#Pain Management Without Opioids

[cobra-creampuff]

we went over the 14yr long torture session in my last therapy visit actually, and i told her that toward the end i was fantasizing about and then actively considering walking into traffic because if i got catastrophically injured then they would have to treat my pain. and she told me that's not an uncommon thing for people to do. that she has heard that many times before.

like think about that. we are so moralistic about drug use and have politicized a particular type of medicine so much, and doctors are so uncompassionate toward and even suspicious of patients who are in pain because of it, that it's NOT UNCOMMON for people who are otherwise not suicidal to start completely genuinely longing to get hit by a fucking car just for the chance to be oh so graciously provided the absolute bare fucking minimum of care.

think about how many different things have pain as a symptom. how many things have pain as the only symptom the patient is aware of. how many of them are life or death crises. heart attacks. blood clots. strokes. bleeding ulcers. those are just what i can think of off the top of my fucking head, AND I'M NOT A FUCKING DOCTOR.

what i had, for example, feels exactly like appendicitis. and they left it for fourteen years because my only symptom was excruciating pain and i didn't fit their stupid little (completely unsupported by evidence, btw) diagnostic mnemonic. if it had been appendicitis, or anything else as immediately deadly that "just" hurts, i would have fucking died the same night i got sent home from the emergency room with "medical" "advice" to take some tylenol and rest - for the first time, that is. out of dozens. how many people do die that way?

because addicts are Bad. and because doctors are too arrogant and biased to practice medicine on the basis of evidence and informed consent when the profit model and conservative propaganda make it soooo easy to stay in the good old days of paternalism instead.

[thethingything]

so we didn't take any pain meds for like a full day because we weren't in that much pain and only took one dose today (because of period pains, not post-surgery pain, weirdly enough) but before the surgery we were on a much higher dosage because of the pain from the abscesses and not being allowed to use ibuprofen for a while and guess who now has withdrawal symptoms again. holy fuck

[natandacat]

That rheumatologist was likely right that brain fog is inflammation in the brain... theres 0 pain but as soon as i take an nsaid it gets better. Too bad i cant really take nsaids!

[another-punk-trans-woman]

Wishing all doctors a very

PERSCRIBE ME PAINKILLERS PLEASE IM IN AGONY EVERY DAY PLEASE LISTEN TO ME WHEN I SAY IM IN PAIN FOR FUCKS SAKE

Okay, now that I have your attention:

Let's talk about classism and chronic pain, shall we?

I work a very physically demanding job as an automotive technician. In the past year, I've been having more and more issues with the chronic pain I was told would 'work itself out' (direct quote from one of my doctors.)

I've been seeking a diagnosis for a long time now, and each and every 'specialist' or professional has the same thing to say:

"It's because of your job"

And then don't do anything to help me. Then, when I say "Yes, I deal with traditional muscle aches and pains as described by my coworkers, but also have different pain on top of that" They not only continue to refuse help, but go deaf and pretend I didn't say anything.

The 'physical labor causes joint pain in everyone' idea, combined with the stereotype of blue collar workers being 'tough' and able to push through the pain without help means that most doctors won't even be willing to help manage pain, much less look beyond the appearance of the patient to find any further underlying problems. A few months ago, one of my coworkers had a *stroke*, the day after he went to the ER complaining of intermittent chest pain. They told him it was likely he pulled a muscle at work, and didn't bother even hooking him to an EKG.

To make matters worse, labor industries pay isn't great, and insurance is usually even worse. So for every appointment, I am paying out the nose to be told to shut up and that I'm fine.

The absurd notion that blue collar workers are all looking for opioid painkillers (Something a doctor told me right to my face) or are just fine and exaggerating needs to die, before it kills more people.

[macgyvermedical]

Harm Reduction Ideas for Substance Use Disorder

Recently I have been listening to a podcast called The Curbsiders Addiction Medicine. If you are a clinician that works even sometimes with people who use substances (every clinician ever), it is a fantastic look at all the harm reduction practices you can use to make these individuals safer. Plus, you get free CME.

I’m hardly going to do the podcast itself justice with this post, but I wanted to share some things I learned from it:

If the dangers of using substances (social and legal consequences, time commitment, health problems, money problems, etc…) was a deterrent, people wouldn’t be doing it. But it’s not. Because uncontrolled substance use is a chronic disease that generally does not get better without treatment. When people are treated, not only do they generally use less, but they have a much lower chance of death and a much higher chance of a happy, productive life- whatever that means for the patient.

Previously (even a few years ago) we hung such treatment on the requirement that people be abstinent from substances in order to receive help. This works for some people, but far from everyone.

The evidence shows that best thing we can do for many individuals is to make their use safer and less of a burden on their life and health. This is called harm reduction, and it WORKS.

Here are some evidence-based ideas for how to help your patients:

Create a space where you are working together with your patient and following your patient’s lead. Do they want to become abstinent? Great! Do they want to use less or use in a more controlled way? Also great! Do they want to continue use in a safer way? You guessed it, also great! Support them in whatever their goal is

Provide or prescribe safe, clean tools of use. Things like clean needles, Pyrex pipes, and straws. This decreases rates of infection and abscesses

Prescribe medications that reduce cravings or reduce/eliminate withdrawal (methadone, buprenorphine, topiramate, bupropion, naltrexone) without requiring abstinence

Teach people safer use practices and safer routes, such as rectal (booty bumping) or oral (parachuting) instead of injection drug use

Prescribe PrEP if people are at risk of HIV without requiring abstinence

Test for and treat the consequences of substance use (such as HIV and Hep C) without requiring abstinence

Provide fentanyl and xylazine test strips so people know what is in the substances they are using and can adjust doses/use pattern accordingly

Recommend Never Use Alone hotlines to prevent overdose death or better yet, take turns using with a buddy

Prescribe naloxone to anyone who uses any substance- nearly all street drugs are contaminated with synthetic opioids and naloxone is an effective way to prevent deaths

People use substances for a reason, especially early in their journey- pain, coping with depression/other mental illness, ADHD, and social issues like being unhoused. Treat the problem if you can find it, and you can help people significantly decrease use or use in a more controlled way

Be aware that return to use (or return to uncontrolled use) is a thing you can plan for with the patient and manage before it even happens

It’s hard sometimes to change the idea of addiction/substance use disorder as something that can only be treated as a reward for staying sober. But thats why so few people seek treatment for it. The evidence does not equivocate. Harm reduction WORKS.

[sarcasm-is-my-form-of-attack]

Impulsivity

Modern Viktor x Fem! Reader

Your chronic pain has you at the end of your rope as you hopelessly search for something to relieve your pain. Help comes from the most unexpected of places: a walgreens at 9:45 pm.

Reader is mentioned to be an art/theater kid and is also disabled like Viktor and suffers from chronic pain. No use of y/n. Also not proofread we die like redacted

Word count: 4.6K

High key inspired by @meownotgood and @gaybybirth because reading their writing made me want to write again. This is the most self-indulgent thing I've ever written and I'm terrified to post it. But I'm being brave! likes, comments, and reblogs are appreciated! I may make a part 2 depending on how this does. I hope you enjoy!

Pain makes it incredibly hard to think. Even though you're used to it and it's something you feel every day of your life, the burden is still quite heavy. But there is no pity for Atlas, and his shoulders will ache for the rest of time as he holds up the sky without the relief of Tylenol.

So now, you're standing in a Walgreens at 9:42 pm in the pain management aisle, shifting your weight from foot to foot to relieve the pain radiating from your hips to your ankles, trying to pick a topical pain relief gel that will actually work. You've tried most of them here; Bengay, Aspercreme, Biofreeze, Icy Hot, and nothing. Sure, they work for a few weeks but your fucking mutated joke of a body adapts and grows accustomed to whatever you use. The brace you wear on your left knee is itchy and pokes into you through your fleece-lined tights and it's not helping matters.

Giving up on reading the box of Voltaren you're holding, you crouch down to put it back and pick up something else. Your pain-addled brain is piss-poor at making decisions it seems, as the moment you bend, your knee cracks in such a way that a painful heat spreads through your entire body. It was loud too, you know it was. Eyes are staring at you, burning a hole in your head as you wince and grit your teeth against the waves of pain hell-bent on knocking you down.

You feel the urge to collapse, just sit on the floor, and read the labels and boxes there without having to stand, despite how utterly ridiculous you'd look.

