On Buprenorphine

Since the age of 13, I have been taking opiates in moderation for chronic pain. I started with morphine (and the occasional hydromorphone), and since an MVA approximately three years ago (I am now 19), this was briefly supplemented with oxycodone.

As someone who has been on every opiate available, I have formed preferences as to which is best, and I flatly refuse to take others. The classic opiates are the best; these include (dia)morphine, hydromorphone, oxycodone, and fentanyl, although I will not take fentanyl patches due to the O/D risk. I will not take pethidine (Demerol®) or anileridine (Leritine®) for their neurotoxicity (they can cause seizures in high doses, and aren't strong enough, forcing me to take high doses) or tramadol or tapentadol for their thymoleptic (SSRI) activity (they are one step away from the so-called anti-depressants and have a far worse withdrawal). 

I have taken methadone for cough that would not go away and later suffered my first and last episode of drug withdrawal; I liked methadone but hated the very long withdrawal period. I have experience with ketobemidone (Ketogan®), dextromoramide (Palfium®), and dipipanone (Diconal®), but none beats the classic opiates.  I even wrote up an opiate rating chart way back when; buprenorphine isn't included, as I had regrettably not tried this amazing substance before in adequate dose.

I was referred to a doctor who treats primarily addiction cases, but this fellow (who I shall call Dr Smith, because that's his name) agreed to treat my pain even though no addiction existed, then or now. His favourite opioids, in order of preference, are buprenorphine and hydromorphone. Score! I originally insisted on hydromorphone, my favourite opioid. However, Dr Smith refused to supply it unless buprenorphine was first trialled, and I was quickly started on 16 mg of Suboxone®.

Suboxone® is a form of the typical opiate buprenorphine; I use 'typical' here to mean that its effects mirror that of morphine and hydromorphone, with no NMDA hallucinogenic effects such as those that Physeptone® suffers from.  There are three forms of buprenorphine: patch, pill (to be taken under the tongue), and injection.  No swallowable pill exists, as swallowing buprenorphine makes it 1/5 as strong as when taken under the tongue, so making such a version would just plain be wasteful, not to mention liable to abuse; if there were a swallowable version, the doses would be 10, 20, and 40 mgms, like oxycodone.  The patch is for a week, which (in my case) makes it unwieldy and impractical, not to mention not strong enough (doses delivered are in microgrammes per hour—that's right, microgrammes).  Suboxone® is one brand of the oral version of buprenorphine: there are two others, Subutex® and Temgesic®.

Buprenorphine has some disadvantages, though; some are not immediately obvious.  It is unique in its mode of action in that, past a certain point, the duration of the dose will be longer, but diminishing returns in strength will be apparent.  In addition, buprenorphine kicks all other opiates off of their receptors (in effect, it pulls the key out of the lock), and it binds very strongly to opiate receptors once it finds or makes itself a free spot.  This is a mixed advantage and disadvantage; it is tough to overdose, but once a toxic state is reached, good luck fixing it.  The biggest disadvantage is that not every country's medication licencing board has seen fit to approve Suboxone® treatment for pain; it is seen by the FDA, for instance, as purely an addiction treatment—many American doctors disagree though.  The patch, though, is always treated as a pain treatment.

Now, let it here be said that, in the UK, Suboxone® (or a version thereof) is used to treat pain, not just the patches. For marketing reasons, the pain version is called Temgesic® and is priced lower than Suboxone®. Temgesic® is available in 200 µg, 400 µg, and 2 mg versions; Suboxone® is available in 400 µg, 2 mg, and 8 mg versions. Both contain the same ingredients in the same ratios: 4:1 buprenorphine/naloxone.  In Subutex®, no naloxone is included.  Naloxone, also known as Narcan®, is the antidote for morphine poisoning if taken by injection; it will completely reverse the effects of morphine, whether beneficial or harmful.  Narcan® will relieve some effects of morphine and related drugs if taken by mouth—the primary effect it will relieve is that of bowel upset.  

