Archive for the ‘drugs work’ Tag

Drugs are bad, kids

Sunday, January 20th, 2013

I’ve just read another engaging, scary article from America about their drug policy – Reefer Madness Redux: If You Smoke It, You Will Become Addicted! Much like the Storyville documentary I recommended last week (see Wonkblog for an interview with the director), it points out the freakish hysteria that surrounds drug policy in the States – which is frightening not only because of its extremity (reminiscent of Brass Eye’s ‘cake’), but also because it exposes the origins of our own society’s beliefs about drugs and those who use them.

I have to admit, the recent blogs I have written on decriminalisation, the comments that have followed, and then the paper released a week ago by, of all people, the supposedly stuffy old folk from The House of Lords, have had quite a profound effect on me. Possibly because the primary focus of my work for so long has been heroin users, I have discounted the idea of legalising drugs as a ludicrous notion. The cycle of hard dependency is awful, debilitating, inhumane even, and to enable that process, to support it, is just not right. If you prescribe a heroin user heroin, he will always be a heroin user. Where is the motivation to stop? And hence he will always be trapped in that miserable existence, always dependent and disempowered.

And to be fair, whilst working with heroin users, I couldn’t really muster up the energy to even entertain the discussion. I didn’t read newspapers, I didn’t watch the news, I didn’t even watch documentaries which I knew would be interesting but which required some emotional investment and deep thought. My coping mechanism to manage the daily adrenaline come-down and affective exhaustion was to shut down any chance of a conversation, social or internal, with something so conclusive and sharp that there was really nowhere for the enquirer to go. And so the topic of decriminalisation remained, as with anything else contentious, packed at the back of my mind, stacked underneath more important and unattended issues such as ‘stopping smoking’ and ‘life direction’.

But recently, for the first time, and from the perspective or decriminalisation instead of legalisation, I thought about it more fully. Heroin users make up a small proportion of illicit drug users (I think there are about 160,000 heroin users in treatment at present, which is tiny percentage of the population when you think about it – I mean, in the UK 10 years ago, 500,000 people were taking ecstacy every weekend night, by way of comparison) and I realised how fixated I had become on the misery of opiate addiction.

And so, thanks to this blog, my mind has been reopened to the debate. The questions I am asking myself, and the possible conclusions that could be drawn, are honestly head-mangling. Here are my confessions…

The first thing I have realised, which may sound obvious but clearly I’m not that bright, is – drugs have been conceptualised in our society as being ‘bad’ (as in “Drugs are bad kids, m’kay” – Mr Mackey, school counsellor, South Park). Of course I appreciate that there are obvious links between drug use and crime – if you have a physical dependence on heroin, you are more prone to stealing something to avoid painful and anxiety-provoking withdrawal symptoms. However, how many ecstasy, or cannabis, users do you know that have ever stolen anything? Anyone who went clubbing during the height of ecstacy use will know that you were more likely to leave a club with a selection of random presents (eg a dog made out of drinking straws, a crown made out of flowers – people were very creative in showing their boundless pleasure to meet you) than you were to get your wallet or phone snatched. And in terms of violence, you were a hundred times more likely to get an exuberant hug from some sweaty random on the dance floor than you were a slap.

And where the American Government got the idea that cannabis smokers were likely to be violent… You’re more likely to get a fight out of road kill.

Now I have always known that the Americans made most of this scare-mongering up to maintain control – my understanding was that, in the case of cannabis, it was to ensure the ongoing success of the cotton trade on which the American economy depended, to safeguard against the main market rival, hemp. The documentary I keep banging on about, The House I Live In, states it was used as a method of controlling and criminalising the Mexican population. The article I mentioned at the top of this page points out that as these theories have become unsustainable, the fear-badgers are claiming that 1 an every 6 adolescents who try cannabis will become addicted, develop mental health problems and need treatment.