"Are you alright?" Your right knee hits the floor as you shift into a kneeling position to look up at the person speaking to you. A long tweed overcoat, a thick red scarf, a cane, nice Oxford shoes, pale skin, worried amber eyes, and tousled brown hair meet your gaze. A man, a very beautiful man is standing a mere three feet from you, eyebrows pinched in concern. You blink a few times, willing yourself to remember how to act like a normal person and not a gobsmacked fool.

"Oh, yeah I uh…" You swallow and gesture wildly to the wall of products, and then visibly deflate "…no there's no way to make a joke out of this. " A laugh slips out, pitiful. You look back up at the man and the corners of his mouth are quirked up at the sides. Thank god, maybe he finds your misfortune endearing.

"They do tend to keep the best products just out of reach, don't they? Nothing at eye level ever seems to be worth your time. Just another cruel joke the health industry plays on the less abled." He looks between the wall of lotions and pills and you, his smile widening.

You smile too, less self-deprecative now and more understanding, "Ah, a fellow health industry hater, amazing. Damn straight, they bleed us dry and expect us to thank them. Greedy schmucks." With one hand on the metal shelf and the strength of your good (better?) knee, you manage to pull yourself into an upright position, even with every nerve in your body screaming at you and your left hip wanting to jump ship, leaving you alone in this sea of agony.

"Just trying to find something that doesn't stop working after a few weeks and also not develop an opioid addiction at the same time." Ah, maybe you could make a few cute jokes that this cuter man will appreciate.

"As one does." He leans both hands on his cane and nods his head conspiratorially. You giggle, you can't help it. Maybe it's the pain-induced delirium or maybe it's because you find the man in front of you incredibly attractive. But who's to say?

"Might I make a recommendation?" His accent is lilting and thick and it feels like every word out of his mouth is wrapped in a velvetine cloth. That metaphor makes no sense, your brain thinks. Shut up, chimes your heart.

"Please. I was about to start considering just chopping off my leg and being done with it." He laughs out loud at that.

"Ah, we've all been there." His attention is pulled back to the shelves and his fingers twitch as he looks for something. He's focused, insanely so, and it makes you feel important, seen. This random stranger, looking for something that will help you with such fervor.

God, it's been a while.

He bends at the waist to grab something off of the second shelf from the bottom and you definitely don't fixate on the way his long fingers curl around a box.

"This is Arnicare. The main ingredient was only legalized here a mere decade ago, it's never failed me thus far." He hands it over to you with a smile. You take it, a little awestruck and make a sincere effort to not freak out over the fact that your fingers brush his own. They're warm, good god.

"Thank you. This is invaluable insider information." You hold the box to your chest in gratitude.

"Of course. Tiger Balm is my favorite but they don't typically sell it in-store due to popular demand. I usually, unfortunately, turn to Amazon to buy it when it's in stock." he continues, putting one hand in his pocket and leaning onto his cane. You nod, making mental notes as you go.

"You are saving my life and my sanity right now. Truly." You pause, and then, with bravery that you didn't know you had-

"I'm (name)." You stick out your right hand, so that way if he chooses to take it, it won't be with the hand using his cane. He stalls for a moment and you fear you've made a horrible fool of yourself, but then he chuckles and shakes your hand gently. You can't get over how warm his hand is, skin soft save for the callouses on his palm and fingertips.

"Viktor. It is nice to meet you." His eyes crinkle as the gentle smile he wears widens.

There's a charged beat where your hands linger a moment longer than what is expected and you laugh it off before letting go. "Sorry, I uh…have been running on far less than the recommended amount of sleep and have been eating meals that do not classify as meals."

"I don't think I have ever gotten the recommended hours of sleep a day in my life."

Your eyebrows shoot up, "Really?"

"Really. I think my blood is 60% espresso at this point. Such is the life of academia." He shrugs as if to say, what can you do?

You look down at the product in your hands, and then back up to him, mind racing in a thousand different directions that all leave you terrified but at the same decision.

"You know, there's a really nice late-night coffee shop in this same shopping complex. Their coffee is the only coffee I confidently drink after 4 pm. Which, is arguably not healthy but, what can you do?" You blurt out, rather impulsively. He's a little shocked, it's clear on his face, but there is still a smile there.

"Are you asking me if I'd like to accompany you to grab coffee at…9:45 pm?" He tilts his head quizzically after checking his watch.

You nod a few times, "Absolutely I am. And maybe it's the fact that my hip hurts so bad and it's prohibiting me from feeling fear but…yeah. Wanna get coffee at 9:45 pm?" He's staring at you incredulously, but it's sweet and amused.

He laughs again, and it's a low, rumbling sound, "I was already planning on getting some kind of caffeine. Sure. I would love to." He's looking at you so intensely, almost like he's studying you. Self-consciousness washes over you suddenly as you realize you've sort of completely derailed whatever he'd been doing.

"Sorry, I didn't mean to interrupt your shopping or your night…"

He shakes his head as if it were impossible to interrupt, "Interrupt my night? My night full of no plans other than grading papers until my eyes bleed? Alone and without the company of a pretty girl? Ah yes, how dare you come between me and those plans." his tone is playful, sarcastic and the nervousness fades from you as quickly as it came. Your eyes narrow.

"Oh, so he thinks I'm pretty?" You grab your purse from off the ground and start to move backward toward the register, and he follows, adjusting his cane and bag sheepishly.

"He does."

"Good because she thinks he's pretty too." You venture quickly before your brain can catch up with your mouth. It only takes a second for him to catch up with you, strolling through the aisles of a near-desolate Walgreens.

"Lucky him."

The cashier at the counter looks as though they'll fall asleep as they bag your items: the Arnicare and a bottle of dark green nail polish. "I swear I'm not typically this impulsive." You call over your shoulder as the cashier hands you the receipt and you stuff your things into your purse. Viktor walks up and puts his items on the counter - allergy medication and a pack of multicolored pens, presumably for grading - and turns to you while fishing out his wallet.

"Somehow, I highly doubt that." He pauses, thinking over his next words, "Not that being impulsive is a bad thing. I could stand to be more impulsive." It's an apology where there doesn't need to be one.

You shrug, "No offense taken, because you're right. I was...just trying to save face."

"Why?"

"Well…" Why were you trying to save face? "I feel, maybe a professor wouldn't be so inclined to hang out with someone so uninhibited? Some people call me childish." As he takes the small bag from the cashier, you find his eyes again, and they are full of mirth.

"Firstly, not a professor. I'm a PhD student at the University not far from here. We, as TA's, usually get saddled with grading assignments and papers." He walks forward with you, letting you walk through the automated doors first, probably so you can lead the way to the coffee shop.

"Secondly, I disagree. Impulsivity does not automatically equate to childishness. Some people say impulsive, I say driven, or passionate. Spontaneity is life." You stare at him unabashedly as you walk. This man, Viktor, waxing poetic about the benefits of impulsivity on your behalf. He's smart, obviously, but not in a haughty I'm Better Than You way. It's refreshing. And while you may not be a traditional academic, you understand to some level.

The cold bites at your skin, and you regret your decision to forgo a jacket, so you shiver when you tell him, "You're incredibly good at making me feel better about myself. I bet your students love you." He laughs at that - you're noticing that you seem to be quite good at making him laugh - and shakes his head disapprovingly

Then, guilty, "Not when I'm assigning pop quizzes after returning from winter break and calling them out for using AI."

"Ok the AI thing I completely understand, but assigning a pop quiz after a break is just cold on so many levels." College wasn't that cruel to you, but there had been many a quiz that you bombed simply because you hadn't been prepared for them. One or two that immediately followed a break.

The coffee shop comes up quickly and you move to open the door, but he's faster, shifting his bag to his elbow and grabbing the door for you as he quips, "Ah, so I see you would've been one of the students who failed that quiz." He's teasing you, and it's working.

"I can neither confirm nor deny. Although don't look at my freshman year grades. They force the art kids to take two semesters of stats and…it was just a fucking torpedo into my GPA."

"Fair enough." His laugh is quickly starting to become one of your favorite sounds.

The warmth of the dimly lit shop is nice, especially after just being out in the cold. It seeps into your bones and mercifully leeches out some of the pain in your hip.

The shop is small, quaint, and its setup reminds you of a library. Secluded booths and tables with individual lamps on them, bookshelves lining the walls, and everything made out of dark wood. Viktor looks around in awe for a moment, then, "How have I never stumbled onto this place before?"

You mentally pat yourself on the back. It had been a few years ago that you'd found this place. After a bit of an insane night out cut short by a friend getting you kicked out of the bar, you frantically searched for food places open late. This place immediately popped up leading you and your friends to feast on pastries and sandwiches washed down by the most delicious coffee you'd ever had.

