Prescription Quest: Another Month’s Epic Saga

Posted on September 9, 2023 by Brian H. Gill
My methylphenidate prescription, with one day left. (June 10, 2021)
My methylphenidate prescription, which must be re-authorized each month.

First, the good news.

Two days of this month’s quest for a prescribed medication have passed without incident.

I’ve asked my pharmacy to request legal authorization: so that they may sell me another month’s supply of methylphenidate. They’ll also be looking for a supplier who has enough in stock.

If all is in order, that sale may take place: but only after what I have on hand runs out.

Around the middle of next week, I may know whether or not the current request for authorization got lost in the mangle.

After that, there’s still a possibility that the pharmacy cannot find a supplier. But that’s another recurring — and vexing — issue.

The not-exactly-good news is that I go through this routine each month.

Sometimes the authorization gets processed in a timely fashion: and includes a ‘do not provide before’ date which matches the day on which my current supply runs out.

Sometimes that doesn’t happen. Last month was one of those times.

What follows is my account of last month’s epic prescription quest; a saga fraught with suspense, drama, defeat, and ultimately: triumph —

— Along with what I see as at least a partial explanation for why a seemingly-straightforward process is anything but.

Controlled Substances Act: It Seemed Like a Good Idea at the Time

Hygienic Productions's film poster: 'The Devil's Weed', also released as 'Wild Weed', 'Marijuana, the Devil's Weed', 'The Story of Lila Leeds and Her Exposé of the Marijuana Racket', 'She Shoulda Said No!' (1949)
A dire warning from 1949: released as “The Devil’s Weed”, “Wild Weed”, “She Shoulda Said No!” – – –

I do not miss “the good old days”.

Don’t get me wrong. I occasionally indulge in nostalgia. Taking a stroll down memory lane, rose-colored glasses firmly in place, can be a pleasant experience.

Brian H. Gill's collage: a rotary telephone, ca. 1955; Number One Electronic Switching System, 1976 and after; title card for The Addams Family titles, ca. 1964.; family watching television, 1958; publicity still from Batman. (ca. 1967)My nostalgic reveries take me to places like a back yard in Moorhead, Minnesota, that isn’t there any more. Or a sunlit semicircular kindergarten reading area. And that’s another topic.

I don’t know how many folks seriously believe that there was a time when wise and benevolent officials passed laws which protected citizens from sinister forces and un-American influences.

An adolescence which occurred entirely within the Sixties, exposure to ranting radio preachers and discussions of Timothy Leary’s wisdom — In a way, it’s a wonder I take any secular authorities seriously, and I’m drifting off-topic again.

Or maybe not so much. Although I have not found reliable discussions of the issue, I remember when a fair number of Americans realized that letting doctors write prescriptions for personal use was not a good idea.

That, and what I hope was a sincere concern for public health, gave us the Controlled Substances Act (CSA); which took effect in 1971.1

“PUBLIC LAW 91-513-OCT. 27, 1970“

“AN ACT

“To amend the Public Health Service Act and other laws to provide increased research into, and prevention of, drug abuse and drug dependence; to provide for treatment and rehabilitation of drug abusers and drug dependent persons; and to strengthen existing law enforcement authority in the field of drug abuse….”

“Reefer Madness”, “Captain Planet”, and Perceptions

Chester County District Attorney's photo: drug paraphernalia on a counselor's desk. (2017) via BBC News, used w/o permission.Again, I remember the Sixties.

Substance abuse was as much a problem then as it is now: my opinion.

But the federal government setting up rules and punishments that put marijuana in the same category as heroin, ecstasy, and LSD?

That, I think, did little to impress those of us who were not in a blind panic.

No, that’s not quite true. It did impress quite a few of us: and made exploitation flicks like “Reefer Madness” lastingly popular in some circles.

That was then, this is now.

America’s decision-makers today are about my age, give or take a decade or so. I don’t think they’re any more wise — or daft — than the bigwigs of my youth.

But they’ve been living in the same America that I’ve experienced: so a new set of concerns, assumptions and preferences are in play. That, I figure, is why recreational use of cannabis became legal in Minnesota. Starting August 1, 2023.

If you’re bracing yourself for a rant: relax. I think House File 100 is neither a sure sign of the coming apocalypse, nor a great step toward a groovier future.I do think the new rule will keep lawyers and civic leaders busy for the next year or so.