The jump for me is to see the bare truth of this process – making drug use and drug users immoral – in our own country and with all the drugs that come somewhere on the sliding scale between cannabis and heroin. To disclose drug use outside of closed drug-using circles is social suicide – people will look you differently, watch next time you go to their house to make sure you don’t nick that fiver they’ve left on the side, and definitely not trust you with their children. Now these are moral judgements. They are not based on any evidence about you as a person, nor are they based in evidence about drug use. (Well they could be, you might be a right dodgy little scally for all I know, I’ve got no idea.)

But the shocking realisation for me is that I have, to some degree, internalised this moral code and perpetuated it. Despite my education, despite the years spent surrounded by drug users, and despite even my own substance use, it is only now that I realise that I accepted, at some subconscious level, that drug use was bad. People who took them were either to be pitied for needing them, or deserved what they got because they were choosing to break the law. And breaking the law must be immoral, because why else would these rules be made if not to protect us? God, it is scary acknowledging one’s own indoctrination. And yes, possibly my substance use served to prove what I had always known – that I was frankly a pathetic and despicable human being (Catholic-style guilt, must beat oneself with a stick).

Yet despite this, I still worked with people, to some degree, by categorising them in one of these two genii – to be pitied or getting what they deserved. To some extent, I understand that a) this was a survival technique, one can’t manage a horrendous caseload AND be philosophical, and b) there is some truth in these sub-groups – people do make choices, both as a result of their past experiences and their present, informed options. But what if I dumped the value-load? What if drug users were just people who chose to put substances in their bodies, not bad or sad?

Were this standpoint adopted, it would have an impact on the drug treatment system. For a start, a significant group currently receiving drug treatment would not want it. Without the label of illegality, those just trying to avoid prison would almost certainly lose their motivation to engage with services. This could be a positive and a negative thing – but it would free up resources for people who wanted to make changes to their lifestyles (instead of the pointless, endless investment in people who have no interest in reducing their drug use or making it safer, as per current service provision), and would certainly make drugs workers’ jobs less depressing.

However, it would open drug treatment to a much wider group – those who don’t want negative repercussions, such as having their drug use recorded on their medical records, which could cause problems with insurance or employment in the future, or those with children who fear judgement by the authorities and worry that by speaking about their problems with substances they may lose the right to parent. These people, surely, deserve access to advice and support as much as any other – and think about how the country would run if the next generation weren’t burdened with the hidden harm of substance misuse.

The epiphany for me is – it is not just our legislation that needs to change in this country, although of course this is a major part of social change (look at what the smoking ban has achieved). It is our conceptualisation of drug use, a paradigm shift from the domain of morality to that of health and economics. Again, look at the changes to social perceptions of smoking since the introduction the ban in public places, which has been, in some ways, the reverse process – smoking is bad now, and people who do it are wrong for polluting other people’s air. But that was for a substance at the other end of the scale, that was too sociably acceptable, to the point that it was difficult to enjoy a meal in a restaurant, going out in the evening came with a guarantee of waking up smelling like an ashtray, and those in the pub trade were becoming ill and even dying because of other people’s substance use. What I am starting to realise is that drugs that have been, for many years, unacceptable even in one’s own home with no negative impact on anyone but possibly oneself, need to be ‘less bad’, or even not bad at all, for there to be any honest discourse about the real problems they cause people. Imagine a smoker refusing to present for lung cancer treatment because they thought they would have their kids taken off them.

There is really no difference, morally, between the smoker with lung cancer and the amphetamine user with psychosis. Or between the businessman who drinks every day and has a heart attack, and the heroin user with a deep vein thrombosis. All make choices to use a substance that puts them in need of a health intervention. Without that health intervention taking place as early as possible, the cost of the intervention itself will increase as the problem becomes more complicated and effects other areas of the individual’s health. The person’s level of productivity and function will decrease. This all costs the taxpayer. So, like it or not, moral judgements can be expensive.

Sweet jesus, first I acknowledge my secret affiliations with the Iron Bitch, now I’m putting my hand up to judging drug users. I’m doing a pretty good job of discrediting myself and my life’s work. Well done me.

