The holly and the ivy (part two)

So, I sat down to write a post about holly and ivy… And then realised I did that last year… In my defence, I was very ill and very starved so my memories of that period are a bit vague…

That being said, I have got new books and new sources and so on since so I thought I would revisit this seasonal topic anyway, possibly focusing more on the mistletoe instead.

Holly

Holly is a plant of lightening, eternal life and the White Goddess (before it was co-opted by Christianity).  The berries, being scarlet, could be used to repel witches and Pliny the Elder went a step further and said that holly trees around the house prevent sorcery.  Self seeded holly plants would bring good luck as well as protection from storms and fires.

There are two kinds of holly, the male prickly version and the female smoother type, and according to a Derbyshire tradition, they should be brought into the home at the same time.  This would ensure that the year ahead would be prosperous.  If you accidentally brought the male holly in first, the master of the house would have absolute rule in the year ahead and if you brought the female holly in first then the mistress would be in charge.  Despite this, there is also a tradition that says that holly shouldn’t be brought indoors at all.

Whether you decorate your house with holly or not, you shouldn’t harm a holly tree.  One explanation is that holly was the tree on which Jesus was crucified and so hurting the tree would lead to his blood and tears flowing out of the wound.  Another is that holly sprang from Christ’s footsteps.  Holly is also said to be representative of his crown of thorns, the red berries his blood and the white flowers a reminder of purity and his virgin birth.

Ivy

Like holly, ivy has a mixed reputation.  During the 19th and 20th century, some people considered it unlucky and wouldn’t bring it into the house at any point in the year, possibly because ivy is associated with graveyards.

“Anyone who wishes to dream of the devil; should pin four ivy-leaves to the corners of his pillow”
– Cornish Folklore, The Penguin Guide to Superstitions of Britain and Ireland

Other uses for ivy in divination include popping a leaf in your pocket before you leave the home and the first male you see will be your future husband.  Ivy can also be used to foretell death.

Ivy leaves have been recommended as a cure for various ills including corns which could be treated by wrapping the leaf around the corn.  Cups made out of ivy wood were thought to cure whooping cough.

Ivy was said to be sacred to Dionysus and Bacchus, gods of wine, and thus was hung outside inns to show that good wine could be found there.

“In ancient Greece it was called cissos because, according to a mythological legend it was named after the nymph Cissos, who, at a feast of the gods, danced with such joy and abandon before Dionysus that she fell dead from exhaustion at his feet.  Dionysus was so moved by her performance and untimely death, that he turned her body into ivy, a plant which graciously and joyfully entwines and embraces everything near it.”
– Folklore and Symbolism of flowers, Plants and Trees

Ivy growing on a home would protect the inhabitants from witchcraft although if it starts to wither, watch out for disaster, infertility, infidelity or financial problems.

Ivy has become associated with love and fertility, possibly as it clings to all it touches…

Mistletoe

And talking of love… I don’t mean to put you off kissing under the mistletoe but…

The toe of mistletoe meant twig and mistel may be connected to the Germanic word for dung… Possibly because a common belief was that mistletoe didn’t grow from seeds but instead was the result of bird droppings, because it only grows high in trees and never on the ground.

In Scandinavia, we have stories of the gods and the much loved Balder began to have nightmares.  In order to try and ease his fears, his mum, Frigg, stepped in:

“Goddess Frigg made all swear never to harm Balder the god of light, but she overlooked the insignificant mistletoe plant, deeming it too young to swear the oath.  Loki, spirit of evil, gave a mistletoe dart to Hod, the blind god, who, unseeing, threw it and killed Balder.”
– Discovering the Folklore of Plants

The idea of kissing under mistletoe in Britain at Christmas was first reported in 1813 and may well be the result of misunderstanding that dates back to Pliny the Elder in AD77…  With this in mind I’m not going to look at the idea that it has links with paganism and druidy, this is covered in detail elsewhere and may be part of convoluted information initiated by Pliny…  That said, one article I read (I accidentally deleted the link) suggested the shape of mistletoe was reflective of a certain piece of anatomy and thus might be the reason for the link with sexuality and love…

In terms of superstitions and traditions, there are limited associations beyond kissing, however:

“It is considered very unlucky for a house unless some mistletoe is brought in at Christmas.”
– Derbyshire tradition recorded 1871

“If you want to have extra good luck to your dairy, give your bunch of mistletoe to the first cow that calves after New Year’s Day.”
– Yorkshire tradition recorded 1866

