#medications

various medication blinkies - 150x20px

Okay, as I am currently Solarpunk posting, let me talk about the topic that in regards to Solarpunk actually is worth critiquing. If you actually - you know - do interact with the community and the stories.

Because here is the thing: Solarpunk as a genre generally tends to be actually quite good about most of the base infrastructure. Most writers in the genre do actually think about how energy is produced and how the associated supply lines work. They think about how food infrastructure works. And how people get around. And how the internet works. They also do seem to have some thoughts at least about how waste management works - though admittedly that is often a bit less thought out other than "renewable materials" and "recycling". Not perfect in that area, but... at least some thought is there.

No, the big issue is health - and disability care.

Look, I am a disabled person myself. I cannot walk long distances on my own. I struggle with stairs. And I need to take 12 different medications. 9 of them daily, the other three in weekly or biweekly intervals. I need to see specialist doctors at least once a month - usually more often. And frankly: I still actually am still more abled than a lot of other people. I can still work. I can still travel with fairly little preparation. I can still do fun stuff without needing to overthink it. And while I do need my medication: I will survive if I am without any single one of them for a week. All of them for a week gone would be an issue. But some of my medications are at times hard to get due to international supply chains and... that is fine. I can live through that.

But others can not.

And this is an issue that a lot of Solarpunk stories just do not consider.

Accessibility in Solarpunk Worlds

So, here is one of the core issues: when most people hear "accessibility" they first and foremost think of wheelchairs, hard of hearing people, and blind people. And that is of course only a small fraction of people who are actually disabled.

We are on tumblr, so chances are y'all have been told about this just a bit. You likely know that people in a wheelchair usually can walk to some degree but might struggle with balance, or exhaustion, or other issues. Some people might be in a wheelchair on some days, and not on others.

You might also know that people with autism and ADHD and other neuro differences might just need environments that are not as bright, not as loud, and so on.

But chances are that other than this... you do not know much. And it is not your fault. It really is not. Because this is just not taught. And currently a lot of people kinda try their best to fully "other" the disabled people. So you do not think of disabled people as people who are largely "functioning" as society expects them to.

But yeah. Disability can have a lot of faces, and even the same disability can look completely different in different people.

You know. Not everyone likes to use wheelchairs. Not everyone who has lost a limb wants to use prothesis. Not everyone who is hard of hearing finds hearing aids useful. Not everyone with ADHD profits from medications.

And then there is the other big issue: cars.

Because a lot of Solarpunk conversation rightly criticize cars and the car centric infrastructure we have. But the issue is if we do not have car accessible infrastructure it also means that ambulances cannot access a lot of areas. And... those are kinda important.

And of course there also is just the additional bit that while I absolutely think that we should finally get away from car centric infrastructure. But some people will just need cars of some form. Because for one reason or another public transport, bikes and the like will not be working for them. And this is an issue that a lot of people engaging in Solarpunk just do not want to admit.

Petrochemicals and Medication

And then we have that one big issue. And that is petrochemicals.

Right now a lot stuff in our society is in some way or form tied to petrochemicals. So to oil. We take the oil out of the earth for fuel, but as we only use some part of it for the fuels, some part for plastic, and some parts for... other stuff.

And some of this other stuff is medications.

A lot of medications on the market right now go back to some chemicals that originates with the petrochemical industries. And some of those chemicals we right now cannot produce without earth oil being involved at some point.

No, this is not all medications of course. There is a bunch of stuff that is largely done without petrochemicals involved. Stuff that might be produced by fungi, bacteria, or - we have to remember that - genemanipulated animals. But even those medications currently at times still need some solvents or other materials either to work, or to be stabilized for longer than a few days.

And of course a lot of other things related to medicine are super dependent on Petrochemicals. Syringes are made of plastic. A bunch of other stuff is as well. And while for those maybe we might at some point be able to recycle that stuff into a good quality - but right now we are actually not able to do that.

A lot of people who disagree with anarchism or Solarpunk keep saying that the issue is somehow related to people no longer caring for disabled or sick people. But generally, I do not think it is a problem. Humans always have been taken care of one another. Medical jobs tend to be generally the kind of job people like doing - or would like doing if they were not constantly overworked and underpaid.

But one issue we need to keep in mind is... that we still will need to pump oil for the time being. Because otherwise people will die due to no longer being able to access life saving medication.

The Invisibility of Disabilities

One of the core issues with all of this is - of course - that disabilities tend to be treated like invisible within even progressive circles. Everyone is kind of aware that disability exists, but people who are not themselves affected often will just straight up ignore anything that goes past wheelchairs, blind and hard of hearing people.

Often enough, even among leftist people, there is also the narrative about "We will just heal everyone for good", not realizing that a) this is very unlikely, and b) that this is actually eugenicist ideology.