The naloxone is included, not as common myth has us believe, so as to discourage abuse by the intravenous route, but to discourage the primary side-effect of opioids (included in morphine and in oxycodone for the same reasons), namely, difficulties in the lower digestive tract. This is due to buprenorphine binding almost irreversibly to receptors; naloxone will not dislodge it in any way approaching reliable. For pain, Temgesic® is taken four times a day; it is favoured especially in cases of laryngeal malignancy. Canadian doctors have not yet learned of this excellent use of buprenorphine and provide it for that most insidious killer, addiction, only. 

Except Dr Smith, apparently. He put me on buprenorphine for my pain, and I have quickly grown to love it. Sure, it might not offer instant relief, but I'd much rather relief that lasts. Dr Smith, however, was ignorant of the appropriate manner to dose Suboxone in chronic pain; he prescribed it to be used in the time-honoured protocol for addiction management: once per day, supervised. I had issue with this and was permitted to dose it in the British fashion, four times per day, self-supervised. This allows for dose variation, which Dr Smith dislikes intensely, but I favour (narcotics are addictive, after all, and it is nice to take a holiday once in a while). My prescribed dose is 16 mg per day, but I don't take this much as a rule. The most I have ever taken is 8 mg per diem; two halves or four quarters.  My usual dose varies between 4 and 8 mg per diem.

The reason I have grown to love buprenorphine is that it has all the psychological effects of morphine and its sisters; it has qualities of an excellent anti-depressant and anxiolytic, and certainly beats all the synthetics.  No synthetic opiate possesses the excellent quality of morphine, in my opinion.  Some may love methadone, but the green syrup may just drink you up instead of the other way round.  In some situations, buprenorphine is less controlled; this just adds to its appeal, as it's easier to convince a doctor to prescribe it.  Thank God for buprenorphine—I now take no other medication and I am happy this way.  It seems that one's skills are infinitely improved on opiates, for a particularly narrow definition of 'skills': writing, drawing, driving, flying, computer operation, and other sit-down arts of all forms are vastly improved by the added drop of creativity.  Nor is there any sluggishness or motor impairment, as with other drugs.  Opiates are genius in their subtlety—it is sometimes hard to know they're there.

If you ever have the chance of trying buprenorphine or hydromorphone, do it.  You will be very pleasantly surprised.

And the Award for Idiot of the Month Goes To...

Rick Santorum.  From way up here in not-so-snowy Toronto, Ontario, I heard this disgusting sloppy, sucking sound, like a plug being pulled out of a bathtub drain.  "Oh, fuddle-duddle.  Santorum's got his head up his arse again," I thought.  I switched on my telly, changed the channel to the Chicken Noodle Network, and changed my opinion---Santorum's diagnosis was worse.  Much worse.  Not only was Santorum's head up his arse, but so were both his legs... because he had his feet in his mouth again, too.  Now, I know Santorum appeals mainly to those foetus-worshippers and holier-than-thou Jesus freaks who believe that life begins at erection, but what he said this time around was nothing, if not purified, triple-distilled, steam-separated essence of stupidity.

"President Obama wants everybody in America to go to college [university].  What a snob.  There are good, decent men and women who work hard every day and put their skills to the test that aren't taught by some liberal college professor trying to indoctrinate them.  Oh, I understand why he wants you to go to college.  He wants to remake you in his image."  This is what Rick Santorum shat out at a campaign rally in Detroit, before this Super Tuesday.  Santorum is a hypocrite and a liar, since what Obama really said was that each and every American needed to have the opportunity to go to university; all of Santorum's vile offspring certainly study or have studied at accredited institutes of education.  However, suppose we take this at face value.  What's wrong with every youth in America going to university or college?  Does Santorum want to lower the collective intelligence and in other ways ruin one of the greatest countries in the world?  University has always been, and will always be, the benchmark of intelligence and success in this society.  Not that having a skilled trade certification is bad; I look upon it as being equivalent to any other post-secondary specialisation.  It certainly isn't better than being a doctor or lawyer, the way Santorum would have the American people believe.