“If you hang up mistletoe at Christmas, your house will never be struck by lightening.”
– Staffordshire tradition recorded 1891

In Herefordshire, mistletoe was thought to be associated with dark magic and wouldn’t have been taken into the home lightly or used to encourage kissing.  So think carefully the next time you find yourself under a sprig with someone else…

Resources:

  • The Penguin Guide to the Superstitions of Britain and Ireland
  • Discovering the Folklore of Plants, Margaret Baker
  • Folklore and Symbolism of flowers, Plants and Trees, Ernst and Johanna Lehner
  • Folklore Thursday
Advertisements

Let’s do it like they do on the Discovery Channel…

Whilst my last post focused on sex primarily in a reproductive context, animals have sex for many reasons, just like humans do.  However, “for decades, biologists, anthropologists and psychologists have suppressed inconvenient evidence of homosexual behaviour among the human and nonhuman animals they observed” (Julien Dugnoille).

I’m going to start by looking at same sex activity as it’s one clear thread of evidence that not all animal sex is for reproduction.

There are many more bisexual animals than we tend to think and note I’m saying bisexual because often the animals aren’t solely engaging in same sex activity (which I’m going to say because same sex sex is a mouthful!).  Often, they are also having sex with the opposite sex when the opportunities arise.  The BBC also discusses whether we can claim some animals are homosexual as opposed to bisexual.

Ultimately, these are human enforced labels and as Eric Anderson says:

“Animals don’t do sexual identity.  They just do sex.”

You’ve quite possibly heard about the ‘gay’ penguins in a zoo.  They coupled up and started building their nest and sitting on rocks.  When the zoo realised what was going on, they placed an egg from a female penguin who was struggling to care for it in the nest.  The male penguins successfully incubated and raised the chick.

Same sex dolphins can become partners for life engaging in sexual behaviour, for example males can have a temporary female relationship but will return to the initial male partner afterwards.  Further, two male couples can join up to become a foursome.  One theory is that it helps to have a companion when feeding and resting because they can look out for danger.

Some male greylag geese pair up and when it’s time to raise children, they find a female and raise them together as a trio.  Some don’t but research shows the advantage of a trio; there is better defence against predators, the female has a higher social rank and better chance of survival and the female has more time to devote to her chicks because two males are helping.  After the chicks are raised, the males stay together whilst the female leaves.

In a reverse make up, roughly 2% of oystercatcher breeding groups are made up of two females and one male.  Additionally, up to a quarter of black swan families include parents of the same sex (Scientific American) and in some bird species, males steal eggs from females and raise them in same-sex unions.

Whilst these examples might feel like the exception to the rule, observers have witnessed as many as 1500 species of wild and captive animals engaging in same sex activity.

“Homosexual behaviours is surprisingly common in their animal kingdom.  It may be adaptive- helping animals to get along, maintain fecundity and protect their young.”
– Emily Driscoll, ScientificAmerican.com

Moving on from same sex activity to other non reproductive sexual activity, we find types of fruit bats who engage in oral sex, both female on male and male on female.  There is also masturbation and attempts to mate with the dead…

But what is all this sexual activity about?  Obviously, some sex is about reproduction, but pleasure, bonding and keeping the peace are all reasons for engaging in sex.

Bonding can be important for group species and strong bonds can be very helpful when facing off rivals or seeking protection from other group members.  This bond is also important in maintaining a strong group dynamic and sexual activities can diffuse social tensions.  Another type of bond is that of a parenting couple who may engage in sexual activity to maintain their bond whilst raising their young.

It’s interesting to look at an example, the bonobo.  Bonobos use sex to greet each other, to resolve conflict and for pleasure.  They engage in mutual masturbation, oral sex and penis fencing and are in general a very peaceful species.  Perhaps humans would be more chilled out if we had more sex?

But lets take a second to focus back on masturbation.  As well as humans, many other primates engage in masturbation and this can range from simple stimulation with their hands through to using twigs and leaves and other inanimate objects.  Females have been observed inserting objects into their vaginas and one male orangutan created his own sex toy:

“In one display of sexual ingenuity, a male orangutan created his own ‘sex toy’ using a large leaf, through which he poked a hole with his finger.  He then proceeded to thrust his erect penis through the hole for additional stimulation.”
– Carin Bondar

Sexual activity may also help some animals to reiterate their social hierarchy and may allow individuals to climb the ranks.

