Pain management and ADHD medication

I seem to be stuck in an annoying situation.

Short recap: I have both ADHD and fibromyalgia. These two conditions tend to have a lot of overlap (they are both thought to essentially be dopamine dysregulation issues), and both of them have a “let’s try different things out” treatment regimen.

Because of ADHD I have great difficulty in focusing on my work.

Because of fibromyalgia I have great difficulty in focusing on anything other than pain.

The medications which help me with fibromyalgia preclude me from being prescribed medications which help me with ADHD.

In the past I’ve found oxycodone to help with the most acute fibromyalgia flares, but doctors won’t prescribe it because of the war on opioids and the belief that anyone who uses it must therefore be a drug addict.

Presently I find cannabis (specifically CBD) to be helpful with fibromyaglia in general, but doctors won’t prescribe it because of the war on drugs and the belief that anyone who uses it must therefore be a drug addict.

All of the ADHD medications out there are amphetamines, and will be prescribed but only if someone passes random drug tests which check for opioids and cannabis (among other things). Any trace of those chemicals in one’s blood stream gets them labeled an addict, regardless of actual frequency of use or severity of symptoms being treated.

Of all of the mainline fibromyalgia treatments I’ve tried, none of them have had a lasting effect, and their side effects have been troublesome or even life-threatening.

So my choices are basically: be in pain (and be unable to work), or be unable to focus (and unable to work).

Right now I am tapering off of nortriptyline and am in pain, but I’m avoiding the use of cannabis with the hope that maybe I can try Adderall again when the nortriptyline taper is done with. Not that my use of cannabis has anything to do with whether Adderall is an option or not beyond the legal requirements, but my psychiatrist insists that unless I become and stay “clean” (and holy fuck do I hate that word for it) there’s no way she can prescribe me more.

If Adderall doesn’t work out for me my last-ditch hope is that I can go back to completely self-medicating with cannabis and caffeine. Even though caffeine is just as addictive (in fact, caffeine is the only thing I’ve ever been addicted to!) and has just as bad side effects as amphetamines. But it’s not a controlled substance and is seen as “safe.” But in the meantime, I’m disallowed from using cannabis to help me with my pain until I am cleared to try Adderall again.

Every argument that can be made about most illegal drugs (that isn’t based on their illegality, anyway) can also be made about caffeine. Which isn’t to say that I think caffeine should be banned — but that the other drugs shouldn’t be. Okay, don’t make it a complete free-for-all that just anyone can buy at any time or anything, but there are legitimate medicinal uses of both caffeine and amphetamine, so why not also allow cannabis and opioids? Cannabis, especially, is safe, not particularly addictive (at least not physically), and has plenty of health benefits in terms of both mental and physical health (reduced blood pressure and so on).

What are the problems with opioids that aren’t rooted in their legality? Let’s see. They can kill from an overdose (so can caffeine), they are addictive (so is caffeine), they can be associated with irresponsible behavior like driving while impaired (which people do on caffeine all the time, even if the impairment doesn’t come from caffeine itself)… what am I missing, here? Sure, the drug cartels that manufacture it are a problem, but that’s rooted in its illegality, and even legal caffeine sources have the same damn problems.

Anyway. I am extremely not a fan of how drug use is treated. Why some drugs are considered okay while others aren’t, and how things that people need and rely on are seen as lesser. These attitudes need to change. I’m glad to see more states heading towards legalization or at least decriminalization. Maybe someday they’ll be seen as legitimate treatments and not just an excuse to get high.


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