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From drugs work to the grave

Tuesday, December 18th, 2012

It’s a funny thing, contemplating a career change. We all spend years expressing internal groans at the sound of the morning alarm, hiding underneath the duvet, begging and praying that some natural disaster has occurred overnight that will suffice as an excuse not to go in today (death for a few people is surely a justifiable pay-off, no?), only to discover from a quick scan of available media that today is a day like any other. Shitbags. But the brief glimmer of hope that you might not have to deal with X,Y and Z today has meant, unavoidably, that you have now carved a brain-path directly to X, Y and Z – and so work starts straight away.

The simple joy of the morning shower is spent internally arguing with the nob-end that sits near you in the office, who you would never come into contact with socially and would subtly shuffle away from if you had the misfortune of a chance encounter in a public arena, but have to not only tolerate but attempt to be civil with, every miserable working day, leaving you resenting your pay-packet because it represents you whoring your soul to the devil. Then breakfast, surely intended as a pleasant and civil part of the day, is made somewhat less so as your bran flakes remind you of the dead, flakey skin around yesterday’s necrotic wound, and you find yourself wondering whether this would have the texture of a freshly-served crisp flake or a milk-soaked chewy one. And despite your attempts to gee yourself up with one of your favourite albums on the way to work, the sense of impending doom induced by the knowledge that today is going to entail battling the Safeguarding referral system (“Sorry, run that by me again – this is supposed to be a high-threshold, fast-response referral process, created to protect children from the most severe types of immediate harm, but you won’t take verbal information and no longer offer the facility for me to discuss the case with a social worker first – so I have to spend an hour completing paperwork, then face the traumatic, potentially damaging and counter-productive scenario of informing the family I have serious concerns about their parenting and so are breaching their confidentiality, in the knowledge that you will probably knock it back or do nothing about it anyway?”) means that you may as well be listening to someone shouting “You are mortal and one day, possibly soon, your time on earth will be over, more than likely following a period of extreme pain” in a broad South African accent, for all the relaxation the music provides. And that’s before you get to work to discover what shit has hit the fan overnight – who has been arrested, who has been admitted to hospital and, unfortunately, on occasions, who has died – and start getting paid.

But – for all its pains and strains and drains – not only does it pay the bills, it has seen you through some hard times. There is no better distraction from a failing relationship than a critical deep vein thrombosis with severe cellulitis; no quicker way to forget about personal tragedy than premature labour induced by persistent crack use.

However, without this job, would the relationship fail? And for everyone one case worthy of your emotional input at a time of personal heartache, how many needless metaphorical arse wipes must you perform? How many faces do you imagine smashing into desks with screams of “If you rip the copper out of your own boiler your landlord has every right to evict you, that doesn’t make you a victim – my own tragedies far surpass yours so I frankly couldn’t give a shit about the hole you have just dug yourself into!”? Imagine getting home each evening with something left to give other than anger and irritation at the world…

It’s a strange pay-off, and one which I am currently making attempts to unpick – is the emotional investment (or drain) offset by the distraction from one’s own problems? To what degree are these intense investments and distractions responsible for the lack of progress in one’s own life? And, fair enough, I might not want to be a drugs worker any more – but if not a drugs worker, then what? Do I have an identity at all? Or if I jack it all in, will I slip into a deep depression, brought on by a sudden lack of purpose, and find myself opening cans of baked beans with a screwdriver underneath a motorway bridge?

The only way I can resolve this internal dialogue is to remind myself that – if I stay in this job, I am likely to become ill(er) in the head, have very little or no chance of maintaining a healthy and drama-free relationship, and will probably, at some point, slip into a deep depression and find myself opening cans of baked beans with a screwdriver underneath a motorway bridge. I think I can make a fair, educated guess that, in this case, it is not better the devil I know. And so, career or no career, there is no healthy future for me as a drugs worker – and whatever the months and years ahead may hold, at least for now I have you lot to rant at, and have a sense of purpose in my attempts to inform and entertain. Thanks guys, you are keeping me (relatively / debatably) sane. And anyway, I like bar work.