In some cases, animals may engage in non reproductive sexual activities such as same sex sex in order to gain sexual experience.  It’s interesting to note that it seems that same sex activity appears to be more common in captivity (although that could just be because its easier to observe), possibly because of a lack of alternative options and greater need for stress release.  In a similar way, you tend to find higher than ‘natural’ rates of same sex activity in prisons.

Time for another example!  Most penguins are not monogamous but it is by turning to Adelie penguins that we really get our eyes opened.  A scientific paper from 1915 had been hidden away for years, labelled not for publication and when it was rediscovered in 2009, it became clear why scientists of the time were reluctant to publicise the observations.

“They were ‘gangs of hooligan cocks’ whose ‘passions seem to have passed beyond their control’ and whose ‘constant acts of depravity’ run the gamut of masturbation, recreational sex and homosexual behaviour to gang rape, necrophilia and paedophilia.  Chicks were ‘sexually misused by these hooligans’, including one who ‘misused it before the very eyes of its parent’.  Strayed chicks were crushed and ‘very often suffer indignity and death at the hands of these hooligan cocks’.”
– Lucy Cooke quoting Dr George Murray Levick

Whilst this all sounds incredibly shocking, there is an explanation.  Adelies get together in October, flooded with hormones and only a few weeks to mate.  Young males are inexperienced and don’t really know what to do or how to act and this can lead to some questionable activity…  In their hormonal eyes, a frozen penguin in the right position can look a lot like an interested female… Apparently necrophilia isn’t just restricted to penguins…  Lucy Cooke references pigeons mounting dead house martins, male house sparrows attempting to mate with dead females and the same going on with a couple of pheasants…

In addition to all of this wonderfully interesting and fun goings on, we have those animals which change sex.

Suggested reading:

Birds do it, bees do it, even educated fleas do it…

Sex in the animal kingdom is vastly more exciting than much of human sex.  Just look at the praying mantis – she literally eats her mate!

The sex lives of animals are just as diverse as the different species are and, despite what some people might have you think, sex in the animal kingdom isn’t just for reproduction.  We can be sure of this because some animals have sex when they aren’t in season and so reproduction is not an option, and others engage in masturbation and same sex sexual activity.  That being said, in this post, I’m going to look at the sex itself and consider other sexual activity in another post.  To start with, let’s take a quick look at how you might attract a mate.

If you’re a male hippo, you might try spraying urine and faeces over the female that’s caught your eye.  A male bowerbird will build an elaborate bower to entice a female.  Other creatures might identify an appropriate male through song or scent or via chemical signals in urine markers.  For sea slugs, it’s a poke between the eyes that gets your partner in the mood…  Violence is also a hallmark for elephant seals, with the male being much bigger than the females.  A male will fight for a beach and then mate with all the females on it.  Whether they want to or not.  Some creatures will even use electricity to try and attract a suitable mate.

In different species, what makes an attractive mate differs.  For female zebra finches, it’s the level of exploratory behaviour that matters whereas for orangutans, it’s all about the males ability to share.  In the orangutan world, a male who shares is important because males can be coercive and sexually violent towards females.

If none of this convinces you of the complex nature of animal sex, perhaps you should check out the leopard slugs mating process, of which there is a handy youtube video.

Lets also take a quick look at pandas; pandas are well known for being terrible at sex but this isn’t the case.  A big issue with breeding in captivity has been trying to pair up same sex pandas and expecting baby pandas…

“The wild panda is a secret stud, fond of threesomes and rough sex… Female pandas prefer the males that can leave their sexy scent marks the highest up a tree.  Scientists have described males adopting a selection of athletic poses – ‘squat’, ‘leg-cock’ and, most remarkably, ‘handstand’ – in order to squirt their pee as high as possible.”
– Lucy Cook

We often assume in the animal kingdom that if monogamy is not the norm for a species, that it’s the male who has multiple partners whilst females have one.  This is not the case.  And biologically it makes sense.  If a female mates with a male and then realises there’s a better male, she’s going to want her babies to come from the second male so they are of the best genetic quality.  Additionally, there is a lot of sexual violence and coercion so the female may have been forced into mating with a male she doesn’t want to reproduce with.  For some males, a gift can entice the female and, in those species, it makes a lot of sense for the female to play the field!

