The Opiate Crisis: An Ethical Dilemma

How dare they. How fucking DARE they. Prepare for the rant of a lifetime.

I know. I know what you’re thinking.

“Didn’t you just post something saying you weren’t going to post on this website anymore?”

And in fact, you would be correct. But this, folks, THIS requires publication on a site that is relevant towards mental health because those of us who are apart of this marginalized community are being targeted once again. And quite ruthlessly. And have been since the beginning of this pathetic scapegoat of a problem called the “Opiate Crisis.”

Let me clarify: the crisis is indeed real. It is authentic and it is terrifying. People are dying. Children are dying. Mothers are dying. Fathers, sons, brothers, sisters, nieces, nephews, aunts, uncles, cousins, are dying. Fentanyl is being mixed with Heroin. Doctors are standing on the roof tops of their clinics tossing bottles of 60 Oxycodone pills to whoever cares to play catcher.

Why do I call the opiate crisis a pathetic scapegoat? For one reason and one reason only: it’s distracting us from the true perpetrators of the crisis in the first place. Those of you who have followed this website for the past four years, and specifically the last two years, know where this is fucking going.

*Knock knock* Big Pharma? Big Pharma! Hey, it’s me, open up. We have to talk.*Cocks shotgun*

I just finished watching a clip of The Daily Show with Trevor Noah (who I think is such a brilliant replacement for Stephan Colbert, who I also loved) where Trevor mentions Trump’s claims that Mexico is to blame for all the drugs and crime coming into America. I didn’t care about Trump’s words, I’m used to him saying unfounded statements. What I cared about was what came next.

Trevor describes a doctor, one Barry Shultz I believe his name was, who managed to dispense 800,000 opiate tablets over a period of 16 months to his patients from the pharmacy in his clinic, some of which were prescribed with 60 Oxycodone a day. He justified this by stating “Sixty a day is a large number, I admit. But, if it’s taken properly–”

The reporter asks how to take 60 Oxycodone a day properly. The doctor replied, “some people need that dose”.

No. Some people don’t need that dose. What YOU need is that check you receive from the pharmaceutical companies for pushing their product.

Then, came the claims I was waiting for. Then, came the pharmaceutical companies which were caught falsifying information and bribing doctors; if these five specific doctors chose to push a specific Fentanyl spray they, combined, were awarded over 800,00 dollars, treated to lavish dinners, and granted access to specialized strip clubs. That was Insys theraputics. Purdue Pharmaceutical was sued by their state under the grounds that they were personally responsible for launching the opiate crisis. I don’t know how truthful that claim can be, but the company did admit (in 2007) that they had purposefully misled doctors and consumers on the truth of their opiate’s addictive properties.

The company chose to create a strategy to get the feds off their back. In an email from 2001, chairman Richard Sackler, stated quaintly: “We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminals.”

Well. Look who’s calling the fucking kettle black. “Reckless criminals.” And what the fuck are you, mister former Purdue Pharmaceutical chairman? A saint? A fucking angel? What a sack of shit.

This is a game people, a game of chess, and innocent human lives are the betting agent.

This doesn’t just happen with opiates, it happens with psychiatric medication too–lying about efficacy, pushing doctors to diagnoses specific conditions to prescribe certain medications, insurance companies refusing to pay for therapy unless a client is diagnosed and medicated. I mean, the history of Johnson and Johnson C.E.O Alex Gorsky says it all. I will forever fucking bash his name.

People seem to forget the history of what is slowly becoming the least dangerous of all opiates: heroin. People seem to forget that morphine, derived from an opiate substance, was also once killing people (and still is) on an astronautical level due to its addictive properties. People seem to forget that a chemist then synthesized heroin, a very pure heroin, and a pharmaceutical company pounced on it. That synthesized pure heroin was advertised as an alternative to morphine that was not addictive.

Little did they know, right?

