Monday, February 27, 2006


I read, with disbelief, that a drug company in the UK has been suspended from some trade organisation for taking doctors lap dancing. I am struggling to get a bloody biro out of the few drug reps I see. In the old days it was Viagra boxer shorts (surprisingly comfortable, I might add) and big purple zyprexa mugs (labelled with the name of a prominent antipsychotic), nowadays it's slim pickings. Prescribing for heroin dependence apparently isn't as sexy as heart attack prevention. And generally our clients aren't big spenders, because if you can afford to be a big spender you don't go on methadone, you stay "on the hammer".

This is true, by the way. At the moment there is a drought, or so I am reliably informed, of good quality heroin, and has been since about October 2003. This means that my clinic is full of earnest people looking to get (and succeeding in getting) their life together. Crime rates drop, families are reunited, and young lives are saved.

But the distressing truth is if a shipment of weapons grade heroin were to arrive on the docks tomorrow, the next day the clinic would be almost bare.

Anyway, this all got me thinking about the paradox at the heart of all of this. The people we see, the people who come into the clinic, are people who have been free for much of their lives. Their lives have proceeded according to their wishes and plans, not those of others. They have kicked against the pricks, that kind of thing, they seem to see boundaries and expectations as things to be transgressed.

And I'm not trying to romanticise this, as if the methadone clinic is populated exclusively by the fey and the other-worldly. It's not. It's populated by people who didn't stay in school, or didn't get a job, or didn't think that your telly should stay in your house, or who thought that tablets didn't have to be only for sick people - that kind of thing. People who did the things that they (and the rest of us) were told not too.

The word libertine can be used to mean either free-spirited or morally bankrupt, depending on your view a fair few of my clients are libertines.

Anyway - fast forward to now. They sit in the clinic until they are told to come in. They are given doses which I decide of a drug that sometimes the courts order them to take. At any time they may be asked to provide a sample of urine for us to analyse. Frequently a nurse (of the appropriate gender) follows them into the toilet to ensure that the urine is their own.

They must turn up to the clinic at the same time (give or take about an hour) seven days a week. They may thus be restricted from travelling more than a few hours away - travel interstate is extremely difficult, overseas is virtually impossible. After months of demonstrating your trustworthyness, with sequential clean urine samples and demonstrations of impeccable behaviour at all times, they may be granted "take-away" doses... but these can be withdrawn if they misbehave or are ten minutes late for an appointment.

Now, I'm not arguing that these draconian restrictions are unnecessary. In the south where I work we have one of the highest rates of deaths from "diversion" of methadone - methadone is a synthetic "poor man's heroin" and it can be surreptitiously spat out of the mouth into a cup and then injected into the veins for a more marked (but shorter acting) effect.

I have clients who grind up tablets and inject them into their arms, who frequently present to the Florey having taken handfuls of "some tablets I found in this guy's house" - people where if we keep them alive for a year, it's a medical miracle. If I gave these people a months supply of methadone I would be dragging bodies out of the toilets all day.

But the thing that struck me the other day is how the people who could not or would not be constrained, who decided that the things that held the rest of us back would not held them back, they are the ones who have to pee in a pot when someone says. It's almost as if there is only a finite amount of liberty in someone's life - that if you use it all up at the beginning, you end up in the methadone clinic. It doesn't have to be the methadone clinic, of course, you could be in fetters, or in the madhouse - anywhere else where you do what they say.

And the flip side of this, I suppose, is the people who spend their lives obeying and then are eventually rewarded with power and prestige and freedom - and then have to find something to do with it.

So there you go. Spend as much of your liberty as you can when you are young, broadening your mind and so forth, but not so much that you use it all up before you die.

Thanks for listening,



Blogger Prom said...

I don't think that's it at all actually.

I've always felt free. I don't obey laws just because they are there and I don't feel less free because of them.

I tend to do most things my way but the big difference I think is the ability to project out various outcomes of one's actions.

I certainly had access to various drugs including heroin in my youth but picked and chose based on a profound desire to experience things without losing my freedom to the tyranny that is addiction.

5:41 AM  
Blogger Chade said...

"Life is not a journey to the grave with the goal of arriving safely in a prettily preserved body, but rather to skid in sideways in a shower of gravel and party shards; thoroughly used, utterly exhausted, and loudly proclaiming FUCK ME THAT WAS BRILLIANT"

Although, I do believe that there should be a boundary of some kind; a restriction. If one lives their lives too free then they will never know the happiness of freedom earned.

10:36 AM  
Blogger Foilwoman said...

I think one can find a great deal of freedom within constraint. For example, with any craft or sport or game, the more knowledge, skill, and discipline one has, the more one has the ability to do. I think rules give us boundaries and limits within which to test our talents and coping mechanisms. Once we're capable enough, we don't need the limits to protect us, but the eternal id, the toddler seeking immediate gratification that is the drug addict (or my not-soon-enough-to-be-ex) is really not free at all, but imprisoned by need and desire.

1:09 PM  
Blogger Bronze John said...

Probably agree with Prom here - I don't think I put this at all well.

What I was trying to say was something about the fact that people who overstep boundaries early on end up more constrained than the rest of us.

Myself, I don't know why I didn't take drugs. I could say it was terror - terror of addiction, madness, brain damage, that kind of thing. Maybe there was some deep terror of losing control generally, but I really doubt it - I did drink alcohol.

I think the thing is I'm not one of those novelty seekers. You know those reports on 'animals on drugs' where chimpanzees come across fallen fermented fruit and eat it and get drunk?

Well, if you look closely at what happens it seems that not all the chimpanzees try the fruit. Some abstain, some watch and then are more cautious, others rush in, some overindulge and may become habitual fruit abusers. Presumably to end up on some chimpanzee methadone programme.

I'm one of the chimpanzees who watches and tries a bit, but actually consumes to excess very rarely.

And I do feel less constrained than the people I see in the waiting room, and I don't know that I would have felt much more free if, in my youth, I had done more than drink and have one solitary session of marijuana.

9:34 PM  

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