Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

The Narcan Is Working, But The Dealers Aren’t.

So it’s not clear exactly how many have died, but one report says “several” Western Pennsylvania people have died of overdoses of heroin in bags stamped “Piece of Mind.”

Narcan has saved at least another 15. Which, it’s about time Narcan is out there. It should be as easily available as condoms, IMO.

As in any story, I like to read the social media comments sections. One woman wrote,

Any person that could hand over these drugs to make a dollar should be dead themselves.

I’m pretty open about the fact that I’m recovering from addiction. What I talk less often about, because it’s not my life, is the fact that I come from a family pretty full of people with addiction. A few of us are in recovery. But a bunch of us are dead.

Here are the Pennsylvania people arrested so far.

heroindealers

They remind me of some of my cousins. When those cousins were still alive, of course. When they were alive, they were tricking, stealing, and also selling drugs.

You think people start out at 8 or 10 dreaming of looking like these dealers by 28 or 30—unhealthy, hard, haunted?

The reader writes,

Too many kids losing their lives. Too many kids losing their parents. How can we put a stop to this… I don’t care.. You get caught putting this on the street you need to be in jail for the rest of your life. Period.

Interesting.

You think all drug dealers aren’t parents?

You read the word “drug-dealer” and you think “kingpin”? As a friend pointed out to me, these are not the Drug Dealers who the DEA ought to be going after. These are the street-level folks who are basically heroin users selling a few bags on the side. Their main problem is addiction. “They are tortured souls,” my friend said. And they need treatment and a hell of a lot of support.

You think there are no people with addiction who are so sick they shoot up in front of their kids, teaching them how to do the same?

Putting a drug dealer away for life is depriving another kid of his or her parent. You may argue that the drug-dealer deserves it, but does the kid? Research shows that kids who grow up with incarcerated parents are more likely to become just like those parents, and/or to develop other serious health and social problems. These people in the mug shots probably grew up with parents who were mentally ill, addicted, incarcerated. The cycle repeats, unless we a a society stop it. We need to figure out a better solution that just killing them or sticking them in prison.

She writes,

I can’t believe what society has came too

Well, hon, I can’t believe what society has came too, neither. What it has come to, according to you, is this: we should imprison for life people who straight-up sell heroin, but we should let off scott-free people who trick others into signing bad mortgages and deprive them of their life savings and blow the bottom out of the economy and cause the largest recession since 1929.

Also, what it has come to is this: we are finally admitting addiction is not just a low-class black-folks and white-trash problem. It’s not just in Washington and Johnstown. It’s in Pittsburgh. And in Pittsburgh it’s not just in Homewood and the Hill anymore. Although when it was, not too many people cared: another reader wrote,

They don’t make a big deal when it happen in North Philly. Y do they care when it happen in West Pa?

It’s in white upper-middle-class Upper St. Clair, too.

And even if you grow up white and “privileged” and go to college, you’re looking at a shitload of debt and a shrinking job-market for anyone not doing software or drone development. SUPER good times, this economy. It SUCKS, and the 1 percent is overjoyed because a lot of the 99 percent is so hoodwinked about the situation that they either don’t bother to vote or, if they vote, they actually support the people who are enacting policies that enable the yawning class gap.

The Narcan is working, but a lot of people in this society are not. And as Gabor Maté, Johann Hari, and a number of other people writing about addiction have pointed out, we don’t just need to detox “junkies” and send them on their ways—or even to put them on maintenance drugs—to solve the problem. We need to create a society where they actually have a chance of doing productive work for a living wage that pays for both their student loans and a place where they can keep their heads out of the rain.

Otherwise, cutting, bagging, stamping, and selling dope looks like a pretty damn good way of making a buck.

//

Richard Pryor: “They call it a ‘epidemic’ now. That means white folks are doin it.”

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Middle-Aged White Women: Why Are We Dying?

Selfie of G. I'm 51, and I'm in the demographic that's dying fastest from painkiller addiction.

Selfie of G. I’m 51, and I’m in the demographic that’s dying fastest. I have six years in recovery from painkiller addiction.

The New York Times is all over the “narcotic epidemic” this week.

Probuphine

First we had a story about the recommendation for FDA approval of Probuphine, the implantable plastic matchsticks saturated with buprenorphine. The story was mostly about how sticking this drug inside our bodies would reduce overdose deaths from heroin, prevent us from selling buprenorphine (Suboxone) on the streets, and keep us compliant with taking our doses.

The trajectory of the story (“Let’s cure all addicts with this drug!!”) was saved by a CDC physician and a West Virginia University doctor, both of whom said we can’t just implant these sticks into people and send them on their merry way.

