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in which i vent my frustration with doctors and how we treat chronic illness (again)

So I’ve been taking more ativan than usual lately bc the bottle I got that was prescribed to someone else expired a month or so ago and I’m trying to finish it up, rather than simply tossing them. Now when I say ‘taking more than usual’ I really mean that I’ve been taking it whenever my anxiety goes above its normal levels (not just for panic attacks). In other words, I’m using my medication as prescribed. Instead of carefully hoarding my (usually) tiny supply for when my anxiety symptoms are at their most extreme. Of course, bc ativan is a benzo, this is a Bad Thing and why my doctor only prescribes me 10 at a time. But I’ve been thinking about the alternatives and, well, fuck doctors.

If you google ‘ativan’ (or the generic ‘lorazepam’) you’ll find a few articles discussing it. And most will end up making some sort of statement that it is possible to become addicted to it and that you can overtime tolerate it better and require higher doses. Stopping suddenly (if you’re taking it regularly) can mean withdrawal. All of which means that depending on your doctor, they might be reluctant to prescribe this (or drugs of a similar class). Which… like the issue with narcotics, ends up being another way that the medical system fails disabled people.

In the beginning… About four years ago, I first sought treatment for anxiety (thusly diagnosed as ‘general anxiety disorder’) because I had noticed that I had started drinking more as a way to manage my anxiety. My entire life I have never been a very frequent drinker (for several reasons I won’t get into here – but none of them moral). I began to worry when I realized that I was having one drink a few nights a week… every week. And I was almost always doing so when my anxiety was high. In other words: I was self-medicating with alcohol.

This isn’t actually all that surprising for me given that the year in which my drinking started to become a problem, was also the year that I… quit smoking. Which, it turns out, was what I had been using to self-medicate my anxiety. I had smoked for ten years. I did not want to develop another addiction, particularly not alcoholism (given family history and trauma-related stuff). I also didn’t want to go back to smoking because it took me three years to quit and I also know that smoking is terrible for your (physical) health. These days, with my fatty liver, it is even more important that I stay away from alcohol in large quantities, since drinking is one of the major causes of fatty liver disease.

So off I go to see the doctor. And I get prescribed an anti-depressant bc those are often prescribed for GAD. And yeah, it helped and I was good with that. However…. it didn’t do a whole lot for my panic attacks. Which I hadn’t realized I’d been having for many, many years. In part because my personal set of symptoms weren’t quite what the mainstream has as the Stereotypical Panic Attack. But whatever. I figured it out and saw a pyschiatrist who diagnosed me with mixed depression and panic disorder. Ah. Now it all becomes clear.

It was only after this point did I get my first prescription for ativan. For a total of 10 pills with no refills. At a point in my life where it was very stressful and I was having like 1-2 panic attacks a week. But I also worry, and this is personal thing, about addiction. I didn’t like my experience with nicoteine and I don’t want to become addicted to anything other than caffeine for the rest of my life. So I didn’t (and still don’t beyond the past few weeks) take my panic meds every time I have a panic attack.

During this time too… I rediscover weed and have been using it as a way to self-medicate my anxiety. Now. Medical marijuana is a thing in canada but… I’ve heard it can be difficult to get a prescription. I haven’t dared to ask my doctor but I’m also about 99% sure he wouldn’t. And, while it may not be much longer, it is still illegal. And something you have to buy off the streets (with all inherent dangers). But I prefer weed over alcohol when it comes to self-medding my anxiety. Although it does mean, in a way, that I’m smoking again. Which… still isn’t good, even if it is only a few times a week.

And so it has been. Me sparingly taking my meds bc I’m worried I’ll run out but also supplementing my supply with someone else’s very generous prescription. Her prescription for ativan is 1mg/day with seemingly never ending refills. So she always has tons of extra ativan. Which I usually split in half bc my prescribed dose is 0.5mg. I prefer mine bc they are sublingual and work within minutes but, as they say, beggers can’t be chosers.

I’m going into effort into giving all of this background info because my increased use of my meds over the past few weeks has made me realize that… Well, I hate doctors. All of them. Including my family doctor who, on the whole, is one of the most decent medical professionals I deal with. However… He still ends up pushing me into self-medicating my anxiety. Either through ‘black market’ prescriptions or via weed (which I also smoke/ingest for anxiety).

All of this comes to a head after I read an article about how at least one research paper has come out to say that alcohol causes seven kinds of cancer. I related this to my brofriend and he was like, ‘meh, everything causes cancer these days’. A sentiment I usually agree with because this appears to be the message we get a lot. Except that… knowing that within science and medicine the use of the word ‘cause’ is actually very rare when it comes to something like describing the connection between alcohol and cancer.

Most of the time, we’ll see statements about how substance x increases your chances of getting cancer. Or it is strongly correlated with certain kinds of cancer. But ‘causes’ actually has special meaning in this context because it generally means that the evidence that supports the claim is so heavy and unambiguous that there is very little room for doubt. And it makes a difference because, as noted by the article I read, drinking at all causes cancer.

Prior to this point most of the messages we’ve been getting is that if you drink moderately, alcohol is basically harmless. Things like liver damage and all that only happen if you drink excessively. Which is where things like, ‘oh, a glass of wine a day is good for you bc anti-oxidants’ or whatever comes from. Except that if this article is right (and more and more other studies and scientists confirm the causal relation), drinking a glass of wine a day will cause cancer. In the same way that smoking every day causes cancer. Although one of the main (worrying) differences is that they still don’t know how alcohol causes cancer. Whereas we know how smoking does.

