Anyone who’s ever been prescribed a controlled substance knows the dance all too well: the red tape in psychiatric medicine is a poorly implemented, short-sighted formality at best. At worst, it’s a completely offensive, often humiliating, and even degrading process. While it’s always flattering watching an ego-driven psychiatrist pontificate some frontline fight against humanity’s drug addiction, the reality is much less flattering: No addict on earth is supporting a real drug addiction on mere 30-day supplies. It’s laughable.

Take Adderall as example.

Speed addiction is notoriously excessive and dragon-chasing, occurring over long periods of (sleepless) time. It takes hundreds of milligrams per day to sustain these addictions. Doctor shopping aside, that means a standard 30-day supply may last an addict 2-3 days tops. But ask any stoic psych-provider and you’d think they were single handedly fighting human suffering, terrorism, and crime all in one, simply by resisting your measly 10-count Benzo or Adderall prescription. (10 Topics Never to Tell Your Psychiatrist).

Addiction is a state of perpetual surplus.

Without it, there is simply no addiction possible. While any substance can be abused at any dosage, actual drug addiction requires ten-fold increases in consumption (and supply). Therefore, micromanaging any patient 30-day supply becomes a burdensome formality and text-book act in futility; a potentially offensive gesture lacking constructive follow through.

The truth is, preventing addiction is the only fair responsibility a med-provider has. Which is accomplished with script/dose frequency and script/dose frequency alone. Preventing abuse is impossible, as is being an addict on 30 pills. Only trust can monitor these. So policing any patient, particularly under pretenses of suspicion, will only and inevitably fray social bonds, building mistrust and resentment at the expense of personal offense… all without actually mitigating effective risk. Ignorance like this is dangerous.

What a good med provider won’t tell you…

The formalities imposed are not intended to help or protect you as the patient. They are only there to protect themselves and mitigate presumptuous risk, specifically the meandering burden ever-present between the DEA and their license to practice. Smoke and mirrors. A cute facade. A personal interference.

I once had an ignorant family member confuse chronic mixed-mania with Adderall addiction. While I was rambling through acute madness, this family member was checking my pockets for pill bottles. Without even once asking me for a statement of truth, he took his paranoia directly to my psychiatrist and in weasel-like fashion undermined my entire psychiatric care, pegging me a hopeless drug-seeker. When I confronted him on these treasons, he tried burying it all under the guise of “trying to help”. Meanwhile, my psychiatric management plan was catastrophically damaged. At the benefit of no one.

The seed of ignorance snowballs out of patient control.

Ignorance spreads like the wildfire wind of disease it is. Before I knew what hit me, my trusted med-provider of 2 years was prescribing Adderall in 7-day doses 4 times a month, causing awkward lapses and cumbersome pickups. Between phonecalls and refills, 6 hours were spent per month finagling pharmacy logistics due to this new restriction… all for a 30-day supply of medicine 10 year olds take before social studies class. Simply to appease a budding ignorance I had no part of; To satiate their due-diligence, not mine.

Mind you, nothing in my patient behavior ever indicated any addiction or reason for concern. This includes aggressive weekly in-person visits with a therapist and psychiatrist (up to 8 per month). Weekly weight and blood pressure checks… and “mandatory” urinalysis (drug tests) imposed by the psychiatrist “required for all patients for insurance purposes” (a lie as I later learned). They did everything but finger my prostate… which they accomplished metaphorically instead.

To this day, I refuse to take mandatory drug tests to treat ADHD, and so no longer take these very effective meds. The whole invasive process is completely offensive.

The policing began in response to external ignorance.

The patient cannot control external ignorance, but its threat is still very real. This reality is a dangerous potential every patient faces, and one of the fundamental concepts at the core of Catching Karens entire mission: how to maintain integrity when overwhelmed by ignorance.

In addition to just not being helpful, the new script-restrictions objectively quadrupled my effective co-pay: A 400% increase. All so my med provider could convince herself she wasn’t my drug dealer. And the purpose? Preventing an actual drug addiction? No. We weren’t protecting or empowering anything but absurdity and ignorance.

The patient-provider bond of trust was broken.

Beyond its ineffectiveness, the critical patient-provider bond of trust was completely broken; easily the most tragic part… at a time when patient needed it most. Instead of taking patient word or asking for a statement of truth, patient voice went from empowered to side-stepped to silenced entirely. Ignorant ultimatums were then dictated direct: pick up meds in 7-day increments or get no meds at all (unfortunately, ultimatums like this happen all the time in mental health). This went on for an entire year.

While policing imaginary drug addictions, lithium caused permanent kidney damage (CKD).

While this overzealous med-provider “professionally” policed an imaginary drug addiction, she blatantly missed 2 years of blood tests clearly showing healthy kidneys degrading into stage 1, then stage 2 Chronic Kidney Disease (CKD). All based on a lithium ultimatum (#) she gave me our first day: Treating ADHD requires patient take at least one mood stabilizer. This caused permanent kidney damage, a dangerous oversight I was powerless to. Not even a Google review of feedback was possible. Accountability completely absent.

There exists a startling shortsighted irony: by breaking a 30-day script into four separate 7-day scripts, a med provider actually increases the potential for patient abuse. Indeed, while acute drug abuse (mg per bender) may initially go down, net abuse (benders per month) goes up 4-fold, increasing effective risk. This includes doubling the number of sleepless nights, and increasing risk for manic response exponentially. In other words, one medium bender over two sleepless nights can now be replaced by 4 shorter benders over 4 sleepless nights; effectively increasing net abuse per month. All concepts completely off professional radar.

It’s simple street-math no med provider will address.

The real problem isn’t my damaged kidneys; the larger issue is related to improperly policing patients. While some sort of drug-abuse monitoring should always be present, knit-picking 2nd grade scripts isn’t the solution. Furthermore, any time a med-provider begins policing a patient the working relationship rapidly devolves… This is trust you can’t always get back.

Being your own patient-advocate and quality control officer is crucial: A good patient will always be assessing their psychiatric leadership with great care and critique. While insulting grown professionals is never constructive, a social-system able to hold patient-provider accountable is needed for success. Whenever in a leadership vacuum or arena of misguidance (as is common), it becomes an imperative responsibility of the patient to be the leadership they need. The first step is ensuring you establish an effective patient voice. The second step is making sure you maintain that voice in perpetuity. And through it all, ignorance will be your biggest archnemesis.


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