'Reefer Madness' (1936, released 1938-1939) theatrical release poster. (1972)So, how could legislation as comprehensive and potent as the CSA progress from the desk of congressman Harley Orrin Staggers to President Nixon’s signature in just one year and one month?

I’ve got an idea about that.

American lawmakers of the late 1960s may not have been consciously following the wisdom expressed in “Reefer Madness” (1936).

On the other hand, they were American lawmakers. They had grown up in a culture which had produced “Assassin of Youth”, “Reefer Madness”, and “The Devil’s Weed”. I suspect that their attitudes and assumptions were shaped by their socio-cultural environment.

I also see echoes of “Captain Planet and the Planeteers” in today’s climate change laws.2 And that’s yet another topic.

Scheduling Scary Substances

Joanna R. Lampe's chart for the Congressional Research Service: Controlled Substances Act Schedules I through V, listing abuse potential, official medical use if any, safety and dependency, with examples. (2021) via Wikipedia, used w/o permission.The Controlled Substances Act (CSA) sorts drugs into five “Schedules”: I, II, III, IV and V; with the most scary in Schedule I, and the least in Schedule V.

Caffeine, alcohol and nicotine aren’t “scheduled” substances, since we already had federal rules and regulations for them.

Anyway, here are quick definitions for the first two scary-stuff CSA categories:

  • Schedule I
    • Has a high potential for abuse
    • Has no currently accepted medical use for treatment in the United States
    • There are no accepted safe-use standards for its use under medical supervision
  • Schedule II
    • Has a high potential for abuse
    • Has a currently accepted medical use in treatment in the United States, or a currently accepted medical use with severe restrictions
    • Abuse may lead to severe psychological or physical dependence

Again, I remember the Sixties. I accept that folks had reasons for being scared of what we now call “controlled substances”. I’m just glad that coffee isn’t on the lists. Even though chugalugging enough might lead to psychosis. I am not making that up.3

August, 2023: Another Chapter in Brian’s Saga

Vincent van Gogh's Sorrowing Old Man' or 'At Eternity's Gate.' (1890)I talked about why I started taking methylphenidate last month, so I’ll recap that and move along.

About 16 years ago, my wife said I should consider seeing a psychiatrist. I thought she was right, so I did: and now have a list of diagnosed disorders including but not limited to:

  • ADHD: Attention deficit hyperactivity disorder, inattentive type
  • ASD: Autism spectrum disorder
  • Cluster A personality disorder
  • GAD: Generalized anxiety disorder
  • PDD: Persistent depressive disorder
  • PTSD: Post traumatic stress disorder

They can’t be “cured”, but I’ve got options for dealing with some.

Symptoms of ADHD, for example — I’ve (probably) got the inattentive type — can be legally treated with methylphenidate: a Schedule II controlled substance.

And that’s why I’ve been using a Schedule II controlled substance for 16 years.4

These days, life isn’t nearly as difficult as it once was.

That’s very good news.

Red Tape and Me

Jenn Finch's photo: scenes from the City of Dunwoody, Georgia, AAPI Cultural Heritage Celebration, (May 1, 2022) via City of Dunwoody website, used w/o permission.I don’t particularly enjoy experiencing a federally-mandated red tape ribbon dance each month.

But I do enjoy focusing more on what I’m doing and less on supervising my brain.

So each month I submit my request for an authorization, and hope that this time the process works right the first time around.

Times being what they are, clarifications may be in order. I’m okay with ribbons, dances, ribbon dances, the color red and the City of Dunwoody, Georgia. The latter is where Jenn Finch took that ribbon dance photo for Dunwoody’s AAPI Cultural Heritage Celebration.

Dealing with “red tape”, literally and figuratively, goes back at least to the Holy Roman Emperor Charles V in the 16th century; which, apparently, is where the idiom “red tape” came from.5 I realize that red tape won’t be going away any time soon.

A Glitchy AI and the Value of Typing Exercises

Brian H. Gill's 'Narcissus-X Desk'. (2017) laptop, imaginary online chat robot, and Nullurpa can ('The Unsoda')Notes I took during last month’s quest for a needed prescription weren’t nearly as complete as I thought they’d be.

Which is no surprise, considering what I’d been going through.

One of the complications, a minor one, was that the regional healthcare provider had upgraded its patient interface.

Now, instead of listening to a recorded list of numbered options and pressing the appropriate keypad button, I listened to a pretty good imitation of a human voice, which asked me why I was calling.

