Hi, everyone. How are you? I'm alive-ish. I've just wrapped up a project that I'm extremely proud to have been a part of, and nobody died or even caught on fire. Which was a minor miracle, since I've spent the past couple of weeks living mostly on Sudafed. It is spring now, which is my allergy season. I can deal with gooey eyes fairly gracefully, but the sinus ick can get very unpleasant if I don't stay on top of it. If I let all the snot accumulate, it gets harder to clear out, and things start to swell, and overall the entire insides of my face get angry at me and make my life unhappy.

Fatigue has also been an issue lately. I don't know what's wrong, precisely, but since I don't have limbs dropping off without warning, it's not an emergency, and it'll take me three months to get a doctor to talk to me about it. I'm not sure what I think that's going to accomplish, either. I suspect they're going to shrug and tell me 'do less stuff', which is not an option, unless I want to starve while letting my boredom climb to a blatantly hazardous level. I can take Benadryl for allergies, and make this worse; or I can take Sudafed for it, and do the opposite.

I have been pondering, not without bitterness, why it is somehow okay for me to take amphetamines to un-snot my face, but if I take them to stay awake, I am a horrible person and should be burnt at the stake.

Amphetamines do both of these things equally well, and in fact, do them for the same reason: They prompt a shower of adrenaline, which prepares your body to run from hungry saber-toothed tigers. The process turns down all things not essential when fleeing for your life, including goo production, appetite and digestion, extra blood flow to things that aren't used when running. etc. Adrenaline also acts as a bronchodilator, and boosts your heart rate, the better to fuel your terrified sprinting. Basically, it hits everything attached to the α- and β-adrenergic receptors -- it does the exact opposite of drugs like propranolol (a "beta-blocker") and clonidine (an "alpha-blocker").

The first member of the class, originally dubbed "phenylisopropylamine", was initially synthesized in 1887 from má huáng, also known as ephedra, for the scientifically-important reason "because we can". This is the same reason some other dude cane up with methamphetamine a few years later. It was that kind of era in chemistry. You can imagine that it was unusually hazardous to be a chemist back then, although it did also give us things like plastics and Vaseline and Tylenol, so you can't complain about the recklessness too much. It took until 1927 for someone to realize that you could actually do something with all these ephedrine derivatives, other than point at them and declare that you discovered them, and it was a guy who synthesized a bunch and then ate some to see what happened. Up until the past couple of decades, this is how all drug effects were discovered. Makes Timonthy Leary and the Shulgins sound slightly less out of their minds, doesn't it?

In 1934, someone finally got around to marketing the stuff commercially, as Benzedrine, in the form of a decongestant inhaler. It took the world less than a year to discover that the stuff also made you super-alert and happy, a quality that was promptly (ab)used by the Army in WWII. I'm not sure about other branches, but the US Air Force still stocks "go pills" and "no-go pills" for pilots who need to sleep and fly on a very strict schedule no matter how many things are exploding around them. Up until quite recently, the "go pills" were still straight-up dextroamphetamines. (They switched to modafinil, a stimulant with a slightly different mechanism of action, a few years ago. The "no-go pills", previously benzodiazepines, are now zaleplon or zolpidem.) In addition to prompting a release of adrenaline, amphetamines also prompt the release of dopamine, leading to their use in treatment of attention deficit (hyperactivity) disorder, which is thought to result from a shortage of dopamine in the prefrontal cortex.

If you want to make the argument that using Sudafed to keep myself awake is not using it as directed, well, guilty as charged -- the box does say that it's for temporary relief of sinus pressure and congestion. If I take it to promote wakefulness and flip out, the manufacturer is legally off the hook. If you want to tell me that taking it to keep myself awake is somehow extra dangerous, then we have an entirely different argument on our hands. The exact same amount that clears out my face also keeps me very, very alert: 30-60mg of instant-release, or 120mg of time-release. This is the dosage level listed on the box you get at the drugstore. It's frankly kind of heavy for me. The average human used to calculate the standard doses of OTC drugs is taken to be a man weighing something like 65-70kg, whereas I'm female and weigh something like 50-55kg, depending on how much I've remembered to eat lately. The recommended doses of OTC drugs are almost universally kept at least an order of magnitude below any harmful level, because people are idiots, and Poison Control can only handle so many calls.

[The major exceptions here are caffeine, which is so widely available you can achieve intoxicating doses with minimal effort -- although dangerous doses require somewhat more planning -- and acetaminophen/paracetamol, which you can OD on terrifyingly easily, starting at about twice the dose you can buy as "maximum strength". You could theoretically do yourself in with aspirin, but you would have to intentionally eat the entire family-sized bottle. All of these things were grandfathered in, due to having been in use for decades before the Safe Food & Drug Act of 1938. The theory was that if you hadn't worked out how not to hurt yourself with them in the preceding 50 years, the FDA was probably not going to save you.]

All drugs have multiple effects, whether you like them or not. Pseudoephedrine does do a number of things I have to watch out for, including acting as an anorectant. I did forget to eat for about 24 hours at one point, and failed to notice this until the technical director turned up to rehearsal with a tupperware full of scones. It also knocks my heart rate up to about 100bpm for a couple of hours, which is high for me and somewhat less than comfortable, but well within human normal range. (My heart is fine; I accidentally got proof of this when I went into Mass General with an unstoppable panic attack and scared the intake nurse, who dropped me on Cardiology with alacrity when she read the output of the pulse oximeter and realized my heart rate was spiking close to 140bpm. Apparently I am not supposed to be able to ignore that.) Stimulants borrow energy from the future in order to keep you going now, so I am fairly uncomfortable when they wear off; I am generally kind of dysphoric and cranky, and I have to remember to take some prophylactic Aleve, because when the vasoconstrictor effect wears off, I tend to come down with a cracking headache.

These side effects are the price you pay for getting the medication to do what you want. This happens with all drugs, even those you take with the official blessing of a doctor. I've done my risk analysis, and none of the side effects I've listed are dangerous to me at this dose; the major cost I am looking at is that I will feel kind of shitty for a while in the evening when my circulating levels of amphetamine taper off. That is a price that I am sometimes willing to pay in order to regain my ability to breathe and run around for a few hours a day, in the same way that I am sometimes willing to put up with a hangover in exchange for being enjoyably drunk the night before. The cost rises as rapidly as the benefits dwindle. The initial release of dopamine and norepinephrine depend on there being stores of neurotransmitters to dump all at once; when the stores run dry, I just get twitchy and unhappy and the stuff generally ceases to do what I want it to do, at which point I stop taking it.

It's my brain I'm altering, and I know what I'm fucking doing to the point where I can argue pharmacodynamics with the doctor and win. So why is it that chemically unclogging my nose is a noble goal, whereas not face-planting in the middle of my tech week is reprehensible?

I suspect I am extra annoyed by the hypocrisy here because I have a feeling that if I told a doctor what I'm taking to keep myself functional these days, they will try to insist I stop taking it. They can go hang. There are official medical equivalents to everything in my pile of technically-legal chemicals -- the muscle relaxant baclofen has the same mechanism of action as phenibut, and prescription levodopa exists and is given to Parkinson's patients. It just won't be issued to me, because I don't have the specific problem officially recognized as requiring it. I think it's pretty clear that I've figured out what the underlying issues are, since both of these substances have fixed things that have literally never in my entire life worked correctly. I just don't fit the dominant narrative, and so most of what I say on the subject is ignored.

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