For those who live with pain

I take the following for pain: Neurontin, Ambien, oxycodone, marijuana, and Cymbalta (an SNRI—selective serotonin and norepinephrine reuptake inhibitor). These drugs are what’s left of the 25 or 30 I’ve used, a list that includes every legal narcotic I know of, a half dozen sleeping pills, various anti-inflammatories, and, for good measure, Elavil. Cymbalta (see photo) has helped most, but, due to insurance changes, my cost for my next prescription will be $607 for a 90-day supply. While looking online for substitutes, I learned that Effexor (another SNRI) is equally good for pain and, because it has been around since 1994, comes in a generic form for $12.32. 

The high cost of Cymbalta is why, if you live in America, you are barraged with Cymbalta commercials, whereas you never see Effexor advertised. Along with price, other disadvantages to the latest “miracle drugs” is that their long-term downsides are unknown and they are rarely more efficacious than older drugs. So, why did my doctor prescribe an expensive medication before trying me on a dirt-cheap drug that is likely to be just as effective? Hell if I know, although I’ve noticed that doctors don’t usually know how much drugs cost. They also used to get kickbacks from pharmaceutical companies, although my understanding is that the government put an end to this.

It’s good to remember that you’re probably in a better position than your doctor to know which drugs might help you. For instance, if you suffer from ongoing pain, your medication options are limited, and with a little effort, you can learn what they are and stay abreast of the latest research. Of the drugs I’ve tried for chronic pain, I would say that narcotics are both the most heralded and one of the least effective. I mention this because some of you have trouble getting narcotics, and, as a consequence, appear to hold them in higher regard than they deserve. The reason for their relative ineffectiveness is that you quickly build up a tolerance, so if your starting dose is 5-10 mgs, you might be taking six times that amount (and incurring six times the risks) after a few weeks and still not get as good a result as you had with your initial dose. It is for this reason that I try to limit my narcotic intake to twice a week, but even then the tolerance problem remains. 

No doctor ever told me to take more than 20 mgs of oxycodone or Dilaudid at a time. This used to leave me in the troubling situation of thinking that, my god, I’m taking this strong narcotic that people rob pharmacies at gunpoint for, and I’m still in terrible pain—my condition must be hopeless. When I increasingly turned to the Internet for drug information, I learned about narcotic tolerance, and realized that my doctors simply weren’t taking tolerance into account, so I started increasing my own dosage, but no matter how much I took, I soon needed more. (If you should ever consider increasing drug dosage without your doctor’s consent, bear in mind the following statement from the American Centers for Disease Control and Prevention: “In 2008, more than 36,000 people died from drug overdoses, and most of these deaths were caused by prescription drugs.”)

Rather than the prescribed strength being too weak, I’ve also seen it go the other way. For instance, if I had used that 100-microgram Fentanyl patch that one doctor gave me, I’m pretty sure I would be dead. After another doctor started me on a triple dose of Demerol, I could hardly get out my chair for three days. Such overkill (ha) is another reason that you should do you own research.

Because of my positive experience with Cymbalta, I’ve become very interested in anti-depressants for pain relief. Some of you might know that the old tricyclic antidepressants (Norpramin, Tofranil, and Elavil, to name a few) have long been given for pain. Then came the SSRIs (Prozac, Lexapro, and Zoloft are three that I’ve taken), which weren’t good for pain by themselves but were good in combination with a tricyclic. The next advance was the SNRIs (Cymbalta, Effexor, Pristiq), which are effective for the pain of arthritis, fibromyalgia, and neuropathy, along with depression, panic disorder, social phobia, and obsessive-compulsive disorder.

As you can imagine, any drug that can do all that can also kick your ass, as I discovered when I stopped taking Cymbalta cold turkey last November and felt utterly exhausted, experienced excessive scalp sweating, had symptoms approximating the early stages of a horrendous cold, and wanted to rage one minute and cry the next, symptoms that continued for nearly two months. Since I had stopped taking narcotics at the same time, I assumed I was suffering from narcotic withdrawal and so did my doctor. When I finally went online, it didn’t take me any time to become convinced that it wasn’t the narcotics, it was the Cymbalta. Why didn’t my doctor know this? Maybe he didn’t sleep well the night before, or maybe he was thinking about his last patient or the fight he had with his wife that morning. I have no idea, but I do know that one should never go to any doctor with the assumption that everything that can be done will be done, and that it will be done right. I’ve experienced situations in which so many mistakes were made by so many people in so short a time that I imagined myself trapped in a Monty Python skit.

