base2 

https://www.sciencemag.org/news/2016/05/why-taking-morphine-oxycodone-can-sometimes-make-pain-worse

The danger, is peoples definition of "normal life" changes in response to perceived pain. That's the abuse hook that snags normal people into junkie-dom. Both points can be true at the same time.

I don't otherwise disagree with anything else you have wtitten. Defensive, maybe?

jackrippah

Some people actually need pain meds for more than 3 days. People who simply can not function well enough to get through a day without the meds. Who have to maintain a household - take care of the kids - make a living. I believe most rational people don't want or need two serious problems and stop use, as you said 'as soon as I (they) could' . Perhaps I am naive but I believe that most ordinary people who are taking opioids long enough for them to become addicted are in a box created by their medical problem and a poor pharmaceutical solution for survival which slowly become less and less effective. I don't believe that they are morally weak. I think that they are being failed by the current state of the art/science medical art. Not their lack of taking personal responsibility for taking a medication. Just an opinion.

KraneXL

Junkies are junkies from the start, and there are precursors that should be apparent to any competent healthcare practitioner. It really doesn't matter the compounds they use.

Is everybody that drinks an alcoholic? Because some people abuse it should we stop its manufacture? Seems like we would have learned our lesson about prohibition by now. Yet we just continue to follow the same ineffective pattern time and time again.

canklecat

You were doing so well until the final ad hominem. But if we're swapping references to studies published in credible journals, perhaps it' not out of line to challenge our motivations if the goal is to refine opinions rather than to simply discourage conversation.

Yeah, I've read various studies that investigate the possibility that routinely taking analgesics may actually prolong chronic pain.

There are similar studies suggesting a rebound effect for OTC NSAIDs. Several pop culture magazines for athletes recommend we don't take ibuprofen or aspirin after a workout because it may interfere with prostaglandins. However these pop culture publications tend to oversimplify the original studies to the point of being useless and even harmful. The cautions to avoid NSAIDs regarding prostaglandins are aimed at peak condition athletes who are trying to optimize their workouts. For a competitive athlete in their 20s-early 30s in sports where victories are decided by nths of a second or degree, it's valid to look for every possible edge.

It's not at all equivalent to tell a 60something cycling enthusiast to refrain from taking ibuprofen for chronic inflammation caused by arthritis, old and new injuries and chronic pain that isn't receptive to alternatives.

My main complaint about the current anti-opiate hysteria is that it lacks context, is based on hysteria, and lacks sensible solutions.

For example, a responsible medical approach would evaluate benefits vs risks for each individual patient. If a patient complains of pain that isn't responsive to OTC analgesics after 10 days, a responsible medical approach would involve an evaluation. Ask the patients about their histories with alcohol, prescription and non-prescription drugs and recreational drugs. Weigh factors that might be contributing to pain, such as situational and emotional stress -- does the patient have a supportive or non-supportive home and work environment? Loss of income due to disabilities?

Is the patient willing to submit to the same record keeping expected of any medical professional who dispenses opiates? For example, when a nurse dispenses a prescription pain med to a hospitalized patient, every dose is carefully recorded. So it's reasonable for a doctor to reach an agreement with the patient to encourage responsible use of self-administered home prescriptions. Ask the patient to keep a pain journal and note everything taken for pain, from NSAIDs to topical analgesics to massage to prescription pain meds. Review it regularly. If the patient appears to be taking the prescription pain meds appropriately they may be granted less supervision over time.

But that isn't being done now. At every medical appointment this year (and there have been many since I was hit by a car in May), I'm asked about my pain level. I tell them honestly, without exaggeration. They note it and completely ignore it. When I specifically ask for a refill of as few as 10 pills, they say no, they aren't allowed to anymore. Take more ibuprofen. The irony is that years ago the doctors told me to take less ibuprofen because of risks to my stomach, rebound effect, aggravation of my psoriasis and psoriatic arthritis (yup, ibuprofen can actually aggravate those symptoms). Now they're telling me to take 2400-3200 mg of ibuprofen a day, a ridiculous amount that's far higher than I ever took when they used to tell me to take less.

