I don’t have much to say, right now, in response, but I wanted you to know I did read your comment, and I do think you make some very needed points, and I have been thinking about this hard ever since you posted. I want to understand it in a genuine way. That’s going to take me awhile. But thank you so much for taking the time to make these criticisms. It’s something I want to address in a top level post sometime, but unfortunately (if you’ve noticed) I don’t have much time/energy for new posts now that work has started. But… certainly thinking about it, trying to avoid making the same mistakes again, trying to make sure I understand it correctly, and really hoping to be able to raise the issue in a post some time in the future.

(Just commented on abbyjean’s post here, as well.)

I have a post in the queue…but yeah, we have an extra step for my pregabalin, b/c it isn’t in our fomulary. Good times.

But this:

And I can tell you from experience: hydrocodone withdrawal is nothing compared to Effexor withdrawal

Yup. And, yet, I have found it worlds easier to get a doctor to prescribe me Effexor than hydrocodone or Lyrica…b/c (and I am only talking about MY experience here) see, Effexor has to do w/ my head, ya know, and that would mean that it really is all in my head, right where they want me to say it is…/digress…

My doctors couldn’t time it right so that I could do all of this once a month…I have to get my hydrocodone and pregabalin at different times each month, which is a treat. All of this is why I quit meds altogether for a while and pretty much lived in my apartment…I couldn’t handle having to explain myself all the damn time.

I have gone through several days of serious withdrawal several times because it is so damned difficult to fill my narcotic pain medications. I’m scared of it happening again every single month.

I take three narcotic pain medications. One is minor enough that it’s not a big deal. Two are the big time ones that have lots of special rules attached. One of those, the Kadian, is a time released morphine capsule that I *HAVE TO* take twice a day. Because it’s the kind of medication that has to stay in your system to be effective and because the body goes through serious withdrawal if it is suddenly removed, it is completely irresponsible for any medical practice to allow me to miss a dose. But it happens.

And here is why:

1. My doctor has to write the scripts down physically on paper and they must be either brought in to the pharmacy by me in person or sent through the mail. They cannot be called in or faxed in.

2. I see my doctor every three months, and he is allowed to write out three separate scripts for the current month, the next month, and the month after that. They have to be separate scripts, not one script allowing for refills.

3. These scripts are dated with the date I see my doctor, and can only be valid for 60 days. So I would have to fill the medication the day of the appointment, then exactly 30 days later, and then exactly 30 days after that in order to be able to use all 3 of them. After 60 days, the script is voided and the pharmacist refuses to fill it.

4. The date I see my doctor rarely matches up with when my current bottle of pills runs out (because it’s not like they can schedule me for exactly three months out every time, so it just ends up not matching up every time). And I am not allowed to get this medication more than 2 days early. So, if I see my doctor on the 21st, but my current bottle of medication doesn’t run out until the 30th, then I can’t take the script in to the pharmacy any earlier than the 28th. So then I take the second one in on, say, the 26th of the following month. And then … that third month I am screwed because even taking it in on the 24th, I am 3 days late on that particular rule. But I also can’t bring the script in any sooner than the 24th, because I am 3 days early on the other particular rule.

5. This leaves me with the only option left which is to only get the two month’s worth of paper scripts from my doctor and calling in for the 3rd at the exact right possible time. This gets tricky, too. Because I still have a narrow window of time to work with. I have to order the script in time for my doctor’s office to write out the script and send it in the mail and for the pharmacy to fill it before I run out, but not so early that my insurance company will deny it because I tried to order it too soon.

6. Add in that there is currently confusion between my doctor’s office and my pharmacy as to how I am supposed to handle ordering this medication. My doctor’s office no longer allows me to call them directly and ask them to send the script to the pharmacy. They tell me to call the pharmacy, ask the pharmacy to fax my doctor’s office, and then the doctor’s office will send the pharmacy the script. But every time I do this, the people at the pharmacy get all upset about having to contact my doctor’s office and remind me that with this type of medication they can’t do anything until my doctor’s office physically mails them the paper script. Which I know. And my doctor’s office knows. But for some reason we all three have to do this dance every month anyway. There is no auto-filling for morphine, right?

7. So, every three months, I have to find the exact right date to make sure I’m in the right window of time for all of these stupid rules, and you know, hopefully, I’m not too sick to function at this exact right time or have a totally human moment and forget like the rest of the population is allowed to do sometimes or happen to be out of town or … whatever. I have to be on top of this, and then I have to call the pharmacy (note also that I have anxiety around making phone calls so it takes some extra gumption for me to do this in the first place), do the little annoying dance with the pharmacist I talk to, who has to fax my doctor’s office (and I’m most functional later in the day which means the doc’s office is usually already closed and they won’t get the fax until the next day – or days later if this occurs over a weekend or holiday), and then a receptionist at the doctor’s office has to get the fax, give it to a nurse, who gives it my doctor who can write out the script (unless he is gone in which case they have to track down another doctor who has no history with my but who is willing to write out the script in his colleague’s stead anyway), and then he gives it to a nurse, who gives it to the receptionist, who sticks it in an envelope for it to go out in tomorrow’s mail, and various postal workers throughout town handle it, and finally it lands at the pharmacy where any number of people might open it, type it in to the computer, connect with the insurance company, make sure everything is correct, and then finally fill it and *MAYBE* contact me letting me know it’s in (this does not always happen, I often have to check every day on my own).

