MyDoorsAreOpen
Bluelight Crew
- Joined
- Aug 20, 2003
- Messages
- 8,549
I took nearly a year long break from BL, during which time I didn't keep contact with anyone I knew from this website. I needed to get some perspective on myself, this website, and my reasons for participating in these forums vis a vis other BLers. It was my first year out on my own as a family physician in middle America, and I found myself thrust onto the front lines of a battle I was reluctant to fight: America's opiate addiction crisis. I had to learn the hard way the telltale warning signs of someone who saw me as nothing more than a source of narcotics (and/or benzos, and/or stimulants, less commonly.) I've always felt something of a conflict of interest. On the one hand, I take a very libertarian approach to recreational drug use, as I do to really all of medicine: it's your body and your life. I'm just a consultant. I'll never lie to you if you ask me a question, but then again when you walk out of my office, it's wholly up to you whether you take my advice or not. I'm not your boss. I can't really make you do anything. At the same time, I have a family to support and a living to make. The DEA and other regulatory bodies are watching me, now more than ever. So while I don't judge anyone's choice to put anything in their bodies or brains so long as they're not endangering anyone else in the process, if your choices in this matter involve controlled substances used in ways that violate laws or medical guidelines, please forgive me for refusing to have any part in it. I've even hinted to drug seekers I've called out and fired from my practice, that if it's recreational drugs they're after, there are far easier ways to obtain what they're looking for than pretending to be a patient with a real medical need. I don't think I'm being a hypocrite at all. I've put all sorts of things in my brain in the name of fun, but I've obtained all of them completely outside of the healthcare system. I don't mix business and pleasure.
I gave BL a big break because coming here began to leave a bad taste in my mouth. I'd read the forums, and often feel like I was being invited to side with the same people who I was angry at for playing me for a mark in my professional life. I'm a gentle and caring soul, who never developed the hard "don't fuck with me" edge to their personalities that many doctors develop in the course of their training. I still insist that the benefits of being more Mr. Rogers than Judge Judy has helped me (and my patients) more than hurt me. But the cost is that there will always be people who will try harder to con me than they would most doctors.
I've returned here presently drug-free. I suffered a disaster which could have cost me my life this winter. I took this as a clear omen that it was time to take an indefinitely long break from my beloved marijuana. With a clear head and some hard noobie experiences behind me, I can now say confidently that I have nothing but compassion for the opiate addicted, while at the same time secure in my decision to be extremely sparing in my prescription of opiates. Simply put, I prescribe narcotics only short term, as part of a comprehensive treatment package, for pain that's insufficiently controlled by all the other treatment modalities. I don't tolerate patients declining, quitting, or no-showing to everything but their narcotics. I only prescribe opiates when the patient and I have a clear endpoint in sight, which involves getting to the root of, and doing our best to fix, the source of the pain. I'm very upfront with patients about this. I use a lot of analogies, and compare opiates to a hot air balloon. In a pinch it will lift you over your troubles. But we need to have a plan in mind for where and when it's going to land, because it won't fly indefinitely. Anyone who merits daily round-the-clock narcotics gets referred to a pain management specialist. I don't trust myself to tell the difference between a patient who still needs round-the-clock narcotics and one who just likes the drugs and/or is afraid to quit. Pain doctors can, because that's all they do. Also, state governments have made the prescribing of chronic narcotics prohibitively bureaucratic. The deterrent has worked on me, because frankly my time and energy are better spent face to face with patients, not filling out paperwork. Pain clinics have staff whose whole job is to jump through these numerous hoops on behalf of patients.
I understand that this balance I've struck will rub many people here the wrong way. I know that many people here are going to take what I have to say as, at the very least, an unwelcome interruption to the pro-opiate circlejerk they're used to here. At worst, there will be people who say that I and other healthcare providers who prescribe opiates the way I do are part of the problem, not the solution. Say what you will, I really don't care. I'm only doing what I feel deep down is right and responsible, and in line with all else I believe. Most importantly, though, no one can now argue that I just don't understand because I've never used opiates. I now have.
Last spring, I literally found a pill box on the ground in a parking lot, containing what my pill identifier app told me were various denominations of oxycodone, morphine sulfate, and tramadol, the former two in both immediate release and extended release formulations. There were over 50 pills in all. There was no identifying information on the box. It literally fell into my hands. I realize someone out there must now be pretty livid. But nor could I see any ethical problem with keeping them. I took this as a sign. Maybe this was my chance to understand what so many people I've known, and indeed many of my patients, have put everything on the line for.