“Female fallow deer deliver only a single offspring per year and therefore have limited chances to get it right.  They often seek the most dominant eligible bachelors for sperm deposits: however if too many females have ‘come-a-calling’ he’s liable to be sperm-depleted or may provide ejaculates with a more limited supply.  With only one offspring per year, it’s vital for females to ensure successful fertilisation, so they often engage in polyandry as a form of insurance.”
– Carin Bondar

When it comes to sex organs, the animal world is also pretty diverse.  Opossoms have bifurcated penises and vaginas which can accommodate these.  Hyena’s clitoris very closely resembles a penis and extends to an impressive 20cm!  The female spotted hyena is the only known mammal with no external vaginal opening, instead they have to urinate, copulate and give birth through the pseudo-penis… Painful!

Looking to the males of the world, we find a beetle with a spiny penis and ducks with corkscrew penises (and females with corkscrew vaginas of course).  Slugs also have corckscrew penises and if they happen to be reluctant to come out again after sex, the partner will just, er, nibble it off…  For the tuberous bush cricket, it’s the testes that cause the problem, taking up most of their abdomen:

“At nearly 14% of their body weight, they are disproportionately large when compared to other species. Just think, a 100kg human would be walking around with 14kg of testicles, which would be mighty uncomfortable.”
Susan Lawler

But if you thought that was mind blowing, wait till you hear about the Drosophila bifurca, or to you and me, a kind of fly.  The male produces 6cm sperm, more than 20 times the length of the male!

We tend to assume that orgasms are strictly a human affair but this isn’t the case at all.  scientists have detected orgasm in many different species including macaques, orangutans, gorillas and chimpanzees, although it should be noted these are generally the males of the species.  Perhaps because most human research about orgasms is about men and so the markers of an orgasm are male centric…  But that’s just this feminist’s ponderings about why…

There are also those animals that never have penis in vagina sex.  For example, African mouthbrooder cichlids reproduce orally.  Males will approach a female who then opens her mouth, which is where she carries her eggs, the male then sprays the eggs with sperm and fertilises them. Females will carry the eggs in her mouth until they hatch…

The argonaut octopus also doesn’t need to have ‘traditional’ sex.  Despite being very sexual, they engage in something called tele-sex where sperm is produced in a specially adapted penis which then detaches from the body and swims off to find a female. This penis then impregnants her and eventually the male regrows a new penis.

In another post I will consider animal sexuality but as a taster of what is to come, consider the whiptail lizards – a species made up entirely of females.  Instead of mating in the conventional way, or as a result of having both sets of organs, they make clones of themselves!  That said, they still need to engage in a mating ritual to stimulate egg production…  As only females are available, they take it in turns to act of the roles of males and females.

All of these weird and wonderful sounding sex lives just scratch the surface of how animals reproduce.  And as sex isn’t confined to reproduction, in another blog post, I’ll be looking more into the types of activity animals engage in without expecting babies to come along.

Suggested reading:

Opioid addiction and chronic pain: How to tell when someone is addicted

Because of the legitimate pain and need for pain relief, identifying when a chronic pain patient is addicted is a very difficult area.  It is common for someone taking opioids to become physically dependant and tolerant of them over time but this isn’t the same as an addiction.  For addiction to be present, you’d expect behavioural changes in addition to the dependence.

The behavioural changes in a person addicted to necessary prescription medication tend to be harder to spot than those in a person addicted to unprescribed substances.  As they have a legitimate need, it’s easier to cover up or explain away possible signs of addiction and some of the sings of addiction are also explained by the chronic pain itself.  However, a cluster of signs can indicate the need for concern and to explore the possibility of someone being addicted.  These signs include:

  • Frequent contact with doctors, whether that’s visits or phone calls
  • Having appointments about a different issue and asking for a prescription at the end of the appointment
  • Doctor shopping – contacting or visiting different doctors so there is less continuity and the person can play the doctors off each other a bit to try and get more opiates.
  • Manipulating care providers
  • Frequently complaining about medical conditions which justify the need for the drug use and which also justify the need for increasing dosages.
  • Complaining about new medical conditions and pain.
  • Reporting certain drug allergies and lack of therapeutic effect of alternative drugs which mean that the opioid is the only option for pain relief.
  • Frequent reports of losing medication and prescriptions.
  • Declining work or school performance
  • Relationship dysfunction
  • Decreased interest in other pain relieving options such as regular physiotherapy and other ‘health’ work needed to improve quality of life
  • Defensiveness when talking about prescriptions.
  • Increased irritability and anxiousness especially about the availability of the drug, when the next dose is etc
  • Overwhelming concern about the amount of medication etc
  • Mood swings, irritability, anxiety etc
  • Concern from friends, family and other observers
  • Insisting on managing own medication, especially in hospital settings
  • Increasing side effects and lack on concern about them
  • Signs of withdrawal

The physical side effects of opiates can also be a warning sign, especially if they seem to be getting worse.  When it comes to opiates, there is a sedative effect which can be seen in confusion, poor judgement, poor memory, drowsiness and unsteadiness.