"I was just lucky. When you're drunk and hungry, you can find anything." You walk towards the back of the shop, picking out a booth in the corner, "Is this ok?"

Viktor nods, hanging his cane off the table and shrugging out of his jacket. There is a moment where you feel you might keel over right there, but it is through sheer power of will that you remain standing, because holy hell this man is attractive. He's wearing a three-quarter sleeve black turtleneck that clings to his body in a way that's not loose, nor is it skin-tight. You can see the barest hint of something underneath, perhaps a back brace to help with stability. Sitting down in the booth, you try to avert your eyes to no avail, as they roam over the dark brown slacks sitting high on his waist. It's a miracle you're not drooling. Staring down at the red, long sleeve sweater you'd paired with a deep brown skirt, you can't help but think we match.

He sits down slowly, and you recognize the strategy to minimize pain, then folds his hands in front of him. "So, freshman year statistics? I believe you called it a 'fucking torpedo'?"

"Of course you picked up on that."

"Well, you were rather emphatic about it." The smugness is radiating off of him in waves and it stokes the fire in your gut.

Huffing, "Not everyone can be a whiz at math and science. I mean, what are you getting your PhD in?"

It looks like he's biting back a shit eating grin, "Biomedical engineering."

"Oh fuck off."

He releases the hold over the grin he was hiding and you're blinded by it. It absolutely makes sense, in retrospect. His analytical gaze, as if taking things apart in his mind and putting them back together, even just the way he speaks, so sure and confident. Your mouth opens to say something but a waitress decides that moment is a prime opportunity to get your drink orders.

Viktor orders a Turkish coffee and you order a French vanilla iced latte with cinnamon. As the waitress leaves, he wrinkles his nose.

"You call that coffee? It is just sugar. And iced? It's freezing out."

"Oh so first you critique my grade in stats, and now you attack my coffee order? You hate me and want me dead." Your arms fold in front of your chest as you stare at him in mock challenge. His hands shift to rest on his biceps, fingers spreading over the evidently lean muscle there and you fight to keep your breathing steady.

"I retract my statement, I bare you no ill will."

"Yeah you better, me and my sugar coffee will beat the shit out of your boiled coffee grounds." Now it's his turn to raise his eyebrows.

"You mock my drink, a traditional drink from my home country? Now you hate me and want me dead."

A warmth pours over your cheeks and you feel it heat the tips of your ears, all the way down to your shoulders. Something flashes in his gaze that tells you he definitely noticed.

"Touche." It's only a minute more before the waitress returns with your orders, said minute filled with meaningful glances and sitting adjustments on your part, your hip still aches slightly, but it's easier to ignore at this point.

You're mid sip when he fixes you with a stare, hands wrapped around his own drink, and asks, "So I can rule out anything to do with statistics, but what do you do, miss (name)? I believe you referred to yourself as an 'art kid'?"

Ah, the tricky part of explaining what you do to an academic. Not to say you weren't an academic yourself, just…a very different flavor of it.

"Yeah. In college I dual majored in Psychology and Theatre Arts. So I feel like I play both sides of the field, despite how many of the other scientists refuse to recognize psychology as a science." You spit the word as if it were a dagger, still holding a vendetta against your 11th-grade physics teacher who called it a pseudo-science.

"But my real love is Theatre. Whether it be Musicals or Shakespeare, it's my passion. I dialect coach on the side to make extra money, but mostly I love performing." There it was, out in the open. Would he call you foolish? Tell you to get a real career? Get up and leave? Probably not, but anxiety can lead you to places you wouldn't dare venture with a gun.

Pensive, he sits, staring at you with renewed interest, "Your impulsivity must suit you well in that career path, always having to think on ones feet and remain immersed in the moment." You instantly smile again.

"Exactly! There have been so many times when people have forgotten their lines and I've had to come up with something on the fly. It's…exhilarating." There's a certain sparkle that lights up your face whenever you talk about theatre, it's your passion, you can't help it. You only hope it translates.

"I know it must seem silly, pursuing the arts. Hell you're probably going to go on to change the world in a field like 'biomedical engineering'." You muse, leaning your cheek into your hand as you meet his eyes. It flatters him, you can tell, as he shifts in his seat, puffing his chest out slightly in pride.

"While I thank you for your vote of enthusiasm, I do not find it silly to pursue the arts at all."

"You don't?"

"No. I find it inspiring that you are pursuing your dream. I am pursuing mine. We should all chase after what we want." His eyes are thoughtful, kind, and you want to swim in them forever.

A beat, then, "A lot of people have called me stupid. But I can't see myself doing anything else. I know it's cheesy to say, but it feels fated. Like, I'm supposed to be doing this. It's what my atoms traveled billions of years to do." Staring into your cup, you're hit with the intensity of this confession. It's not something you tell to most people.

"And…" he clears his throat, "I think it is the most admirable thing one can do, to follow what you believe your destiny to be." Good god you like this man, you like Viktor. Not just as an infatuation or a crush, you want to get to know him.

"Thank you, Viktor." Another sip of your drink and the sugar spurs you onward, "Do you happen to like theatre? I'm sure an English lit class somewhere forced you to read at least one Shakespeare play. They did always seem to make the STEM kids suffer through classic literature as some sort of revenge for putting us art kids through math." His gaze fixes you to your spot and you find that even if you wanted to, you wouldn't be able to pull away from it. It's hypnotizing and has you pinned with the sheer force of it. You were learning that above all else, Viktor had a quiet intensity to him.

"I have read my fair share of Shakespeare as well as a few greek plays, but I admit, I read them mostly from an analytical standpoint, and not for mere enjoyment or to marvel in the artistry. My favorite would probably have to be Macbeth, though." He takes another sip of his coffee that still has steam curling off the top of it.

You nod approvingly, "A splendid choice. Your aesthetic certainly fits the more tragic, macabre, dramatic plays. Though I could see you enjoying Much Ado About Nothing."

"I…thank you?" Eyebrows pinched in confusion, he laughs.

"No, no it's a compliment! You just have a very…dark acedmia, gothic vibe to you. it…it tracks."

He leans back in his seat, "Gothic?"

"Yeah. it's incredibly attractive don't worry."

…

Wait-

"Incredibly attractive you say?" And he's sipping on his coffee again, watching as that all too familiar flush spreads over your skin again. Damn your mouth.

"You…I…hell-" You sip your coffee in an effort to keep yourself quiet. He's making you bolder, making you feel comfortable, loosening your tongue, beckoning you into the sea like a siren and you're not sure if you'll be able to tread water.

"Hey," his voice is soft, coaxing, "for what it is worth, I too find you incredibly attractive. I'm sorry, I did not mean to make you so flustered." The sincerity in his voice has you reeling. Placing your coffee down, you rubs at your cheeks with your hands.

"Somehow, I find it hard to believe you're that sorry when you seem so pleased with yourself watching me flush." You accuse, somewhat parroting what he said about you denying your impulsivity. Now it's his turn to flush, his pale cheeks turning rosey at having being caught.

A comfortable silence washes over the both of you momentarily as you sit with the confessions that have just been made. Well…it's nice to know that the attraction is mutual. Both of your coffee's were near finished by this point, and there was a part of you that regretted how fast you drank it.

"How is your leg?" He breaks the silence after the waitress returns to take away your empty glasses. You roll your hips slightly, testing the tension and how far the pain radiates.

"Mm, better. Could be worse, it's starting to ebb finally, but I'm still planning on slathering that Arnicare you recommended all over my leg and laying in my bed until the pain finally goes away." You conclude, hoping to God that the Arnicare works as well as he's hyping it up. "Maybe go crazy and light a lavender candle."

He's digging something out of his bag as he responds, "I'm glad it is feeling slightly better. I fully endorse the Arnicare, it has helped me immensely over the years and I trust it will help you too." The waitress returns to drop off the check and it's too late that you realize Viktor had been looking for his wallet as he places money in the little booklet and hands it back to her with a soft, "Keep the change."

You stare at him in mock offense.

"What?"

"Don't what me, you didn't even let me attempt-"

"There was no universe in which I was going to let you pay, so why even entertain it?"

"Let me pay? You are evil." But you're smiling as you slide out of the booth.

"Maybe so." Is all he says as he stands up, readjusting his shirt and grabbing for his coat. Checking your watch, you realize it's 10:45 and you've spent nearly an hour with this man, and yet it feels as though it's only been minutes. Bidding goodnight to the workers, you bothexit the shop and are hit with a blast of cold air.