I’ve gone into some detail about anti-depressants for pain control because Cymbalta has worked fairly well for me without severe side-effects or a tolerance problem. It’s important to remember that chronic pain causes anxiety and depression, problems that worsen the pain, and that anti-depressants have the advantage of treating these along with pain. The worse downside to Cymbalta—so far, anyway—is that, having been through drug withdrawal a few times by now, I worry more about drugs that cause withdrawal than I do about drugs that I can easily stop. Whenever I start to focus on such concerns, I remind myself that living with pain and depression pose their own serious health risks. For example, chronic pain makes a person more prone to accidents; depression impedes his immune system; and the two of them together make it impossible to get adequate sleep. I, like so many of you, can no longer imagine a drug-free life despite the fact that I anticipate dying earlier because of it.

I have found living with pain—and the resultant disability—to be a major challenge to my desire to live at all. Many people experience this, and because of it, I have a great deal of sympathy for other sufferers. We share a problem that can be very hard to treat and that many people don’t understand (especially if you “look normal”) and often seem bored by. I do understand what pain sufferers are going through, at least somewhat, and I am far from bored by it. Just as some of you worry about me, so do I worry about you. I am hardly the worst-off of those in my blogging community, and I can thank many of you for helping me keep my head above water.

Snowbrush's happy outing that ended disappointedly

I saw Satan today while eating a granola bar in front of Jerry’s Lumber Company (and, no, I’m not trying to fool you into thinking that pink taffy is a granola bar). He was a distinguished looking man of 70 in black pants, black shoes, a black coat, a black fedora, and carrying a black mug. I wanted to yell out the window, “Hey, Satan, is hell still under a heat advisory?” but was afraid it would embarrass him, what with it being commonly known that Satan is a shy demon. What did he look like? He looked like an open and cuddly version of Dick Cheney. (During the reign of GW Bush, I sometimes wondered if Satan was dyadic, with Bush being Dumb Transparent Satan, and Cheney being Sadistic Conniving Satan, and them both being bloodthirsty because they hate one another and take it out on us.)

Finished with my granola bar, I went into the store and specifically into the store’s male restroom where I sat down to rest with the hope (but not the prayer) that no one would come in and stink the place up. While I rested, I got to thinking as follows: Peggy has never let me teach her the first thing about managing her own finances…. Peggy’s refusal to learn about finances means that I control every penny Peggy has including her workplace retirement. Peggy can’t even get into her own accounts without my help…. My next blogpost will definitely say: “Hello from sunny Acapulco. I took Peggy’s money and ran away with a twenty-year-old blond called Taffy because her limbs are so charmingly flexible. ‘You couldn’t get a twenty year old,’ you say? Ha! With Peggy’s money and my drugs, I would say that I made-out okay. Hee, hee, hee.”

Done resting, I left the restroom and proceeded, first west, then north, and then west again into the main part of the store where I headed (as I always do, no matter what I’m really there for) down the indoor and the outdoor plant aisles, talking friendly-like to the plants while people stared admiringly. I don’t buy indoor plants anymore, because I don’t have room for the ones I already own, but I saw a Rex Begonia, and I just knew I was going to make an exception, and I was right (it’s a lucky plant that comes home with me, unless it dies).

When Rex and I got to the checkout, the 20-year-old blonde checker said that Rex Begonias are her favorite plant, and that’s when I heard the theme music from The Twilight Zone because I knew that her and me coming together like that had to be more than a coincidence, and I became a theist on the spot. Right away, I knew I should leave Peggy and marry that woman, but then I remembered Peggy’s money which I hadn’t stolen yet. Then, I got to wondering if maybe the woman’s name was Taffy. “Are you Taffy?” I asked. “No, but my boss calls me Daffy because customers often complain that I charged them twice for the same item.” Upon hearing this, I went back to being an atheist and drove home embittered.