It has nothing to do with curbing addiction and overdoses. It has nothing to do with patient care. It's strictly about preserving the licenses and certifications for doctors and health care organizations.

That part of the system is broken right now.

Only one nurse has actually responded, during my recent intake exam with the VA. She asked about my routine pain level. I tell her it's never less than 3-5 since my back and neck were broken in a 2001 car wreck. I can cope with that chronic pain without any special meds. I have for nearly 20 years. I use ibuprofen, topical analgesics (Stopain roll-on is terrific stuff), warm/cold packs, soaks in a hot bath with epsom salts, massages, etc.

So she asks about my current pain due to the shoulder and neck injury. I tell her it's a 6 at the moment, often 7-8 in the middle of the night, enough to prevent sleeping or most ordinary activities including the bike rides I used to enjoy. She looked at me and said "That's a lot. This has been going on for months and your other health care provider did nothing?" So the VA promptly referred me to another doctor and their own pain management clinic and phsical therapy clinic. That's how it should be done.

As I've said many times in these discussions, junkies spoil everything. They have their own issues that are completely different from the vast majority of patients who are dealing with pain. The current main risk is from black market fentanyl, not oxycontin which was more of a risk 10-15 years ago, and certainly not from Tramadol or even the older hydrocodone. Even heroin has paled in comparison with the risk of black market fentanyl.

But we're all being treated like junkies. That's why the system is broken.

base2 

Here again, I don't disagree with you. Everything you have said about the state of the industry is true, & I agree that it is broken. Everybody knows it. So much so there's t.v. shows about doctors who defy the odds to better serve their patients despite the system. Ref: Bones, House, New Amsterdam, et al.

And that shot in the dark? It wasn't baseless ad hominem. I've made no accusations towards you. Nor have I made any judgements on you either. You are, however, very obviously defensive about your pain management. The disproportionate amount of testimony you have written to support your claim is evidence of how strongly you feel on this topic. Your logical fallacy is argument from emotion.

Anecdote: I've watched my father-in-law, who has breathing problems descend and climb out of opioid use for years depending on what doctor he can convince of what ailment. I've watched him sell "The good stuff" to his sister. It's all free, insurance & the VA pays for it...besides, he really, really believes he is in pain, too. Funny, he magically comes alive & feels better a week after the pills run out. So on comes a new ailment & a new batch of doctors. Based on 20 years of knowing him, the doctors are right to cut him off. He also really, really believes he needs the stuff.

The system is broken, but it's not the doctors, it's the insurance companies, the drug manufacturers, & their relationship to eachother. The lobbying/marketing/special treats/bribery to the doctors ought to be illegal. People who NEED shouldn't be left wanting. Sorry I touched a nerve, I wasn't even thinking of you when I did the first post & you've done an awful lot of writing on what I can only guess you think my position "must" be...Whatever that is. That I'm a "pray it out" doctor-rejecting, religious purist? A "man-up, bro" macho persona? Maybe a super leftie "chemicals! Ack!" cartoon person? I really dunno. What version of me lives in your head? I'm actually, genuinely curious.

Truth be told, my father-in-law is getting old, and when he has the pills, he doesn't care. He just sits.

Hondo Gravel

canklecat

Thanks for the feedback, that helps me see your perspective too. I think if you'd said "advocate" rather than defensive I'd have reacted differently. But the intent would be the same, despite the words. I have strong opinions on the topic because before my own recent bout with with pain I was the primary caregiver for three consecutive older family members since the early 1990s. Before then in the 1970s-early '80s I worked in health care (mostly dialysis, some operating room and other patient care experiences). I have a lot of experience with patients who are experiencing legitimate pain.