So, right, lots of people involved – lots of room for human error. And then, of course, I have to physically get to the pharmacy to pick up the medication which requires me getting a ride from someone or having them do it for me (which could cause problems), so that’s one more person involved. And again, if I’m having a few off days, getting to the pharmacy can be a challenge for me in and of itself.

And if anything goes wrong, as it often has, or if a new rule springs up somewhere (and this has happened to me too) that I wasn’t aware of, narrowing my window down even further, or if I didn’t pay close enough attention to the dates and mess up when I order the medication, etc. here is what happens to me:
lots and lots of extra pain, increased insomnia, nausea, extreme irritability, chills and other strange sensations on my skin, feeling as if all of my nerves have been exposed and/or lit on fire, watery eyes, sneezing, shaking, sweating, muscle spasms and tics, feeling cold and hot at the same time, blood pressure and heart rates going through the roof, feeling as if I’m running a marathon while simultaneously being unable to move, paranoia, suicidal feelings, extreme restlessness, and just basically some of the most horrible sensations physically and emotionally you can think of.

And even once I get the medication back into my system again, it takes days, weeks, longer even to recover from the experience and get back to my normal levels of functioning again.

Because someone somewhere decided it was a good idea to make yet another law making it difficult to fill a prescription. Because someone at the pharmacy, doctor’s office, or post office made a mistake – which happens, we all do it. Because I made a mistake. Because I got one of the fifteen medications I take mixed up. Because I couldn’t get a ride. Because so many stupid reasons. I have had to go through that misery. And am likely to have to do it again.

And I’m sorry, but that is obscene.

And this doesn’t even address the fact that if there were some emergency situation in which I couldn’t get this medication refilled, I’d be up a crick. Like if I were out of town and the car broke down and I was stuck there. (I am not allowed to use any pharmacy but the one I always use – I signed a contract to that effect.) Or if there was bad weather or a natural disaster and I was stuck at home and/or the pharmacy ran out of medication/became inaccessible. These scenarios run themselves through my mind a lot. I can’t build up a reserve of pills for emergencies because they don’t let me refill it early enough to do that and even the small amount I might manage on occasion to build up gets used during those times when I run out to help avoid those pesky withdrawal symptoms! Ugh.

This is, um, a bit of a pet issue with me. *pets issue*

Thanks for writing about it!
.-= Rosemary´s last blog ..Glee and Beer =-.

For that privilege, I grovel and beg and apologize for being in pain once every 30 days.”

*hugs* That is just awful. How can people be so cruel?
.-= sanabituranima´s last blog ..Like lightening =-.

Neverthelss, some of that stuff hits home. This is gonna be a bit long-wided and self-focussed, but I’m sure this isn’t just relevant to me.

I’m on several psychiatric medications, and this is something that happened to me a few months ago. (The idea of meds=shameful is so pervasive that I don’t want to say exactly wat I’m on. If people who know me read this…)

I go to see Dr. L, who is lovely. I tell her some problems I’ve been having and that current meds aren’t doing anything. She suggests I start on [drug] as well and writes out a script. So I go to the pharmacy.

sanabituranima: I have a prescription I need filled. (Hands over the script)
PHARMACIST: We don’t have any of that in. We’ll have to order some in and you can pick it up tomorrow.
The next day
sanabituranima: Hi. You had to order some [drug] in for me.
Pharmacist: There was a problem with your prescription.
sanabituranima: (Is puzzled) You didn’t say that yesterday.
Pharmacist: You need another prescrpition.
sanabituranima: Why?
Pharmacist: Well, just take it back to your doctor and she’ll sort it out.
sanabituranima: (gives look of blank incomprehension) Huh?
Pharmacist: We need a new one. Just to be sure.
(Sanabituranima goes home and phones doctor.)
sanabituranima: Hi, is that Dr L’s secretary.
Secretary: Yes.
sanabituranima: There’s a problem with the prescription Dr L gave me.
Secretary: What?
sanabituranima: I’m not quite sure. The pharmacist just said to ask for another one.
Secretary: Ok, Dr L will post you another one.
Two days later, when the new script arrives
sanabituranima: Hi. (Gives new script)
Pharmacist: (Looks at news script for a few minutes) Do you have any ID?
sanabituranima: I’ve never needed ID for prescriptions before.
Pharmacist: Yes, but [drug] is a controlled substance.
sanabituranima: (Gets out university campus ID card) Here.
Pharmacist: I need to see a driver’s licence.
sanabituranima: I don’t drive.
Pharmacist: This isn’t a valid ID.
sanabituranima: Well, what am I supposed to do?
Pharmacist: You need a valid ID.
sanabituranima: I haven’t got anything else.
Pharmacist: Do you have a passport?
sanabituranima: Not with me.
Pharmacist: Well, can you run along home and fetch it? (The rest of the dialogue obviously isn’t exact, but I specifically remember “run along home.”)
About 20 minutes later
sanabituranima: Hi. I’m here for my prescription.
Pharmacist: Do you have your passport this time?
sanabituranima: Yes. (Shows the passport)
Pharmacist: Is this your passport?
sanabituranima: (increasingly puzzled and annoyed) Yes.
Pharmacist: This photo is of someone with much shorter hair than you.
sanabitranima: (exasperated) My hair grew. It happens.
Pharmacist: (Grudgingly hands overbox of pills)