To treat or not to treat (Part 2)

Wednesday, December 5th, 2012

Sorry I went off on one a bit yesterday. I was in a vile mood. And sorry to mental health nurses in Community Drug Teams, I do recognise there are some of you out there who are very committed to working with drug users and aren’t just in it for the supervised urine tests.

The point I actually intended to make before I got side-tracked by my own negativity and social bitterness was – who should receive drug treatment, and who shouldn’t? The political back-drop I outlined yesterday does have an impact on this, as there are trends, depending on who is in power, how they feel about drug users, and how much money is available. However what I want to briefly consider here is a more clinical perspective.

When I first started as a treatment worker many years ago, prescribing methadone was perceived as an additional risk factor. The logic was that if someone was taking central nervous system (CNS) depressants, such as heroin, alcohol, benzodiazepines such as Valium, (all of which, may I add, are widely sought-after by engrained heroin users, and a combination of which is almost always present in cases of fatal overdose), and now the new wave of nerve painkillers such as pregablin and gabapentin, then adding another CNS depressant such as methadone would increase the risk of overdose.

Buprenorphine (Subutex) therefore became a popular choice – another opioid but which only works on two of the four opiate receptors in the brain, and so stops withdrawals without sedating. Subutex also blocks opiate receptors, making it difficult to get any effect at all from heroin when taking a regular, reasonably small dose of Subutex. It is brilliant stuff. However, in order for it to work, no heroin can be used for 12 hours before taking the first dose, and of course little effect can be gained from further heroin use – so needless to say, it is not a popular choice amongst the old hardcore. (Now in prisons, where it is crushed and snorted to get a buzz… that is a different matter.)

So, imagine that you are assessing someone for treatment – they come in and tell you that they are using heroin every 6 hours and their mental health isn’t great. Subutex might not be appropriate as they want the sedation provided by heroin to manage their mental state, so you decide together to opt for methadone. But this person has no intention of stopping heroin use at present because it is the only way they can block out the trauma they experienced as a child, which they do not feel ready to address until they have somewhere stable to live.

So the question is – do you offer them treatment?

In the olden days, the answer would have been “No”. People had to say they had no intention to continue using heroin once receiving a prescription, and this was monitored through regular drug tests. Any heroin-positive urine samples sent heads spinning, and would probably result in being given an ultimatum, and possibly no prescription (ouch). The logic behind this was that dual use would increase overdose risk.

The harm reduction movement changed that – once people had dared to continue to prescribing to those still using heroin, research showed that high doses of methadone not only ‘drowned’ opiate receptors and so also had a blocking effect, making it more difficult to experience the euphoric effects from taking heroin – but the surprise conclusion was that people were actually LESS likely to overdose when taking heroin on top of methadone. This was because people’s tolerance to opiates was so high that risk of overdose was greatly reduced, as long as they took their prescribed dosage daily to maintain their tolerance at this level. (If you imagine an alcoholic, who is used to supping a bottle of whisky a day, drinking half a Carling… if you want to try this experiment at home, get yourselves down Wetherspoon’s with a ¬£1.40 in your pocket and talk to anyone sitting alone at the bar.) Plus, taking a decent dose of methadone meant no withdrawal symptoms; and so less frequent injecting, less dodgy, desperate injecting, and so less hepatitis C, HIV, deep vein thromboses and cellulitis. And so the answer back then would have been, “Yes, treat, and keep treating until they get bored with paying for something they aren’t getting an effect from”.

So how would the question be answered today? Well although methadone in itself is pretty cheap, and Subutex not unreasonable, the cost of these medications often lies in the level of monitoring that is required, because they are ‘controlled medications’. This often means paying the pharmacist to dispense it in single doses and supervising its ingestion each day. It also means more frequent monitoring by doctors and drug workers to ensure that prescribing is safe and to reduce extraneous risk factors such as mental health problems and homelessness.