And, over the past decade being around a lot of older and disabled folks I've seen some situations that could be considered misuse of prescription pain meds and recreational drugs and drinking. Even at this relatively later stage in life (I'm 60 now) I was surprised to see how little some people change with age. If folks were scamps, rascals, ruffians, ne'er-do-wells, druggies and drunks when they were younger, they probably won't improve with age. They only get a little slower, need less to get wasted, and their drunken/drugged threats can usually be safely ignored. And I realize our local public hospital, where I'm also a patient, is chock full of these folks.

But I've also learned to not jump to assumptions and conclusions about the pain levels other folks claim to be suffering.

For 11 years I was my mom's caregiver. I took over that role unexpectedly and somewhat reluctantly. I had just finished a 15 year stint as caregiver for my grandparents, who died 10 years apart. They weren't terribly difficult patients, and were fortunate to have a modest but reliable retirement income and very good insurance, so all their basic needs were met. Grandmother used small amounts of hydrocodone for years and it helped. She remained remarkably independent and was active around her home and garden until age 89. My granddad used hydrocodone less often and mostly preferred old school remedies from his youth -- stuff like BC powders, Doan's pills, anything that was familiar from years ago. I know he was in pain but he preferred to be grumpy than to be drugged.

So I could continue working full time, while aides and housekeepers visited for a couple of hours a day. But after helping settle their estate sale I was ready to move on to something completely different. Anything other than health care.

But my mom's case was completely different and far more demanding. Besides disabling physical issues she was also in the early stages of dementia, which gradually worsened over the decade. She had a lot of chronic pain, but wasn't a good candidate for much physical therapy or exercise. The best she could do was putter around home, use her walker to get the mail and visit neighbors, that sort of thing.

And she was a recovering alcoholic, who quit around 1988 and never had a relapse. Because of her sobriety she was reluctant to use any opiates, so for awhile she declined refills of Tramadol back when doctors had the discretion to refill those routinely without government nannies interfering with medical professionals. But after two knee replacement and one shoulder replacement surgery, and worsening problems with lifelong scoliosis and lordosis, she was in chronic pain. But she rarely used the full prescribed dose of 3 Tramadol a day and often went 45-60 days between refill requests for a 30 day supply. In particular her best neurologist encouraged her to make good use of the pain relievers to ease the pain so she could get up and move around during the day. That particular neurologist was very good about reminding her that the purpose of prescription pain meds was to enable patients to function more normally, not to just sit around in a drugged stupor all day. Mom was pretty good about heeding that advice.

So her doctor knew she was a safe bet and low risk patient, despite her history of alcoholism. And while mom reacted strongly to anesthesia and morphine in the hospital (hallucinations and disorientation lasting for weeks), she never experienced any side effects from the small amounts of Tramadol she used. It seemed to meet all of the claims from the European studies I'd read years ago.

For awhile she had visiting home health aides and nurses, but lost the Medicaid funding for those a few years ago. Frankly I wasn't sorry to see them go. Some of them were grossly incompetent or lazy -- there are no licensing standards or experience requirements for unskilled aides in Texas. The nurses filled mom's daily prescription reminder box, but some of them got it very wrong and I had to check and redo it anyway. Some of the aides tried to get into mom's meds, so I had to hide or lock the meds away.

In December her femur broke spontaneously while she was walking in the kitchen. Fortunately she wasn't further injured in the fall. I palpated the area and thought the titanium knee joint had come apart. Mom thought the femur itself had broken above the knee. Turns out she was right. She was surprisingly calm after the initial shock and was pretty calm and quiet after a couple of minutes while we waited for the ambulance. They gave her fentanyl for pain, which is a wonder drug for severe pain when administered correctly by professionals. It worked very quickly, lasted only 20-30 minutes and mom wasn't confused, disoriented or hallucinating as she had done under morphine and other anesthetics.

That experienced relieved my doubts about whether my mom occasionally exaggerated her pain level descriptions. During doctor's visits she'd describe her pain level as 7-8 and I thought "Nah, it can't be that bad," but I didn't say anything. Turns out she had a pretty high tolerance for pain so when she complained it meant she was in serious discomfort. When I saw how bad the femur break was, yet she had cried for only a minute or two, I realized she was much tougher than I'd given her credit for. The paramedics said the same thing -- they see patients in severe pain who don't admit it.

