My Favorite Narcotics and Why I Love Them

This is a story of pain.

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I’m not a doctor, and I don’t know much about the opioid crisis. I’m a user. I’m on the demand side of the business. There are probably more than 100 million people like me in the United States and perhaps a billion worldwide. I want to tell my story, hoping it will influence the conversation.

I use narcotics and have for decades. Here is how I classify the drugs I have used:

  1. Entry level: Codeine, Darvon, Valium, Vicodin
  2. Mid-level: Oxcyontin, Percoset, Morphine
  3. High-level: Fentanyl

Fentanyl is my favorite. Fentanyl killed Prince, Tom Petty, and now kills about 30,000 Americans a year.

Before I continue, I want to mention that I drink about one glass of red wine a month. For some genetic reason, all hard alcohol tastes like battery acid to me. I have never smoked, taken heroin or cocaine, and I can’t stand the taste and smell of marijuana.

What Drives me to Use Narcotics

I’ve seen the ceilings of a lot of hospital emergency rooms. Whenever I have the chance to get a prescription for a bottle of narcotic pills, I take it. I hoard them.

How I Use Narcotics

I have a friend who feels nervous being in the same room with a bottle of Morphine. He tells me that if he starts he can’t stop. He recently had wrist surgery with no anesthetic, because both he and his doctor believed he would be worse off in the long run if he got any narcotics into his body.

That’s not me. I live for adventure. About every ten years, I have major reconstruction of some part of my body. I’m used to it and don’t mind paying the price for my habit.

I get exactly the use of a narcotic it was designed for and no more.

A Big Piece of the Puzzle

Here’s the key statistic, from that document I just linked to:

Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.

So perhaps as many as 75 percent of patients are more like me. Without breaking it down carefully, there could be more than 100 million people in the United States who don’t have chronic pain and can safely use them for pain relief as needed. It’s gotten more and more difficult for us to get painkillers when we need them.

Finding a Supplier

When I fell ice skating in Zurich and couldn’t get up because my hip was broken, the ambulance person came and started a line of Fentanyl immediately, waited for it to kick in, and then moved me onto the gurney and into the ambulance. That was when I learned how amazing Fentanyl is. It’s a wonder drug. It removed the pain, yet it left me clear-headed enough to do research on my phone about the upcoming operation, call family, and manage my medical affairs. The Zurich hospital kept me comfortable until I went into the operating room.

Two years later when I broke the other hip in London, the idiot ambulance driver made me hop up the ladder into the ambulance, causing me some of the most intense pain I have ever experienced. I told him I have an intertrochonteral fracture of the left femur, and he said I probably just had a bruise or a sprain. I asked for Fentanyl, but he laughed and gave me 400 mg of Tylenol. At the hospital, they gave me a bit more Tylenol. They said they never give Fentanyl to patients — it’s too expensive. I asked for Codeine (cheap) and was denied until it was time to go to the operating room.

Moving a patient with a broken femur sounds like this:

“Okay everybody, one … two … three!”

“AAAAAAAAAAAHHHHHHHHHHHHH F*************CK!!!!!!!!!!!!!!!!!!!”

Been there. Done that.

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Osteoporosis and a very active lifestyle don’t seem to mix very well, unless you like titanium.

So I hoard these pills and travel with them. I never know when I’ll need them. Many years ago, a friend gave me an old bottle of Vicodin he didn’t need. That bottle lasted me ten years. In my experience, a ten-year-old pill is about 80 percent as effective as a new one. I would gladly give a pill to a friend who was in pain but have never had to.

Most days, I have shoulder pain and work through it. Last week I had diabolical shoulder pain. I can’t work and can’t sleep when it’s that bad, which is about 3–4 times a year. So I took an Oxycontin. It let me keep working through the evening, stay clearheaded through a complex banking transaction, and get to sleep easily. I didn’t need another one the next day.

I had three separate oral surgeries this year to install an implant. The doctor said I should take some Tylenol. Thankfully, I had my narcotics and was able to take a pill on three separate evenings, spread several months apart.

I don’t have many Oxycontin left. I can’t ask a friend who is a doctor to write me a prescription — all narcotics are now very carefully controlled. It would be foolish to order pills from India or China, because these days they could simply be deadly. That means I can’t get a bottle of pills unless I get really hurt again. I should start taking more risks!

The Problem with Opioids

Short acting and with fast onset, Carfentanyl has, weight for weight, around one hundred times stronger effects than fentanyl and thousands of times stronger than heroin. It is more effective at reducing pain response in rats than any other opioid.

Carfentanyl is made by many labs and in many different strengths. It’s cheap. It’s easy to get into the country. At its most concentrated, the amount in a normal size suitcase could kill everyone in Boston. This is what makes the opioid epidemic so deadly — people easily kill themselves with uncut or poorly dosed Carfentanyl.

It’s not the Drugs that Are the Problem

First, it’s mostly not people’s fault. The number of people using drugs for fun or just to relax is very small. Many people die each year as a result of chronic pain and a dysfunctional system that leaves people lonely and in despair, coming back for more drugs — and getting them — when that’s not what they need. Listen to Alex Cahana break it down:

Second, it’s still not people’s behavior. Genetics are a huge driver. Here are some relevant papers:

We see much the same thing with alcohol abuse. Danielle Dick tells the story of her research on the genetic causes of addiction. We are learning more and more that addiction is more driven by genetics than by some “addictive” properties of the substances.

For me, it’s definitely genetic. I don’t seek meds. I seek adrenaline, and we know there’s a genetic component to that.

Addicts vs Patients

The average doctor treats “addiction” and “drug-seeking behavior” as synonymous. This paper lists signs of drug-seeking behavior that doctors should watch out for, like:– Aggressively complaining about a need for a drug
– Requesting to have the dose increased
– Asking for specific drugs by name
– Taking a few extra, unauthorised doses on occasion
– Frequently calling the clinic
– Unwilling to consider other drugs or non-drug treatments
– Frequent unauthorised dose escalations after being told that it is inappropriate
You might notice that all of these are things people might do if they actually need the drug.

Those of us who actually need the drug are severely underrepresented, because the pendulum has swung too far toward “preventing the opioid epidemic.”

An App to Take Pills?

The app would be part of my primary-care physician’s services. Today, a physician can’t give me a prescription for even one pill without a doctor’s visit and a lot of justification on his end. (Doctors are under intense scrutiny as a result of a small number of doctors prescribing far too many opioid pills as a service to junkies.) The app should help me determine what I need. For example, a headache could just be a headache, but it could also be a concussion. The app could get me to the right doctor, emergency room, or specialist, or it could just give me a prescription and send me to the pharmacy.

Ideally, we discover new drugs that are more effective and less likely to lead to harm. Eventually, we may use DNA tests to help. In the meantime, those on the front line of the opioid epidemic struggle to create a reasonable framework of diagnosis, treatment, and life-saving interventions.

Summary

I’m speaking for those of us who can successfully self-medicate and have been discriminated against. There could be hundreds of millions of people worldwide who would benefit from easy access to pain meds. Yet the system is making it increasingly difficult — and dangerous — for everyone.

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David Siegel is a thought leader in blockchain and an expert on digital money. He is the author of The Token Handbook and the Digital Money Book. His new project can be found at Permissionless Finance. You can find all of his writing at www.dsiegel.com

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Provocateur, professional heretic, slayer of myths, speaker of truthiness to powerfulness, and defender of the Oxford comma.

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