Read that quote again: "There are good, decent men... [who] work hard every day... that aren't taught by some liberal college professor trying to indoctrinate them."  *sniff* Do I smell something?  Let's measure just how much bullshit has piled up just in that one sentence.  First of all, Mr Santorum, do you seriously mean to say that a welder or a plumber works harder than a doctor, lawyer, or accountant?  If you do, you seriously have another thing coming... dumbfuck.  Yes, that's right, I said dumbfuck.  Second, liberal college professor?  Seriously?  Now, as far as I can understand, liberal in America doesn't mean the same as it does here; we use the word 'liberal' to mean something like your 'Democrat'; you use the word to mean someone almost obscenely left-leaning, like the opposite of the word 'Fascist'.  Not every college professor is a Democrat, so how can you even say that a majority, or even a significant proportion, is 'liberal'?  Last of all, the role of college is not to indoctrinate you.  The role of college is to teach you how to think on your own, so you don't get indoctrinated.  I guess that's what Santorum wants out of America... sheep.  Poor, stupid, blind sheep.

In Tennessee, he went and spouted his mouth-shaped anus off yet again.  "Why does Obama want everybody to go to college?  So his liberal college professors can be indoctrinating people like he was when he was in college.  People need training; they need skills; but they don't need to go to where Barack Obama thinks they should go.  They need to go where their dreams and their heart wants them to go and where their opportunities fit what's best for them."  What if they want to go--gasp!--to college?  What if the great majority of American youth has dreams and hearts calling them off to academia?  Why should they listen to Rick Santorum and not their hearts and dreams?  College shouldn't be for those who are 'gifted'; college should be for everyone who has two brain cells to rub together.  If you think Santorum can ever lay claim to any form of speech other than the deranged ramblings of a tattered mind, try reading this aloud with a straight face: "More education is not necessarily a good thing."  Now, Santorum never said those words together in one sentence like I've written them right here, but that's what his endless blithering basically boils down to.  College indoctrinates people.  To what, believe in literature and maths and the tensile strengths of aluminium, copper, and silver?  Give me a break.  Give America a break, too.

No wonder Santorum has been satirically re-defined on the Internet as an unprintably obscene concept.  Bearing that in mind, I'll go right ahead and print it for you.  Santorum.  Noun.  The frothy mixture of personal lubricant and semen that is commonly the result of anal sex.  Rick, you're full of it, mate.  Full of santorum.  If Rick Santorum did, through some miracle, get the Presidential nomination, so definitive and resounding would his defeat be at the polls that he, as well as the sheep who had thrown their lot in with him, would never see political daylight again.  The simple fact is that the vast majority of American high-school students wish to go to college; even more (I seem to recall the figure being ninety-four per cent.) parents want this for their offspring. American families understand that the work force and the citizens of that great country must take the wheel in order to survive economically as individuals and as a country.  Anyone who says that there is a shortage of youth choosing a four-year university over a technical or trade programme is similarly out of touch.  The real problem is that there aren't enough graduates going either into university and succeeding there, or into a career college and succeeding there also.  America needs to stand and deliver.

Hey, at least we know to whom Santorum's campaign panders: the redneck, uneducated lowest common denominator that is the real problem with America today.  Why don't all the young folk just go fishin' in the water hole with uncle Bubba all day while he tells us about the facts of life; get a little sip o that fine country moonshine? Who needs all that book lurnin' anyhoo, thats for them fancypants libral city folk.  Rick?  Are you listening?

Zany Book Titles

Here's a change from my usually serious political, technological, and medical fare: humour!  Yes, that's right, I said humour.  With a 'u'.  That's the way it's spelled correctly.

So, I was looking through my library the other day.  Yes, I read ink-and-paper books; in the decadent age before Kindles and iSlabs and other ridiculous nonsense like that, that's all we had.  I noticed some titles that seemed to leap out at me from the bookshelf, just like their equally weird and wonderful authors.  Without further ado, here they are:

- Auto Repair for Dummies, by I. Will Fix
- An Introduction to Law, by Dewey, Cheatem, and Howe
- The Economic Impact of Crime, by Robin Banks
- Advanced Mining Safety, by Dinah Mite
- A Textbook On Urinary Lithotomy, by I. P. Freeley
- Sex: The Ins and Outs of the Ins and Outs, by Heywood Jablome
- Elementary Psychiatry, by Lucinda Heade
- Cooking for Breakfast, by Chris P. Bacon
- Hypogonadism in the Adult Male, by Drew P. Wiener
- The Complete Idiot's Guide to Plumbing, by Dwayne Pipe
- Depression: A Medical Overview, by Sarah Tonin
- A Clinical Guide to Neurology, by Sarah Bellum
- Chronic Pain Management, by Moe Fiennes
- An Introduction to Queue Theory, by Yul B. Neckst
- Addiction Therapy, by Hugh Foria
- Gifts for All Occasions, by N. M. T. Bochs
- The Culture of New Orleans, by Marty Graw
- A Guide to Engineered Textiles, by Polly Esther Close

On Government

The United States of America are not a democracy.  They used to be, certainly, but since the middle of the 20th century, everybody seems to rule but the people—the demos in demokratia.  There are a few reasons why, but it all really comes down to the size and power of the American government.

First of all, what the hell is the U.S.A. doing in Syria?  What the hell are they doing in Afghanistan and in Mesopotamia?  Last time I checked, those were independent countries.  There's a civil war going on in Syria;  protestors took up arms against the ancien régime, since it obviously was not treating them right.  The civil war in Syria should remain a civil war; what interests does the U.S.A. have in supporting one side or the other?  America is not the world police.

The problem of Afghanistan would have been resolved in a different way in the 1950s: America would consult the United Nations about the blatant human rights abuses, and it would be up to the United Nations to decide whether action should be taken.  More likely than not, the U.N. would temporarily lend full control of the territory to a particular superpower under a so-called 'mandate' until the problem were resolved.  

In fact, this is precisely what happened after the end of World War I.  The former Ottoman Empire, allied with Germany, Austria-Hungary, and Italy, was embroiled in civil war; the British, naturally, found this convenient, and delivered military aid to the Arab rebels.  The Arab rebels won, and the Ottoman Empire was fractioned up.  The Ottoman Empire, though, was not like the British Empire, in which borders existed and everybody knew what they were.  In the Ottoman Empire, boundaries were so blurred as to have disappeared entirely.  When it was split up, the British knew that, unless boundaries were drawn, the Arabic part of the former empire would engage in infighting; Colonel Lawrence, a young military intelligence officer, was sent in to draw up a map for the partitioning of the land.  To keep things fair, Palestine, Jordan, and Mesopotamia was given to the English, while France got Lebanon and Syria; on average, each lasted about fifteen years before gaining its independence.

Second, drug law needs reform.  I liked the old Pure Food and Drug Act; what's wrong with ensuring that all foods and drugs were adequately labelled with their contents?  However, the Controlled Substance Act is a work of pure stupidity, or evil, or both.  For instance, antidepressants, though they cause withdrawal symptoms far worse than any opiate, are non-controlled, simply because they have no "abuse liability".  In other words, they don't make you feel good.  Even on a non-medical basis, however, controlling the use of substances has no basis.  Before 1914, no country in the world had a law controlling the distribution and possession of drugs, and the world did just fine.

I disagree with recreational drug use, especially of hallucinogens and of marijuana.  However, the problem of addiction is a medical one.  It should be up to the medical establishment to cure the disease, not the government to put miscreants in prison where they mingle with true criminals, like murderers and rapists.  There is such a thing as responsible drug use; if there was no way to use a drug of abuse responsibly, why are so many drugs of abuse used medically in hospital?  Pure morphine is one of the least dangerous medicines available; if it is injected with a clean needle, it will cause zero damage.  The danger is not in recreational use, but in abuse: in some individuals, the use of a particular drug may balloon out of control—the definition of addiction.  Therefore, it is essential to treat these people, without subjecting everybody to harsh criminal punishment.

Third, pull a dollar out of your pocket.  What is this dollar?  Quite simply, it's a promise that the government responsible for its printing has gold or silver on hand to pay the value of the dollar upon request.  If money is printed without procuring the appropriate amount of gold, it's essentially worthless.  Before Pres Nixon cancelled it in the 1970s, there was a simple system in place: one troy ounce of gold cost thirty-five dollars.  Gold, not paper, was the unit of account, and almost all gold in America was held by the Federal government.  Since then, the price of the dollar became a fiftieth of what it had been.