But after the femur repair surgery mom's dementia worsened badly and she never really recovered. She's been in a nursing home all year and probably won't be able to live at home again.

I didn't expect to have my own first-hand experience with being a "geriatric" patient with chronic pain, but life doesn't care about our plans. I was hit by a car in May and that changed everything. I have a little different perspective on the issue now.

At the ER the staff said the shoulder break and dislocation were pretty bad and offered morphine. I laughed and said, nah, just a Tramadol or hydrocodone will be enough. I might be in more pain in a day or so when the swelling and inflammation kicked in. But for that moment the pain wasn't too bad. They gave me one pill but said the morphine was available that night if I needed it.

The only other times I've had any prescription pain meds, I used them very little. After a couple of dental surgeries I used hydrocodone for only two or three days, and returned to work the next day. I finally threw out the unused pills a year or two later. When my back and neck were broken in 2001 I had a month's supply of oxycontin. That lasted me for 10 years. I took it very rarely and didn't like the sensation -- it was an effective pain reliever but made my skin crawl and itch.

Anyway, there should be ways for medical professionals to evaluate patients individually for pain management, and up until around 2015 they were still able to -- although they rarely actually did a full patient profile to do risk assessment, usage patterns (days, times, circumstances when pain meds were needed, to help identify effective treatment, etc.).

Now my disabled neighbors who have histories of substance abuse get no meds for legitimate pain. I understand the reluctance of medical professionals to risk their licenses and certifications over high risk patients. But the current approach doesn't solve any problems. It only shifts the burden. I've seen some neighbors who had been sober return to drinking heavily again to cope with pain. This creates a burden for other neighbors who don't cause problems. Some of them hang out in the parking lots of nearby convenience stores and gas stations hoping to score something to ease the pain. It's a sad sight, seeing people in their 70s and older begging for dope. I don't know what the solution is for that.

I've tried anything I could find that's legal. Luckily the kratom I mentioned in another lengthy post helps. I can function, do housework and laundry, do my physical therapy, etc. I use it only a couple of times a week when the pain is pretty bad. I don't ride my bike outside on those days, but do use my indoor trainer. Exercise boosts my natural body chemistry's pain relievers and often the best I feel is the 2-4 hours after exercising and riding my bike. Unfortunately it's short-lived. The body doesn't know or care where the pain relief comes from, whether exercise induced or externally administered.

Frankly it's an inferior solution. But it's the best we have for now.

canklecat

Yup. A week or so ago while riding the bus to and from my medical appointments, I overheard a couple of guys my age who go to the same health care system. They were talking about taking advantage of the system by exaggerating their pain. Then they'll resell the meds for a ridiculous profit, like $10-$20 per pill for something that cost them anywhere from $20 per bottle to zero, depending on their copay with Medicaid, etc.

These guys were the cliched grifters everyone thinks of when they hear about druggies and abuse of the medical system. Pissed me off so much I had to restrain myself from fussing at them or just pepper spraying them both as soon as they stepped off the bus so they'd have some real pain to complain about.

Reminded me of a former neighbor, an ex-con who was so broken down by age 50 he wasn't fit for the prison system. So they paroled him out to our apartment complex where he continued his druggie ways, including his scuzzy associates who broke into the mailboxes and other apartments. They made him our problem. And when he started failing his drug tests, he sabotaged his own health to avoid going back to prison. During the day he'd go around in a wheelchair, with his swollen, bloody bare feet showing, acting like he was disoriented, stuttering like he'd had a stroke. Late at night when most people were asleep or gone, he'd walk around, talk normally and brag about getting high. He was angling for a transfer to an assisted living facility to get more benefits and access to more suckers.