But you know what?—that’s exactly what will happen. Because that’s exactly what has been happening for two decades with SSRIs, which were approved for major depression, were never intended for lifetime use, and were recommended for use concurrent with psychiatric therapy. But the NYT has run stories about, gosh, therapy is so expensive! And to get SSRIs you no longer have to see a psychiatrist. You can go to your PCP, who most likely isn’t qualified to treat depression.

But you’re probably diagnosing yourself, so hey.

And you know what else?—the FDA will approve Probuphine for opioid addiction, but dollars to donuts it will be prescribed off-label for other stuff. Also, doctors will up the doses—off-label. Because that’s what happens with drugs. Doctors aren’t bound to prescribe only for approved uses. And they don’t. And doctors usually don’t know much about the drugs they prescribe. Most doctors who prescribe buprenorphine have no idea how strong it is.

I bet you a dollar that many people with opioid addiction who try Probuphine will wind up with permanent bupe implants.

Because doctors know how to get us on this stuff, but they never know how to get us off.

BIG News: Whites Are Dying Of Overdoses.

omg, AND!!: whites are now dying of overdoses faster than blacks. Which is HUGE news.

Because guess which race makes up the majority of the NYT’s audience—and that of the other major media outlets (except AlJazeera).

For the past five or six decades, black heroin addicts have been dying from overdoses (and ancillary illness and crime), and their communities have been bombed out by the war on drugs, but their deaths and mass incarcerations have not spurred the kind of critical, apparently sympathetic spotlight that the media is now turning on white overdose deaths.

The headline (“Drug Overdoses Propel Rise in Mortality Rates of Young Whites”) says young people are dying fastest, but when you get to the graphs, you can see that among women, the age group that’s dying fastest is 45-54—my age group.

Deaths from drug overdose. Source: NYT.

Deaths from drug overdose. Source: NYT.

Eileen Crimmins, a professor of gerontology at the University of Southern California, said:

For too many, and especially for too many women, they are not in stable relationships, they don’t have jobs, they have children they can’t feed and clothe, and they have no support network.

It seems weird that they spoke to a gerontologist for this story, but in fact among white women it’s the older ones of us who are dying fastest.

We have no support network. She says.

Recovery is all about building a support network. It’s also all about finding out how we can contribute to society, which is how we earn a living.

It’s strange that the Times didn’t put these two stories together. After all, the thinking in one (“painkillers are killing whites”) leads directly into the other (“Probuphine will save painkiller addicts’ lives—because everyone knows dopefiends can’t stay off drugs any other way”).

That is the way treatment is headed, by and large.

There is no reliable science to show that people addicted to opioids have a tougher time staying off their drugs than anyone else addicted to any other drug, as long as we have access to a support network. But the popular idea is that we painkiller addicts have wrecked our neurology for good.

And this is the line scientists will take because their research is funded by pharma. This is the line pharma will take because it will sell more drugs. This is the line physicians will take because prescribing drugs takes less time in the consultation room and helps them avoid the time-consuming work of actually getting to know patients. And this is the line journalists will take because they don’t bother to challenge their “expert” sources’ thinking.

So why are we dying?

Painkillers kill pain—physical and emotional. They numb the human being.

In a larger sense, to get at the real cause of why we’re dying, we could ask what we’re numbing out. What is the pain that we’re bombing out with drugs?

That’s a discussion I’d love to participate in, and that would not only keep people alive in a minimal, technical way but rather help them thrive and also cultivate people’s overall long-term quality of life.

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I’m Not A Unicorn.

It’s been a long time, dudes!! The New York Post is running a story today about middle-aged women and addiction to prescription painkillers. The reporter was looking for a middle-aged middle-class white chick to talk about this, and guess who she found.

The online headline says I was a “perfect mom and wife,” but I was not a perfect mom and wife inside my addiction. I was a lot less than that.

And as always with newspaper stories, some things didn’t make it in:

  • That my son (who is now 18) knows about my addiction, is my biggest supporter in recovery, and has always had my back (read here, and here, and here, where I told him about my addiction)
  • That both my parents were addicted to legal substances and died because of their abuses of those substances.
  • That I do not hold my doctor responsible for my addiction, but I do hold her responsible for failing to screen me for risk of addiction before giving me drugs like pure hydrocodone and morphine and fentanyl, and for failing to recognize my addiction and respond with compassion and treatment, not judgment and punishment.

The biggest thing that didn’t make it in is my main reason for talking to the Post. (I mean, the Post is famous for Page Six, right? but if it had been the New York Times or Pro Publica or the Kalamazoo Gazette, my motive would have been the same.)

I talked to this reporter because there are other reporters out there (here is one example; there are many others) saying that once you’re addicted to opioids, you may as well resign yourself to taking drugs for the rest of your life.

black-unicorn-tattoo-design

(It’s hard to find an edgy unicorn image. They’re usually pink and lavender and sparkly. This black tattoo-design is cool. I’ve been thinking about getting a tattoo—maybe I’ll ask Cara to put this somewhere on my skin)

I am, however, not a unicorn. I know so many people, including many many women, who no longer cop heroin or snort Oxy. And they don’t take methadone or Suboxone, either.