The truth is, as the money dries up, doctors and mental health trusts are going to be significantly less interested in working with heroin users. Half of those still walking around have got bits dropping off them – open abscesses you could fit your fist in at the top of each thigh and swollen, purple legs, from injecting into the femoral vein and irreparably damaging the blood supply to the legs; terrible general health from years of poor diet and jabbing bacteria-laden substances directly into their blood vessels; and quite probably hepatitis C. To treat, they are expensive and time-consuming. And so, I fear, the answer to the question will increasingly be, again, “No”. And doctors can be extremely eloquent and creative when it comes to finding justifications for why someone is ‘not appropriate for treatment’.

Oh god, I’m having a go at doctors now, what is my problem?! I’d better go before I piss off the whole medical profession and start making wild claims like “All radiologists are gay”…

To treat or not to treat, that is the question

Monday, December 3rd, 2012

A recent paradigm shift within the drugs field has further complicated an already difficult and lively debate around what constitutes drug treatment and who should qualify for it. This movement has, weirdly, sprung from a combination of both grass-roots support groups and the Coalition’s austerity measures.

In years gone by (and still in some regions today), Community Drug Teams were primarily made up of mental health nurses who, from what I could see, had got fed up with shift work on acute wards (having to work nights with full-blown nut jobs) and decided that community work was probably a cushy number (9-5 weekdays and 44p a mile). On the whole, these services met very nicely the needs of the nurses – and the prescribing psychiatrists – who admittedly had to endure sitting in grubby rooms in run-down buildings (god forbid drug users be seen in health centres and mix with the public), escorting their patients to the toilet for weekly supervised drug tests in return for a methadone prescription. Services were there to treat, almost exclusively, heroin users; a social group who, at the time, were massively excluded and disempowered, and who were very much at the services’ mercy. The power dynamic was engrained and aggressively maintained – CDT consultation rooms were reminiscent of Dickensian orphanages, and for those of us new to the field and not (at that point) full of cynicism, it was uncomfortable to witness. The approach was not holistic, nor did it address the psychological or social needs of the individual, and only those prepared to dip their caps, express their subordinate gratitude, reduce their drug use as instructed, attend regular appointments, and grovel for several weeks, if not months, ever made it past the waiting list for a prescription.

For those who did make it as far as an appointment with the prescriber, the only treatment available was low-dose, short-term methadone. The standard treatment plan was: enter treatment, stop using all drugs immediately, then reduce methadone dosage rapidly until opiate-free. Unsurprisingly, this method was rarely successful, as not only did it leave service users in a state of opiate withdrawal from treatment start until several weeks after treatment end, it also failed to take into account the person’s reasons for starting to take heroin in the first place – so as the opioids reduced, past trauma resurfaced, mental health problems were unmasked and exacerbated, and the reality of life hit right between the eyes. And should Mr Druguser share his concerns with Mrs Nurse, possibly disclosing self-prescribed codeine or Valium use to manage the symptoms produced by fast detoxification from methadone, he ran the risk of being labelled ‘not ready for treatment’ and being plonked back onto the waiting list. People could sit on these for up to a year in some areas, and the nurses seemed to miss the fact that heroin – well, it’s quite moreish. Needless to say, what became known as ‘The Revolving Door of Treatment’ only helped anyone whose motivation was extremely high, support networks were excellent, and mental health was completely stable. Everyone else spent their time trying to get onto a script, only to be either kicked off mid-treatment, or detoxed so fast that relapse onto heroin to manage withdrawal symptoms from methadone became almost unavoidable.

Then people started dying. Or at least, the public started to notice people dying. Bodies were being dumped in wheelie bins and skips because the Police automatically attended overdoses with ambulances. Families of the dead started to campaign, drug services came under fire, and at the same time, the links between Class A drug use and acquisitive crime were being formally logged, making these problems not just for those at the bottom of the social strata, but for the whole community.

