No huge opinions here either way, I just wanted to put something in about the opiates + pain thing (not as a pile-on for chowder, don’t worry, lovey). I’ve never been in the situation of so much constant absolute agony for so long, thank goodness, but after my surgery in August I was given codeine to dull the pain. I spent the first week after my surgery in a dull haze, either sleeping or vaguely awake and sometimes in a vague sort of discomfort. I tried to wean myself from the stuff before time and the pain was agonizing, staggering, to the point that I overmedicated and got nauseated.
But I understood, all of a sudden, why people could get addicted to this stuff. How it could become normal to live your life that way. Scared the heck out of me, enough that I did my level best to stop taking the medication as quickly as I could, or at least to slow it down. No more preemptive dosing – letting the pain start first.
It is treated as an opiate legally. Although it is an opioid agonist, it is not an opiate antagonist, competing for receptors and hence blocking the effect of opiates (such as naloxone).
Methadone induces many of the soporific effects of netural and synthetic opiates without the stimulant ‘rush’ effects. It is in itself a drug of abuse on the streets and is widely referred to as an opiate.
Referring to it as an opioid is devoid of significance in common parlance.
Agont=y can be psychological as well as physical. This lies at the root of drug dependency.
Modern treatment of drug addiction and dependency recognizes that the major analgesics have more than one mode of action- they cause immediate pain relief for the perceived immediate pain and additionally they cause separation from the psychologically unwanted consequences of pain.
I have experienced this directly when I suffered from a near ruptured appendix some thirty years ago. I was in considerable pain as I was waiting to be transferred to hospital and was prescribed repeated doses of sub-lingual buprenorphine- an opiate analgesic. After fifteen minutes of so it did stop my perception of the immediate pain, but well before that it changed my perception of the pain so that I was totally intellectually aware of the pain- knew where it was, was able to rate the pain etc., but this awareness had absolutely no emotional attachment- I was not anxious about the pain or its consequences- I was emotionally detached from everything, merely intellectually aware.
This explains how it is that many people use and abuse opiates and many people who do so do not progress to dependence and addiction. Figures are difficult to come by, but there is nowhere near a 100% conversion rate from use to dependence to addiction. Those who become fully dependent or addicted are those people with a psychological pain that the opiate effectively creates the separation from the anxiety attached to their current social situation.
As noted above, rapid detox (cold turkey) is extremely unpleasant for the person involved and others around them, but is simple to do and results in a complete independence from the chemical affects of opiate addiction. Once detox is complete, there is no chemical craving for the drug involved. However, there is a learnt behaviour that such opiate use creates a psychological protection against the pains of the person’s life (the agony above) and they will be likely to relapse if they do not learn to avoid this process.
There are no ‘good’ and ‘bad’ dependent persons. The mechanism is exactly the same whether the original source is medical prescription or street use.
Additionally, many people are able to start and stop opiate use without major withdrawal problems (at least no more so than nicotine or alcohol).
Finally it should be noted that most of the personal and societal negative effects of opiate addiction are related to the societal pressures placed on the dependent person, rather than on the use/abuse of the opiate in itself.
Blaming the victim is one of the least helpful strategies in trying to deal with this complex social problem. It is like blaming the poor for their poverty.