In saying all of this, I’m not trying to shame anyone for smoking or drinking. No, that isn’t my point at all. I’m trying to point out that my subtle replacement of nicotiene for alcohol in self-medding my anxiety was trading one poison for another. Although, by available evidence, pot is definitely a better choice for self-medding. Except that its illegal (for now). More to the point: because both tabacco and alcohol are legal and readily available they are very common choices for self-medicating. And we also know that disabled people (physically and mentally) have higher occurences of addiction (same with other marginalizations, btw).

Its amusing to me that despite going to the doctor as a way to avoid self-medicating, here I am four years later doing that very thing. Using an illegal substance and/or using prescriptions in what might also be illegal ways. So all I’ve managed to accomplish, it seems, is switching my self-medding regimen for legal and very socially acceptable ways to illegal and not quite as acceptable.

And when I say ‘amusing’ I really mean that I’d love the opportunity to spend five minutes screaming in my doctor’s face. Not screaming abuse mind you, but screaming out of frustration. Because this is all really and truly frustrating.

There is a lot of moral panics these days about abusing prescription medication. I think benzos are like second most abused after narcotics. All of this worry generally means that doctors, like mine, become reluctant to prescribe them lest they ‘over-prescribe’.

It also means that someone like me, who has a lot of anxiety surrounding addiction, becomes worried about it. I actually have anxiety about becoming addicted to ativan (which regardless of its ability) actually is one of the main reasons I try not to take it. It also so happens that I don’t particularly like how it makes me feel. Sure, it calms me down but I don’t like how slow/stupid I get. I’m basically useless for the rest of the day. It also makes my sleep apnea worse so I usually feel like garbage the day after too (extra daytime sleepiness).

And I’ve communicated all of this to my doctor. Still, though, 10 pills at a time with no refills. And I’m always afraid to ask for more lest I be labelled as a drug-seeking fiend and get denied access altogether.

Sure. Looking over the list of long term impacts of taking benzos, it seems no better than alcohol or smoking. Although for most of the long term impacts, it requires daily use. Which is somewhat better than either alcohol or smoking. Somewhat. But it doesn’t actually matter, you see.

Its pretty clear from my history that I need something to help manage my anxiety. And regardless of my access to medical care, I will end up doing something. First I smoked, then I started drinking, now I’m on prescribed meds (but also some non-prescribed and one illegal substance). Sure all of this could point to me simply having an ‘addictive’ personality. Or it could just mean that if/when I get addicted to something its because I lack adequate access to healthcare.

I go with the latter, given that I’m able to regulate my usage (now that I’ve quit smoking at least). I don’t crave ativan, alcohol, or pot. And because of my experience being addicted to nicotiene, I very much do know the difference between craving bc I’m addicted and using something bc I need to (in this case for managing anxiety).

I’m laying this all out because I’m just so fucking frustrated with all of this. It always appears like I have no good options and that simply getting treatment for anxiety (and this is just one disability I’m using for today’s example), will always and forever have to be a source of anxiety itself. What gets me about the whole prescription thing though, is that it appears that doctors don’t seem to realize that it might be incrementally better for them to maintain control over our access so that they can also supervise and monitor our health.

In other words, I guess I’m sort of talking about a harm reduction strategy here. My unsupervised self-medding in the past was Not Good for me. Smoking for ten years as a terrible impact on your health that takes a long time to heal. Drinking regularly (heavily or not) also appears to have a pretty much guaranteed negative impact on your health. Prescription medications like benzos or narcotics also have negative long term impacts on your health. All of these can be a cause of addition and abused. But we also know that untreated mental illness has a longterm negative impact on your health.

(And before anyone jumps down my throat. I’m poor and do not have health insurance. Medication in some form or another is the only affordable care I’m able to access at the moment. Therapy, all therapy, is too fucking expensive. Also its a personal choice to use medication to manage my mental illness and that’s my fucking business, ok?)

So which is better, exactly? Because from my life experience it’s going to be one (if not more). My past behaviour suggests that I will continue to seek some kind of substance I can use to manage my anxiety. So which should it be? Smoking, drinking, or prescribed medication? I’m inclined to say that the main advantage with prescribed medication is that, as I said earlier, it gives your doctor the opportunity to monitor your health while you’re on the medication. Of course this only applies if they actually prescribe enough so that, um, a person like me doesn’t have to resort to the ‘black market’.

I could’ve just skipped talking to my doctor altogether and kept drinking. Probably be addicted by now. But that’s ok. I’d be managing my anxiety and I’d have easy and consistent access to my ‘medication’ of choice. Which in a different way, would be a vastly improvement over my current situation. I mean, they sell that drug of choice pretty much everywhere in the world.

And it would also be socially acceptable. People don’t really blink if you have a beer at lunch. Or wine with dinner. Not even if you do it everyday. Coming home everyday and having a beer or something is seen as a perfectly acceptable thing to do. Few people have a problem with a person having one or two drinks everyday. It’d certainly be better than this guilt-shame-anxiety complex I have about taking my prescribed medication. I also wouldn’t have to deal with the medical industrial complex and its constant fat shaming. Or the gatekeeping. Or the infantilization and, well, general shaming for pretty much anything and everything.

God. Even writing this all out makes me half-tempted to go off my meds and just do this instead. I won’t, for now, because I can get the gov’t to pay for my meds via subsidy whereas they’d never pay for me to get alcohol. But I also know that as soon as I move out of this city, this is probably where I’ll end up given that every other place I’ve lived in canada it is nearly impossible to get a family doctor. So once my access to consistent medical care is gone, thus goes my access to prescription medication.

All in all. The moral of this story is that the medical industrial complex doesn’t care about disabled patients (esp. not chronic ones). Sure you can get a short-term benzo prescription if something traumatic happened. Or you can get a narcotics script (like I did) if you have acute pain or just had surgery. But have an ongoing problem like anxiety or chronic pain? Lol, fuck you and be prepared to suffer with a smile if you want anyone to deal with you. Or self-medicate and deal with that.