I could rattle off stuff like the above constantly because it portrays how my brain actually operates as I overlay reality with imagination, something which I do all day long. 

Losing church, losing readers

I lost at least two long-term Christian readers following the post about my decision to stop attending church (three posts back). I was sad about that, especially coming as it did right on top of my disappointment regarding the church. Then, the following sentence came into my head as I lay awake one night, “I am cast back upon myself,” and I found cheer in that, upon myself being the one place I can absolutely depend upon. Even if other people remain loyal, they can still die, and there’s only so much they can do anyway. Eventually, it all comes back to me.

While thinking about my absentee readers, I remembered that I had more to say about my decision to stop going to church. I didn’t say it sooner because I didn’t know how to express it sooner (if I had, I might not have lost my readers because what I have already said, if taken alone, seems harsh). Now that the words come to me, they flow effortlessly. It is often true that something I can’t say becomes easy to say once I get a little distance between myself and the situation that inspired it. The fact is that I went from feeling very welcome at church to doubting that I was welcome at all. 

For much of the time I attended, I was in email communication with two of the women who go there, and it was with them that I shared my objection to the requirement that I say the word Christ as a prerequisite for taking communion. Neither wrote back, at all, ever, and I took that as a very bad sign. Had I continued to feel welcome, I might have continued to go to Bible study even if they hadn’t relaxed their rule about communion. As things stood, I enjoyed Bible study fairly well (shallow though it was), and I also enjoyed the people, but I needed dialogue about the communion issue, and when I immediately ran into a wall of silence, I assumed that the only way for me, as an atheist, to be accepted was to keep my mouth shut about things that bothered me, and to express a reverence for Christ that I didn’t feel. When, after I quit going, no one contacted me to say I had been missed (everyone in class had my email address), I took it to imply that I probably wasn’t missed.

During my first weeks at St. Mary’s, I felt increasingly idealistic and even optimistic due to the initial warmth and liberalism of the people, but left feeling more jaundiced than ever in regard to the merits of any kind of organized Christianity. I don’t know of anything about the Christian religion that outrages non-Christians so much as hypocrisy. I assume that Christians feel pressure to pretend to be more loving than they are, but the result is that they look worse when they fail than they would have looked had they not pretended. And, no, I am not speaking about every Christian. The only reason that I don’t hate the Christian religion more than I do is that I believe in the goodness of some of my Christian readers. That made it all the harder to lose at least two of them. I suppose they thought I was being an ass over the communion issue, but I only brought it up because I wanted to feel that I belonged and because I believed it an occasion when I had something to teach. Perhaps, the reader was right who wrote, “the Church…is not interested in learning from you. From its viewpoint, you should be learning from it.”

In any event, I deserved to have my feelings discussed even if I was in the wrong, because I shared them with people who claim that love is the virtue that they hold in highest esteem, and love does not shut people out by ignoring problems. I could, of course, have talked to more people, but having been so treated by the two who had shown the most interest in me, I saw no reason to think that any good would come from contacting those who seemed less interested, and I assumed that, even if I had, the most likely outcome would have been animosity. Silence is a very effective wall. When people are yelling, there remains the desire to be understood if not to understand, but silence just says, “Go away.”

For those who don't already think I'm crazy...

I realize that there’s nothing straight people like better than to listen to a druggie talk about how high he got, complete with details about all the stupid things he did, so I’m here to oblige.

I grew up in rural Mississippi during the ‘50s and ‘60s. This was before marijuana arrived and before teenagers realized that every cow pasture contained mushrooms that would make a person have visions. I occasionally heard tales about the ass-kicking power of Valium, Methadrine, Percodan, or Queludes, but I never knew anybody who had any, and there weren’t any drug dealers in my area, only bootleggers. All that my generation had to get wasted on was liquor, and, since Mississippi was still under Prohibition, liquor was abundant and any kid could buy it. I don’t know why the frequent teenage driving fatalities (I started driving while drunk as soon as I got my license at age 15) didn’t cause public alarm, but people seemed to assume that there was just something about teenagers that made them get drunk, flip cars, hit bridge abutments, and get runover by trains, and there was really nothing anyone could do to stop it. This was before MADD convinced the nation that drunk driving should be taken seriously, and during which drunkenness was portrayed as funny on prime time family television. 