In Solarpunk people tend to actually think about most other infrastructure. Food, information, energy, water. That tends to be taken care of. But medical infrastructure? Infrastructure for emergencies? That is often the kind people do not think about enough.

And again: yes. It is highly likely that if we had a world in which we were not working ourselves to death, where we are not constantly stressed, where our basic needs are being taken care of, and where we have community, a lot of acquired disabilities would be more rare. We know that people who have community and less work stress will be much, much less likely to develop cancer or heart disease.

But there are still disabilities that will be there from birth. There will still be disabilities in old age. People will still have accidents. And people will still suffer infectious diseases. And yes, some people will still have cancer and stuff.

So, ideally any Solarpunk story should account for that. And for how they are supposed to get care, and medication, and pretty much anything else needed to survive.

and it's only very recently that I have worked out that by Self Esteem they mean more like-- trusting myself. to be able to do what I want done. and my whole life I have been real shaky on that not because I don't think I'm awesome but because I have become increasingly and miserably aware that I have a fucking neurological condition. or two. that make it extremely difficult to do certain things no matter how much I want them done

and now that I've gotten myself diagnosed and medicated I am more getting what they mean. like. now I know I probably CAN do the thing if I am properly medicated and have gotten a good night's sleep and deploy the right playlist. and everything is way less scary because of that

Buprenorphine is an opioid. But, like, a special kind of opioid.

There was a time, the 1920s through the 1970s, when opioids just... weren't prescribed outpatient. If you were getting opioids, you were either recovering from surgery in a hospital, in the final stages of dying of cancer, or you were getting them illegally as heroin.

Full stop.

The reason? Fear of opioid addiction (which had been a major problem in the decades leading up to this de facto prohibition) was firmly instilled in the medical psyche.

But options for pain management were a lot more limited than they are today, and opioids? Well, they're useful.

So in the 1960s UK researchers John Lewis and Kenneth Bentley set out to create an opioid with a lower risk of addiction (and side effects in general). And in 1969 they largely succeeded with buprenorphine. About a decade later, in 1978, buprenorphine was approved to treat severe pain in the UK.

In the 1990s, it would be approved to treat pain in the US, and in 2002 it would be approved for what it is probably most well known for today- treating opioid use disorder.

There are several things that make buprenorphine different from other opioids. One, it has a pretty long half life. A half life is how long it takes for half of the drug to be eliminated from the body, and gives an indication of how long the drug works. Buprenorphine's half life is 38 hours, and its effects generally last a little over 24 hours (though it can be dosed multiple times a day in small doses for acute pain).

A long half life means steadier control over pain and potentially a lower risk for abuse because people aren't getting cycles of highs and lows like they might with other opioids.

Two, it has a relatively low risk of euphoria. Euphoria is name for the "good" feeling people get from opioids. While it's not impossible to get mild euphoria from buprenorphine, it is pretty unlikely compared to other opioids and typically doesn't last with repeated doses, meaning there's a lot fewer people who would seek it out as a way to get high, leading again to lower rates of abuse.

Three, very low rates of hyperalgesia. Opioids do a thing where, if taken consistently over time for pain, the pain actually gets worse. This is called opioid hyperalgesia, and it's separate from just building a tolerance to the opioid itself. The pain the person experiences literally gets worse, which sucks if you're trying to treat that pain.

It is fairly rare to get opioid hyperalgesia from buprenorphine.

Four, and potentially the coolest, it has a ceiling effect.

We have opioid receptors in our brains and throughout our bodies, which are how opioids, which bind to those receptors, treat pain and cause side effects. Generally, the effect of an opioid is modulated by how many of our receptors are bound at one time. For example, more bound receptors means more pain control, but also more side effects, like sedation and respiratory depression (slowed breathing).

If too many receptors have opioid molecules sitting on them, we die of an overdose.

Buprenorphine binds to these receptors too (in fact, it will knock other opioids off the receptors so it can bind to them), but instead of fully binding, it kind of "half-binds". It's sitting there so nothing else can sit there, but it's not causing the same level of sedation and respiratory depression common with other opioids.

That also means that after a certain dose (about 32mg), every opioid receptor is bound to buprenorphine. But unlike, say, oxycodone, where if every receptor was bound the person would be dead, if every receptor is bound to buprenorphine, the person would be getting very good pain control but markedly less sedation and respiratory depression.

Meaning it is almost impossible to overdose on.

Not only that, but because buprenorphine binds so strongly to opioid receptors, if a person who was taking a high enough dose of buprenorphine took a different opioid, they would not be able to overdose (or get a euphoric effect) on that opioid either because the other opioid wouldn't be able to bind to the receptors. This is part of why it is so useful for treating opioid use disorder- it manages the physical dependence/prevents withdrawal by sitting on those receptors, but it doesn't allow effects from non-buprenorphine opioids.

Pastel Medical Decome