I first made the decision to use the opiate pills as a way to get myself through onerous mountains of undone work. I never came to work or saw patients high. But over the years, the reason my profession has become less and less attractive to sane people who want a life, is that it now requires a rather enormous amount of behind-the-scenes administrative work: signing off on documents, reviewing test results, tasking my nursing staff to send letters to patients or call them, filling out forms, writing letters of advocacy, writing long complicated office visit notes with just the right medico-legal boilerplate, and more. It's largely the fault of insurance carriers and Medicare, who are making us dance ever more complicated jigs for the nickels they throw at us. I plan to someday open my own practice, with 1-2 employees max, which doesn't take any insurance or government money, and just charges a $50/month subscription fee per patient, freeing me from a lot of the bullshit documentation requirements. But for now I'm learning my trade and working for The Man. As a result, I've tended to get rather behind in my work. And every time I go to catch up, I'm faced with people who are angry and disappointed in me: patients angry I haven't gotten back to them with their lab results, filled out their forms, or made their referrals to specialists yet. Bosses and administrators unhappy my charting and billing aren't up to date. You get the picture. This aspect of my job really rips at my moral fibers. Although I know I'll always make some mistakes and let some things fall through the cracks, I can't abide a daily onslaught of such anger and disappointment. Especially since I know that if my workload were lighter, I'd be willing and able to get everything done in a timely fashion, AND have a life. But the higher-ups tell me that seeing a lighter patient load wouldn't pay the bills.
So I spent a week catching up, each night taking between 20 and 60 morphine equivalent milligrams, with some ondansetron to help with the nausea. I found that when I did this, digging into my work and cringing at myself for the things I'd left undone way too long was not an issue. I was completely emotionally blank. It felt like I was just doing the most insignificant, emotionally neutral thing in the world, like getting dressed and brushing my teeth, or taking out the trash. And I could just keep going with it. I didn't feel mentally and emotionally exhausted after handling 2-3h of this kind of work; I could go on for 5h or more. When I realized I'd better get some sleep for the next day, I'd just smoke some marijuana and pop on a shitty YouTube video about Secrets of the Egyptian Pyramids or something else far out and paranormal, and nod off with a very dry mouth and a shit-eating grin on my face.
And catch up I did. The final day of my catch-up week was a Sunday, and I stayed high on MS Contin (with plenty of coffee) the entire day, just plowing through the last of my remaining work. I told myself at the beginning of that day, before then even, that this would be the end of my opiate binge, because I will have achieved my goal. By this point, I should add, I was crushing up the long acting pills into a powder, dissolving them in water, and injecting this into my anus with an infant oral syringe. This cut down a lot on the nausea, but I could tell my hemorrhoids were flaring up.
At the end of that Sunday, I triumphantly announced to my family that indeed, I'd caught up. And I was very proud of myself. I had a pleasant dinner out consisting of some very spicy hot Thai food and stomached it no problem. I was afraid I'd have a nasty withdrawal after a week of daily, fairly high-dose opiate use. But to my surprise, I didn't. I felt just a satisfied afterglow, tinged with the knowledge that a monkey was off my back. There was no diarrhea, no twitching or sweating, no yawning, no salivation or runny nose. I had a markedly decreased need for sleep for about a week, which didn't seem to affect my work or home-life performance at all. That and my libido came back with a vengeance. But other than that, nothing. I'd set my intentions for how I was using the drug, and when that goal was fulfilled, I knew it was time to stop, and I did. I'd gotten the message and hung up the phone.
But I was not out of pills. Later on, around the holiday season, I set a very different intention in my foray into pharmaceutical opiates, with drastically different results. I had just learned to ski for the first time, in a beautiful winter setting. Everything was going perfectly well. I was on top of my work and liking my job, and my home life couldn't be more idyllic. So I came home, took off my sweat-soaked ski gear, and suddenly said to myself, I'm going to stay high on opiates all through my Christmas break (about a week). I've earned it. I deserve it. And I'm going to to do it just for the thrill, just for hedonic pleasure. Why not? I don't know what made me say it. But I did it.