"Why are you…you did not bring a jacket?" Viktor stares at you as if you've grown another head. "Are you…it is below freezing out!"

You pause, and breathe in the crisp cold air, "I like the cold, it's not so bad, I promise I'm ok." But he's already moving to grab the scarf from around his neck and balance his cane on his arm.

"Viktor-"

"Shush." Your mouth shuts and you let him wind the red scarf around your neck. It smells like him, woody and warm and you know you'll be breathing it in later.

"Bláznivá žena." He murmurs in what you can only assume is his mother tongue.

"Well, that didn't sound very nice." You chide. His hands still as he finishes securing the scarf. Whatever he was about to say dies on his lips as he stares down at you. Despite the freezing air swirling around you, everything suddenly feels warm. And you know how cliche it sounds, but truly, it feels as though the world melts away and you are stuck in this little circle of warmth.

He looks from your eyes to your lips, "Can I-"

"Absolutely." You answer far too quickly. He laughs again, and its lighter than the others, as if a weight has been taken off of his chest and the laugh had been filled with air, just waiting to escape.

He wastes no time in bringing his hands up to your wind bitten cheeks and pulling your lips to his. They're slightly chapped, but warm and sure and soft as he kisses you. Your breath is gone and you realize every cheesy thing you've ever read about kisses is true. It is all encompassing and earth-shattering. If you knew anything about physics you would say that it feels like atoms colliding.

Seconds, minutes, hours, you don't know how long it is before you finally detach. You leave your eyes closed for a few seconds more, basking in the feeling.

"Wow." It's barely a whisper when you finally speak, opening your eyes to find him staring down at you, smiling unabashedly.

"My thoughts, exactly." His hands slips down your shoulders before one of them finds your hand, the other taking his cane as he leads you back to the parking lot. It's nice, just walking hand in hand with him to your cars.

"This is me." You murmur sadly as you come upon your car, parked in the handicapped parking spot. He stops and looks at you in disbelief, and you furrow your brows in confusion. His hand detaches from yours, reaching into his pocket and pulling out his car keys, clicking the unlock button. The car parked directly next to your beeps and unlocks. You'd parked right next to one another and you absolutely lose it, doubling over in laughter.

"Oh my god that is crazy."

"Well, given the fact that we both have handicapped stickers-"

"Nope, shush, let me have this." You turn back to him after catching your breath and hold out your hand, "Let me see your phone."

He obliges, even unlocking it for you before dropping it into your waiting hand. With half numb fingers, you input your phone number and contact info before returning it to him.

"To let you know how well your recommendation works." You smile as you head toward your drivers side door, unlocking it and sliding into the seat so quickly, you leave Viktor stunned. He shakes his head in mock annoyance and walks over to your window, tapping on it until you roll it down.

"Yes?" But he's leaning in and kissing you again, stealing the breath right out of your lungs. When he pulls away, you're left just as stunned as he was.

"Nothing, just wanted to say Goodnight." He walks off, gets into his own car, right next to you, and drives off, all while you're sitting in your car, window still down, and processing what just happened as the cold blasts you.

Wordlessly, you roll up your window and smile uncontrollably.

For the first time in your life, you are thankful for your chronic pain.

[crippleprophet]

rules of engagement before we begin: do not seek the original post out to interact with it negatively or harass op in any way. if i find out about anybody doing that sort of shit i’ll block them so quick it’ll be the fastest i’ve moved all year. ok thx here we go

[image description: three screenshots of a post with the username blacked out. the introductory & closing paragraphs are as follows, & the bullet points will be listed within the body of this post. the introduction reads:

nobody warns you this but addiction happens without you noticing and one of the first things that it attacks is your ability to care. if you find yourself using recreational drugs every day, stop and take one day a week sober. if you struggle with this or if you don't see the point of the exercise, you are likely already addicted and you need help.

nobody ever taught me the warning signs for drug addiction, only that "it costs lots of money and destroys your life!!!1" which is not helpful if you can't recognize a developing addiction in yourself. so here's some things to watch out for with recreational drug use.

the conclusion reads: yes this applies to weed. weed is a drug and you can get addicted to it like any other substance. addiction is not the same as physical dependence; it is psychological and it can happen to anyone. you are not immune to addiction. end image description.]

now! fundamentally why i will never align with this kind of perspective is that i affirm addiction as a social construct, like all so-called mental illnesses, & the psychiatric institution which invents & reifies them as a fucking sham.

answer quickly:

what substances is it possible for one to become addicted to? does this include caffeine? why or why not?

is the claim of sugar addiction legitimate or anti-fat pseudoscience? what, if anything, differentiates this from other addiction science?

what is the harm of the so-called opioid epidemic: access to a safe supply of narcotics, or the lack thereof?

can an autistic person who eats the same dinner every night, for example, be said to be “psychologically addicted” to it if they have a meltdown & subsequent ongoing distress + disinterest in food when it is discontinued?

can you be addicted to psychiatric medication? immunosuppressants? why or why not?

my point is less that these behaviors are not indicative of addiction but rather that that wouldn’t inherently make them harmful. fuck it, let’s take it point by point!

planning your day around drugs e.g "i'll give myself an extra half hour before heading out so i can get high first"

this whole post had me asking “literally what is the problem with this,” starting with this first bullet! why does someone need to leave for the grocery store at 5:30 instead of 6, or whatever? and the other recurring theme: what happens if you replace “drugs” with “pain management”? (chronic pain is not the only valid reason to get high—all reasons for drug use are equally value-neutral—but it certainly still is one.) “i’ll give myself an extra half hour before heading out for my pain management to start working” is the kind of calculation familiar to most people with chronic pain. “stop and take one day a week without pain management” is not a test of whether you “need help,” it’s torture.

now, disregarding one’s priorities or commitments to other people in favor of drugs can happen, & in many circumstances it’s harmful to the other people impacted. that’s not what was said here, & stopping that behavior does not require getting sober.

rapidly switching emotions around drugs. you love them but you hate that you love them so much. you hate the way you feel on them but you hate being sober. feeling guilty after using even when you didn't give a crap beforehand.

do you know what else i love but hate that i love, what else i hate using? my fucking bed. three years ago, my mobility scooter. this is not a logical argument, this is a bullshit argument. my feelings about something do not inherently reflect its harm to others – or to myself, even, though i firmly argue for the right to make “self-harmful” decisions regardless.

you know what people hate being on but hate worse being off? the vast fucking majority of medications.

why might a drug user start to feel guilty when they previously didn’t? being shamed by friends, family, or a fucking tumblr post; surpassing a constructed threshold of “acceptable” use they didn’t know they’d internalized; experiencing new or greater access issues; beginning to probe their morality around drugs & unpack things they were taught; experiencing consequences of criminalization; getting triggered.

caring less about spending money. if you are budgeting for drugs like they are food, you are likely prioritizing them more than is healthy.

“if you are budgeting for pain management like it’s as important as food, you are likely prioritizing it more than is healthy.” health is absolutely useless as a value for me anyway, but: the food’s no good if i’m too nauseous or too dead to eat it.

prioritizing drugs over other people’s financial needs is harmful! this wouldn’t happen if food & drugs were provided to people; some people wouldn’t need as many drugs if their needs were met otherwise; people’s needs being met shouldn’t be dependent on their parent / partner / self not using drugs; this harm is not what the bullet says.

getting high to do household chores and other unpleasant things because it would suck less and be more bearable on drugs

“things should suck. because god wills it i said so.”

feeling anxious or restless while sober, not knowing what to do with oneself, feeling lost or ungrounded.

again just. what’s the problem with that. so what if being sober sucks or is boring or stressful or demanding. so what if someone decides to deal with that sober or decides to use more because of that. who gives a shit.

thinking about doing drugs constantly even while sober. maybe it's the first thing you think of when you wake up. maybe when you're bored or otherwise have free time, drugs are one of the first things you can think of to occupy yourself with.