If the person is open to a discussion, it can be much easier to get an idea about addiction however the caginess that comes with addiction can make this very difficult.  Unless a person is very open with you, these are probably questions best asked by medical professional, or dropped into conversation more as thinking points.  Avoid making it seem like an attack as anyone attacked about any part of themselves is likely to just get defensive.

  • Quantity: Does the person take more medication than needed? Are they taking more than they used to? Are they taking it more frequently?
  • Attitude: Do they want to cut down or stop taking the medication? Are they using the meds despite knowing they are having dangerous effects on their body?
  • Time: Do they spend a lot of time thinking about the drugs and when the next dose can be taken? Do they spend a lot of time getting and using the drug?
  • Social effects: Are they able to manage their responsibilities? Is drug use affecting any of their relationships?  Are they socialising as much as they used to?  Are they withdrawing from activities?  Has their circle of friends changed?
  • Do they get cravings and urges to use the drug?

Again, I want to reiterate that this is a grey area and it’s hard to identify when legitimate use for chronic pain turns into and problem.  It happens slowly and insidiously.

If you or someone you know is addicted to any kind of drug, please seek help and advice.  If you or someone you know is in immediate danger, ring the emergency services.

Opioid addiction and chronic pain: Long term effects

There are a number of common side effects of opiate use including feelings of euphoria, feeling spaced out and ‘high’, and drowsiness.  According to the RCOA, between 50% and 80% of patients in clinical trials experience at least one side effect from opioid therapy.

“Evidence shows that chronic opioid therapy is associated with constipation, sleep-disordered breathing, fractures, hypothalamic-pituitary-adrenal dysregulation, and overdose… Opioid-related adverse effects can cause significant declines in health-related quality of life and increased health care costs.”
A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner’s Guide

To understand the effects of long term use, you need to know that opiates work by depressing everything, including the pain, but also natural bodily functions such as breathing, blood pressure, heart rate and alertness.

Breathing

In terms of breathing, there are a number of ways that opiates affect this vital function.  They slow down your breathing, they are associated with central sleep apnea, atiaxic breathing hypoxemia and carbon dioxide retention.

Let’s bring in some definitions to help explain what these terms actually mean for the patient:

  • Central Sleep Apnea: pauses in breathing while asleep during which the body does not attempt to breathe. A certain number of pauses in sleep are normal but with CSA, the pauses are longer and more frequent and are the result of the brain not sending the right signals to the muscles related to breathing.
  • Ataxic Breathing: an irregular, uncoordinated breathing pattern.
  • Hypoxemia: Low blood oxygen which can cause low oxygen levels in your tissues.
  • Carbon Dioxide Retention: abnormally high levels of carbon dioxide in the blood.

Essentially, breathing is no longer an automatic reflex.  All of these can lead to additional health issues, for example if you aren’t getting enough oxygen there is a risk of brain damage as well as damage to other vital organs.  Deprived of oxygen over a period of time can result in organs shutting down and for some patients, their breathing is so depressed that they fail to wake when they don’t breathe.  It is this, and organ failure, that is behind many opioid overdoses and deaths.

For patients on around the clock opiates for at least six months, sleep disordered breathing issues were found to be as high as 75%, as opposed to 3-20% in the general population.  These effects appear to be related to the dose strength, with ataxic breathing observed in 92% of people taking a morphine equivalent dose of 200mg, 61% of people taking under 200mg and 5% of people not taking opioids.

We will see the effects on the brains performance when we consider the mental effects of long term use.

Gastrointestinal

Just as the breathing system is slowed down, so too is the gastrointestinal system.  The urge to pass stools reduces causing constipation and even impacted bowels.  Opiate use can also cause vomiting, cramping and bloating.

Hormones

One of the things that shocked me when I was looking into the effects of opiates was the impact on the hormonal system.

When you think hormones you tend to think sex so I’m going to start there.  Opiate use can decrease your sex drive, can cause infertility, can cause erectile dysfunction and can cause issues with menstruation.  Fatigue and hot flashes, inappropriate milk production can also occur.