In my case, at least, I was also asked for my name and date of birth. Part way through giving my date of birth — I tried several common variations — the pretty good imitation asked me for my name and date of birth. Again.

I lost track of how many times that cycle repeated before I tried something else.

Instead of giving my name and some variation of the month-day-year format, I started reciting various typing exercises and sayings.

Now I wish I’d written down exactly what I said. Maybe it’ll work again.

Anyway, after maybe a minute of “The quick black dog jumped over the lazy brown fox, now is the time for all good men to come to the aid of the cause, he who hesitates is lost but look before you leap, caveat emptor e pluribus unum – – – “, the pretty good imitation gave up and turned me over to a human.

That particular exercise in frustration did have one positive outcome. I learned that at least two living humans are employed by the regional healthcare provider. Not only that, but both acted as though I was also a living human. That was nice.

Living in a Less-Than-Ideal World

Brian H. Gill. (March 17, 2021)Part of last month’s problem, I very strongly suspect, was that the pharmacy had only given me a 25-day supply for the previous month.

Folks at the pharmacy knew it, I knew it, and that was all they had on hand.

They’re supposed to provide a 30-day supply, but when they’ve only got enough for 25 days — they’ve only got enough for 25 days.

At any rate, when I realized that getting the authorization last month was going to be another insufficiently satisfactory experience, I began taking half the prescribed daily dose.

That is not what I am supposed to do. Ideally, I would trust the regional healthcare provider’s system, and the rules which we both must follow. And, again ideally, my trust would be rewarded by timely delivery of a needed medication.

I keep saying this. We do not live in an ideal world.

I have experienced withdrawal several times. It is unpleasant.

I have also learned that when seemingly-unavoidable SNAFUs happen, easing off methylphenidate both gives the system time to do whatever it does; and buys me time before withdrawal symptoms hit.

Last month, again, I went on half-doses as soon as I realized that there would be trouble. Again.

On August 11, I started taking ¼ of the daily dose. That would have kept me going until August 14. Happily, that’s the same day my pharmacy found another pharmacy with a five-day supply: which, by what felt like a miracle, was authorized.

A Frustratingly Inappropriate “25”, Idle Speculation: and Dancing Robots!

Somewhere in last month’s epic quest, an official authorization arrived at my pharmacy.

Under its terms, they could legally sell me a month’s supply of my medication.

On or after August 25, 2023.

That authorization arrived, if memory serves, before August 11. That’s the day when I started taking ¼ of the daily dose.

I was, in a way, grateful. The authorization might have granted permission for the sale on or after August 25, 2525.

My guess is that folks at the regional health care provider were having their own problems with the new-and-improved system, and it’s intelligent-but-not-very AI.

I’m also guessing that the “25” in August 25 had its origins in my pharmacy’s request for authorization.

In that request, they explained that they had only had a 25-day supply on hand, and that this was for this reason for their request that the August authorization grant permission for the aforementioned sale a mere 25 days after the previous month’s authorized sale.

With a “25” in the request, I can see how a “25” might leak into the resultant authorization.

Particularly when folks were struggling with a system upgrade that someone far upstream from day-to-day tasks had imagined would be nifty-keen.

Honestly, does anyone who actually works with computers and robots imagine that the iron idiots could rebel against their human masters? Successfully, that is?

Which reminds me. It’s been about five and a half years since I quoted XKCD’s Randall Munroe, regarding the perils of a robot uprising. (January 28, 2018)

“…Here are a few snapshots of what an actual robot apocalypse might look like:
“In labs everywhere, experimental robots would leap up from lab benches in a murderous rage, locate the door, and—with a tremendous crash—plow into it and fall over.
“Those robots lucky enough to have limbs that can operate a doorknob, or to have the door left open for them, would have to contend with deceptively tricky rubber thresholds before they could get into the hallway.
“Hours later, most of them would be found in nearby bathrooms, trying desperately to exterminate what they have identified as a human overlord but is actually a paper towel dispenser….”
(“Robot Apocalypse,” What If? XKCD.com) [emphasis mine]

On the other hand, robots have now mastered not only dance, but lip sync!

And that’s yet again another topic.

Miscellanea: “Mental Restlessness”, Methylphenidate, and More

Pmillerrhodes' radar chart, showing data from 'Development of a rational scale to assess the harm of drugs of potential misuse'; Nutt, David, Leslie A King, William Saulsbury, Colin Blakemore; The Lancet. (2007) (369:1047-1053. PMID:17382831). Via Wikipedia, used w/o permission.
Chart showing potential drug issues, from a 2007 study.