“thinking about getting better pain management constantly when you’re in pain”

i feel like you’re gonna tell me the only thing that can really take my pain away is jesus

again like. what is the problem with doing drugs because you’re bored. why do i need to occupy myself, what, fucking productively?

going to work or school while under the influence, especially if it happens regularly and if you're seeing your performance suffer as a result.

what’s wrong with going to school high. derailing a class discussion is a dick move, maybe, but that’s not inherent to being high. work & performance are both very broad terms – a surgeon or someone operating heavy machinery not being sober is putting others at risk of harm in a way a cashier is not.

the idea of taking a 'tolerance break' sounds good to you until it's actually break time, at which point you can come up with 20 very reasonable sounding points to explain why it wouldn't benefit you actually and you should just keep doing drugs regardless.

y’all think this is incredibly circular logic too right? “drugs are bad, so telling yourself drugs are not bad is proof that they’re bad.” took me right back to the sunday school classroom and i wish i was fucking exaggerating. it’s an argument founded upon the inherent wrongness of trusting yourself – what you want to do must be wrong because you want it. this is one of the points that’s a more solid indicator of, like, “congrats! you’re now in circumstances doctors are salivating to psychiatrize as XYZ Use Disorder,” but that doesn’t make it any less nonsense as a moral argument.

even if you succeed at quitting the drug, you keep your dealer's number on your phone "just in case"

so what. what’s wrong with giving yourself the continual autonomy to choose whether or not to do drugs. what’s wrong with quitting drugs for a while and starting using again.

you pretend to be sober when you aren't. you worry about other people noticing how much time you spend high. you make efforts to hide your drug use or minimize how much other people think you're using. you're scared of other people's judgement if they were to find out.

this one might be the most ludicrous to me, which is really saying something. “if other people being bigoted towards drug users makes you pretend to use less than you do, that’s your fault & not theirs.” cool! thanks for the quick heads up to not believe a word you say!

you have mood swings laced with self-hatred, regret, financial worries, and guilt. these mood swings are then very quickly wiped away by feelings of "but it doesn't matter, i can do what i want, and clearly i'm doing just fine while using drugs frequently". news flash, if you are rapidly switching between feeling numb-ok and hating yourself more than anything because of your drug use, you are mentally ill.

again, “the norm knows you better than you know yourself, you can’t listen to yourself, the body is wrong, wanting is wrong, pleasure is wrong, you are wrong wrong wrong.” but god, what a beautiful example of how oppression is psychiatrized: it’s not enough for the oppression to have worked, the system must then convince us that the effects of it working are our own fault. it’s not enough to just kill us with us fully aware of the knife, it’s gotta convince us we’re bleeding out for no reason. if you want any moments of pleasure during your miserable godforsaken little life you’d better put your nose back on the goddamn grindstone and repent. everything around you for your entire life has told you to hate yourself for your drug use but if the combined force of that violence works you are mentally ill, and that is the worst crime of all.

according to this post, when is it okay to use drugs, then? well, not planned into your day, and not at work or school, but not when you’re bored or have been thinking about it too much, and not if anyone who’d judge you or you don’t trust knowing you’re high or you just don’t want knowing is around, and not if you don’t want to quit, but also not if you’ve quit already. you have to hate your drug use otherwise that’s proof it’s attacked your ability to care but hating your drug use is proof you should stop. #JustSayNo

[justkidneying]

Burns

Burns are pretty horrible, if you ask me, and also very interesting. I'm going to explain the classifications of burns and how to write them.

General Info

The first 48 hours after the burn is the most critical point, and has the most impact on patient outcome

You can use the "rule of nines" to determine the extent or total body surface area (TBSA) of the burn. This is important to assess damage and risks

Burns covering more than 20% of TBSA are pretty fucking bad, and you're gonna probably need some intensive support

This amazing inflammation system we have can lead to shock and the coagulation of the blood = very bad, possible death

A day or so later, the patient may develop acute respiratory syndrome due to inhalation of hot air (depending on the mechanism of injury)

Burn Classifications

Superficial Burns (1st degree)

These are painful, red areas that are not initially blistered

There is not significant worry about electrolyte loss or prognosis

May convert to deeper burns if there is treatment delay or infection

Partial Thickness (2nd degree)

These can be superficial or deep

Superficial 2nd degree burns are blistered, and will look pink and wet

Deep 2nd degree burns are blistered, and will look white and wet. They will also begin to bleed if you mess with them

2nd degree burns are very painful, as nervous structure is still maintained in the skin

Full-thickness Burns (3rd Degree and Up)

These result in a loss of skin structures, such as the hair follicles and sebaceous glands

They can look whitish-yellow or be black/charred

The skin will be hard and dry, and will not bleed if you start messing with it

These aren't as painful, as large areas of the injury will have lost nerve structures

4th degree and up cause damage to tendons, muscles, and bone. These are some of the worst injuries, in my opinion.

Treatment

Deep partial-thickness and full-thickness burns are probably gonna need debrided (removal of unsalvageable tissue). You may even need to cut out some bone if it was burned (otherwise you get necrosis - aka rot). Then some good skin will need to be grafted on top

Nonsteroidal anti-inflammatories (like ibuprofen) and opioids are used in pain management (depending on the severity of the burn). Or you can give ketamine or block nerves if it is really bad

Gonna want to get some fluids in severe burn patients

For full thickness burns, you may have to make escharotomy incisions. This means cutting large incisions in the skin to relieve the pressure made by the formation of eschar (a thick tissue that can constrict blood supply)

There's also fasciotomies, which are incisions in the fascia (connective tissue) of the muscles to allow them to expand and swell without damaging the soft tissue, nerves, and vessels of the arms and legs

A topical antibiotic may be useful, such as silver sulfadiazine. Silver nylon dressings are also a great choice. The burned areas should be cleaned daily, as well

Critical burn patients may need more intervention. They will have difficulty maintaining body temperature, so the room can be heated so they don't get too cold. Usually they can start eating (aka using the GI tract) about a day after injury. But you can start nutrition via IV immediately

Complications

Electrical injuries can cause burns to the deep tissues without significant findings on the skin. They can also cause cardiac arrhythmias

Pancreatitis and stress ulcers occur in severe burns

Abdominal compartment syndrome is a potentially lethal condition in severely burned patients, due to the buildup of pressure

Multiorgan system failure is a possibility

Most burn patients get an infection as some point in their recovery, and many have multiple bacterial infection episodes. If this is not fixed, they can develop sepsis

Writing Burns

Focus on what caused the burn. The mechanism of injury is very important. House fires (smoke inhalation), electrocution (arrhythmia), and chemical burns (leeching into the blood stream) all have different things we need to worry about

Figure out the thickness. The mechanism of injury is important here, as well. Touching a hot stove for a second doesn't give someone 3rd degree burns, but mustard gas can. Look up the specific situation you want and try to find information of that (like pictures, accounts, etc.), as every burn situation is a little different

Figure out what you want treatment to look like. If treatment is a bigger part of the story, give a more severe degree of burn, and throw in some complications. People love that stuff (well, certain people do)

For more severe burns (3rd degree and up), don't fall into the trap that they aren't painful. These injuries are insanely painful. Just because someone does not have sensation in the area that was fully burnt, does not mean the rest of their body is untouched. Burns radiate out into less thick areas. So the edges of the wound will be very painful. Their body is also in a really bad spot, leading to pain that isn't as acute or localized.

[notsocheezy]

V-Day - The First Twenty-Four Hours

Guess who's got two thumbs and no penis? That's right, this girlish-shaped thing!

👍👍

My "the surgery" went off without a hitch! And it couldn't have happened at a weirder time. The news has been absolutely wild this week, hasn't it? Mass Windows system outages, Biden dropping out of the presidential race... probably some other stuff... I'll be honest, I'm a little woozy from the Oxycodone, so a lot of the past week escapes me at the moment. But let me tell you all about the first day. I still remember most of that.

I arrived at the hospital at about 5AM yesterday, and they had me wipe down with CHG wipes even though I'd just taken a CHG shower. I guess they like to be safe. But it leaves a residue that isn't the most pleasant thing in the world. It's kind of like when you step out of the ocean and the salt dries onto your skin in a fine, well-seasoned flaky layer.

After that, they gave me a morphine injection into my spinal fluid, which according to the pain management guy, reduces the overall necessary intake of opiates/opioids (what is the difference between those anyway?). So far that seems to be very true. My new bits don't hurt in the slightest even now, after the injection has worn off.

On the other hand, though, there has been excruciating pain in my chest and shoulders. You see, this was a laparoscopic surgery performed with a fancy robot - the DaVinci XI - and they had to pump me full of CO2 so they'd have room to work. That's right folks - I'm carbonated. And they didn't just give me one new hole, but an additional five incisions on my abdomen, which also don't really hurt but damn are they itchy. It turns out though, being a human balloon is a really bad experience. If I'd had an inflation kink before, this would probably have killed it in its tracks.