In 1970, I was a senior in college, and I still hadn’t seen any marijuana. Then one night, my friend, Ed, and I were hitchhiking, and two girls from a school in Virginia picked us up. They had driven all the way to Mexico to buy pot, and were on their way home with several pounds. After they told us this, Ed whispered to me that we should rob them. I said no, so Ed spent the rest of the ride sulking. When we got out of the car, he was so mad that he threatened to push me off an I-20 overpass, so we continued our journey separately. These girls had given us a couple of joints to smoke later, but I don’t remember smoking them, although I’m sure I did. In any event, I smoked a lot of pot over the next twenty years, the quantity being limited by cost, availability, and the fact that I didn’t enjoy getting high everyday because doing that makes the drug work more like a downer than a hallucinogen. My assumption is that most potheads like the downer effect, but feeling sleepy and looking stupid never appealed to me. 

I knew that some shrinks and college professors from New York and California had become excited about the consciousness expanding effects of hallucinogenics, and claimed that such drugs gave them insights that led them to, “Turn on, tune in, and drop out.” Timothy Leary, Richard Alpert (who became Ram Dass), and Alan Watts (an Episcopal priest) were the three I remember best. Then came Carlos Castaneda, an anthropologist who wrote a series of books about his apprenticeship with a Yaqui Indian medicine man who relied heavily upon a large number of hallucinogenics. I found it impossible to believe half of what Casteneda wrote, but I was impressed to think that even the remaining half might be true. In any event, Castaneda was one of the highly educated and respected people who believed in drugs so strongly that they jeopardized their careers by endorsing substances that, they believed, had the power to alter one’s consciousness for the better.

During this period, I was very distressed about the excruciatingly prolonged loss of my religious faith, and my hope was that drugs would give me a way of looking at life that was superior to what I had found thus far. I had heard that other people had seen God while on drugs, and I thought, well, why not me? Of course, I knew that some of these drugs could also induce lasting insanity. At the time, there was a famous daytime TV personality named Art Linkletter, whose twenty year old daughter Diane often appeared on his show. One day in 1969, Diane dropped acid and a few days later jumped from a skyscraper to her death. Art Linkletter, sweet and gentle man that he was, threatened to kill Timothy Leary because he blamed Leary for making drugs seem desirable to the kind of sensitive and searching people—like his daughter—who were the least equipped to handle them.

I personally witnessed two other incidents that made me take drugs seriously. I drove an ambulance at the time, and one night while I was in the ER, two hippies came in with a friend who was having such a bad trip that he didn’t know where he was. While the staff ignored him, two guards roughed him up for no reason that I could see other than that he was on drugs. After that, I realized that no matter how bad a trip might get, I would never go to a hospital for help. In the other incident, my best friend actually did see the Holy Spirit while on marijuana. Afterwards, he would look at me as if from the far side of the ocean and ask, “What’s it all about?” over and over and over. I was the one who finally drove him to a mental institution. He lost his job, his house, and his family, and never did regain his sanity.

In the interest of caution, I started taking half doses of whatever new drugs came my way and working up from there. After I experienced ten continuous hours of full scale visual hallucinations on marijuana while partying with people for whom I felt no rapport, I concluded that I needed to do more than simply start with half doses, so I resolved to go easy on drugs in the following situations: at night, at parties, in cold weather, in strange places, with people I didn’t trust, when I didn’t feel well, or late in the day (how hallucinogenics affect a person is closely tied to his or her surroundings), although I didn’t always stick to my resolve. I eventually experimented with psilocybin, meth, cocaine, LSD, hashish, ecstasy, angel dust, nitrous oxide, and a half dozen narcotics. I also mailed off for exotic drugs like lobelia and kava kava, drugs that the government hadn’t gotten around to outlawing, plus I ate morning glory seeds, smoked cloves, hops, and catnip, and experimented with other drugs that I no longer remember by name. 