And so came the 10-Year Drug Strategy, the new Labour Government’s attempt to tackle the problem. Money came flooding in to fund new services, and the focus of treatment shifted from purely medical to consider social and psychological aspects, meaning that there were opportunities for non-medical staff within the field (sometimes even within the mystical and superior world of prescribing). Services even started to employ ex-service users who had furthered themselves in education and experience. The power dynamic between service provider and service user started to dissolve, drug users were listened to – and, in many cases, preferred and pampered, with complementary therapies, immediate access to specialist education provision, and vulnerability tags when applying for housing.

The philosophy became – treat everybody. The research providing the evidence-base told us that a heroin user is less likely to die in treatment than when not in treatment; lessons from the 80s told us that legal and public denial of injecting practices led to steep increases in HIV and hepatitis C infection as a result of needle-sharing; the costs of treating health problems associated with long-term IV use and policing drug-fuelled acquisitive crime became clearer; and so thresholds for access to treatment were reduced. Harm Reduction was the phrase of the era, and this was extended to the harm caused to communities as well as to drug users themselves. Year by year, the money kept on coming and, to be honest, drug users and drug workers alike became a bit spoilt.

And so we move into a recession and a right-wing government. New presentations into opiate treatment are few and far between because heroin is so pass√©, and those with the will have made use of the plethora of services and reintegrated into mainstream society. The group that are left are not happy – no more free gym passes or massages, no more sick pay for providing sick notes stating ‘substance misuse issues’, but instead an expectation to attend medicals and Jobcentre courses.

At the same time, the Recovery Movement becomes popular. Now the phrase, ‘Recovery’, does not sit comfortably with me. It is a phrase that comes from the mental health domain and conjures in my mind images of the sick – all very 12-Step Model, where substance use is not a choice but a disease for which there is no cure, where the victim must struggle through and put faith in a ‘higher power’ to help them manage this terrible affliction. Dodgy. I personally find it disempowering, patronising and lacking in the notion of personal responsibility – it’s not a disease, it’s a lifestyle choice, you haven’t got cancer for christ’s sake – but I appreciate that it is a phrase that was chosen and adopted by a group of service users, and so who am I to criticise. If it works and people relate to it, that’s fine by me.

The Recovery Model also promotes working towards abstinence. Now abstinence became somewhat of a taboo phrase during the Harm Reduction Years, as the focus was on engagement and retainment in treatment, to reduce the damage drug use did to individuals’ health and the overall damage done to communities (admittedly for financial reasons, not the sympathetic reasons Tony might have had us believe). And so what the Coalition has done, somewhat cleverly it has to be said, it to take a service user-led movement which focuses on moving people away from substance use by moving them towards ‘recovery’, and twisted this into “You know that expensive drug treatment you’ve all been getting for years? Well, much like your benefits, you’re not going to be getting it for much longer. Get your head round it. Oh and – it’s for your own good you know”. Handy – and cheap.

Now I’m not one for enabling drug users to remain unquestioningly stationary – and anyone who has read my other posts will know that I am also sick to death of the ‘dependency culture’ that has developed in this country. But taking a group of people who have been socially vilified then pitied, who have been consistently encouraged to get in treatment, stay in treatment, and routinely drink the green nectar as their contribution to society for the last ten years – and then giving them six months to fully detox from methadone and get a job – that is just too much to ask and too great a challenge to the belief system of someone who thinks that going to the chemist every day is a vocation.

