early

Driving to work yesterday, I pulled over and took this photograph. It was so beautiful in the early morning.

Yesterday evening I walked downtown after work. Our local Kiwanis is working on a memorial for all those lost at sea. I started thinking and wondering if we have a memorial for those lost to drug addiction, lost to domestic violence, for lost innocence.

This photograph is for all those losses.

 

Herd

For the Ragtag Daily Prompt: herd.

I am reading Dopesick, newly out this year, by Beth Macy. I am wondering what make people try addictive substances. At what age and why? To be popular? Herd mentality?

I’ve interviewed my older smokers for years, asking what age they started. Most of them say they tried cigarettes at age 9. Nine, you say? Yes. Parents then look horrified when I say that they should start talking about drugs and alcohol and tobacco by the time their child is in third grade. Recently a woman told me that she tried cigarettes at age 7.

It’s not just talking to your kids, either. It’s modeling as well. What do you model for tobacco, for alcohol, for prescription medicines, supplements and over the counter medicines? Do you say one thing but do another?

I am 100 pages in to Dopesick. The most horrifying new information is that more people under age 50 have died from opioid overdose then died in the 1990s from HIV and AIDS. Also the failure of history: we have had morphine available over the counter until addiction swept the country. Then heroin. This round is oxycontin. And I checked the index: no mention of kratom, sold from southeast asia. It is related to the coffee plant but it works as an opioid. It has been illegal in Thailand since 1943. I think they figured out that it too is addictive a long time ago.

I was an introvert, a smart girl, a geek before there was a word. I did not party and was not invited. I went to Denmark as an exchange student. I tried a cigarette there and decided that I couldn’t afford it and it tasted awful. I drank beer there, but was careful. I did go to a party where I was offered a bowl of pills: no. I was cautious and became even more cautious when I returned to the US.

When and what did you try first? And WHY? What makes us try these addictive substances? The evidence is piling up that the younger we try them, the more chance of addiction. And certain substances addict very very quickly.

Who chooses not to be part of the herd and why?

speaking up 3

Here are speaking up and speaking up 2.

More events in my life:

I am on the metro in Washington, DC. It is not rush hour. I am reading my book.

I suddenly realize  as the metro stops, my car is empty. I am the only one in the car. One man gets on. I am hyperalert. He walks down the car and sits next to me.

The car starts up. I stare at my book.

“Hi.” he says, “What’s your name?”

I don’t answer.

“C’mon. What’s your name?”

“I am reading my book. I don’t want to talk.”

“C’mon, baby, be nice.”

I stand up, purse and book. “Excuse me.” I step by him and stand at the metro car door. I get off that car at the next stop and move to the next one with people on it. Shaking with both the threat and anger, that I have to deal with this.

2. I take a dance class in Washington, DC. I work at the National Institute of Health. I leave my car at NIH and ride the metro.

One night I get off the metro at NIH and I am riding up the escalator, with my backpack.

A man, clearly drunk, steps up on the escalator beside me, and says “Hi, baby, what’s your name?”

“LEAVE ME ALONE!” I snarl and stomp up the escalator. It is dark and there are very few people at the stop and in the lot. I am in danger from this drunk.

I am walking fast at the top, away from the escalator, when I hear running steps behind me. WHACK! He takes a swing at me and runs off. He hits my backpack and not me. I am screaming at him.

He is gone. I run to my car, get in, and sit there, hands on the wheel. Shaking. There is a part of me that wonders what I would do if he crossed the road in front of my car.

My next class is not dance. I take tae kwon do.

3. I have used my tae kwon do once so far. Where? In first year medical school.

No way, you say.

Yes, way.

We have lecture after lecture in the same hall. We usually sit in the same places. I am newly married. The guy behind me starts tickling my neck during a lecture, with a pen. I twitch a couple times and then hear muffled giggles and realize that it’s the person behind me.

I stiffen and wait until I am really ready. Breathe. The tickle comes. I snap a basic block back and forward: and have his pen.

He SCREAMS!

