Sunday, 4 August 2013

Poor Smokers

Massive tax rises on cigarettes will mainly hurt those who will probably never quit
Massive tax rises on cigarettes will mainly hurt those who will probably never quit.

The Rudd government has just announced that tax on cigarettes will increase by 60% over the next 4 years. Of course, health groups and many others will applaud the government for such a move citing the health benefits from reduced smoking rates. And there are many positive reasons for such a tax. But what about the negative impacts?

Price has proven to be the most effective tool for reducing smoking levels as we saw with the last major increase in Australia. When Rudd last increased the tobacco tax excise by 25% in 2010, the Department of Finance reported that smoking consumption decreased by a whopping 11%. Conveniently Rudd and co. leave out the fact that rates were already dropping by 6% and the actual affect was a 5% decrease. Still, more increases can only be a good thing, right?

Well, all is not what it seems. Research clearly shows that by dying younger we become less of a financial burden on society. Harsh but true. All the burbling about health costs incurred by smokers is just smoke and mirrors. And of course there is the growing black market. In the UK, 27% of cigarettes and 68% of roll-your-own tobacco is bought illegally. How big is the black market in Australia? All I know is that it's about to grow.

We all know that nicotine is highly addictive. Some politicians even claim it's more addictive than heroin. So why is this highly addictive substance suddenly so easy to quit? It's hypercritical when governments tout harm and addictiveness when trying to deter smoking but when they want to raise money by increasing prices, addiction is played down. Many, many people find it so difficult to kick their nicotine addiction that they will do almost anything to keep smoking. And there's no magic bullet here, this is the complex world of addiction and the rules are different for each person. 

The one vital question that has evaded this issue so far is not who it will affect but how much it will affect some people. After all, that's the point of this initiative … to affect people. To coax them out of their addiction by causing them financial pain. To put the price of tobacco out of their reach, forcing them to reconsider how they spend their often limited funds. It may sound logical and as a method for reducing smoking, it is largely successful. But elasticity of demand for tobacco is not linear and decreases as the price rises. It should be obvious that those who were going to quit because of price have most likely done so already. Only dedicated smokers, those who were rich enough not to care and the badly addicted soldiered on with their vice. Price hikes are a blunt tool and this new increase will not produce anywhere near the success of that in 2010. The most likely outcome is that it will mainly hurt those who may never quit.

Let's get some perspective here. Lower income families are already struggling, capriciously living day-to-day in a fragile financial environment. One big utility bill or unexpected expense can throw their lives into chaos, making them homeless or without electricity or gas. Add the costs for a smoker and it becomes even more precarious.  

Lack of money can often be the catalyst for family breakdown resulting in violence, ruined marriages and substance abuse. We see it everyday in this country and it's only going to get worse as cigarettes increase in price. Imagine living below the poverty line, week after week you struggle to make ends meet and one day the people who are supposed to represent you decide to rip your guts out.

Any new price increase will not force hard core addicts to quit. Instead, it will cause grief, family stress and force smokers into perilous situations. Do we really have to be reminded about the desperation of addicts and the massive cost on society? And it's not like the tiny population of those addicted to illegal drugs. There's 3.5 million smokers who will potentially be seeking alternatives to feed their addiction. It's not going to be pretty.

So, what does a hardcore smoker do at-the-moment when they don't have enough money? They skip meals or buy cheaper, unhealthy food. They wear shoes with holes in them. Car registrations and other bills are not paid. Then there's the kids. Forget that excursion little Johnny was looking forward to. And let's hope little Carrie likes stale vegemite sandwiches everyday for lunch. The reliance on welfare becomes part of their life. Asking for food vouchers just to feed their children doesn't seem so embarrassing anymore. Buying clothes from the op-shop is necessary. Living below the poverty line becomes a fact of life. 

It's about to get worse.

Most hardcore smokers will never, ever quit cigarettes and they will do whatever it takes to get by. Some women will turn to casual prostitution. Others will commit opportunistic crimes like petty theft and shoplifting. Defrauding Centrelink will not seem so taboo anymore. Others will turn to violent crime, drug dealing and similar desperate measures. Tension between couples will become explosive as their financial situation becomes untenable. Screaming matches, smashing furniture and divorce will define the new household of a smoker. Sadly, children hiding under beds or in cupboards will go unnoticed as families try to adjust to this new reality. And I mean "reality". This is not a movie or a yarn but real people suffering beyond what most of us can even imagine. Can most of us even comprehend what being evicted really means when you have no alternative? Do we really know what massive stress is when you just have absolutely no way to pay that utility bill? Could you live for a few months without electricity? Go on, try and picture what you and your family would do if you received a final court ordered eviction notice and you have no money. Scary, isn't it.