And it’s been more-or-less like that. Every. Goshdarn. Month. And I’m not allowed to get a longer-lasting supply.
*sigh*
.-= sanabituranima´s last blog ..Like lightening =-.

Things are somewhat better now, because I am also seeing a spine specialist, and she is much better about simply prescribing the Vicodin without making me go through hoops to get it. I worry, though, because I’m not seeing her for something chronic, but for an acute neck problem. If we can figure it out and I’m not seeing her anymore, then I have to count on the neuro for Vicodin. And that sucks. I’m using my scrip for acute pain to treat my chronic pain, in other words. Argh.

That’s a lot of “me, me, me!” but I wanted to agree with your post and with the commenters. This issue is REAL.

I get why you are drawing this distinction between the act of taking medication, and additive drug taking, but I do find it problematic. Yes there are many stereotypes surrounding addicted (in)dividuals which are generally negative. The addict is stereotypically self-destructive, out of control, needy; they are basically unable to fulfill the role of ‘responsible’ citizenship. But in your post you don’t seem to deal with/acknowledge the fact that addiction is in and of itself a moralised social construct. Drawing a distinction between the addict/ non-addict (you are saying you belong in the latter category), involves a culturally mediated assessment of whether drugs are being used to restore or disrupt ‘normal’ bodily processes. This first assumes that there is an organic, natural states of physical and/or mental health that is universally desirable, and secondly, that it is desirable that we return to, rather than deviate, from this state.

The addict/non-addict distinction further feeds into a larger process of dichotomising certain people/practices, for example: normal/pathological drug taking, good (in)individuals/ bad (in)dividuals, therapeutic substances/(re)creational drugs, real pain/unreal pain, excessive bodily pleasure/socially acceptable bodily pleasure, justified drug taking/(un)justified drug taking, taking drugs to cope with life/taking drugs for ‘social escapism’ (whatever this is-it is a bad thing). The problem with this binarising process is that it inevitably places people who take drugs within a hierarchy, where doctors and society at large impose value judgments on who is most worthy of taking them.

Is this really constructive though? Does it help people? If so, who? Who determines what is good/bad drug-taking behaviour? Why do we need to moralise people who take drugs?
There is a really good book called ‘What’s wrong with addiction’ by Helen Keane that I would recommend you read (assuming you haven’t already). There is a review of it here: http://www.australianhumanitiesreview.org/archive/Issue-Jan-2003/rooney3.html. I’ll provide an extract:
‘Keane defines the addict as one who resists proper subjectivity in a society in which the individual is “obliged to be free”. One of Keane’s purposes is to rethink contemporary ideas about subjectivity, including the question of whether or not addiction is wholly self-destructive behaviour. That the addict treats the body as an object, something to be experimented with, violated, abused, poses a significant challenge to mainstream understandings of singular individuality…. Locating addiction as a product of “a peculiarly modern regime of disciplinary power and knowledge” (7), Keane’s work is overtly influenced by Foucauldian ideas about the deviant body as one that is both produced by and marginalised within normative power structures.”

In the book, Keane also talks about the way in which addiction is highly gendered. And I agree, I think there are strong links between the social othering of addicts (as irrational, out of control (in)dividuals), and (wo)men, who are stereotypically hysterical, excessive, uncontrolled -you know, the-womb-wanders-the-body bullshit.

Your post was in part about recognising the ways in which access to medication is being controlled by others, and the fact that this control is highly ableist. And I agree, it is disgusting and unethical amongst a lot of other things. But one of the ways in which you’re making this point is by constantly drawing up distinctions between your legitimate drug taking, and that of ‘addicts’. I guess what I wanted to say is that the label of ‘addict’ is such an incredibly complex thing in itself; it is caught up in a process of social othering, of marking certain people’s happ-iness and bodily pleasures as perverse. The disavowal of addictive behaviour, and the distancing of oneself from ‘the addict’, is itself problematic, and there also at play is the assumption that addiction is just objectively a bad thing. No cultural/moral judgments involved. That is never the case though.
( Btw, I’m sorry, I really did try to keep my comment below the 700 wrd limit).