The whole class turns towards us. The lecturer stops, staring. I am facing forward, holding the pen down low, not moving. He has the entire room staring at him, everyone but me. He doesn’t say a word. You could hear a …. pen…. drop.

The lecturer shakes his head and continues.

I keep the pen.

Just think, he’s a doctor.

I took the photograph when we were in Wisconsin. I went to UW Madison. I like being a badger.

beer and the Supreme Court

I want to reblog this and ask: Mr. Kavanaugh, you drank alcohol as a teen. How do you feel about your daughters drinking alcohol as teens? Is this acceptable? Is this expected? Will you turn a blind eye? Or do you have a double standard? Can teen males drink but teen females are “asking for it” and are “bad girls” if they behave the same way?

This matters. I don’t want a Supreme Court Justice who thinks it is fine for either teen males or teen females to drink and use drugs. So, sir, speak up: what message are you sending to all teens in the United States?

https://therecoveringlegalist.com/2018/09/28/the-elephant-in-the-kavanaugh-hearing-room/

admit deny

For mindlovemisery’s prompt: opposing forces. The prompts are admit/deny and presence/absence.

The pairs bring up my current sadness right away. I am struggling with the realization that we have a pervasive legal substance that works at the opiate receptor, is all over the US, and I have to send out urine tests for ALL of my chronic pain and opiate overuse and anyone on any controlled substance. You say, “but it’s legal”. I say, “Overdose and death risk. I can’t ignore it.” Here is the resulting poem.

admit deny

admit to yourself you deny your addiction
the presence of the drug means the absence of the one I love

 

Tobacco Use Disorder

With the DSM-V, there is no longer a separate diagnosis of Opioid Dependence and Opioid Addiction. The two are combined into Opioid Use Disorder. Opioid Use disorder can be mild, moderate or severe. And all of the addictive substances have the same list. So here is Tobacco Use Disorder.

According to the DSM-5, there are three Criterion with 15 sub features, and four specifiers to diagnose Tobacco Use disorder. Use of tobacco products over one year has resulted in at least two of the following sub features:

A, Larger quantities of tobacco over a longer period then intended are consumed.

1. Unsuccessful efforts to quit or reduce intake of tobacco

2. Inordinate amount of time acquiring or using tobacco products

3. Cravings for tobacco

4. Failure to attend to responsibilities and obligations due to tobacco use

5. Continued use despite adverse social or interpersonal consequences

6, Forfeiture of social, occupational or recreational activities in favor of tobacco use

7. Tobacco use in hazardous situations

8. Continued use despite awareness of physical or psychological problems directly attributed to tobacco use

B. Tolerance for nicotine, as indicated by:

9. Need for increasingly larger doses of nicotine in order to obtain the desired effect

A noticeably diminished effect from using the same amounts of nicotine

C. Withdrawal symptoms upon cessation of use as indicated by

10. The onset of typical nicotine associated withdrawal symptoms is present

11. More nicotine or a substituted drug is taken to alleviate withdrawal symptoms

Additional specifiers indicate the level of severity of Tobacco use disorder

1. 305.1 (Z72.0) Mild: two or three symptoms are present.

2. 305.1 (F17.200) Moderate: four or five symptoms are present.

3. 305.1 (F17.200) Severe: Six or more Symptoms are present

(American Psychiatric Association, 2013).

from: https://www.theravive.com/therapedia/tobacco-use-disorder-dsm–5-305.1-(z72.0)-(f17.200)

We have much more stigma attached to Opioid Use Disorder, but list for Tobacco Use Disorder is the same. Most chronic pain patients on long term opioids qualify for at least mild Opioid Use Disorder. UW Telepain says that if they only have withdrawal and tolerance, then it is questionable if they qualify. They also have said that “we don’t know what to do with patients with mild opioid use disorder”.

I find our culture peculiar. People get accolades for saying “I am quitting smoking.” or “I am a recovering alcoholic.” But it’s not ok to say “I am a recovering opioid addict.” People will shun you. Demonize. Gossip. It’s all addiction, so we should stop the demonization and stigmatization and help people and each other.

The photograph is not a brain. I took this about a month ago: it’s a brain size mushroom that was in the church lawn…