When I woke up in Recovery, I was at 10/10 on the pain scale. It was truly miserable. They had to inject me with Fentanyl (Ooooooh, scary!) just so I could breathe. Once they did, though, I was fine. That is, until they moved me onto the bed in my room several hours later. Now the pain comes and goes, but I'm on pills for that.

Other than the chest pain, the most uncomfortable thing is the catheter. It constantly feels like I've just gotten back from a long road trip without pit stops, or the credits just rolled on an IMAX screening of Oppenheimer (I saw that twice, by the way). I have to pee so damn bad, but I'm just kinda... always peeing. Very weird. Nice not to have to get up, but I'm not even really allowed to get up. Which is a shame, because I'm told moving around will help the CO2, ahem, escape. Via the most obvious channel, of course.

On that note, I was on a liquid diet until about an hour ago, and now I've got an omelet and some oatmeal that they forgot to put sugar or salt in. They really want to get my guts up and running again - they gave me a laxative and a stool softener. But I'm nervous about getting up from the bed. I've got more wires attached to me than my PC at home, so I'll need to unhook everything to get to the bathroom.

Anyway, other than being misgendered a concerning amount of times by people who should be able to read the word "vaginoplasty" on my chart, everyone has been very kind. I thought I'd be more scared and depressed being left in the hospital by myself, with all my loved ones hours away, but I've been able to make friends with the nurses.

If you're on the fence about getting this done because you're scared of the recovery process, don't worry. I'm only a day in and I'm doing just fine. Electrolysis was significantly more painful down there than this is. Can't speak for more traditional methods, but the robot is damn good. I, for one, welcome our new robotic sex-change overlords.

Anyway, stay tuned for more. I'm here all week.

[jacensolodjo]

I don't want to be that dude to add a rant onto another post so.

It bothers me when people continue to call House an addict. A dependence on drugs for a legitimate issue is not addiction. His professional and personal problems are not created by an addiction. They're by people not understanding what chronic pain is or chemical dependence. And the fact he's an asshole. And would be a much bigger one WITHOUT THE DRUGS. IS a much bigger asshole WITHOUT THE DRUGS. Because PAIN. Has been an asshole BEFORE drugs.

If you completely cut out the Tritter arc, at no point does House show any real sign of a real addiction. He shows the signs of a man who is not being properly treated for chronic fucking pain.

People in chronic pain on pain management live in constant fear of being called an addict.

House is missing a chunk of muscle. He lives in level 12 out of 10 pain aka agony 24/7. The Vicodin takes the edge off. All of the little sub plots around his chronic pain inevitably fail because then it's a show that isn't all that interesting without the drama of 'addiction' and why he has said 'addiction'. Which is why they slam our heads into it every single season.

Addiction requires abuse of the narcotic. He doesn't get fucking high anymore! He doesn't even chase it! He chases the relief from pain. He takes the narcotics because they help a medical issue.

There are loads of literal medical papers out there written about the whole dependence vs. addiction thing and how harmful it is to patients for them to be called addicts. For addiction to be considered interchangeable/conflated with dependence.

"This conflation originates from the use of the word dependence to describe uncontrolled drug-seeking behaviour in place of addiction in the DSM-III-R, because some lay members of the committee argued that the word addiction was pejorative and the word dependence was more neutral. 'Dependence’ has been easily confused with the term ‘addiction’ when, in fact, the tolerance and withdrawal that previously defined dependence are actually very normal responses to prescribed medications that affect the central nervous system and do not necessarily indicate the presence of an addiction.

Failure to distinguish between addiction and physical dependence can have real-life consequences. People who have difficulty stopping their medications because of withdrawal effects can be accused of addiction or misuse. Misdiagnosis of physical dependence as addiction can also lead to inappropriate management, including referral to 12-step addiction-based detoxification and rehabilitation centres, focusing on psychological aspects of harmful use rather than the physiology of withdrawal."

It should be made clear that dependence is not the same as addiction. The problems with prescribed drug dependence are not restricted to the small minority who are misusing or addicted to these drugs, but to the wider population who are physically dependent on and might not be able easily to stop their medications because of withdrawal effects."

"Physical dependence is when the body requires a specific dose of a particular drug, such as a prescription opioid, in order to prevent withdrawal symptoms. Substance use disorder (SUD), or addiction, is classified as abnormal and is defined by the DSM-52 as a chronic, treatable illness."

"Accurately identifying persons with addiction is critically important for effectively targeting treatment and harm reduction interventions. Misdiagnosis of addictive disorders can lead to a cascade of negative outcomes, including stigma, discontinuation of needed medications, undue scrutiny of both patients and physicians, and even criminal consequences.

Additionally, incorrect diagnosis of addiction can threaten not just patients’ health and ability to function, but their lives. Studies have found that involuntary cessation of opioid pain treatment is associated with triple the risk of overdose death, as well as increased risk of suicidal thoughts and behaviour."

"However, the adaptations associated with drug withdrawal are distinct from the adaptations that result in addiction, which refers to the loss of control over the intense urges to take the drug even at the expense of adverse consequences. [...] Physical dependence is an ordinary biological consequence of taking certain medications for weeks or years— while addiction is continued drug use that persists in the face of negative experience. "

[lifewithchronicpain]

What if I told you that there was a medication that made it possible for my grandma to live at home instead of a nursing home?

And that the same medication allowed my uncle to endure prostate cancer treatments long enough to see his cancer go into remission. And that it helped my mom avoid pneumonia after hip surgery. Or that this medication is the only reason I’m pain-free enough to be able to write this column?

But that’s not all. What if I told you the same medication helps me take care of my cats, as well as the cats at the local animal shelter where I volunteer?

What if I told you that doctors hated this medication? And that many of them also hate anyone who takes it?.

In an age of opioid-phobia, it seems a lot of people – doctors in particular – have forgotten why opioid pain medications like Norco exist in the first place. And why they are such a miracle drug. (Read more at link)

Because of Tramadol I can play with my niece and nephew, foster kittens, do a few manageable hobbies even if I can never work again. I shouldn’t have to fight so hard to have some measure of pain relief when the majority of people who have taken opioids do not get addicted and that risk goes down the longer you take them without any issues.

[twistpixel]

The dug use thing being given a “started as pain management” coat of paint doesn’t bother me because I think those stories shouldn’t be told or anything of the nature it’s just like seems 99% of the sympathy people extend to drug users is that it’s impossible to know if they were one of the (innocent) people who’s doctors deliberately pushed pain meds on them. Like the story of how a pharma corp in the USA was lying about the addictive properties of their products and giving payouts to individual doctors who prescribed mass amounts of them is worth telling but why is it that, or how opioid addiction can happen even in the absence of a structure deliberately designed to funnel patients into addiction, the first thing reached to when trying retell a story about substance use disorder. We live in a world where a parent can’t make a post memorializing their child who passed away from drug overdose without receiving comments about how they deserved it. I don’t think a story about using heroin “just because” is more simple or less complicated or less dramatic or less necessary, to maybe have readers sympathize with a “bad” drug user who “deserved to OD” because like. There are people who think drug users lives don’t have intrinsic worth. Idk

[chronicallycouchbound]

hi I had a question about your cannabis post

i don’t know much about cannabis so sorry if I misunderstand smth

but I don’t understand what “safe” drug use implies,, how can drugs be safe? what’s safe drug use??

i probably have a very narrow view on this topic, so id like to know more

on a different note id like to thank you for your content, I feel that ive learned a lot from this account :)) thanks!!!

(feel free to ignore this)

It’s important to first recognize that more things are drugs than we normally consider: alcohol, tobacco, nicotine, caffeine, cannabis, are all drugs just as much as opiates, benzos, etc. Any medication is a drug.

Any drugs have the ability to be used properly and safely as well as the potential to be used negatively or harmfully. Drugs are morally neutral. Even addiction is morally neutral.

Alcohol can be used to cut loose with friends on the weekend, but it can also be used to cause poisoning. Tobacco can be used to calm down after an argument, but it can also cause cancer. Opiates can be used to manage severe pain, and can also cause overdose.

People have always used drugs historically, and in order to survive, people often need them. Using substances can also not just be medically or recreational, there are spiritual and cultural reasons as well. Some people need substances to manage their emotional or mental needs (especially without supports otherwise).

Any drug can be safe. It’s all in how it’s used, as well as within context.

Safe use looks different for everyone, but personally, I try to encourage methods that are harm reduction focused.

Harm reduction can look like:

• Safe supply of substances to ensure that people are getting unlaced stuff.

• Education so people know how to avoid accidental consequences of their use.

• Access to unused syringes or works to prevent blood borne infections.