Some services, fearing decommissioning, have done exactly that – employed a ‘six months and you’re out’ policy. Others have decided that if someone drops out of treatment, that ‘probably means’ they don’t need treatment any more and so must be classed statistically as a ‘successful discharge’. This lack of any real health-focused philosophy within drug services is driven by the Government’s new system of Payment By Results – and the results they want are drug users out of treatment and into work (hence the targets around successful discharges). As well as the questionable morality of removing what has been sold for many years as a medical intervention (without a change in the research-base about its effectiveness, may I add), it chooses to turn a blind eye to the lack of skill, experience or motivation of most of the people left within this (pretty hopeless) group. Most importantly, it fails to acknowledge the level of psychological dependence on the medication that has enabled the opiate-dependent to function as normal human beings, given that methadone and buprenorphine (Subutex) both have long half-lives where heroin’s is very short, and so users take their medication once a day and then can go about their business (probably watching Jeremy Kyle, training their Staffies to fight, and seeing who picks up benzodiazepines at the chemist today if I’m honest – but many also work, parent successfully, and lead more stable lives than I). The fear of opiate withdrawals is significantly worse and longer-lasting than the physical withdrawals themselves, and politicians encouraging, promoting and feeding that dependency for TEN YEARS, then withdrawing it, is, in my mind, nothing short of abusive.

And where will it take us, I wonder, when in a few months’ time this group are poorer, more desperate and without the crutch that for so long has reduced their risk of dying? Is that a revolving door I see…?

Eclipsed by the Murk

Friday, November 30th, 2012

Our the budding writer continues on her journey, and though she hath faced adversity in her flee from Lord Bureaucracy, and had to ally herself with the lazy and meaningless Baron Twitter, the path ahead is becoming more clear and more easily trod. The band of merry travellers who accompany her on her journey have lightened her load, and their occasional shouts of ‘G’won my son!’ have propelled her when the track became treacherous. Even iPad, her trusty tool, is becoming easier to wield, which can be seen by all as it now doth sport sticky fingerprints, and these make her feel somewhat bilious and induce regular, unconscious finger-sniffing.

And yet, as she walks, she can feel a shadow encroaching, and though she turns quickly to face this dark force, she can see it not. She feels its presence at night when she sleeps, it awakens her and taunts her with its blackness, filling her head with death and destruction. She catches glimpses of it in her periphery as she walks, and it makes her quicken her step. She can feel it when she eats, squeezing her stomach as though it were a lemon, which, although not a pleasant feeling, does help her lose a few pounds around the waist, which is no bad thing.

Although she attempts to turn away from this tenebrous phenomenon, she knows its source, for she hath felt it before and she knows what brings it. For this gloomy suspension is Stress, sent by the abhorrent Lord Bureaucracy to impede her quest, and with it comes the breath of those that drink Special Brew and the stench of those that washeth not their putrid feet for they are without a home, which have been dragged from the land from which Stress came, where amphetamine is ingested like bread and at once the houses are cleaned. And though she tries to escape Stress’ odour and out-run its oppression, the smog surrounds her, and it ages her and gives her spots and bags under her eyes, and she increasingly struggles to resist the temptation of the many public inns that are scattered enticingly along her way and the luscious golden elixir contained within. And the macabre mist begins to engulf her and cripple her, and she struggles to find the strength to battle against her internal desires to stab and slice all those that present even the slightest challenge to her on her journey and say things like “Just chill ouuuuuuuut”. And all of her ration and her tolerance is gone.

And yet, even as she suffocates, and writhes on the path awaiting Stress’ final crushing blow, through the foul fog a group appear; within them a medic, who has long known of her plight and advised whence afore Stress enveloped her; and her father, loyal and true, who picks her up, dusts her down and sticks a much-needed beer in her hand. And then, through the ashen haze, she hears the sound of horses hooves, and on a three-legged steed arrives a union rep, who, though late and almost impossible to contact by phone, knows Stress well and is adept at challenging those who send it. And she gives our heroine the Mask of Advocacy, and wraps her in the Blanket of Legal Terminology, and pledges to protect the aspiring author from the evils that Lord Bureaucracy may send.

And wrapped in her blanket, and softened by the ale, the traveller may sleep, and dream of what lays ahead, and in sleeping she becomes refreshed and rejuvenated, and no longer does she look like a decrepit ascetic with herpes, but awakes fresh-faced and ready to face whatever tribulations may lie ahead.

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