Hormones are also involved in other bodily functions and can affect bone density causing osteoporosis and impaired healing.  Growth hormones, thyroid stimulating hormones and many others are also affected.

Mental

As an organ, your brain is affected and thus your mental wellbeing and functions are impaired.  Opiate use can cause confusion, lack of concentration, drowsiness, depressed alertness, depression and other mental illness.

As the person’s judgement is affected, they can make decisions that they wouldn’t otherwise.  There are impulse control issues as well as impaired insight and issues with reasoning.  Demotivation and apathy can lead to social withdrawal and the persons world can become smaller and smaller.  Moodswings, hostility, increased secrecy and a change in personality can all come about because of opioid use.

Due to the reduced oxygen levels, the brain struggles to perform even basic tasks (such as breathing) and the person can experience agitation and disorientation. Impaired memory is another common effect.

Muscular skeletal

The combination of the confusion and the bone density issues, muscular skeletal issues are common.  Impaired coordination can lead to an increased fall risk, as can dizziness and a sedative effect.  When falls occur, fractures are more likely.

Hyperalgesia

Possibly one of the most counterintuitive effects of long term opioid use is hyperalgesia, that is a heightened sensitivity to pain.  This feels like the most insidious of the effects as it likely leads to more opiate use and makes the whole situation worse…

Pain associated with hyperalgesia tends to be more diffuse than the pre-existing pain and less defined.

Other

Other effects include a reduced immune system responsive, slurred and slow speech, falling asleep mid conversation and not realising it, blackouts and forgetfulness.  Increased sensitivity to sights, sounds and emotions may also be present.  Dry mouth that can cause tooth decay is yet another possible effect as is a suppressed cough reflex.

Whilst one person is unlikely to experience all of these effects, in general the risk increases as the dose increases. Please do not let this put you off taking pain medication that you need, but monitor your use and your mental state and discuss any concerns you have with your doctor.

If you or someone you know is addicted to any kind of drug, please seek help and advice.  If you or someone you know is in immediate danger, ring the emergency services.

Part one: Opioid addiction and chronic pain: Statistics

Opioid addiction and chronic pain: Statistics

There has been a lot in the news about opioid addiction over the last few years, especially in America and primarily about people who have had a legitimate prescription and need for painkillers.  The standard storyline is that someone has an acute injury, has been prescribed opioid painkillers, gets addicted and then takes them without a pain need.  Whilst this common tale is an important one, it can be hard for those of us who have a legitimate need for long term opiates because of chronic pain.  We can find ourselves having to justify our need for pain relief, having that need doubted and minimised, and in some cases have much needed medication stopped.

My position in this debate is a very complicated one.  I use opiates daily.  I can only function because of the pain relief they give me.  I can only write this because of the pain relief.  Even with constant pain relief, I still experience high levels of pain and very reduced function and ability to participate in normal daily tasks.  I strongly defend my use of opioids.  I don’t think I should have to justify my use of them repeatedly and I don’t think I should be treated in a degrading manner when I ask for them.

However.  And this is a big however.

Someone close to me, who has a legitimate need for pain relief, is almost certainly addicted.  And I’m having to watch this person essentially kill themselves.

What happens when someone who needs opioids on a long term basis, for a chronic pain condition, becomes addicted?  It is probably because it is so complicated that this isn’t a story we hear as often.  This story has many parts and I’m hoping to cover them in a few different posts, partly to educate myself about the effects of this addiction and to try and unpick how it happens and what can be done about it.  For confidentiality and privacy, this isn’t going to be the story of the person close to me.

Statistics and definitions

Before we can talk about addiction, we need to try and find a definition for addiction, which turns out to be harder than expected.  It seems that opioid addiction, especially in chronic pain patients, is something that science has yet to agree on a definition for.

What we do know is that physical dependence is not the same as addiction.  Physical dependence is a physiologic adaptation to the continuous presence of certain drugs in the body.  Physical dependence is an expected consequence of prolonged use.  Tolerance to opioids is another expected consequence of long term use and is not a sign of addiction.

Addiction is characterised by behaviours including being unable to control drug use, compulsive use, cravings and using the drug despite knowing it’s harming you.  It cannot be identified on the basis of one event, instead it is necessary to observe a number of behaviours across a period of time.  Where physical dependence and tolerance are expected, predictable responses that occur with persistent use of opioids, addiction is not.