But in some public health circles, it is said that there is no “proof” that we can actually do this. Nobody (except the tens of thousands of people who live opiate-free today) has “proven” that abstinence from opioids is possible—that human beings can choose to live drug-free and actually for-real carry out that choice.

There does exist, however, some evidence that people who are addicted to painkillers or heroin stay off street drugs and stop injecting if they take other opioids. (A lot of the research is driven by the desire to find a way to control the spread of HIV infection through needles.) So indefinite maintenance with these drugs—possibly for a lifetime—is now touted as the “evidence-based standard of treatment” for illnesses like the one I have, no matter what your circumstances.

I’m very cool with anyone who chooses to take drugs for life. If you WANT to drink methadone or suck on bupe films forever to keep from shooting or copping, it doesn’t matter to me. I considered it myself at one point. I have no problem with it, and I will not bristle at you in comments sections.

It’s unfortunate that a lot of people who choose maintenance say the way I do recovery—and the way so many other people I know who have long-term abstinence from opiates do recovery—is not “evidence-based” and therefore is sentimental, stupid, unscientific, or dangerous.

I will bristle at that. (I will still not judge you, but I will bristle, because you are judging me.)

It’s the people who DON’T WANT to drink methadone or eat bupe that I hear from.

I write and speak to places like the New York Post because I have heard from so many people who want to quit their maintenance meds and can’t find anyone to help them. Including, probably, many people who stand in grocery store lines reading the New York Post.

Let me restate in words of one syllable: they want help and can’t find help. Think about that. They are paying, per month, maybe $400 cash to the “Sub doc” plus whatever it costs them to buy bupe, or they are buying bupe on the street, and they want to quit, and they can’t find help.

I want to demonstrate that help is available. In order to demonstrate this, I’m willing to do hard stuff.

It’s kind of a little bit hard to talk to a total stranger from a newspaper with a circulation of half a million and admit that you took oxy just so you could, like, make breakfast for your family. And that you changed dates on scripts, and that you let people down, including the people you loved and who loved you most, and made super-problematic moral decisions inside your addiction.

But anyone who has been inside addiction and who hopes to get out will know what I’m talking about when they hear these stories. And hopefully they’ll see a light at the end of the long dark tunnel.

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Hydrocodone Homebrew and MIT Bullsh*t.

Ken Oye

Dr. Kenneth Oye, MIT prof of political science and engineering.

Listen to Dr. Kenneth A. Oye, a professor of engineering and political science at M.I.T., saying this in the New York Times this morning:

Hydrocodone doesn’t give you the high that other compounds do.

I agree. It gives you a MORE AWESOME high! Like/share this link if you agree.

I’d like to send Oye some of the mail I’ve received over the years from folks whose genetic predisposition was turned on by hydro and who have spent tens of thousands of dollars buying Vikes through the internet and on the street.

Now Stanford scientists are homebrewing hydro. Hydro Pale Ale! Hydro lager, Hydro stout, Hydro ESB. So eventually we won’t need to buy bricks from the poor Afghan farmers!! In the name of American technological innovation and self-reliance.

I’d like to see Stanford, MIT, and other schools spend the money on researching effective treatment standards and educating medical students about how to recognize and treat this illness.

The Stanford High-Tech Homebrew Team.

The Stanford High-Tech Homebrew Team.

Suboxone Detox Redux.

Four years after posting this interview with Dr. Steven Scanlan of Palm Beach Outpatient Detox, I’m still getting mail about how to tolerate Suboxone withdrawal. This piece and a couple others I’ve written rank in the top 10 in Google searches, and over the years I’ve been so deluged with comments and private emails about people’s struggles to get free of this drug that I keep a huge separate file for them all. I’ve talked or exchanged emails with some of these folks, and eventually I plan to put out a booklet that collects people’s experiences with this drug that is—depending on where you live—variously doled out like candy by doctors who don’t understand its strength, or available only if you drive two hours or three hours through the wilderness and pay cash to doctors who run their Suboxone clinics like whorehouses.

A reader named Bob wrote this morning:

I was using 16mg a day for 2 1/2 years, I was in excellent physical shape, ran 4 times a week, multiple half marathons, but felt enslaved to this drug. I went to an out-patient 6 week detox program, just in one week I went from 16 to 8 a day, next week went down to 4 a day, then the following week I went down to 2mg a day for a week before I “jumped”, I stayed off of it for 2 days, had ungodly withdrawals, so they gave me 2mg for one more day, I then went 9 straight days with nothing before I did 4mg on a relapse, now I am at day 6 with nothing. I am a business owner and cannot afford to be ” on my game”…any ideas as to when it gets to be ” manageable?”