Now spare a thought for the single mother staying home to look after her young children. If she smokes and cannot quit, life is basically over for her. Because of another thoughtful Labor government initiative, single parents with children over 8 are forced onto the lower paying New Start scheme. This nasty policy is spun as a caring way to gently "encourage" people into the workforce. 

The government is dressing up brutal financial attacks on those who are the poorest as compassionate policies. I'm simply lost for words here as I'm trying to describe how much it makes me despise the government. It probably best explains why I hate politicians so damn much.

Carnage from the cigarette tax hikes will be felt mainly by low income groups
Carnage from the tax hikes will be felt mainly by low income groups.
Let's face it. This is not a health driven issue but a need to plug a massive hole in the government's budget. Any government in power would be faced with this issue whether Labor or Liberal. Revenue is down and the budget needs to be balanced. Most people understand that. What I don't get though is why the government has an insatiable need to be in surplus? And isn't there better ways to raise this cash? As usual, the reasons are purely political and some smokers will have their lives ruined because of it. It's simply not good enough. Most economists agree that Australia can run a deficit like most other countries do. This basic strategy would eliminate all the government's proposed cuts and increased taxes. And then there's the petrol excise that was fixed by Howard in an attempt to win over voters while introducing the GST. A simple realignment would cost drivers only 1.5¢ per litre but would raise about $23 billion over the next four years. 

And as a final "fuck you" to smokers, the government maintains it's ban on electronic cigarettes containing nicotine … the single most effective method to reduce the smoking of carcinogenic cigarettes. It's a stark reminder that anti-drug lobby groups like Quit are just far too influential on government policy. If the government really cared so much about our health, they would ignore the anti-drug/smoking groups and give smokers access to e-cigs. 

If health was really the issue then this policy would have been better thought out. What about making cigarettes only available via prescription? This would stop most new uptakers and be too much trouble for casual smokers. What about age limits so that the price pain is only inflicted on younger, less addicted smokers? Why aren't e-cigs used for treatment? It's just so obvious that this is not about the government's concern for our wellbeing.

As usual, those with enough money will not be affected. I don't smoke that much anymore so personally it won't really effect me too much. And those I know that still smoke just feel betrayed by Rudd. Not voting for Labor won't be a vote for Mr. Rabbott or The Greens though. They fully support the idea of hammering smokers with increased prices. I dare say we will see a few votes going to The Australian Sex Party, Wikileaks or the Drug Law Reform Party. The main result I can see for Rudd's master plan will less votes for him. Maybe even 3.5 million of them.  

Monday, 17 June 2013

The Joys of Being in Recovery

On rolls another year. And like each year "in recovery", life goes on with an array of challenges, changes and temptations. 

I have not touched anything now for many, many years with the exception of a beer about a year ago, an occasional glass of red wine with dinner and I smoked a bit of ice one sunny day. I have an excellent work contract, a steady relationship and an above average health. But something is missing and I still feel like my life is on hold.

Each year my life gets better in some aspects but worse in others. Well, not actually worse but more complex and frustrating. It's often said that issues that affect our lives are relative to our current situation. What stresses us out today might be minor compared to a decade ago. And the problems we may see as insurmountable to us are just minute compared to what others have to contend with. I'm sure that even if I was stinking rich, married to the Minogue sisters and healthier than Chuck Norris, I would still be worried out of my mind. Like I said, our problems are relative.

My daily dose of Slow Release Oral Morphine (SROM) has halved since this time last year. SROM is the magical medication that keeps me away from heroin. It's been a hell ride but overall, I am in a much better position now than anytime since my headlong dive into junkism. But there is a problem and one that is more frustrating than heroin addiction itself … the mess they call recovery.

Recovery is subjective and depending on who you talk to, it must be done a certain way. Some people insist that cold turkey is the only way out while most recommend substitution treatment like methadone. Others swear by the 12 steps program while a lucky few like myself receive something more practical. And then there's the naltrexone cheer squad who have their own ideas. So who is right? 

Forget the multitude of research showing that each person has unique needs. Forget the constant stories of users relapsing. In fact forget it all. If you're in the system, you are at the mercy of whoever you get burdened with regardless of their knowledge and success rate. For all the talk and money spent on recovery, it seems that our medical system is just not geared up to deal with individual needs. Not once have I been asked what I think is best (for me) or if I feel comfortable proceeding with a particular course. If my doctor and the specialist had it their way, I would be totally clean in a just few short months. Who cares if I relapse or my life becomes unbearable?