When it comes to defining addiction in the context of patients with chronic pain who are taking opioids, R K Portenoy has suggested the following definition of addiction:

‘‘Addiction is a psychological and behavioural syndrome characterised by evidence of psychological dependence, and evidence of compulsive drug use, and/or evidence of other aberrant drug related behaviours’’

The American Society of Addiction Medicine defines addiction as “a primary, chronic disease of brain reward, motivation, memory and related circuitry.”  The psychological aspect and the compulsive nature are important in helping to figure out the grey area between appropriate use and addiction.  With the latter, there is an intense desire for the drug, loss of control over drug use and compulsive drug use, and continued use despite significant side effects.  As opioids impact the brain and can lead to a temporary feeling of intense pleasure, addiction can develop quickly.

It proved very difficult to identify statistics around addiction amongst people who have chronic pain in the UK so instead I took a look at statistics around opiates and drugs in England and Wales:

  • Around 1 in 12 (8.5%) adults aged 16 to 59 in England and Wales had taken an illicit drug in the year 2016/17
  • In 1993, there were 471 deaths from opioids but by 2017 there were 1985 deaths.
  • 279,793 individuals were in contact with drug and alcohol services in 2016/17, with a majority of them having used opiates.
  • In 2017, there were over 24 million prescriptions of opioids – an increase of 10 million since 2007.
  • Fatalities from the synthetic opioid fentanyl were up by almost 30 per cent in 2017 from the previous year.
  • In 1996, there was one death which mentioned tramadol use but by 2011 there were 154 deaths.

A 2014/15 survey for England and Wales looked at the effects of using prescription opioids which were not prescribed to the user.  Whilst this is something slightly different to my focus, it can show some of the impact of addiction.

  • Overall, 5.4 % of adults aged 16 to 59 years had misused a prescription-only painkiller not prescribed to them
  • People with a long-standing illness or disability were more likely to have misused prescription-only painkillers and to have used an illicit drug in the last year.
    • Among those with a long-standing illness, 8.5 per cent had misused prescription-only painkillers in the last year (compared with 4.8% without an illness) and 11.9 per cent had taken an illicit drug in the last year (compared with 8.1% without an illness).

Basically, in summary, opioid addiction is not rare, it can affect people who have a legitimate pain relief need and it can destroy lives.

In future posts I’m going to take a look at the effects of long term opiate use and abuse, how to tell if you or someone you know is addicted, how the risk of addiction could be managed and how someone who is addicted can be helped.

If you or someone you know is addicted to any kind of drug, please seek help and advice.  If you or someone you know is in immediate danger, ring the emergency services.

Guilty until proven disabled

Guilty until proven disabled

Perpetual fear

Neverending stress

Constant foreboding

And continual dread.

Fight and battle

Battle and fight

Repeat, repeat, repeat…

Misunderstanding.

Invalidating.

Minimising.

Erasing.

YOU. ARE. ABSOLUTELY. FINE.

Disrespected. Intimidated.

Manipulated. Humiliated.

Scrutinised. Patronised.

Head crashing

From the brick wall

You’re bashing against.

Prepare to feel guilty.

Prepare to feel paranoid.

Judged a fraud?

You’re a liar, undeserving.

Judged disabled?

You’re worthless, a burden.

And the trial doesn’t cease

If you pass the tests.

The walls have eyes

And the public are spies.

Perpetual fear

Never-ending stress.

Fight and battle.

Battle and fight.

Repeat

Repeat

Repeat…



Today I spoke at a seminar for International Day of Persons with a Disability.  The event was centred around the benefits system and the experiences of disabled people.  When I was asked to be involved, I started pulling together my thoughts about the benefits system and resulting blog post began to turn into the poem above.

A few snippets from the notes I made when listening to other people at the seminar:

The process and system exacerbates conditions.  It is ineffective.  Inappropriate.  And a waste of time and money.  It does not get disabled people into work and may even move them further away from the world of work.  It is unethical and inefficient.

Failures in the system are plunging people into debt, leaving them unable to buy food, making people reliant on friends and family and charities just so they can survive.

“It just smashes your self-worth.  You’ve got to lend money, you’ve got to beg to borrow… you don’t know when you’re going to get money to pay it back”
– Disabled woman, quoted in an ESRC report

Disabled people are under siege from the very system that should be supporting us.

The DWP are stealing dreams and hopes and futures.