Cocaine in the united state was processed in a similar fashion. Most street drugs that don’t include a plethora of battery acid and other ridiculous chemicals, street drugs that are derived in some form from a plant, were often first in the hand of pharmaceutical giants. That’s how the public got their hands on it. Why do you think the idea of legalized marijuana is terrifying? I’m not sure how someone could fuck up marijuana, but leave it to people like Alex Gorsky and Richard Sackler and I’m sure they’ll find a way.

My point is that the opiate crisis is not the addicts fault. It’s not the drug’s fault. It’s not even the doctor’s who relinquish their will and fall ill to the temptation of strippers and hundreds of thousands of dollars. It’s the company which lies, which manipulates, and which dictates these disgusting actions.

This isn’t an opiate crisis. It’s an ethical crisis. It’s a philosophical, moral crisis.

Change my mind.

Sudoku and Neurotransmission

There’s nothing that can convince me that this life is meant to be as complicated as we make it. There’s nothing that can convince me that we will ever find all of the answers, and to think that we have some already is naive and wishful. These are the things I think about as I backtrack in my Sudoku game, something I used to hate doing as a child because I could never get it right the first time. I have once in my life, but that was in a bout of mania. As much as I like to think it was my own brain power, it was really just a flood of neurotransmitters doing all the work.

250px-sudoku_puzzle_by_l2g-20050714_solution_standardized_layout-svgI was thinking about this the other day, about neurotransmission and Sudoku, and how they both have algorithms to describe their process. We have more neural connections in our brain than we have estimated stars in our galaxy. 1000 times more, to be exact. Sudoku has a bunch of different number possibilities, but only one answer. I fear neurotransmission is not as simple.

We have an algorithm for the probability of neural transmission: when certain neurons will fire and the chance of that happening, essentially. I believe if we do wish to describe the processes that happen in our brain, math will be the catalyst for success in that field. There are too many connections, too many variables, to settle on an explanation as simple as, say, a chemical imbalance.

I came across an essay in PLOS medicine titled “Serotonin and depression: a disconnect between the advertisements and the Scientific Literature.” This is a big deal. Although published in 2005, their words are still very relevent today. I’m sure you have heard in commercials about psychiatric medication that “so and so disorder is a chemical imbalance, and [insert drug] works to correct that balance”. Notice they will never explain how or why, because they simply don’t know. We don’t know.

And that’s where my area of study will be, once I do graduate: let’s explore this idea of chemical imbalance and what it may mean. My ultimate goal? Disprove the theory.

That’s a long way off, and it may only be a pipe dream, but I believe I can catalyst a different type of thought in the mental health community by proving, scientifically, mathematically, whatever you want to call it, that something like a chemical imbalance cannot possibly exist. Why?

As the essay says:

Attempts were also made to induce depression by depleting serotonin levels, but these experiments reaped no consistent results [9]. Likewise, researchers found that huge increases in brain serotonin, arrived at by administering high-dose L-tryptophan, were ineffective at relieving depression.

As it also says:

Contemporary neuroscience research has failed to confirm any serotonergic lesion in any mental disorder, and has in fact provided significant counterevidence to the explanation of a simple neurotransmitter deficiency. Modern neuroscience has instead shown that the brain is vastly complex and poorly understood.

And of course, let’s not forget:

There is no scientifically established ideal “chemical balance” of serotonin, let alone an identifiable pathological imbalance. To equate the impressive recent achievements of neuroscience with support for the serotonin hypothesis is a mistake.

comic-bubble-hmm_1609021If there is no established balance, there, logically, cannot be an imbalance. This article focuses purely on serotonin and depression, but this in fact relates as well to the dopamine hypothesis of schizophrenia and any other neurotransmitter they claim causes certain mental health issues. These studies are indeed correlational and not experiments. What does this mean for us that struggle mentally?

It means the door is open again. It means we can find a different explanation. It means we can focus on genes. We can focus on environment. We can focus on the way society structures thought–how we’re taught to think about ourselves in the first place. We can focus on things we can change, rather than this pipe dream that a little pill that may or may not cause more harm to our bodies/brains than good, can cure anything at all.