An image from Brian H. Gill's brain scans in 2018.Turns out that methylphenidate goes back to 1944, but it wasn’t called a stimulant until 1955.

That’s when the U.S. government gave the okay for its medical use.

In the 1960s, doctors started prescribing it for kids diagnosed with Hyperkinetic Reaction of Childhood (HRC).

It’s been a CSA Schedule II controlled substance since 1971, with a similar status under the Convention on Psychotropic Substances. And that’s still another topic.

HRC is what we call ADHD: Attention Deficit Hyperactivity Disorder.

As a label, ADHD is new; but descriptions of something like it go back at least to Alexander Crichton’s discussion of “mental restlessness” in 1798.

Depending on who’s talking, something like 0.8% to 7% of kids have ADHD, with a third to a half of them still having the condition as adults.6

Social Interfacing and Living in Uncanny Valley

National Institutes of Health's illustration: regions of the brain affected by PTSD and stress. (ca. 2018)My memory tells me that diagnosing kids with ADHD was all the rage a few decades back, sort of like everything caused cancer during my college years.

At any rate, those fads passed; and now there’s official recognition that adults can have ADHD too.

ADHD in both children and adults is almost always called a disorder.

My son made a good case for the consensus opinion’s validity. His view is that because humans are social creatures, a condition which hinders social interfacing is a disorder.

I think he’s right. However, although I see ADHD and similar conditions as literally abnormal — “ab” “away from” + “norm” “rule” — I don’t necessarily feel that my neurological quirks are a disorder.

But, again, I think my son is right: and figure that my feelings come partly from having spent the bulk of my life as someone with undiagnosed psychiatric disorders.

Which reminds me: it’s time to wrap this up, and I’ve been thinking about posting videos of me talking in A Catholic Citizen in America, which isn’t as much of a non sequitur as it may seem.

My son, and oldest daughter, whose quirky circuits are so much like mine that a genetic component — that’s even more topics, and they did say it was okay for me to mention our shared experiences.

The point I was groping for was that my affect display — the way I talk, my facial expressions and body language7 — is off the norm.

But not as much as it might be. I’ve had seven decades of practice, mimicking typical human behavior. Even so, I’ve gotten the impression that sometimes I come across as someone whose home address is 1313 Eldritch Lane, Uncanny Valley.

This is where I was going to discuss why being healthy is okay, along with other ways that my faith affects how I live, and how my coffee drinking habits have changed.

But it’s late Friday, so that’ll wait for another time.

Now it’s time for the usual link lists:

1 A short Sixties sampler:

2 American angst, then and now:

3 Coffee and Schedules:

4 ADHD. With me, it’s personal:

5 Red tape and ribbon dances:

6 Drugs and a disorder:

7 Loose ends:

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About Brian H. Gill

I was born in 1951. I'm a husband, father and grandfather. One of the kids graduated from college in December, 2008, and is helping her husband run businesses and raise my granddaughter; another is a cartoonist and artist; #3 daughter is a writer; my son is developing a digital game with #3 and #1 daughters. I'm also a writer and artist.
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2 Responses to Prescription Quest: Another Month’s Epic Saga

  1. The Overlord Bear says:
    September 17, 2023 at 12:27

    Reading you talking about experiencing stuff like, say, withdrawals brings me awe, Mr. Gill. I mean, it’s great that you talk about it, but what it makes that even better is how humbly and thoughtfully you talk about such things. I long to have the ability to talk about my own struggles like that if God wills it, because even if I can’t be like folks described as “neurotypical,” I still got blessed with this ability to express this much, and I don’t want to waste whatever potential He gave me. So yeah, thank you very much again to you too, Mr. Gill.

    Reply
  2. Brian H. Gill says:
    September 25, 2023 at 20:07

    Thank you! And – well, I see “humbly and thoughtfully” as the only reasonable alternative. Besides, I’ve been working on that sort of thing for decades: a certain degree of progress may not be all that surprising.

    I wish you well in your struggles: I’ve found that prayer helps, which again should be no surprise.

    Let’s see. What else? Not wasting potential and the individualized kit God issues to each of us – that is another topic, and an important one. How to achieve that goal is something I’m still working on.

    Circling back to the start – thanks again. 🙂

    Reply

Thanks for taking time to comment!