I even took one drug that was so good that I wish I could feel that way forever. The drug was called ecstasy for good reason. Think of how you feel when your heart is overcome with sweetness for everything and everyone, and that’s what ecstasy is like several times over, or at least it was for me. The second time I had some, I shared it with a woman friend while visiting her and her husband. A half hour later, she became panicky, and her eyes started darting rapidly from side to side. I assumed she was having a seizure. Naturally, her husband was concerned, maybe the moreso because she was a nurse, and would lose her license if he took her to a hospital. Because I too was on ecstasy, I had every confidence that I could follow my friend into the depths of wherever the drug was taking her, and bring her right back out. And I did. First, I radiated love like the sun radiates light and warmth. Then, I held both of her hands in mine, looked into her darting eyes, and told her with complete certainty that she needn’t worry at all, because everything was going to be just fine. Because I believed this, she believed it too, and everything was just fine.  

Ecstasy is a very long-lasting drug, and the day after this incident, I was sitting on a city bus looking at passing cars when I noticed that their wheels were spinning backwards. In another hallucination (while on meth and marijuana), I heard the best music of my life coming from a toilet that had been flushed. I’ve also seen demons, heard angels, watched my face turn into the face of a turtle without knowing I was hallucinating, spent hours happily watching rapidly changing psychedelic patterns, felt intimately connected to angry red wasps, and watched trees dance. 

Two years ago, I got a marijuana card, and now I have a supply of marijuana that is far stronger than anything that was available in the old days. Twice, I’ve eaten too much (I “capture” the THC in butter and bake it into cookies). On the first of those occasions. I became extremely nauseous, could only move isolated muscles with sustained effort, and found that walking, crawling, or holding anything in my hands was impossible. On the second, I had visual and auditory hallucinations. No one gets that high on purpose—not more than once anyway—but it’s very hard to get a standardized dosage on cookies that are so strong that I limit myself to one-eighth of one small cookie and even that can sometimes be too much.

I’ve come so far in my ability to handle drugs, that hallucinations no longer scare me—not much anyway. What I’ve learned is that if a hallucination is troubling, I can turn my head away in order to either stop it or, if I’m lucky, find one that I enjoy. For example, the last scary one I had was when I looked at a wooden Santa, and saw it looking back at me with fiery eyes filled with hatred. There was a time when my eyes would have become stuck in his, but I immediately turned away, at which point I heard voices in the air above me, but they weren’t scary like Santa’s eyes, so I was sorry when they roared off into the distance.

Despite the risks, I don’t understand non-psychotic people who don’t experiment with drugs. I’ve known quite a few, but, “I’m not interested in drugs,” or, “I like myself the way I am,” only makes them seem, well, ignorant in that they have no way to know they’re uninterested in a given drug until they try it, drugs being so unlike other experiences and so unlike one another. As for liking oneself without drugs, the most interesting drugs (the hallucinogenics) don’t cause you to like yourself—they show you other ways of looking at reality. As the parlance goes, they take you on a trip, and you come back tired. As I see it, how could anyone NOT want to explore altered states of consciousness. To me, the desirability of it is so obvious that one doesn’t need a reason to justify doing it but rather to justify not doing it. You will grow from certain drugs if only because you experience heightened creativity and come to see “normal” reality as but one possibility and that, as desirable as “normal” is, other realities have a lot to recommend them.

Of course, I would agree that a person should evaluate the risk posed by a particular drug, and that some drugs really are so bad that one might reasonably choose to avoid them altogether. Meth, for instance. Bad stuff, meth (Just do a search for “meth before and after pictures”). But why avoid every psychoactive drug in the world because some of them are bad? I would also agree that a lot of drug users behave in ways that give drugs a bad name, yet I would offer in defense that a great many drug users are immature and troubled people who use them inappropriately. The fact that drugs will fuck you up doesn’t mean that this is all they will do (or even what they will do if you don’t overdose), but that’s all a lot of users get from them because that’s all they bring to them. The only drug that I have regrets about is alcohol, and it’s the only one that’s legal.

The Doors’ drug-inspired music captured a taste of what hallucinogenics sometimes feel like. Along with people like Leary, they and other bands inspired much of the drug use of the era.