To deny that there is a biological component would be ignorant of me. To accept the propaganda that pharmaceutical companies place in front of my eyes would be even more ignorant of me.

There could be a chance that neurotransmission is just like Sudoku, and that perhaps there is one single answer and we just have to back track and back track and back track until we find the right numerical composition. But more than likely that isn’t the case. This isn’t a pattern devised by a computer. This is a pattern devised by universal chaos and quantum processes. What is there to correct? What’s created by nature is created by nature, and for us to label that right or wrong, normal or abnormal, is rather selfish and egotistical.

What else could it be, if not a chemical imbalance then? We could brainstorm ideas for hours. Genetics–if your mother has what we label as schizophrenia, there’s a greater chance you will too. But stop. It also depends on: Environment. There’s a striking number of people who receive this label who have been through some type of sexual abuse, physical abuse, severe emotional abuse, and often voices and delusions reflect this pain. What does that tell us? That deep pain that isn’t processed properly leaves a lasting stamp on our neural connections, and turns something on and off in our genetics. Socio-economic status plays a role: think of all the homeless people you see wandering the street talking to themselves. Assume they are not on drugs, and you’re dealing with a mental health issue. You think it’s easy to get well in poverty? You think there isn’t trauma in poverty? What effect does trauma have on the brain? There are studies on this, but what does it mean for neural connections? What does any of the things I just mentioned mean?

That’s what I plan to study in my life. I’ve given up the fight against these pharmaceutical people. I can’t fight a corporation. But I can fight their bullshit research with real research.

Ironic, considering Research Methods is my LEAST favorite class.

And that’s today’s Mental Truth.

 

 

How Sick Are You, Pt 2

Another long stretch since I’ve written. I spent some days adjusting to medication, some days hating myself for taking medication, and other days deciding to come off of medication.

Experiment number 2984719374:

Hypothesis: I will have a burst of energy and feel-good neurotransmitters flooding the gates of my synaptic terminals, followed by an immediate and harrowing decline which will, therefore, push me inevitably towards reuniting with the medication I so despise.

Methods: I will stop both the Abilify and Trintellix and monitor my moods and/or whatever aspects of psychosis that may rear its ugly head.

Results: TBD

Discussion: TBD.

Now that we have that settled, let’s talk a bit about mental health and awareness. There are so many great people out there doing great advocacy online and in person. There are so many great Non-Profit organizations doing the same. There are even clubs dedicated to such a thing at my college campus. And yet, there are still people wary and ashamed of their mental health. Let me give an example of how this thought process is still prevalent.

Today, while sitting in my Cognitive Psychology class, we were going over, for the umpteenth time in my life, neurotransmission, synaptic terminals, receptors, antagonists and agonists, Dopamine, Gaba, Norepinephrine, and Serotonin, some of the main receptors you learn in an introduction class. It follows that we should then speak about the dis-regulation of some of those neurotransmitters, and discuss the THEORY of chemical imbalances: regarding primarily dopamine and schizophrenia, serotonin and anxiety/depression.

Again, the idea of a chemical imbalance is a (repeat after me kids):

situation-clipart-theory-5

which means it can never be proven, only dis-proven.

Anyway, that brought up the topic of SSRI’s, their side effects, and their withdrawal symptoms.

One young woman, who was probably younger than I am, raised her hand and said this:

“I was wondering about the withdrawal symptoms, because I take an SSRI, and I noticed that–well, I don’t have depression, it’s for some nerve problems–but I noticed that when I didn’t take it even for just a couple days, I was sleeping a lot, I couldn’t focus in this class . . .” and yada yada yada, personal life bullshit.

But what struck me is that she immediately discounted the experience of depression. She wouldn’t want her classmates thinking she’s “mentally ill” now would she?

And this is why I advocate for changing the culture around this term “mentally ill”. Because people are ashamed of that, of “being ill”. But what if we weren’t “ill”? What if we were perfectly well humans with a variation of neurons (a very, very, very large variation of neurons) that just so happened to result in different experiences? What if believing we are “ill” is keeping us, well, “ill-er”?

