable to me so I don't exceed that dose in any single 5-6 hour period.  I usually break them in half & dose gradually over time rather than all at once.

In addition to their wondrous effects on physical & emotional pain, opioids definitely have a recreational side for me.  I view them like a kid views presents on Christmas morning: with great excitement & anticipation.  (At least the good ones like hydro & oxycodone, which I rarely have access to).  They turn my world from black-and-white to technicolor & wake up my senses rather than numbing me or helping me "escape".  Opioids illuminate something deep within my soul that is otherwise extinguished & there's no denying that.  They are fun in the purest sense of the word.  It's a complex relationship.

There is a legitimate biological basis for why opioids "miraculously" alleviate depression, anxiety & other unpleasant sensations.  They mimic our body's own endorphins (endo = "endogenous" orphin = "morphine"), which are hormones that naturally relieve both physical & emotional pain.  Endorphins are responsible for the "runner's high" that marathoners often experience after a long, arduous run & they serve an important function in the body.  The theory goes that some depressed or anxious people suffer from a deficiency or malfunction within their endorphin system, which is why Low-Dose Naltrexone (LDN) therapy exists.  You can read about that here.  In addition, opiates also release a rush of dopamine--the brain's reward chemical responsible for feelings of energy, focus, arousal & motivation.

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Endorphin graphic (credit: mindblowingwellness.com)

My first opiate was hydrocodone.  I was 20.  Within a few minutes of dosing, I was talking up a storm & felt this powerful--yet totally natural--feeling of euphoria that seemed to come from nowhere.  In fact, I forgot I'd even taken the pill until I really thought hard about it.  From that night on I was in love.

I eventually branched out to codeine cough syrup, opium poppy pods, dihydrocodeine, Percocet, OxyContin 20s, tramadol, kratom...whatever I could obtain that I knew came from a safe source.  Opioids were never far from my mind & I took one of the above most days, yet there were times I couldn't obtain them for whatever reason.  Withdrawal wasn't fun but paled in comparison to SSRI withdrawal...at least in terms of duration.  The symptoms for me were nearly identical & mostly involved mental misery like severe anxiety & panic attacks.  The difference is that opioid withdrawal lasted about a week while antidepressant withdrawal dragged on for a full month.  (And neither compares to benzo withdrawal which is on another planet in terms of severity & duration).

Yet I never escalated to trying super-potent opioids, injecting anything or binging in a way that lead to problems with my finances, relationships or health.  When I ran out of opiates, which I did regularly because of my borderline-agoraphobia & aversion to seeking out IRL sources of drugs--I simply sat at home & endured withdrawal.

So am I really the exception to the rule?

There must be other pain patients or self-medicators who ENJOY THE EFFECTS of opioids but are able to control their use without letting their tolerance get out of control or overdosing.  Right?  We're told you can't both enjoy the high AND use these drugs responsibly for legit medical purposes without getting addicted (note: physical dependence does not = addiction).  Despite doing so myself for 15 years, if I were to confess my use of drugs to my doctor or psychiatrist I'd get the lecture about denial, addiction & needing help.  I would cease to be taken seriously as a patient with real physical & mental health conditions that needs help for those standalone diagnoses, with doctors focusing ONLY on my substance use.  And that sucks.  I've seen it happen even with occasional weed use in other people so I don't dare disclose that info.

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Happens every day

And now for the real kicker.

I wish I would've discovered opioids sooner--in my teens instead of my 20's.  I know for a fact they would've prevented a huge amount of suffering & bad decisions that caused me & others a lot of grief.  Maybe I would've felt more comfortable in my own skin instead of sitting alone at lunch & spending hours stuck in OCD rituals every morning.  Perhaps I would've had the courage to start a conversation or make eye contact with my peers instead of nervously driving right by them at the local hangouts or looking at my feet when we passed in the hallway.  At the very least, I KNOW I wouldn't have ended up in the psych ward repeatedly or gotten sent to alternative school for acting crazy.

I know this because opioids changed my personality so drastically that others commented on how "mature" I seemed immediately after starting them (without knowing why).  And I feel the change internally.  I'm slower to anger, more thoughtful, happier, more optimistic.  Just a more content person all around.  The only "denial" I've experienced has been when I've attempted to quit opiates & told myself I didn't need them...that they weren't beneficial & I could do just as well without them.  (I did the same thing with my antidepressants, going on a 6-year hiatus during which I convinced myself they were unnecessary.  That year was filled with so many drugs & even a couple suicide attempts that I eventually came to my senses).

It's the same with opiates.  I can't deny the positive effects they have on my life, even when you factor in the drawbacks.  And I HAVE quit for 6 months, 8 months & even a year at a time before, so I know what it's like to be totally clean & sober after long periods of use.  While I don't obsess or crave opiates after quitting, it just feels like I'm not functioning on all cylinders without them...like life is passing me by while I put on a fake smile & pretend to be something other than an anxious, unmotivated mess.  An alien walking around in a human-shaped meat sack.  And life is too short to feel that way when you KNOW there's something out there that can fix it with minimal toxicity to your body even with long-term use.  (Unlike many psych meds).

The only problems I can see with opioids is that they're not readily available to those who need them & there's a general lack of education among users.  Withdrawals are the problem; not the drugs themselves.  Withdrawals drive people--addicts--to do things they wouldn't otherwise do, such as panhandle, steal, prostitute themselves, lie & con loved ones to get their fix.  It's the withdrawals that do this; not the drug.  The drug is what allows them to feel somewhat normal for a time, even if it's not a practical solution to their problems (such as with heroin, which is too short-acting & potent/euphoric to allow users to live normal lives.  To say nothing of the risks of injecting drugs).  Drugs aren't a solution to life's problems.  They're a temporary Band-Aid at best.  But for some of us with severe emotional or physical pain, that's the best we're going to get.  

I choose kratom as my daily med now only because it's cheap, legal & available--not because it's superior to other options.  It's not.  It irritates my stomach lining to no end.  I get recurrent ulcers as a result of drinking daily kratom sludge, and the taste is nothing to write home about.  Plus you never know what heavy metals or other contaminants might be present since it's processed overseas.  But I'm grateful to have it.  If it were taken away by the DEA or FDA many people including myself would be in a major bind--forced to choose between possibly adulterated street drugs instead of a plant with centuries of safe use behind it.

Looking back on the past 15 years of responsible opioid use, I see a mix of positive & negative experiences.  But I fully expect to keep using them in this manner for the next 15 years.  Unless some miraculous depression treatment is invented, I will do what I have to do to make the most of this short life.  I refuse to let the shaming & addiction rhetoric from concern trolls make me feel bad about a catastrophe that has not materialized.  The real catastrophe is untreated or under-treated mental & physical illness and pain.

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(Note:  I don't suggest anyone start using kratom or other opioid agonists if they don't already.  I'm also not claiming they're an easy class of drugs to resist going overboard with.  But if suicide is your plan & you haven't tried kratom or opioids, what's there to lose by exhausting ALL your options before checking out?)

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