When I first approached the specialist pharmacotherapist to cut my dose nearly two years ago, he came up with a simple plan. Drop 50mgs every two weeks and soon I would be magically opiate free. Even I knew that was a big ask. And after voicing my dismay at such a rapid tapering he told me it would be fine. Of course it wasn't. 

Dropping 50mg every two weeks is just ridiculous. I have been on some form of opioids for nearly 20 years and every forced attempt to drop my dose just resulted in chaos. The upside is that when I initiate the reduction, it works.

It was me who suggested an initial drop of 100mg then maybe 50mg every month. I knew I was ready to start this long, painful journey and reducing my dose by a whopping 100mgs was a show of good faith that I was serious. Silly me! This enthusiasm was quickly exploited and the "maybe" drop of 50mgs each month became fortnightly. Of course it was a massive failure and after several pleading emails it was changed to monthly reductions.

I stop exercising and put on weight. I smoke more. I stop interacting with my family and hide myself away in my office. I stop contributing to the household (cooking/cleaning/caring for the pets etc.). I neglect family and friends. My focus on work deteriorates which costs me my income and the bills pile up. Even simple tasks such as showering becomes a drag.
-Extract from a letter to my specialist

Eventually, the monthly reductions started taking their toll. Dropping my dosage was causing too many problems and heroin was again becoming an attractive alternative.

The pressure to keep lowering my dose by my largely ignorant doctor and the specialist has been intense. It takes several long winded emails and some major pleading just to keep my dose fixed for another month. Sometimes I wonder if they actually understand that I am on a maintenance dose to keep me stable. If it was methadone, there would be no pressure whatsoever. 

It is a medical fact that forced recovery simply does not work. For some folks the idea of forcing junkies to rapidly drop their maintenance dose is appropriate punishment for being an evil druggy but for doctors it is just not good enough. There is ample research readily available and anyone, including a doctor, can just Google it. So why does my doctor and pharmacotherapist keep insisting that I constantly drop my dose?

It gets really tiring trying to explain the affects of lowering my dose when I am not ready. I have repeatedly explained to them that just prior to my dose dropping my clinical depression gets worse, I become very anxious and it causes me incredible stress. This falls on deaf ears. Even saying that I fear I may return to heroin isn't enough to reassess my situation. What is that about? You would think this would send off alarm bells. You would think…

The last 12 months have been pretty scary at times but I have somehow managed to get through. But as I have mention many times, each reduction causes incredible stress and distress. I manage to get through it but now it's proving to be counter-productive.

Each month as it comes time for my dose to drop and for weeks afterwards, I become extremely apprehensive and anxious. I feel that every everything is just too daunting and I loose any motivation I may have. It also makes me depressed. Naturally, I want this to stop. When I loose my motivation and feel depressed, everything suffers. At my age, this is not an acceptable situation especially after putting in so much hard work to get this far.
-Extract from a letter to my specialist

I can't help but question the reasoning behind the current policies for prescribing opiates. There are no major physical health problems with long term opiate use which only leaves the problem of dependance and any psychological issues. If SROM improves my ability to lead a normal productive life without causing any physical problems then why are the so called experts hell bent on dropping my dosage when I'm not ready? The physical health advantages from having a steady supply of SROM are glaringly obvious; 20-30kgs lighter, a regimented exercise plan, a healthier diet, a massive reduction in smoking and much less back pain. These benefits alone should justify my monthly script. Then, of course there's the huge benefits to my mental health; participating in work, socialising, integrating into the local community, reduced depression and anxiety, increased mental aptitude.

I wonder why diabetics are not forced to reduce their insulin? What about those on Ritalin or other medications to deal with specific mental health issues? Why are opioids singled out? If these medications help benefit our lives then they should be readily available for recovery as well.

We all know what causes the extreme paranoia around prescribing opiates and it should not exist in our advanced, modern society. The war on drugs -encouraged by sleazy politicians, the trash media and the anti-drug nutters- is probably the single most destructive policy in modern history. And when it affects the process of recovery you know it has really just gone too far.

Living life whilst in recovery is not pleasant although it's better than the constant cycle of heroin addiction. I suppose I shouldn't complain but it's hard when I know there's an easier route. I just want to know why those people and governments departments who are supposedly experts in addiction and recovery seem to know so little about addiction and recovery.