What if the perception of those experiences changed from unpleasant to being perceived as unique, variable, malleable, valuable, curious, and wonderful?

That’s not to say the struggle isn’t hard, because it’s very hard. But the harder we believe it is, the harder it will get.

Now, this could all be the feel-good neurotransmitters talking, because I started my little experiment about two weeks ago, and that is about the amount of time it takes for this poison to slowly remove itself from my body. Although, if you know anything about half-lifes, it never really goes away.

But whether or not this is me being euphoric and grandiose, I think we need to expand the discussion around neurotransmitters, and inform the public of just how wrong it is to think that the pathway of ONE SINGLE neurotransmitter leads to something as complex as what we call schizophrenia or what we call anxiety, Bipolar, Depression, any of it.

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You’ll read in a lot of studies released to the public–or at least glorified in the media–that they’ve found another link of dopamine to this, another one of serotonin to that, and it’s just not feasible that with 30-100 different molecule versions of neurotransmitters (granted there are a few that do a lot of the work) and 100 Trillion estimated neural connections plus constant variation of cell death/growth, neural connection death/growth, as well as environmental and genetic influences that dictate those neural connection and sell growths and deaths, that ONE neurotransmitter is going to be responsible for making or breaking our mental health.

Now, we can say that they are correlated. We can say we see increased dopamine in people who experience what we label as schizophrenia. But you cannot, and I repeat, CANNOT use that as CAUSATION.

Fuck I can’t stress it ENOUGH.

Psychology 101 folks: CORRELATION IS NOT CAUSATION. 

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Dopamine may be high during what we call psychosis, but that does not mean that the high dopamine CAUSED the psychosis, or that the psychosis CAUSED the high dopamine. We haven’t learned what “causes” mental health struggles yet, that’s why chemical imbalance is a THEORY.

See how much you’ve learned already today.

And that’s what happens in a lot of these articles that are debriefed by media or science magazines online with writers who don’t know a single thing about psychology. They get hung up on correlations.

It’s also a result of research publications being manipulated to suit the needs of pharmaceutical companies.

It’s a fact that if you give someone a drug that decreases dopamine, you’ll likely see a decrease in what we call psychosis. You’ll see a decrease in a lot of other things too, and those are what we cal side-effects. But are those drugs really doing anything to the thing we call psychosis, or is it just blunting some aspects of the self? Because often “psychotic symptoms” continue during the usage of said drug.

These are all questions I can’t answer, and neither can the magazines that publish articles on published research. It’s important to read these things carefully and really take a moment to look inside of yourself and ask yourself if you want to consider yourself broken, sick, ill, and helpless.

And that’s today’s Mental Truth.

 

Genetics and a Book Recommendation

feeling_blank_by_kenikio

I woke up feeling blank as usual and lay in bed in this robe that, honestly, I’m getting sick of feeling on my skin. I spent twenty minutes . . . a half hour . .  . an hour staring at the wall listening to thoughts pass behind my eyes that made no sense at all and then, because I’m terrified of spiders and always wonder about them, put my ear to my wall wondering if I could hear them scurrying around in the wood. No such luck.

After that charade was over I figured I’d trudge out into the kitchen and get some food before my stomach killed me.

It’s two in the afternoon.

I sat at this computer with my food, purposefully avoiding the second email from my previous employer, and got prepared to stare at a screen for another twenty hours.

5231811-a-bowl-of-spilled-neopolitan-ice-cream-on-white-carpet-that-is-melting-stock-photoDays mesh together like strawberry, vanilla, and chocolate in a bowl in 100 degree weather, and I’m sure I’ve mastered the art of existing, regardless of the circular philosophy you send yourself in at an attempt at defining it.

That being said, thank you to those of you sending encouraging words. I know sometimes it doesn’t seem like much to just send a positive word to someone but just reading them reminds me I’ve been through this before and can make it out alive yet again. What I will do after that I have no idea. For now, I’ll ride the wave until it crashes on the shore. Whenever that may be.