• Having a designated driver or trip sitter.

• Sitting with someone while they use in case they have negative effects.

• Access to naloxone/Narcan to reverse opioid overdoses.

• Starting with a lower dose and going slow with use to ensure you’re getting the intended effects.

And harm reduction is so much more than just about substances, it’s things like seatbelts in cars and condoms and STI testing. It’s the lesser of two evils and a primary focus of harm reduction is that it keeps people alive above all else.

Some people like to say “harm reduction keeps people alive long enough to get sober” but I personally feel like sobriety isn’t always the solution for everyone, nor is it accessible to everyone.

But yeah, safe use exists, and most drugs ARE used safely every day. That’s what a pharmacist’s whole job is for.

•

I appreciate this ask, I’m always happy to talk about harm reduction. I co-founded a local harm reduction organization and have done a lot of advocacy around this— everything from reversing ODs, speaking on panels, testifying for bills with the ACLU, training communities on how to administer Naloxone, distributing safe use supplies, etc. I have a lot of personal experience with addiction and feel very passionately about this. I was tired of my friends dying and I just want to make the world a safer place.

[bullet-prooflove]

Help Wanted - Bottles x Reader

Tagging: @proceduralpassion @crazy4chickennuggets @callsignartemis @kmc1989 @darqchilddaydreamz @the-person-in-the-circle @librarian1002 @prettyinpunk85 @thanossexual @@littlestroman @im-just-a-mississippi-girl @lunamoon @s1lverhand @wakeama @adaydreamaway08

When your dad gets sick you pull away from him. Bottles isn’t sure if it’s a self defence mechanism, if you need the brain space or what. All he knows is that you aren’t around, and that you stop picking up his calls. When he goes past your house, it’s dark and locked up. It goes on for a few weeks. The two of you have only been together a few months but the idea of you in pain wounds him, your absence in his life cuts deep.

When he does catch up with you it’s at the supermarket of all places. It’s ridiculous how something as normal as buying toilet roll can turn into a twist of fate. He isn’t looking where he’s going when he comes around the corner of an aisle, and he bumps into you literally. He knows it’s you before he even registers your face, the recognition is instinctive at this point, he’s attuned to your presence. He catches the scent of your perfume, sensual and soft with a hint of mandarin.

You look tired, your hair is pulled back into messy bun and looks like it hasn’t been washed for days. Your face is gaunt and there’s dark shadows underneath your eyes. You are far from the vibrant girl he knows and loves, and it kills him.

“Talk to me.” He requests his hand coming to rest upon your arm, his thumb chasing over the hollow of your wrist. “As a friend, as a lover, I don’t care what.”

It’s at a table, in the outdoor seating area of the café next door, that the whole thing comes pouring out of you. Your dad’s been sick for a while, longer than you realised and you don’t have time anything else in your life right now.

It had started with him calling you at odd hours to ask when Family Fortunes was on, something that he had never done before. Bottles remembers these phone calls vividly, because they always seemed to occur around a similar time on a Saturday. Your phone would ring and the two of you would look at the clock and he’d say “It’s your dad” without even looking at the call display.

At first you had thought he was just lonely, your job as an events manager kept you busy especially with the Santo Padre Summer Festival on the cards. Then one day you’d popped over and discovered he’d had a mini stroke. He’d lost movement in his left hand, he could barely hold the remote, his memory was shot to shit, and he was asking where your mother was despite the fact, she had passed away five years earlier. It was soul destroying.

You are one of the strongest people he knows, so when you start to cry it breaks something deep down inside of him. He shifts seats to the one alongside of you and wraps his arms around you because this shit is far too much for one person to bear. He holds you close as you sob into his chest, cradling you close.

He knows a thing or two about being exhausted and overwrought, how it feels like a weight bearing down on you. After his father died of an opioid overdose, his mother hadn’t been able to get out of bed for weeks. His relationship with both of his parents had been fraught, but he had spent that time taking care of her. He made sure she ate, that she had company and little by little he’d helped pull her out of the depression until she had started to function again. He knows that this shit isn’t easy. That between your job and caring for your father you’re wearing yourself down, he can see in your eyes how your struggling to cope.

“Let me help.” He asks you. “Please just let me help you.”

He must catch you in a moment of complete weakness because you agree.

The first time Bottles turns up at your father’s house, the old man thinks he’s one of the in-house nurses that he’s managed to run off. There’s been a couple of them so far and none of stuck around more than a few days. After spending a couple of hours with your father he can see why.

He’s a veteran, he used to be a Captain. People like that hate anyone to seeing them vulnerable, so they lash out. Bottles thinks that’s part of the reason he didn’t tell you about the mini stroke in the first place, he didn’t want to shift this burden onto your shoulders.

Albert or rather Bertie, is not kind with his words but Bottles has lived through worse. He’s entire life has been far from a walk in the park and he’s now a Prospect in the Mayans. Your father is a cake walk compared to that. He isn’t sure how it happened but the three of you slip into a routine. You’ve taken as many days as you can away from work, so Bottles steps in to cover the time you’re away. He cooks for Bertie, he helps bathe him, cleans him up and changes the sheets if he doesn’t make it to the bathroom in time, he does as much of the heavy lifting as he can until Bertie starts to get a little better.

When you come home, he shoots out and deals with club business. At night, he curls up around you in your single bed, holding your close and whispering tender words into your ear until you fall sleep, surrounded by Blink 182 posters and Evanescence playing on the C.D player because he’d forgotten that they’d even existed. He switches it up with a couple of Green Day C.Ds after he’s flicked through your collection.

“There’s no money you know.” Bertie tells him one day when the two of them are in the living room watching Family Fortunes. It takes Bottles a minute to understand what he’s saying. “She doesn’t get much if I die. That’s why you’re here isn’t it?”

“I’m not here for the money.” He informs Bertie as he raises to his feet and collects Bertie’s bowl from the tray set across his lap and places it inside his own. “I’m here for her, to make sure she takes care of herself.”

“I used to take care of her and now she takes care of me, how fucked up is that?” Bertie says in a rare moment of clarity. “I fucking hate it.”

Bottles can understand that. Parents are God in the eyes of children, and this is what happens when you realise that they’re just mere mortals like the rest of you. He knows how jarring this whole experience has been for you, and for Bertie. Confronting your own mortality changes you, he knows, he spent his entire childhood, thinking he was going to die every time he went under the knife because a child with a disability wasn’t good enough for his parents. He sets the bowls down on the floor beside his usual chair before sitting down again.

“I had forty-six surgeries by the time I was eighteen,” He confides to Bertie, pulling up his trouser leg and showing your father his scars embedded deep within the tissue of his leg. “Suffering isn’t new to me, you can’t imagine the shit I’ve gone through, and I can’t imagine the shit you are going through but I know what it’s like to feel like your life isn’t your own, to feel frustrated by your own capabilities.”

 “I don’t want this for her.” Bertie tells Bottles.  “I don’t want her putting her life on hold to take care of me and I don’t want to end up in one of those homes where they feed you gruel and leave you to die alone in a bedroom where the curtains are still drawn because nobody bothered to open them.”

“I hear you.” Bottles says. “It’s fucking depressing.”

“So, what are my options?” Bertie asks him. “I rely on my daughter and her… What even are you?”

Bottles shrugs his shoulders because truthfully the two of you have never really put a label on it.  All he knows is he’s committed to you; he has been since the moment he kissed you on your doorstep.

“The man who loves your daughter.”

“Boyfriend? Partner? The guy who hoses me down when I make a mess of myself?”

Bottles finds himself smiling before he shrugs his shoulders.

“All of the above.”

“I’m serious when I’m asking you what my options are.” Bertie informs him, his gaze straying back to the T.V. “I need to start figuring shit out before I start losing my marbles and the decision is taken away from me.”

“I could find out.” Bottles offers as he leans in close. It feels like the two of them are engaging in a conspiracy, because the both of them know that the idea of putting your father in a home is not something you agree with. “One of the guys in my club, his mom has memory issues. She started to fall down a lot. He managed to get her into this sweet place up by the community centre. She loves it there, she’s made a lot of friends, there’s all these clubs she goes too, they do some pretty cool shit. I could look into it for you?”

Bertie reaches across the space between the two of them, his strong hand grasping Bottles’.

“Could you?” Bertie requests before he tilts his head to the bedroom door where you’re sleeping. “I have a feeling we’re gonna have a fight on our hands.”

"I'll talk to her." Bottles promises the older man. "See if we can't all get on the same page."

