Thread by @Deezovariez

I can only imagine what my medical records say. I used to go to appts & explain my issues through quips & comedic hyperbole. Being entertaining is a masking behavior ingrained by decades of undiagnosed ADHD, but later I discovered it's considered a red flag for "drug-seeking"

https://twitter.com/ChadDKollas/status/1437083071422025728

Although it feels like the moment I was diagnosed w bipolar (in a low-income clinic, rarely seeing the same disinterested provider twice) I became a "drug-seeker" regardless. I had been getting 30 5mg pain pills a month, that's when I got cut off, didn't put it together til now..

And at the time that was totally fine, I didn't argue, my pain from the initial back injury was finally improving, so makes sense. But then a few years later the undiagnosed endometriosis pain intensified. I was working a low wage job, made like $100 too much a month for Medicaid

My experience the second time couldn't have been more different. No MRIs, nothing more in depth than x-ray. A clinic doctor threatened to 5150 me for crying in an appointment. I begged someone to help me, but I couldn't afford regular care. I was frustrated. I was a "drug-seeker"

It's frustrating. Doctors insist that they provide the same level of care to all patients, but we know that isn't true. If you're poor, Black, a woman, you're less likely to be believed, referred for procedures or specialists, be prescribed opioids or stimulants for pain or ADHD

If you can't afford regular care, can't regularly get to appointments without transportation, can't afford to purchase multiple alternative drug-sparing treatments first (often not covered by insurance), those things affect your care- even if you have no control over them

It seems like red flags for a "drug-seeker" mostly line up w various ways that ADHDers & autistic ppl mask, or our unmasked behaviors. I was chatty, friendly, squirmy, constantly trying to make my doctor laugh bc being funny is one thing I didn't (usually) get in trouble for

Drs seem suspicious or even hostile when I rock back & forth or stand & sway, but it's easier for me to focus & process. The situational anxiety of increasingly difficult appts leads to repeatedly rubbing my hands up & down my thighs. I think its a stim or a sensory thing for me?

Instead of these symptoms of my ADHD (& maybe autism) confirming that I'm telling the truth, the hyperactivity & stimming is called anxiety and/or seen as a sign that I'm faking for drugs. The affects of emotional dysregulation, RSD, & medical trauma are seen as a manipulation

When I'm in distress, pouring my heart out seeking care, when I've compiled questions & ideas to make progress/prove I want to act as a partner in my own care, and then Drs dismiss me or think the worst of me for being myself- that RSD spiral is incredible. It's all-consuming.

So every time I see a Dr all those things that seem to make them distrust me- rocking, swaying, rubbing, crying from sorrow & frustration- intensify. Drs close off. Needing care & getting apathy triggers intense RSD, like what's so wrong w me that just being me is a red flag?

The DEA frightening Drs into denying care, training Drs to see red flags everywhere, this obsession w cleansing healthcare of "drug-seekers," endangers the care of neurodivergent ppl, women, BIPoC, trans ppl, poor ppl- ask them & most will have multiple medical horror stories

Making abortion illegal makes it illegal for poor & marginalized ppl- bc rich ppl will always be able to buy their way into care. The same is true for drug prohibition- rich ppl are less likely to have the longterm untreated conditions & trauma considered "red flags" for us poors

And algorithms just compound the damage. An algorithm doesn't need to say "woman = don't prescribe." If it counts CSA, abuse, domestic violence, rape, & PTSD as "red flags" (which NarxCare does), then the algorithm is effectively biased against women.

Black ppl & white ppl do crimes at about the same rate, but we know that Black ppl are disproportionately arrested & incarcerated. So a "colorblind" algorithm that sees formerly incarcerated ppl as "high risk" is effectively biased against Black ppl- no explicit racism required

Disabled ppl & trans ppl experience high rates of physical & sexual violence, and high rates of poverty. If those factors are incorporated into the algorithm (they are), then the algorithm doesn't need to say "no disabled, no trans" to be biased against disabled & trans ppl

Medical drug prohibitionists pat themselves on the back for keeping meds away from vulnerable & marginalized ppl (bc we're destined to become "add*cts"), without considering that perhaps we're more likely to use illicit drugs bc we're less likely to have access to healthcare?