Yesterday night was a long, long night. Got to sleep around 4am, woke up at 5.30 after a nightmare that was violent enough that I fully dislocated my shoulder in it, leaving me basically trapped in bed, then dozed on and off unti leaving the house at 7.30 to get to my 8am GP appointment with Dr Hpm. I had five questions, and these are they, as I asked them, with the answers;
1) Can I get half of my Laxido swapped for glycerin suppositories?
a) Yes, of course. Here, have a non-repeat prescription for twelve infant-sized 1g glycerin suppositories, which the pharmacist advises “Oh, just take five at once”.
2) Can I have my NSAID changed to a stronger one?
a) Yes, of course, have some diclofenac. I somehow manage to leave without a diclofenac prescription though.
3) I’ve not slept normally since March, it’s making me exhausted and feel like shit, and I’ve been taking far more diphenydramine than I really want to. Can I have some help?
a) No, because you might end up addicted to sleeping pills. Have you tried a hot milky drink? (Literally. He actually invoked the legendary ‘hot milky drink’. He may as well have said ‘How about turning off all the screens and sitting quietly for an hour before bedtime?’ This ignores the fact that I no longer have a ‘bedtime’, and that I wake up screaming at least twice a night. He said that sleeping pills were only very rarely given out, nowadays, and that they were worse than heroin and stopped working after a week (All verifiably false, by the way, I know plenty of people who take zopiclone regularly and have done for years, and it still work.)
4) Can I have more diazepam, the stuff that everyone has been happily prescribing me on an as-needed basis for most of this year, and that has been the only thing to reliably stop the muscle spasms?
a) No, because it’s addictive. We don’t want you to end up with an addiction problem on top of your existing problem.
4b) Can I have a non-addictive antispasmodic then? I do need something to stop the painful spasms which can cut through heavy doses of morphine and turn my hands blue.
a) No, have you tried putting a heat pack on them? Or an ice pack? Two pounds of frozen peas, that’s the best thing.
5) Physio told me that my GP was the one who needed to sort out the investigations into my hip and give me the steroid injections. Will you?
a) No, ask Rheumatology.
In fact “Phone them up and ask yourself” was the answer to all my questions about other departments and trusts – Rheumatology, Stanmore (With the addition of “Say you’ll take a cancellation, that you’ll get down there at a minute’s notice”), CBT for Pain. Everything.
He was also very, very concerned about the fact that I used morphine as a painkiller. Worried that I was addicted. And lo, has kept me on half rations for a second month, meaning that I’m going to spend another month in pain. If you give me 60 tablets to last 30 days, and tell me to take 1-2 every 12 hours, I’m going to run out by about week three. Or I’m going to go back to rationing out my medications, and spending most of my time in a medium amount of pain. And sleep less.
But now, really, I want to talk about addiction.
The title of this post for once actually has meaning, rather than just being a random thought that’s popped into my head whilst loading the page. The Rat Park experiments were a series of experiments (no shock there) done on rats (surprise!) by Bruce K. Alexander that involved altering various features of their environments and seeing how willing they were to take morphine in various situations. The (simple) version of the outcome of the experiments was that there’s very little basis to assume that a drug-induced adiction theory is correct.
So, what’s drug-induced addiction?
Basically, there’s two ideas about how people become addicted to substances; Drug-induced addiction is that the very nature of the drug makes people addicted to it (This giving rise to myths like “If you take crack cocaine once, you’ll always need more, because you’ll be addicted”) and the other is that it’s the social factors around drug-taking that make addiction possible in the first place (Alexander’s words were “Severely distressed animals, like severely distressed people, will relieve their distress pharmacologically, if they can”). Effectively, if (as a human) your association with morphine is that it’s the thing that you take for fun and to get high, you’re likely to get addicted. If your association with morphine is that you take it to relieve pain, even though you’ll incidentally get high, you’ll possibly end up with a dependency, but you won’t end up addicted.
If you’re interested, look up Bruce K. Alexander’s papers on addiction, he obviously talks about it in much greater depth than I can here, and with much better clarity.
I am dependent on morphine. I sometimes take it at levels which could be dangerous for someone who is morphine-naive, and usually take it at levels which would make someone morphine-naive very lightheaded and drowsy. This is because I have a tolerance for it, which is another side effect of regular use. My need for morphine is because I have regular, acute, musculoskeletal pain, radiating from constant fresh injuries, for which I must take a strong painkiller. The strong painkiller which works best for me is morphine. Thus, I am dependent on morphine. If I was no longer in pain, I would no longer take it.
You probably know what addiction feels like – Most people have felt headachey and faint after missing their morning coffee, or short-tempered and generally terrible when craving a cigarette. And with that feeling of “urgh” comes a craving for more – More caffeine, more nicotine. If I go for a week without morphine, I don’t feel terrible, and more importantly I don’t crave more to take the withdrawal effects away. For the first day, I get a slight headache and feel stiff, bruised, sleepy and emotionally fragile, but my drug of choice to fix that isn’t “more morphine”, it’s a paracetamol, and lots of fruit juice, and maybe a nice heavy breakfast. If I was addicted, my first instinct on feeling that distinctive bruising around my eyelids wouldn’t be “Oh, time for a big cup of tea and a lazy day” it would be “Take the morphine.”
I’m dependent, I’m not addicted. And I know that having a life without hypermobility related pain isn’t possible, but that the best chance I have for getting somewhere close to that is a mixture of exercises and medication. And the medication makes it easier to do the exercise. Grim as it sounds, even if I was addicted – If I motivated myself to go out and do things with the promise of morphine when I got home – that would still be better than spending my entire life in pain and miserable, for the sake of not offending the puritan sensibilities of a doctor.