I think Bob meant he couldn’t afford to be OFF his game. It seems like, in his detox center, they wouldn’t let him taper down to the minuscule doses that are most helpful in Suboxone detox. Many, many practitioners prescribing this drug do not understand its pharmacokinetics—how it behaves in the body, and how the body processes and neutralizes it. They think 2mg is a small amount.

 

A Suboxone film, cut for tapering.

A Suboxone film, cut for tapering.

Look at this picture. This is how some people taper off Suboxone. They cut the dissolvable films into little bitty pieces. The company that makes Suboxone does not advise doing this, because they say they can’t guarantee the drug is evenly distributed throughout the film, but guess what?—I think it’s because they don’t want people to taper off it. I’ve talked to Tim Baxter, M.D., global medical director of Reckitt Benckiser, manufacturer of Suboxone. In two separate interviews he told me, “We don’t promote detox.” They want you to stay on this drug. But you don’t have to.

Disclaimer: I’m not a physician, I’m just sharing experience and making space for many others to share theirs. If you want medical advice, you need to see a doctor. ... That said, Bob, 2mg is a significant amount of bupe to jump from. Like jumping from about 60 or 70mg of morphine (the gold standard drug to which all other opioids are compared in their analgesic and receptor-binding strength). I was tapering off the equivalent of 400-500mg morphine per day, and I used Suboxone for two months. I jumped off about 1/8 of a milligram—the tiniest bit in the photo above. Dr. Scanlan and other doctors who understand buprenorphine, the opioid drug in Suboxone, taper people down to fractions of a milligram before they jump.

So you’ve been six days clean after taking 4mg, and you continue to be physically active? Awesome job. Keep it up.

Some tips—take what you need and leave the rest:

  • Get good food. Eat no sugar, no caffeine, and as much organic protein (meat, fish) and vegetables and fruits as you can. Fuel your body well.
  • Get good sleep. Don’t take sleep aids, except for maybe benadryl or melatonin, which Dr. Scanlan prescribes during Suboxone detox (see above). A low dose of gabapentin helped settle my legs and get sleep. Hot baths also did the same thing—fill your tub with scalding water and enjoy feeling your muscles relax. Scanlan also prescribes Librium (chlorodiazepoxide)—if you can get a provider to help you for a month or so by prescribing a low dose of this, it may help you sleep.
  • Keep exercising. This will ease your restless legs and arms, reset your opioid receptors, and increase your energy levels and your appetite for good food. Yoga is also effective to stretch and relax the muscles that feel cramped and jumpy.
  • Meditate. Research shows that for recovering addicts, meditation restores the connection between the limbic brain (the part where cravings live) and the prefrontal cortex (the part that lets us make good decisions). In detox and post-acute withdrawal, meditation calmed my mind and helped me understand that every goddam moment of detox passes and that I could make good choices to foster my health.
  • Read Dr. Scanlan’s paper about Suboxone detox. Pay special attention to the section called “The Jump,” in which he says he tapers people down to very low amounts and advises his patients to stop the drug when they have a week or two to take it easy on themselves.
  • Find a supportive community. Anyone who has been taking Suboxone is struggling with an addiction. And nobody gets sober alone. We all have to learn to ask for help. When I was detoxing, I needed to be in touch with people every day. I did this partly on the public forum Opiate Detox Recovery (which has a special Suboxone forum), and partly in a 12-step program, where I got a sponsor who I called almost every day, and where I went to meetings where I met people who had done what I was trying to do and were holding down jobs, raising kids, and most of all being happy.

Even more information about how to take care of yourself while detoxing and dealing with post-acute withdrawal is included in my book, The Recovering Body, which you can get on Amazon and in your local independent bookstore. 

Edit: Here is an email from a guy called Larry that came in several days after Bob’s:

I’m a 60 yr old male engaged in hiking, climbing and biking.  I’ve had a 15 year long opiate addiction.  I’ve used suboxone for 2 years.  I started at 4mg.  I requested the low dose as I felt 8mg/16mg was more than I needed.  I reduced my dosage from 4mg to 1 mg over 4 months,  from 1mg to .25mg over another 4 months.  I jumped off from .25mg  ( 1/8 of a 2mg strip).  I had moderate WDs for a week, 3 weeks of significant lethargy and continuing mild lethargy.  I’ve been clean for 2 months.   I can feel it getting better and I’m staying the course.  I really don’t have any choice.  The alternatives are all non starters for me.

If you don’t make it this time, taper to a lower dose, no more than .25 mg.  It’s worth doing.

(Emphasis mine. :) ) Fifteen years on opioids, and he’s now free. Congratulations, Larry.

Good luck to Bob, Larry, and the countless people out there who are trying to get free. Let us know how it goes.

Recovering Body_small

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