For the umpteenth time I'll say it -- junkies ruin everything. Fortunately guys like that are *not* representative of most disabled seniors I've met who have legit chronic pain. (And I don't consider myself disabled or a "senior". I don't care what the label on my medical chart says. I'm not "geriatric".)

Hondo Gravel

Biker395 

800 mg of Advil works about as good as the standard opioids for me, and with no constipation. Easy choice.

Colnago Mixte

These pain killer regulations are part of the "Do Something About the Opioid Crisis" mindset. Since the authorities can't do anything much to stop illegal opioid abuse, why not go after the people who are using them legally? After all, that's much easier and cheaper than rounding up a bunch of junkies and throwing them in jail. And it shows how much our government really cares about us, and how it is looking out for what conventional wisdom currently thinks is in our best interests.

The bottom line: It's hard as hell to get a pain pill prescription filled. Wow, the thrill of victory over over the Opioid Crisis that was growing in leaps and bounds, until the government wisely stepped in.

KraneXL

Depends on the type and level of the pain you have: muscle soreness vs arthritis vs a broken leg, for example. Advil (ibuprofen) works fine on the pain associated with inflammation. Acetaminophen (Tylenol) or aspirin work better on common headaches. Aspirin is also an anti-inflammatory, so it can go either way.

However, the pain mentioned above is typically many times greater than these typical ailments -- think of taking Advil for relief of pain from a broken leg or kidney stones -- a Level 4 pain compared to a Level 10 pain. These types and other high level nerve induced pains, which OTCs have no effect on. Politician managed healthcare. Do we even need doctors?

Hondo Gravel

Dudelsack 

As a GI guy I will say we've seen a dramatic spike in bleeding ulcers, what with the use of NSAIDs and demonization of PPIs. We'll also see an increase in interstitial nephritis.

Opioid addiction is a problem.

I think some of it is an expression of meaningless in our culture. Most of us live pretty pointless lives, or at least that's what we think. And yes, we will see a huge black market for tramadol and hydrocodone.

That's all I gots to say about that, Jenny.

Biker395 

I was taking Advil for post-surgical pain from reconstruction of my tibial plateau. I was astounded how well it worked (I actually took only 600 mg). I've been told I have a rather high pain threshold, but without the Advil, the pain was quite strong. I've actually had eight (!) surgeries in my life and have needed fewer medications than most. Lucky, I guess.

Drug addiction mystifies me. I regard it as quite complex with a lot of contributing factors. It will take a better man than me to figure it out.

As for me, I take them only when absolutely necessary and only as much as necessary.

tyrion

Don't leave home without it.

tyrion

Good news: the makers of oxycodone have patented a drug to help people stop taking oxycodone.

https://www.rollingstone.com/culture...atment-722646/

canklecat

Pain thresholds are a mystery to me. Even after working in health care for years I still don't know why humans experience pain so differently.

I've had chronic neck pain for 17 years since the first time I was hit by a car, and the recent car-smacking aggravated the neck and added shoulder pain that's barely relieved after 5 months. On the worst days nothing helps other than oral opiates like Tramadol, hydrocodone or cyclobenzaprine. No amount of ibuprofen helps because it's not an inflammation that's receptive to NSAIDs. A local anti-inflammatory injection several weeks ago did help a bit, but only around the shoulder blade, not the side or front of the shoulder, or neck.

But last year I had a minor self-induced bicycle crash, busted up my ribs, and never went to the doctor or took anything stronger than ibuprofen after the first couple of days when cyclobenzaprine muscle relaxer helped me sleep. I was up and riding my bike again in two days. The ribs didn't stop hurting completely for six weeks, but that was mostly a problem in bed trying to roll over or get up. It didn't really hinder other activities.

I crashed a few times when I was younger, racing crits and just commuting. Never took anything stronger than aspirin or acetaminophen.

About 20 years ago my left forefinger was crushed in a machine and the first joint was nearly amputated, just dangling from a bit of flesh, tendons and ligaments. X-ray showed the fingertip was crushed into seven pieces. The ER splinted it. I never took anything stronger than ibuprofen. It healed a bit crooked with the nail still overlapping in two layers, but is mostly fine. A little tingly and numb in cold weather.