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Like My Work? - Why Not Buy Me A Coffee

[scientia-rex]

Ageism is Bad

If I had a nickel for every time a patient comes in with an issue and says, "Maybe it's just that I'm getting old," I'd have way too many nickels.

Here's the thing. Maybe! Maybe it's a direct consequence of aging. Your body will change with time, guaranteed. If you live long enough, like into your 60s, you'll get osteoarthritis, the "wear and tear" arthritis we're all most familiar with. Your skin will start to thin as your body stops making collagen and elastin, and in addition to making you wrinkly, that also has the actual health consequence of making your skin easier to tear and harder to heal. If we lived to be 120, we'd all get Alzheimer's. If we lived to be 150, everyone's kidneys would completely fail.

But there are so many disorders that can be manageable, if not curable. Things we can treat, things where we can slow down progression, things where we can minimize symptom burden. Just because you have osteoarthritis doesn't mean we can't try to tackle the pain, without opioids in most cases. And if you have pain that's changed dramatically in a fairly short period of time, maybe, in addition to the typical diseases of aging, your immune system finally Xeroxed something one too many times and you have rheumatoid arthritis, where you make antibodies against your own joint lining. Maybe you have polymyalgia rheumatica. Maybe you have dermatomyositis. And if you don't tell me about it, or if you do tell your doctor but they brush you off with "oh, that's just getting old for you!", then you're suffering unnecessarily.

There is more than enough suffering in being human and being alive that we can't alleviate. Why wouldn't we try to help where we can?

[emmis15]

Daryl's Three favorite memories.

1-

Daryl Dixon might be a very closed off person with a receptive but unfriendly personality, but even with his bad attitude or rude way of relating to his surroundings, he somehow managed to hit the jackpot amidst the walking dead and the pain.

Katherine Sánchez, the girl he met on the farm, was different from the prejudices that he had already placed on her shoulders. To think that just because of her last name or her millionaire family in New York that she would be a privileged and stupid girl was far from who she was, and one of the first nights we were all together, she could see it.

—I never said being a drug addict is a good thing, don't put words in my mouth. I'm just criticizing how you think people become addicts. It's a Disney fantasy to say 'bad people are addicts' or 'people with no future' because it's false and totally uninformed, especially for a cop. Did you know that overprescribing opioids for every damn physical problem created an entire generation of addicts, right?—Kat asked Shane as she took a long sip from the bottle of red wine.

We were all sitting around a campfire in front of Hershel's house; he was inside sleeping while his daughters, except for Beth who was inside, were outside with us. Kat was next to Maggie, who was glued to Glenn, and that made me laugh because his red face from alcohol and skin-to-skin contact with that girl made him look like a tomato. But I stopped making fun of him to listen to the conversation.

—That's what liberals say, it's the only future, more or less with money or without money, for low-income people and a very normal reality for them, girl. ¿Have you ever seen what those neighborhoods are like?—He asked her, looking at her seriously.

—No, but if you put two neurons together, people addicted to opioids, after they stop using them because they couldn't get them anymore and the authorities shut them down instead of helping them because, I repeat, THEY CAUSED THE PROBLEM they'll seek that feeling elsewhere and end up in those neighborhoods. People with incredible futures or normal people who, I don't know, break a leg, for example, end up dead from using crack or steroids.

—¿And what about the people who sell them? Drug traffickers and distributors, what happens to them? Are they good people for giving them what they need? Because I'm pretty sure those types of people aren't normal or people who got into that million-dollar business that takes lives just because they broke their damn legs or something. —Shane responded.

She sighed heavily as she shook her head. I straightened up and stopped leaning against the tree to look at her; the whole group was silent as we watched them.

—And the economic problems of this shit society and monetary organization, plus the crises we go through, don't ring a bell to you? It's much easier to sell drugs without experience than to get another job. Plus, it pays the bills and supports families, but in the same way, it discards people as if they were nothing, since putting drug dealers in prison doesn't achieve anything because it's a whole organization.

—Maybe you have a point in that, but anyway, it's better to lock up a person than to let them go when they do something against the law.

—¿And what about helping them? You were supposed to be a cop and "help people." ¿Do you think these people were there by their own choice? ¿Do you think they woke up one day and said, 'I want to sell drugs'? This isn't like Breaking Bad.

—Girl, I'm a cop, not the president. I just lock up the bad people and save the good ones. End of story.

—That's very black and white, and life isn't like that. We're gray; you can't lock people up just because they resorted to the last thing they had to feed their families. And believe me, I know you're a cop, and not much can be done, but that's where morality comes in, or thinking with your head instead of brutality. ¿Why not help people for something better and dismantle organizations? Or something simpler, ¿instead of locking up drug-addicted people on the street, take them to a hospital or clinics? Something that actually helps them.

—Why does it bother you so much, girl? I just made a joke, and everyone laughed. ¿Can't you just laugh and forget?

—No, because that's not right, since from your privileged and problem-free point of view, you think only bad people among the poor are addicts and will end up living under a damn bridge. But it's not like that. I know I was very, very privileged in life before all this shit happened, even with that, with not lacking anything and never having to worry about money, I ended up in the same boat as the addicts.

I raised an eyebrow at that; it was odd for a privileged person to defend my previous usual situation with my brother or my neighborhood, but now everything closed when she said that.

—¿To what?" I asked her seriously, leaning my elbows against my knees.

—Adderall and antipsychotics. Now I'm fine because it was like a year ago, but anyway, he can't be such a bastard to say that, and it surprises me that he's a cop, although I don't know why I do it since cops are fucking shit—she said, getting up and taking the half-empty bottle with her.

We all stopped looking at her when she disappeared into the darkness to look at Maggie, her friend since they were kids.

—Her parents pressured her to be perfect in everything she did, so she pretended to have ADHD and schizophrenia in front of a psychiatrist to get those prescribed medications after coming to the conclusion that being at the top of success cost a price. She stopped her pills when I found out, and we noticed that it was killing her, but it's still a recent wound, and besides, Kat has always been an advocate for the poor—Maggie explained as she took a long sip of water, looking at the fire.

I got up from the ground and walked the same steps where Kat's body had gone, leaving me standing in the middle of the backyard near the barn, watching her from afar sitting against the poorly painted and old wooden planks at the back with her legs to her chest and continuously taking sips while looking at the moon.

—For a mommy and daddy's girl, you turned out pretty real—I said as I approached her.

—It doesn't matter who provides you with sperm or who gives birth to you; What matters is who raises you and with what mentality those people show you the world— her gaze never left the moon

—¿Butlers and nannies?

—Workers like cooks or cleaners, my mother's assistant and just a nanny. All immigrants because 'people from difficult countries create workers who don't complain', according to my parents—she said with disgust in his voice. —I don't agree at all with what my parents did or with what they thought they had in their heads, besides it seems shitty to me that those people raised me and never had good pay for their extra work.

—The black sheep of the family, it seems—I said with a laugh in my voice.

—My parents' favorite, in case you didn't notice—the sarcasm in her voice made me laugh.

We stayed silent for a long time, both of us looking at the clear sky, enjoying the cold air.

—My brother was an addict, but he was a bad person.

—¿Didn't he make it out?

—¿Get here? No, he was even in the group before he came here and remained an addict. The pills Glenn brought were his.

—¿Did he become one of those bastards or did he go out as a lone wolf?

I chuckled at the latter.

—Rick handcuffed him to the roof of a building, and when I went to look for him, he had cut off his hand to escape — I said as I grabbed the bottle and took a long swig.

—Police brutality doesn't even wane in an apocalypse, it's not surprising, to be honest — her lips pursed.

—I don't know if he's alive, but at least I know that only one Dixon kills another Dixon.

—My father told me that once, only a Sanchez can bring down another Sanchez. He was talking about our empire as the second-largest bank in the United States and our generational wealth, but I think it applies.

We both fell silent, staring at the stars and the moon with the empty bottle between us.

Daryl thought a lot about that memory when he was trapped by Negan, thinking about Kat and how they had thought the best thing that ever happened to him helped him not to think about the images of Glenn or the loud music that deafened him, he just kept reliving moments, but that was one of his favorites.

Hello, this is my first job, and I'm not a native English speaker, so if there's any mistake, please let me know respectfully, and I hope you like it <3

(I want to clarify that I am not an expert on the topic of drugs or anything related. Everything the character says is based on the research I conducted about reality. If there is anything wrong with the topics discussed, please let me know with all due respect so that I can avoid problems and prevent causing negative feelings for others who may feel attacked by the subject matter)