I was a little surprised and disappointed, I must say. I was taking the same doses as before, about 20-60 morphine equivalent milligrams 1-2 times a day, mostly rectally. Sure enough, when I had the luxury of just sitting around by myself and daydreaming, I was in heaven. I came up with some great architectural designs for houses I'd love to build, and plans for new ways to fix the healthcare system. I felt like I was being productive and working towards something, even though I wasn't. But when I needed to get up and do something for someone, it felt like a chore. Even helping my family members with things I normally did with no complaint irked me. Social interaction in general made me irritable -- why couldn't people just let me sit by the fire and leave me alone?! I'm on holiday goddammit! My wife and I fought a couple times over petty things. We never usually fight. A side effect I hadn't noticed before was ringing in my ears and phonophobia (dislike of loud sounds). My children's high-pitched loud voices scorched my ears. I could tolerate physical pains, like my now serious bleeding hemorrhoids, and the splinters in my fingers from carrying firewood. The cold outside felt good -- I felt as though no amount of cold could make me feel uncomfortable. But social interaction and obligations felt unbearable.
I finally forced myself to pull myself away from the pills, surprisingly reluctantly, 2 days after my Christmas break. This time I missed them. And this time, oh Lord did I ever withdraw. I endured 10 days of involuntary muscle twitches, gooseflesh, nightmares (when I could sleep at all!), and what I can only describe as urinating from my anus, at least once an hour. But worst of all was the crushing depression. This was a despair in the same league as an MDMA comedown, a persistent feeling that something was horribly wrong with the world, and I had every reason to be worried and sad. It took me a few days to realize that this was entirely a drug effect, and was not triggered by anything in my external environment. It was a deep and insidious feeling of "fuck it all", which was impossible to will away, and which SSRIs and DXM didn't touch.
When 2 weeks had passed and I'd finally gotten a sense of my old mental state back with the help of some loperamide, I threw away the few remaining pills I had. I never wanted to feel that way again -- either the "high" when I'd used them over Christmas, or the comedown afterward. These drugs had their moments, and when used with the right intentions were good at getting me over certain painful humps. But when I used them with the vague and imprecise goal of just feeling as good as possible, I found they took from me much more than they gave. I felt cheated.
I get it now. I've come to realize something that opiates and cigarettes have in common: I think in most cases, it takes a deep and abiding sense of "fuck my life" to live from pill to pill, and/or from cigarette to cigarette. I get it now. When you despair that you'll ever accomplish anything which will bring you heartfelt joy and purpose in life, then feeling-of-accomplishment in pill form, regardless of the downsides it comes with, must be a more attractive option to never feeling this at all. At the very least if you've decided "fuck my life", it must feel good to be comfortably numb. And this is what I try to convey to patients who I feel like the narcotics a bit too much -- Your pain, both physical and mental, is real, and I intend to address it to the best of my ability. But let's think outside the box for ways to feel some sort of purpose and joy in life, because that's ultimately what makes the hardship of life feel not only bearable, but worth it. All this can be yours without bowel obstructions, itching, irritablity, or such a rough time stopping that you'll burn any bridge to continue.
Tagged by Xorkoth
substancecode_hydrocodone
substancecode_opiates
explevel_experienced
explevel_retrospective
exptype_negative
exptype_addiction
roacode_oral
I gave BL a big break because coming here began to leave a bad taste in my mouth. I'd read the forums, and often feel like I was being invited to side with the same people who I was angry at for playing me for a mark in my professional life. I'm a gentle and caring soul, who never developed the hard "don't fuck with me" edge to their personalities that many doctors develop in the course of their training. I still insist that the benefits of being more Mr. Rogers than Judge Judy has helped me (and my patients) more than hurt me. But the cost is that there will always be people who will try harder to con me than they would most doctors.
I've returned here presently drug-free. I suffered a disaster which could have cost me my life this winter. I took this as a clear omen that it was time to take an indefinitely long break from my beloved marijuana. With a clear head and some hard noobie experiences behind me, I can now say confidently that I have nothing but compassion for the opiate addicted, while at the same time secure in my decision to be extremely sparing in my prescription of opiates. Simply put, I prescribe narcotics only short term, as part of a comprehensive treatment package, for pain that's insufficiently controlled by all the other treatment modalities. I don't tolerate patients declining, quitting, or no-showing to everything but their narcotics. I only prescribe opiates when the patient and I have a clear endpoint in sight, which involves getting to the root of, and doing our best to fix, the source of the pain. I'm very upfront with patients about this. I use a lot of analogies, and compare opiates to a hot air balloon. In a pinch it will lift you over your troubles. But we need to have a plan in mind for where and when it's going to land, because it won't fly indefinitely. Anyone who merits daily round-the-clock narcotics gets referred to a pain management specialist. I don't trust myself to tell the difference between a patient who still needs round-the-clock narcotics and one who just likes the drugs and/or is afraid to quit. Pain doctors can, because that's all they do. Also, state governments have made the prescribing of chronic narcotics prohibitively bureaucratic. The deterrent has worked on me, because frankly my time and energy are better spent face to face with patients, not filling out paperwork. Pain clinics have staff whose whole job is to jump through these numerous hoops on behalf of patients.