Fourth, what the hell is this affirmative action malarkey?  God, what an exercise in Orwellian double-talk!  If a company refuses to employ, say, those of Polish heritage, it's discrimination.  When the government forces this company to employ so many Polish, it's affirmative action.  Seriously.  It is illegal to discriminate based on race, gender, sexual orientation, or any other one of those arbitrary divisions we've created to carve up the human race... but when the government does so, it isn't discrimination?  If you're hiring for a job, the only discrimination allowed should be based on skill.  

Not only does the government discriminate in jobs, but it discriminates in industry funding.  For instance, there is a government incentive to create ethanol from maize; no such incentive exists for ethanol from sugar-cane.  The free market is a powerful thing.  It derives its power from collective intelligence: the fact that a group of experts will make better decisions together than each of those experts acting alone.  There are several surprising examples of this.  For instance, if a number of people take guesses at the number of jelly beans in a jar, the average of these guesses will almost certainly be very close to the true number, even if some of those guesses were way off.  Alternatively, consider the fact that the stock market managed to find the cause of the Challenger disaster months before the official verdict: an O-ring manufactured by Morton Thiokol.  Last of all, there is the simple fact that in 1920, there were over one hundred automobile manufacturing companies based in the United States of America.  Today, there are four.  Therefore, wouldn't it make more sense to leave it to the free market to determine which solutions are best as alternative fuels?

The people don't rule the U.S.A.; paperwork and offices do.  America is not a democracy; it is a bureaucracy.

A Break-Up eMail... would you believe this was auto-written?

So, here's a break-up eMail I had written by a website... just tick a few boxes when the time comes, and next thing you'll be singing is, "Breaking up is easy to do!"


Dear Bitch,

I'm writing you this email because I think our relationship has run its course. Your arrogance seems to have no limits; it's as if you think you're actually somebody. I know you'll probably tell everyone that you dumped me, because you're a liar. But everyone knows that already, so they won't believe you. You couldn't even pass your exams without cheating; I should have known you'd cheat on me too, prick. It might be hard for you to believe, but one thing I can tell you for sure: you really need to work on your skills in bed. I mean, you're just plain bad at sex. Maybe part of the problem is that you drink so much. You can't actually call gin-flakes or beerios breakfast. I'm fed up with kissing an ashtray and seeing you waste your money on cancer sticks every day. It's disgusting. Doing drugs so much really got in the way of more important things. You need to clean yourself up.

And as if that wasn't enough, you have to criticize me all the time! Now it's my turn to be the critic. I give you one thumb up: stick it up your ass! All that nagging of yours worked, assuming your intent was to get rid of me. At first I couldn't understand what smelled so bad when I spent time with you, but now it's clear: you're spoiled like a piece of meat left out in the sun. You don't live in a soap opera, so quit causing so much drama. I'm not a puppet, you can't just control me by pulling on a string, so why do you try to control everything I do? I need my freedom, and there's nothing you can do about it.

Sorry, but you're not even worth keeping as a friend. It's not you, it's me. Really. You may not have realized, but I saw you with him, you fat-fried hamburger-humper! You may not have realized, but I saw you with her too, you greasy-heeled cunt-sniffer! I never want to see you again, jerkface! Stay away from me or I'll beat you with a frozen salmon. I think you get the idea: this relationship is over.

Enjoy your new freedom, slut!
Dude

If you want to get a taste of the magic yourself, just go to breakupemail.com.  Best thing is, it's simple and free!

Lessons in rugby

Rugby is not something you play just for fun... it's something you feel.  All you have to do is believe in yourself, and just as Webb Ellis did on that day in 1823, take the ball in your arms and run with it.  Half the game, however, happens from the neck up.  Discourage yourself and you will lose within the first ten minutes of play.  However, if you try (and I mean make an honest attempt, not score five points) to win; if you believe in yourself; if you practice; if you dare to become the best—if you show your opponents what you are capable of, in other words, you will win the match from the first kick.

Rugby is an expression of life—a single, glittering thread that reflects the whole.  Like life, rugby is messy and unpredictable, a picture of the instinct of survival.  No matter what you do to control it, it will have its own way with you.  The trick is to experience the moment with a clear mind and an open heart.  If you do that, the game—and life—will take care of itself.

