[ExI] 27 psychedelics??

[Rafal Smigrodzki]

On Sun, Mar 27, 2022 at 10:51 AM Will Steinberg <steinberg.will at gmail.com>
wrote:

> No, I reject the idea that you are an expert.
>
> It's one thing if the drugs only have physiological effects, even if it's
> not ideal since you don't understand what the side effects feel like.  You
> can still feel confident about their effects in a functionalist sense.  But
> for psychoactive drugs, I think prescribers being inexperienced in their
> actual effects is one of the reasons so many drugs are wrongly prescribed.
> It's insane to me that--having actually taken amphetamines, for
> example--someone could prescribe amphetamines without having experienced
> the effects.  Because without having taken them, I am confident in saying
> you have NO CLUE what they actually do.  The behavioral observations and
> the physiological data tell like 1% of the story when it comes to what
> these drugs do.  Some drugs are just about the physiological data, ok it
> lowers blood pressure, here ya go.  No problem.  But it honestly disgusts
> me that doctors prescribe amphetamine without knowing what it actually
> does.  And I would bet a large sum of money that if you tried amphetamine,
> you would be a lot more conservative in the amount of people you prescribe
> it to.
>

### Oh, but I do know what 10 mg Adderall "actually" does. It makes it
possible for a person to attend to tasks that are useful but were too
boring to be done without the medication. It makes it possible to succeed
in school and at a desk job for smart people who don't have the ability to
concentrate on reading for many hours, which is necessary to succeed in
many modern situations. I am lucky. I can read for hours and I never needed
pharmacological help to succeed at school but I know many people who would
be relegated to menial jobs without such help. I wouldn't try amphetamine
because I am not the kind of person who benefits from it but I would never
try to dissuade a patient who meets the criteria for ADD or ADHD from
trying. And if they don't like it - they can always stop, low dose Adderall
is not addictive. And yes, I am always prescribing the lowest amount to
start with and I carefully titrate if needed.

Or take Geodon. I am not a demented, agitated patient wiht stroke at night
in a strange, dark place where people poke me with needles. I don't jump
out of bed, unaware that half my body is paralyzed, I don't smash my head
on the floor. I am not in distress, screaming my lungs out, not knowing
what's going on. But many of the patients I take care of are in that
situation. So what should I do? Should I take Geodon myself, conclude that
I don't like it (because it can make you feel fuzzy around the edges) and
then based on this anecdotal experience deny this to patients who need it?
Should I just let them suffer? Let them hurt themselves? Order physical
restraints, tie them to the bed so they will scream even louder? Or maybe
just use 5 mg Geodon IM, which I can tell you is a very low dose but very
effective in giving the patients a good night's sleep, so they can get out
of this place sooner?

Don't try to teach me medicine, Will. You don't know enough.

Rafal
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