At age 15 I was peening some metal for a project and something cracked and slipped out of the vise. Whacked my own little finger with the hammer, splitting the skin down to the bone. It was just numb. I didn't bother telling anyone about it, just poured on some peroxide, bandaged it with antibiotic ointment and it healed with barely a scar within a couple of days.

I've known people who needed opiates for pain when they had injured fingers and toes because of the concentration of nerves. My two finger injuries didn't seem that bad to me.

I've had severe headaches since childhood. The pain is indescribable, and resistant to OTC analgesics and oral opiates. Whenever I've heard people complain about having a "bad headache" yet they're still functioning and not bent over the toilet retching, I can't understand what they're talking about. To folks who suffer from migraines, cluster headaches, trigeminal neuralgia, nummular parietal headache and similarly severe head pain, a headache means total incapacitation. You can't see straight, can't walk without dizziness, feel nauseated, can't get comfortable in any position, and even resort to bizarre rituals such as pinching or punching yourself to distract from the pain.

Nothing helped, until I was in college and was diagnosed with migraines after being taken to the ER. Doctors tried cafergot (ergotamine and caffeine, an older remedy that's obsolete but still available), which only worked sometimes and mostly made me slightly nauseous. Later a neurologist tried preventive meds like tricyclics, valproic acid and beta blockers, which seemed to help a bit more in reducing the frequency and severity. When Imitrex self-injection kits were available my insurance covered a box full of 'em for a $5 copay and that really helped, although it caused an erratic heartbeat -- palpitations or afib, I don't remember which. But when your brain is exploding you don't care about the minor needle stick or side effects. Later another neurologist thought it might be cluster headaches rather than migraines -- and it turned out decongestants like Sudafed and nasal sprays helped, which seems to fit one theory for cluster headaches. Yet another doctor said it seemed more like trigeminal neuralgia and injected a topical anesthetic into the gum and scalp, which completely relieved the pain within minutes and lasted for hours. Some doctors use botox for the same reason.

It would be great if someone concocted an effective analgesic that wasn't addictive and didn't have serious side effects such as respiratory depression. But right now the anti-opiate hysteria would overwhelm any constructive solutions to pain management. The so-called pain management clinic at our local public health system is just an insurance scam, a way to milk more money from Medicare/Medicaid and private insurance, while doing little or nothing to actually help patients. I applied in May. It's mid-September and I still haven't received an appointment with pain management. Even when patients are accepted, three appointments spread out over 6-8 weeks are required before they receive any treatment. Meanwhile patients pay their copays, insurance pays the rest, and the first two appointments are nothing but "consultations" to reschedule the next consultation.

Anyone who's in serious pain will find alternatives.

It's reminiscent of the late 1980s-mid 1990s AIDS issue, when constructive activists were opposed by hysterical factions who were more interesting in demonizing the disease and those who suffered from it than in finding a cure or vaccine. Most of the folks I knew of personally who got it were in health care and got it the same way health care workers are exposed to hepatitis and other blood borne diseases.

JohnDThompson 

There is a difference between physiological accommodation and addiction. People who take opioids for a long time, e.g. cancer patients among others, become physiologically accommodated to the opioid in that higher doses are required over time to obtain adequate relief. A physiologically accommodated person can routinely use and tolerate an opiate dose that would cause serious respiratory depression or even death in an opiate-naïve person, and abruptly stopping their opiates would cause physiological withdrawal. But physiological withdrawal symptoms do not mean addiction. Addiction is a psychological issue in which the person seeks the opiate or other drug for non-medical reasons and it must be treated separately from physiological withdrawal or else there is a high risk of recidivism.

Hondo Gravel

Colnago Mixte

A lot of times, especially on really hot days, when you get to the top of a steep climb and begin your descent, it feels almost identical to having guzzled way too many cold beers, way too fast, on an empty stomach. Fortunately, on a bike you still have your reflexes, unlike with beer. But it sure feels similar, maybe that's why so many drunks are also cyclists, that and losing licenses from DUI's.