I understand that this balance I've struck will rub many people here the wrong way. I know that many people here are going to take what I have to say as, at the very least, an unwelcome interruption to the pro-opiate circlejerk they're used to here. At worst, there will be people who say that I and other healthcare providers who prescribe opiates the way I do are part of the problem, not the solution. Say what you will, I really don't care. I'm only doing what I feel deep down is right and responsible, and in line with all else I believe. Most importantly, though, no one can now argue that I just don't understand because I've never used opiates. I now have.
Last spring, I literally found a pill box on the ground in a parking lot, containing what my pill identifier app told me were various denominations of oxycodone, morphine sulfate, and tramadol, the former two in both immediate release and extended release formulations. There were over 50 pills in all. There was no identifying information on the box. It literally fell into my hands. I realize someone out there must now be pretty livid. But nor could I see any ethical problem with keeping them. I took this as a sign. Maybe this was my chance to understand what so many people I've known, and indeed many of my patients, have put everything on the line for.
I first made the decision to use the opiate pills as a way to get myself through onerous mountains of undone work. I never came to work or saw patients high. But over the years, the reason my profession has become less and less attractive to sane people who want a life, is that it now requires a rather enormous amount of behind-the-scenes administrative work: signing off on documents, reviewing test results, tasking my nursing staff to send letters to patients or call them, filling out forms, writing letters of advocacy, writing long complicated office visit notes with just the right medico-legal boilerplate, and more. It's largely the fault of insurance carriers and Medicare, who are making us dance ever more complicated jigs for the nickels they throw at us. I plan to someday open my own practice, with 1-2 employees max, which doesn't take any insurance or government money, and just charges a $50/month subscription fee per patient, freeing me from a lot of the bullshit documentation requirements. But for now I'm learning my trade and working for The Man. As a result, I've tended to get rather behind in my work. And every time I go to catch up, I'm faced with people who are angry and disappointed in me: patients angry I haven't gotten back to them with their lab results, filled out their forms, or made their referrals to specialists yet. Bosses and administrators unhappy my charting and billing aren't up to date. You get the picture. This aspect of my job really rips at my moral fibers. Although I know I'll always make some mistakes and let some things fall through the cracks, I can't abide a daily onslaught of such anger and disappointment. Especially since I know that if my workload were lighter, I'd be willing and able to get everything done in a timely fashion, AND have a life. But the higher-ups tell me that seeing a lighter patient load wouldn't pay the bills.
So I spent a week catching up, each night taking between 20 and 60 morphine equivalent milligrams, with some ondansetron to help with the nausea. I found that when I did this, digging into my work and cringing at myself for the things I'd left undone way too long was not an issue. I was completely emotionally blank. It felt like I was just doing the most insignificant, emotionally neutral thing in the world, like getting dressed and brushing my teeth, or taking out the trash. And I could just keep going with it. I didn't feel mentally and emotionally exhausted after handling 2-3h of this kind of work; I could go on for 5h or more. When I realized I'd better get some sleep for the next day, I'd just smoke some marijuana and pop on a shitty YouTube video about Secrets of the Egyptian Pyramids or something else far out and paranormal, and nod off with a very dry mouth and a shit-eating grin on my face.
And catch up I did. The final day of my catch-up week was a Sunday, and I stayed high on MS Contin (with plenty of coffee) the entire day, just plowing through the last of my remaining work. I told myself at the beginning of that day, before then even, that this would be the end of my opiate binge, because I will have achieved my goal. By this point, I should add, I was crushing up the long acting pills into a powder, dissolving them in water, and injecting this into my anus with an infant oral syringe. This cut down a lot on the nausea, but I could tell my hemorrhoids were flaring up.
At the end of that Sunday, I triumphantly announced to my family that indeed, I'd caught up. And I was very proud of myself. I had a pleasant dinner out consisting of some very spicy hot Thai food and stomached it no problem. I was afraid I'd have a nasty withdrawal after a week of daily, fairly high-dose opiate use. But to my surprise, I didn't. I felt just a satisfied afterglow, tinged with the knowledge that a monkey was off my back. There was no diarrhea, no twitching or sweating, no yawning, no salivation or runny nose. I had a markedly decreased need for sleep for about a week, which didn't seem to affect my work or home-life performance at all. That and my libido came back with a vengeance. But other than that, nothing. I'd set my intentions for how I was using the drug, and when that goal was fulfilled, I knew it was time to stop, and I did. I'd gotten the message and hung up the phone.