All of THAT being said, I opened my flipboard in hopes for some juicy content, something I could maybe thrust some sarcasm in, twist, and rip a few organs to shred.

I found a gem but not one to mock, one to bring attention to.

I wish it were longer. But I suppose keeping it short these days guarantees more people will take the time to read. I know it helped me get through the few paragraphs with this fucked attention span of mine. I used to be able to read, I don’t know what happened.

This article has to do with genes. It has to do with genes in relation to mental disorders, specifically schizophrenia, one disorder I feel we often attribute heritability to more often than any other. Is that because those of us in the psychiatric research world have no idea what goes on in the process of this disorder? You can bet your bottom dollar.

Do people still say that anymore?

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That reminds me, there is a book I would recommend for anyone interested. It’s called “Of Spirits and Madness: An American Psychiatrist in Africa”. By Paul Linde M.D. He discusses the lives of 9 patients he treated while in Africa, the majority of whom were suffering psychosis, mania, schizophrenia, or a combination of the three. He speaks of getting accustomed to 1) greeting everyone in the hospital every morning as a cultural requirement, 2) learning their customs 3) realizing how absent spirituality is in western medicine these days. He often asked him self “is there a possibility this person is cursed/possessed by his ancestors as the African healers suggest?” He often found the healers methods worked at times.

In Africa going to a Psychiatrist is a last resort. 

In Africa their go-to medication was Thorazine.

In Africa they don’t care about “how” an illness came about, they care about “why”.

750825-_uy400_ss400_It’s an interesting read. I’ve been going to the library and reading a chapter or two because I still owe them 50 cents and I don’t want to pay it.

Anyway, the article I read today had nothing to do with Africa. The article I read, which you can also read here is entitled “There are no ‘schizophrenia genes’ and here’s why”. Written by a couple of professors.

We all know there’s a big uproar about this, about finding a single gene to link to a mental disorder so we can finally have that biological cause that absolutely means . . .

literally, nothing.

But we want it anyway. So we spend millions on trying to find that gene rather than improving treatment standards and training professionals to help those with the disorder live the life they want to.

Logic.

These professors pinpoint the real issues about these genetic studies.

The “Rosetta Stone” gene that got published last year? The one I remember hearing about? On Flipboard?

Studied on mice and had already not been linked to schizophrenia in a 2012 study.

Harvard, good old Ivy League Donate-To-Us-And-We’ll-Give-You-A-Full-Ride-Scholarship-Especially-If-You’re-ethnic-Unless-You’re-Asian, University claimed they produced “a landmark study that provides the first rigorously tested insight into the biology behind any common psychiatric disorder”. Now if that doesn’t already sound ridiculous (it should), the findings which showed the genetic link incredibly tiny, minuscule even, got exaggerated. As usual.

sn-genetransferThere are hundreds of genes that have found to have a tiny effect, a tiny link, to all psychiatric disorders. Including Anxiety. Including depression. Including things like Autism.

This paragraph explains these warped views better than I could have summarized. I couldn’t taint this perfection with my sloppy vocabulary:

The high heritability estimates reported in earlier quantitative genetic studies don’t rule out environmental influences, but have discouraged researchers from taking social causes seriously. But we now know that there are proven strong associations between psychosis and a range of social risk factors, such as exposure to impoverished and urban environments, migration, childhood traumas (sexual or physical abuse and bullying by peers), and recent adverse experiences in adulthood. So why does the genetic story about mental illness continue to appeal?

What’s funny is that a link to an article below is entitled “Study reveals genetic secrets behind Schizophrenia and Bipolar disorder”.

Give me a fucking break here, you guys. Really.

Why does the genetic story about mental illness continue to appeal? Quick fix possibility? Kill the baby before it’s born so it doesn’t suffer? An obsession with the “how” and nothing more? Another reason to call yourself defective maybe? Another reason to prove you’re not part of the average population?

What do you think?