Keep calm... and play rugby.

Republican Candidate Impressions

For the first time in my life, I've been closely following the Republican primary process on television (for any/all Brits reading this, I mean the process by which a candidate is selected to lead an American party).  The reason this is my first time following the primaries, in spite of the fact that I'm a cognoscente of politics, is that it is the political equivalent of watching sausages being made: it's messy.  However, in contrast to the usual 'closed' methods by which candidates are selected in other countries, open primaries almost always produce a party leader who is acceptable to most everyone.  So far for the theories: now for the nitty-gritty.

There are now four candidates in the Republican primaries: Newt Gingrich, Mitt Romney, Rick Santorum, and the old, plodding medical doctor, Ron Paul.  Spkr Gingrich, in my opinion, is absolutely the most qualified to run for President; Gov. Romney seems shifty and avoidant—not good qualities in a politician—although he may simply be anxious when talking about some things (for instance, himself).  Sen. Santorum, a candidate who will certainly drop out of the race soon, simply seems like an also-ran: like a first-grader screaming 'Pick me!  Pick me!', Sen. Santorum just oozes desperation, also something not good to have in a leader.  In fact, I recall him saying something almost exactly like the first-grader almost every time he participates in the debates or makes a speech; the most salient example of this is when, during one speech, he called one candidate (Spkr Gingrich, although Sen. Santorum didn't name names) "too hot", another (Gov. Romney) "too cold", and then went on to imply that he himself is the Goldilocks candidate (just right).

Gov. Romney's 'coldness' (anxiety/deer-in-the-headlights) is a major factor when he debates; one must have his finger on the button to be successful, and he doesn't—his hands hang limply at his sides, so to speak.  The gears simply don't turn at the right speed.  For instance, when Gov. Romney was asked to reveal his tax returns, as did Spkr Gingrich (as well as Mitt's father, Sec. George W. Romney), he waffled, first saying he would "maybe" (politics-ese for 'no') release a tax return, then saying he'd release several of them at once, while sweat glistened on his forehead.  If he's got nothing to hide, then why not release his returns?  More importantly, if he gets shaken by such a simple question, how does he expect to become the world's foremost celebrity (with all the autobiographical questions this entails)?  Another reason Gov. Romney is unelectable is due to a lack of qualifications: Spkr Gingrich and Dr Paul both spent a lifetime in government and can safely call themselves 'politicians', whereas Gov. Romney is a management consultant, a job that pays well but does not provide the appropriate skillset to become a true politician.  In fact, Gov. Romney's chosen career makes him even more unelectable, as management consultancy is a seven-figure salary; Republicans, by and large, are middle-class, and Mitt Romney has, so far, been unable to connect with middle-class voters.

This stands in stark contrast to 'Idea Man' Gingrich.  A schooled-and-raised politician, Spkr Gingrich has no problem in debates, radiating an air of supreme confidence even when questioned on a hard topic, such as his past infidelity.  American Republicans, unlike Anglo-Canadian Conservatives, have a significant portion of so-called 'evangelical', 'born-again', or 'Christian fundie' voters, who have always tended to place more emphasis on a candidate's dirty laundry than on his political worth.  However, on a televised debate, this was all turned on its head when the inevitable question came out, and Spkr Gingrich easily blamed the media: he received a standing ovation.  Owing to the fact that he is a 'mere' politician (which is, after all, what being President is about), Spkr Gingrich has considerably less wealth than Gov. Romney: although this hinders his advertising, it places him on a level field with the middle class of America, his target.  Furthermore, Spkr Gingrich seems to have one idea after another; I swear he must be on some King Hell crank.  Not that that's a bad thing.  America needs someone with ideas to pull it out of the recession.

Then, there's Dr Ron Paul, who certainly seems to be second-best, although as a libertarian (in other words, one who believes government and private life are incompatible), he is, sadly, not taken as seriously as he should be.  Refreshing is the fact that, in contrast to Mitt Romney, whose top campaign sponsors are major financial corporations, Dr Paul's top sponsors are the Army, Navy, and Air Force.  This reflects his stance that America should only go to war with a declaration, a stance that I agree with.