Diary: Another Update on Methadone vs Morphine

DIARY: Well, did I get some good news. SROM (slow release oral morphine) is an option. Though rarely handed out, the specialist informed me that he has previously applied to the health department for a morphine permit for an existing methadone patient. It is rare for this to happen due to Australia's health policy and it took me to ask the specific question to get an answer. He carefully went through every other option and continually made notes being very careful to gauge if I was legitimate or not. The appointment went for over an hour which is along time for a specialist of his calibre. He was very thorough and would often pause to think, sometimes up to 2 minutes. If you have ever sat starring at a doctor for 2 minutes in silence, it can be eerie. Does he believe me? have I tripped myself up?, Is he asleep? The result is not straight forward as he needs to discuss the option with the local D & A counsellor I had met with previously and my methadone doctor. He has recommended I go on anti-depressants again and see a shrink for 3 months. If this fails, he then has more of a case for the health department to give me SROM. God, I am so glad that there might finally be some relief in sight. I wish like hell methadone worked better for me so I could get my life back but after nearly 10 years, I am sure I need to try something else. The vital element to dealing with substitute treatments is to have options. The government needs to listen to the specialists - the more options, the better. Drug addiction is extremely complex but add into the mix, mental health issues and you have a medical minefield called Dual Diagnosis or Co-occurring Disorders (COD). It is hard enough for medical experts to grasp but somehow politicians (and much of the public) don't have a problem with recommending a solution ... jail. Each addict has unique reasons and situations for their condition and having only a few options is the result of irresponsible health policy. Abstinence is the best option and should be the ultimate goal. If that doesn't work, then counselling and substitute treatment if needed. Substitute treatment is very limited at the moment and we have many viable options at our fingertips but the politicians are too weak to let them be trailed especially diacetylmorphine (heroin).

Diary: Hooray ... I'm Sick! / Dual Diagnosis

Diary: And the depression rolls on....

Once again I wake up to another shit day. Same old story. Sore bones, sore back, bleak outlook. Then I think of heroin for a few seconds and into the day I go. I make a really strong coffee, have my methadone, light a smoke and start working on a database system for a client. 

But today is going to be different. Today I am to confirm what might be the most important news of my life.

I am sick...

I thought I would be so ecstatically happy when I found this out. Yes, I was happy but more relieved. I have thought about this for nearly a year and then this research appears. I recently have thought that depression leads some people like myself to 'self medicate' via illicit drugs. This has been tossed around for years but the argument was always that drug abuse came first and that caused the mental health problems like depression. The term 'Dual Diagnosis' is used for the new science of addiction and mental health. Typical reporting of 'Dual Diagnosis' deals with extreme cases of mental illness because average junkies like me were not considered important enough by many. The Australian backed website, HealthInsite talks of the problem known as 'Dual Diagnosis' but emphasises intense mental illness with symptoms like:

• May be alienated and lack support from family and friends
• Won’t cooperate with their health care providers
• Is very emotional
• Is likely to have severe psychiatric symptoms
• May be homeless or moving frequently from one place of residence to another
• Is likely to relapse
• May be hospitalised or taken to accident and emergency departments reasonably often

Dual Diagnosis

A recent study in Science Daily from 2 weeks ago that showed results with the opposite results. Mental Illness And Drug Addiction May Co-occur Due To Disturbance In Part Of The Brain.

The study asks the question:

Why do mental illness and drug addiction so often go together? New research reveals that this type of dual diagnosis may stem from a common cause: developmental changes in the amygdala, a walnut-shaped part of the brain linked to fear, anxiety and other emotions.

From the Dr. Andrew Chambers:

Lead author Andrew Chambers, MD, cites clinical reports that at least half the people who seek help with addiction or mental-health treatment have co-occurring disorders.

This report shows that a mental disorder can cause drug use just as drug use can cause mental disorder:

"Brain conditions may alter addiction vulnerability independently of drug history," says Chambers. He and his colleagues concluded that someone's greater vulnerability to addiction, rather than a given drug's ability to alter the symptoms of mental illness for better or worse (usually worse), more fully explains the high rates of dual diagnosis.

So, does this mean ... after all this time ... most of us have been treating ourselves for a biological condition? Probably.

From another report:

Depression can result from an underactive reward pathway that receives little pleasure from natural rewards. People with depression may turn to drugs to stimulate their reward pathways to more 'normal' levels.

We deserve better...

Just think about it. If it all pans out logically, millions of people worldwide have been demonised, imprisoned, banished, bashed, abused and branded as the scum of society for being sick. Their crime was depression or anxiety etc. and I am one of them.

Are we going to get our lives backs? Are we going to get an apology from our friends, family and others who called us losers or weak? Are the police who threw us around like criminals going to apologise? What about the policy makers and the politicians? These people have treated us as pathetic junkies who were just too weak to stop the insidious crime of ... having a medical condition. Are diabetics just as subhuman as us? They inject themselves everyday but I don't hear the calls to banish them to hell. What if tomorrow we find out insulin is addictive, would they ban it? What if tomorrow we find out insulin gives new users a high, would they ban it then? What about Prozac type drugs? They are called 'happy pills and give a false sense of well being yet they remain legal. If they were taken away we would have to fight with nearly 30% of the population.

The more this sinks in, the angrier I get. Howard's abstinence approach telling us we have to aim for zero use. All the propaganda without scientific/medical support via DFA and other moralistic crusaders. The progressively harsher penalties even though there were many studies pointing towards drug addiction being a medical disorder. What about the many friends that abandoned me for not trying hard enough. Will they apologise? What about the small time dealer who decided not to steal or rob people and instead took the highly criticised but principled route and sold to other users to keep some moral balance to their insane life of addiction. They are amongst the most hated people on this planet and most have probably done jail time. 

I can't even comprehend how much damage the US has inflicted on their addicts. Most US states don't even have needle exchanges! Small quantities of drugs put users in jail. What about Islamic countries? People who self medicate are executed. I could go on but you get the point.

Time for action...

I urge you to write letters or send emails to those with power. Tell the police what the evidence is. Tell the media what the facts are. Demand your MP finds out the truth and does something. Browse the newspapers and blogs for stories about drugs and make a comment explaining the most recent findings. Tell people you know why you use and explain the medical evidence that you are susceptible to addiction.

Important Points:

• Depression and anxiety are major mental health issues and can make people more prone to drug addiction
• 1 in 5 Australians suffer from depression
• Many people with mental health problems have subconsciously been looking for a treatment all their life and one day stumble across their drug of addiction. This immediately fills the void and becomes their medication. Usually it is illegal, often being alcohol or heroin.
• Mental illness effected drug addicts don't often get high anymore. They just get normal.
• Many drug addicts want to be drug free but will never be able to get clean. It's part of their physical makeup.
• No amount of law enforcement will stop most drug addicts with mental health issues from self medicating.
• Why is drug addiction one of few illnesses where prison is the penalty for trying to treat yourself.
• Are medications like heroin or morphine not given to people with mental health issues because of religious or political pressure?
• Canada, England, The Netherlands, Switzerland and Spain give heroin to long term addicts and is extremely successful.
• Misinformation has been the basis for treatment of drug addiction. With new information, treatment should change accordingly.

I would love some feedback.

Good luck.

Related reading:

• Mental illness, drugs and alcohol - a generation of sufferers about whom no-one gives a toss
• Dual Diagnosis: Substance Abuse and Mental Illness