But I was not out of pills. Later on, around the holiday season, I set a very different intention in my foray into pharmaceutical opiates, with drastically different results. I had just learned to ski for the first time, in a beautiful winter setting. Everything was going perfectly well. I was on top of my work and liking my job, and my home life couldn't be more idyllic. So I came home, took off my sweat-soaked ski gear, and suddenly said to myself, I'm going to stay high on opiates all through my Christmas break (about a week). I've earned it. I deserve it. And I'm going to to do it just for the thrill, just for hedonic pleasure. Why not? I don't know what made me say it. But I did it.
I was a little surprised and disappointed, I must say. I was taking the same doses as before, about 20-60 morphine equivalent milligrams 1-2 times a day, mostly rectally. Sure enough, when I had the luxury of just sitting around by myself and daydreaming, I was in heaven. I came up with some great architectural designs for houses I'd love to build, and plans for new ways to fix the healthcare system. I felt like I was being productive and working towards something, even though I wasn't. But when I needed to get up and do something for someone, it felt like a chore. Even helping my family members with things I normally did with no complaint irked me. Social interaction in general made me irritable -- why couldn't people just let me sit by the fire and leave me alone?! I'm on holiday goddammit! My wife and I fought a couple times over petty things. We never usually fight. A side effect I hadn't noticed before was ringing in my ears and phonophobia (dislike of loud sounds). My children's high-pitched loud voices scorched my ears. I could tolerate physical pains, like my now serious bleeding hemorrhoids, and the splinters in my fingers from carrying firewood. The cold outside felt good -- I felt as though no amount of cold could make me feel uncomfortable. But social interaction and obligations felt unbearable.
I finally forced myself to pull myself away from the pills, surprisingly reluctantly, 2 days after my Christmas break. This time I missed them. And this time, oh Lord did I ever withdraw. I endured 10 days of involuntary muscle twitches, gooseflesh, nightmares (when I could sleep at all!), and what I can only describe as urinating from my anus, at least once an hour. But worst of all was the crushing depression. This was a despair in the same league as an MDMA comedown, a persistent feeling that something was horribly wrong with the world, and I had every reason to be worried and sad. It took me a few days to realize that this was entirely a drug effect, and was not triggered by anything in my external environment. It was a deep and insidious feeling of "fuck it all", which was impossible to will away, and which SSRIs and DXM didn't touch.
When 2 weeks had passed and I'd finally gotten a sense of my old mental state back with the help of some loperamide, I threw away the few remaining pills I had. I never wanted to feel that way again -- either the "high" when I'd used them over Christmas, or the comedown afterward. These drugs had their moments, and when used with the right intentions were good at getting me over certain painful humps. But when I used them with the vague and imprecise goal of just feeling as good as possible, I found they took from me much more than they gave. I felt cheated.
I get it now. I've come to realize something that opiates and cigarettes have in common: I think in most cases, it takes a deep and abiding sense of "fuck my life" to live from pill to pill, and/or from cigarette to cigarette. I get it now. When you despair that you'll ever accomplish anything which will bring you heartfelt joy and purpose in life, then feeling-of-accomplishment in pill form, regardless of the downsides it comes with, must be a more attractive option to never feeling this at all. At the very least if you've decided "fuck my life", it must feel good to be comfortably numb. And this is what I try to convey to patients who I feel like the narcotics a bit too much -- Your pain, both physical and mental, is real, and I intend to address it to the best of my ability. But let's think outside the box for ways to feel some sort of purpose and joy in life, because that's ultimately what makes the hardship of life feel not only bearable, but worth it. All this can be yours without bowel obstructions, itching, irritablity, or such a rough time stopping that you'll burn any bridge to continue.
Tagged by Xorkoth
substancecode_hydrocodone
substancecode_opiates
explevel_experienced
explevel_retrospective
exptype_negative
exptype_addiction
roacode_oral
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). But one thing i know is that those front lines can only benefit from good people like you. From my own very limited experience with opiates i wholeheartedly agree with your premise that intention is everything. Opiates need that framework to be controllable. As soon as they become a goal unto themselves (and they always somehow seem to be slanted towards that), they are simply uncontrolled and they will just drag one towards the inhumane that they are. And perhaps this is just true for any substance use, save perhaps for the viciousness it is done with.