PhoenixBiker 

I live in southwestern West Virginia, a region that is home to several counties high on the list for annual opioid deaths. In the city where I live, we once had 30 opioid overdoses in a single day. Suffice to say I'm sensitive to the damage opioids can do. When I had spine surgery, the doctors sent me home with a prescription for Vicodin. I took one, and it worked. When the pain got bad again, I tried Tylenol. It worked, too. From then on, I took Tylenol and threw the rest of the Vicodin away.

Two years ago, I was in the hospital recuperating from a stem-cell transplant. I got a searing headache, and asked the nurse for some Tylenol. She said she couldn't give it to me because of a potential interaction with some of the other meds, but she could give me Oxycodone. I passed and told her I'd just suck it up. That's how scared of that stuff I am.

Colnago Mixte

My understanding is that a lot of these overdoes are not from the actual opiates, it's mega-doses of the additives like Ibuprofen and acetaminophen (both can kill in high doses) that build up in the systems of people taking 20 or 30 pills a day to satisfy their opiate addiction. Someone correct me if I'm wrong here, but opiates alone are much harder to overdose on.

KraneXL

Same for me to all accounts. If I'm at home I suffer in silence, but if I have to go out I can't deal with extraneous issues and fight the pain at the same time.
As to addictions, I suspect these they have to do with personality, mental fortitude, life experiences, and perhaps maybe genetics to some extent? In any event, I've never experience any euphoria from pain killers (although Valium was relaxing), that would make me crave for more. All I get is a reduction in the level of pain.

canklecat

I'm not convinced that addiction is due to personality, mental fortitude, determination or anything we can control.

I come from an extended family where alcoholism and addiction are too common. Both of my maternal grandparents were alcoholics. So was my mom. My younger brother showed some worrying signs of substance abuse, although he seemed to straighten up after he got married. He died fairly young in an accident unrelated to alcohol or drugs. Many of my cousins are alcoholics and druggies, some also with mental health issues.

Whatever it is that snared them skipped me. I dabbled in all the same stuff they did. Some of it was fun. But it was never appealing enough to become the primary focus of my life. There were always other things I enjoyed more. I quit using recreational drugs in my teens. I've always enjoyed beer and a few alcoholic drinks but rarely drank more than 2-3 on any day, and usually didn't drink even a little every day.

When my thyroid suddenly failed earlier this year I realized I wasn't metabolizing alcohol anymore. A single beer would result in sick hangover sensations within an hour. So I just quit drinking beer, at least until the thyroid problem is resolved. I still have some really good beer in the fridge but haven't been tempted to drink it. I'll save it in case a friend visits.

Same with cigarettes. I enjoyed smoking occasionally, especially cigars. But after a bout with bronchitis and pneumonia one winter about 20 years ago I quit smoking cold turkey and never went back. Didn't miss it either. Recently I tried vaping CBD when a friend suggested it was more effective than the oral pills or sublingual drops. I've tried vaping and don't enjoy it. Doesn't tempt me to resume the habit.

I really don't believe it's will power. I think it's just luck of the genetic draw. I saw my mom struggle for years to quit drinking and smoking, making everyone around her miserable to the extent they'd almost beg her to start drinking and smoking again. I've never had that sensation.

Sure, I'm pretty determined about some things, like exercise. I'll ride my bike even when I don't feel well because I know it'll help. But I actually enjoyed smoking weed as a teenager more than 40 years ago and probably would again. I just haven't had the urge. If it becomes legally available in Texas, sure, I'll probably try it just out of curiosity. But I'm not worried about getting addicted to opiates or anything. If it was going to happen, it would have happened already considering how much pain I've had after getting hit by cars twice in less than 20 years and having access to prescription pain meds. I only take enough to stop the pain and haven't had any cravings to keep taking more.