Society tends to view banned drugs and their use in binary terms. People who disclose drug use are instantly assumed to be addicted, regardless of whether they meet the diagnostic criteria for substance use disorder. Anyone who has had any kind of problematic relationship with drugs is, according to 12-step thinking, considered to be in “active addiction” until they have sworn off drugs entirely (a curious term, which implies the “passive addiction” of even abstinent individuals who haven’t followed “the program”). And as many people have told me, any resumption of use—including the kind I recently experienced—is “relapse.”
This pervasive strain of black-and-white thinking erases the complexity of reality. It ignores the fact that some 90 percent of illicit drug use is not problematic, as well as the fact that most of the minority who do experience substance use disorder grow past it in time, without treatment. It neglects the importance of set and setting in determining our reactions to drugs. And it demonizes drugs and the people who use them—perpetuating stigma and fueling the drug war.
As someone who was “out” about my drug use from almost the beginning, I know this all too well. My actual behavior was never enough to convince people that I was honest. As soon as I told them that I used opioids, they believed that I was a monsterous cliche out of Trainspotting or The Basketball Diaries. They allowed media stereotypes about thieving, dishonest “junkies” to cloud their opinion of me, outweighing my actions.
This issue arose when I began looking into getting gender-affirming surgery.
Yet I had always retained the ability to make logical decisions and to manage my use. I used drugs not because I was compulsively compelled to do so, but because the pros outweighed the cons. For a time, drugs were the best option I could find to deal with various trauma symptoms and my gender dysmorphia. But once I found other, more constructive and legal ways to address these issues, drugs, for me, were no longer necessary.
So last year, I began phasing drugs out of my life without much effort. But quitting drugs wouldn’t entirely free me from the prejudices I’ve described.
This issue arose when I began looking into getting gender-affirming surgery. Even after months of hormones I still had, well, enormous knockers. Although my legs, shoulders, back and arms no longer bothered me, thanks to the way my body had become more muscular on testosterone, I never looked flat enough—no matter how many binders or how much tape I wore. My appearance caused me extreme distress. I had to avoid catching a glimpse of my torso in each reflective surface I passed. Showering or dressing was always a nightmare. Every interaction was made more stressful by my ambiguous appearance.
While all major operations come with risks, I figured that the potential gains outweighed the potential dangers. I therefore sought the surgery as early as I could.
During the process of finding a surgeon, I naturally spent a lot of time reading forums and other sources dedicated to such procedures. I learned how long the healing process was. Scrolling through photos of gnarly red scars, I also read that the pain could be quite significant in the days following the surgery. Being able to access adequate analgesics seemed fairly important.
More concerning to me was the climate around opioid prescribing, which has become another front of the drug war.
The idea didn’t trouble me. Although I don’t use anymore, I don’t identify as sober or “in recovery” either. After all, what would I be recovering from? Discontinuing my use was a practicality, not an ideological or moral choice. Not using drugs isn’t part of my identity, because I know that drugs are simply tools which can help or hurt depending on how they are used. I still drink occasionally, though very little because I dislike the feeling of intoxication. I’m open to the idea of trying other substances, such as psychedelics. And I’m happy to take controlled medications if they are prescribed for me in a way that makes sense. This includes opioids.
More concerning to me was the climate around opioid prescribing, which has become another front of the drug war. The overdose crisis and fears of opioid addiction have been used to justify severe restrictions on prescribing for pain patients who rely on opioids. Never mind that only a tiny fraction of such patients ever struggle with their opioid use. This has caused great suffering.
In these days of prescription drug monitoring programs and paranoia, I knew that my former illicit drug use was highly likely to be turned against me if I sought opioid painkillers. I’d heard talk of another trans guy who’d been denied proper medication after surgery because of his cannabis use.
I therefore chose a surgeon who was unaffiliated with any hospital systems likely to have marked me in their files as a “drug abuser.” I was careful not to mention my history of drug use to any of the nurses or doctors I talked to. In a better world, I could have been totally open with any health care professional I saw. But I had long been used to keeping my drug use to myself in such settings. Honesty, I had learned, is only the best policy if you want to be thrown out of offices and denied help.
About a week before he was supposed to perform the surgery, the doctor called my medications —an antibiotic, anti-nausea pills, and oxycodone—into the pharmacy nearest to my home. I picked them up four days before the procedure. Contrary to the stereotypes, I didn’t obsess over the oxys or struggle to avoid taking them. I simply placed them in a drawer with the rest of the meds. They remained there until the day of the surgery.
During the first day and a half after the operation, I took the pain pills every six hours along with my antibiotics. However, I disliked how dazed they made me. The constipation was also really getting to me; I’d forgotten how bad it could be.
As I write, they’re sitting in the same drawer in my bathroom, along with extra floss and various other items I rarely use.
So during the daytime, the pros of the pain pills didn’t outweigh the cons, and I stopped taking them. Although the pain was significant at times, I could distance myself from it by forcing myself to focus on the television and other distractions. It was the same tactic I’d used to cope with the pain of withdrawal in the past. At night I continued to take the medications, however, because I couldn’t distract myself from the pain and fall asleep at the same time. This enabled me to sleep decently despite my considerable discomfort.
Everything, as it turned out, went well. The surgery was successful and I’m pleased with the results. In fact, I’m far happier than I expected to be. I knew that it would help, but the degree to which I feel better has been a surprise. My daily levels of stress and discomfort are much lower, because I no longer find myself obsessing over avoiding mirrors or windows. I feel much more comfortable interacting with people. I’m misgendered significantly less than I used to be.
Without the pills, I would obviously have suffered more pain. I would’ve had a significantly harder time sleeping, which would have made me even more exhausted than I already was, and might have interfered with my healing. Certainly, it would’ve prevented me from looking after my drains or making food for myself.
Now that I’m feeling better, I no longer need them. A number of pills remain in the bottle, because I didn’t need to use them all. As I write, they’re sitting in the same drawer in my bathroom, along with extra floss and various other items I rarely use. I don’t plan to take them any more than I do the extra nausea meds. Why should I? I’m fine without them, and find the side effects too irritating to be worth the bother.
Despite all of this, some abstinence-minded people (and policies) would still frame my decision to take opioid pain medication as a “relapse.” Of course, such thinking ignores the context. My past use was not addictive because it didn’t interfere with my life and hobbies, and when it no longer worked for me I stopped. But even if my drug use had been addictive, taking pain pills as prescribed after a major surgery isn’t the same as returning to chaotic use. The bottle says “take every 4-6 hours as needed for pain,” and doing just that, regardless of the substance or any drug history, has nothing to do with addiction.
Nobody should be left to suffer because of society’s irrational fears.
I’m extraordinarily glad—and, in the context, fortunate—that my doctor prescribed adequate pain medication. Patients in general are all too often left without proper care due to fears of “overprescribing”—and for people who’ve used drugs, the odds are much worse.
This is inhumane. Nobody should be left to suffer because of society’s irrational fears. Restricting access to opioid prescriptions hasn’t done anything to stop ever-rising overdose deaths, which was the claimed rationale—in fact, it has exacerbated the crisis by reducing the availability of opioids of known purity and dosage, pushing people to riskier unregulated alternatives.
More broadly, viewing drug use in binary and reductive terms is nonsensical and harmful. We all use drugs in a spectrum of ways that vary greatly by individual and by context. Sweeping assumptions—that all drug use is addiction, that addiction is a permanent state, that all returns to use are relapse—dehumanize, infantilize and hurt us all.
Photograph via RawPixel/Public Domain