The best-laid plans of mice and men go oft awry

Posted: 02 October 2014
Updated: 13 December 2017

A small dose of alprazolam and I am much better

I have been taking low doses of benzodiazepines for my anxiety for a few years. There have been many times, however, when I ran out of money or I could not get a new prescription (because I could not afford to see a doctor). At various times, doctors have prescribed to me diazepam (Valium), lorazepam, and alprazolam (Xanax).

Most drugs are classed together based on how they affect the body; examples include anti-depressants, cough medicine, and blood-pressure medicine. The chemical structures of each medicine in a drug class can widely vary: analgesic drugs, for example, could be based on salicylic acid, be an opioid, or be many other things. Benzodiazepines are grouped together because of their chemical structure–not because of their medicinal effects–strangely, we tend to talk about benzodiazepines as if their medicinal effects were interchangeable.

I have used three different benzodiazepines because they each affect me in different ways. Diazepam and lorazepam have relatively similar affects on my anxiety and when I have had them, I would have a prescription for one or the other but not both. I have a slight preference for diazapam because, for my body, the positive effects last longer and the negative effects are less severe. The qualitative similarities between diazepam and lorazepam are not surprising because they have a similar “mechanism of action“: they are both agonists of the neurotransmitter GABA. Alprazolam is also a GABA agonist, but it has at least one more mechanism of action that we do not yet understand. For me, I take alprazolam when I am feeling anxiety and when I feel profound sadness. If I take alprazolam when I am not feeling sad, I will fall asleep within 15 minutes. One study suggests that alprazolam affects dopamine and serotonin, which are commonly involved in depression, so that might explain the qualitative effect I feel.

I ran out of lorazepam by May 2014 and I only had one remaining dose of alprazolam when I went to London in June 2014. Since then, I have been trying to get some medication to help my anxiety. In the United Kingdom, I was diagnosed with panic disorder and anxiety, but because of political policy, the doctors did not give me the medication I needed to treat my problems. Instead, they gave me sleeping pills.

In the US, we do not have good health care programs for poor people. I went to a clinic run by the government. The doctor diagnosed me with depression, PTSD, and anxiety, and she acknowledged that the three benzodiazepines would help me. Because it was a government clinic, however, she was not allowed to prescribe the benzodiazepines to me. Instead, she prescribed me an anti-histamine: an allergy pill. The allergy pills did not help me.

I have been living in this new city for about five weeks. I have been trying to see a doctor and get a new prescription for my anxiety. The major obstacle I had to overcome was my anxiety: a horrible Catch-22 that the medical condition I needed to treat was the same condition that prevented my treatment. Additionally, my money was low enough that if I were able to get a prescription and buy the medicine, I would not have had enough money for food or lodging.

Three days ago, I was fortunate enough that a good friend sent me some more money. The money was necessary for my survival, but his action was also a tangible way of telling me that I have value and that my life is worth saving. Two days ago, I was able to overcome my symptoms long enough to get to the doctor and to buy the medicine.

I could only afford one medicine, so I wanted to get lorazepam because it does not put me to sleep like the alprazolam and because it is slightly cheaper than diazepam. (Ninety days of diazepam only costs about US$70 but I must conserve every penny I have.) We had some miscommunication, and the doctor prescribed alprazolam to me. I did not notice until it was filled at the pharmacy. It was better than no medicine, so I kept it.

Yesterday, I had a panic attack, which is extreme anxiety. I took a pill, I felt much better, and I was able to accomplish some things yesterday. In the evening, I had a series of panic attacks, but half a dose was enough to defeat the panic attacks.

The best part, however, is the lasting effects of the medicine. Panic attacks are stress responses: elevated heart rate, muscle tension, hyper alertness, and other effects. Because I have been having daily panic attacks for almost four months, my body and mind are exhausted. Yesterday, I was able to use a small amount of medicine to dramatically reduce how many panic attacks I had and the severity of the panic attacks. Today, I feel much better. My body has been much more relaxed and my heart rate has been normal for most of the day.

I have been so relaxed, and relieved, that I have slept most of the day. That is highly unusual because for the last four months, I have rarely been able to sleep more than a couple of hours without waking up to a panic attack.

I have been unable to get the medicine I need for a few reasons. First, poor people are routinely denied access to cheap and effective health care. This does not only hurt poor people: it hurts all of society. I used to be an extremely productive member of society. Because I cannot get health care for my medical conditions, I am not able to contribute to the world. The health care I need is relatively cheap because I do not need surgery or a hospital or other expensive therapies. For a relatively small investment, society could earn a large return on its money in the form of my contributions to society.

Second, the war on drugs has warped how doctors deliver health care. Compared to many other medicines, benzodiazepines are more addictive and have a higher potential for abuse. They are not as addictive as cigarettes, however, and alcohol is abused much more often than benzodiazepines are abused, but I can get alcohol and cigarettes any time I want. The war on drugs does not have any positive effects but it has many negative effects, including that it interferes with effective treatment for me.

I was able to finally get some of the medicine I need because of the help of my friends. Without my friends, I would not have food, shelter, or medicine, and I would not be on the path to recovery. I still need more help, but I am deeply grateful for the help I do have.

When I can afford it, I will get lorazepam or diazepam to help with my anxiety (without putting me to sleep) and modafinil to help combat my depression. With those medicines, I will certainly be healthier and closer to be a productive citizen again.

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