Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: chronic pain (page 1 of 2)

Community Is Expensive, Drugs Are Cheap

One magazine I sometimes read is More, whose content is designed to help women in midlife. This month they’ve got a long feature on how women with migraines are being deluged with painkillers.

The drugs are “transforming” the migraines from episodic to chronic daily headaches. I’d thought this was my own private anomaly. (This view is part of growing up in an alcoholic family: everything is “personal,” we don’t have anything in common with anyone else, and we Don’t Talk About It.) I’m sometimes forced to take triptans every day for weeks, and this is not good for me but I do it anyway. It’s a common problem for women.

The piece mentions a review of medical-insurance claims published in 2009 that found “almost 20 percent of the opioids prescribed in this country are dispensed to relieve the pain of migraines and headaches.”

But the source wasn’t cited. So I did a little checking and turned up the study, which appeared in the journal Pain (144:20-27). Psychiatrists at Washington University School of Medicine in St. Louis examined insurance claims for opioid painkillers, since self-reports of opioid use are pretty unreliable (we forget; we lie; etc.). They were looking at people who were “chronic” painkiller users (with more than 180 days of opioid use—which means I was a “chronic” user way back in 1999); “acute” users (less than 10 days), and non-users. Some startling results:

  • Chronic users made up only .65 percent—a tiny sector of the total population, but they used almost half of all the painkillers appearing in the claims
  • They had significantly more physical and psychiatric problems than people in the other two groups
  • Women made up more than 63 percent of the chronic users, and they used more of the medical services, especially as they got older
  • More than one-third of all the chronic users—and many more women than men—had mental health disorders.
  • Opioid abuse was twice as common among women than men, while men had twice the rate of alcohol problems.

Classic: We don’t have to drink, because we have our drugs! I can’t tell you how many women I’ve known who had this experience. I think of it as professionalizing our addictions. Being a drunk is low-class—Hurstwood crashed in the Bowery flophouse. But popping those pristine purple pills (which is the way I always remember OxyContin—like little amethysts) is moving it uptown.

And what do the drugs do for us emotionally? Do the scientists ever ask about the kinds of pain the drugs numb out?

Questions for a future interview.

The researchers are calling for pain programs to offer treatment not just for the “physical disease state” but also for the emotional problems that go with the appearance of chronic pain.

The way I hear this is, in order not just to cover up the symptoms but actually to heal, people in pain need other people to listen to us. We need community.

But healing the emotional problems is expensive. It’s a lot cheaper to give out drugs, even Prada drugs like OxyContin. Methadone and oxycodone (both of which I’ve taken; methadone is strong and cheap, I remember my shock when I bought 90 pills for five bucks) are a lot less expensive than the kind of help people might need to really heal. A study in the journal Headache (2010;50(7):1175-1193) last year found that in just six years between 1997 and 2003, U.S. methadone sales shot up by 824 percent, and oxycodone sales rose 660 percent. And this investigative story published in Salon and picked up by AlterNet the other day reported that the DEA has for the past 10 years been rubber-stamping gargantuan increases in production of opioid painkillers despite evidence of massive diversion from Florida to Maine and into the Ohio valley.

Insurers no longer want to pay for long-term treatments that involve patients talking to actual people (this story is trending in the New York Times today; there have been others talking about how psychiatrists only have time to give out drugs and can’t afford to listen to their clients).

It’s expensive to pay a real person.

From an interview with Gabor Maté that I’m going to run later on (stay tuned):

G: Do you think addicts can truly recover? You’re a proponent of harm-reduction for a certain percentage of addicts.

GM: The answer is absolutely yes. Precisely because we’re not isolated human beings. It very much depends on a supportive context. And if you talk to people who have made it, what was the one quality that was always there for them? Community.

The best solution is to build more community. Connection heals.

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G Gets Strong: What Do You Think Is Impossible For You?

Guinevere’s baby twin-pack

Day 71 of my 90-day fitness program.

During my workout last night I noticed I have two baby abs. (My son tried to make it into four but, poking just under my bra-line, he said, “No, you’re right, I think those are ribs.”  :))

This is not a vanity photo. This is evidence… This is an illustration for a story about a little girl who used to fall off the monkey bars in the playground and, in high school, couldn’t run even once around the football field without stopping to walk.

She came to believe she was “just not the kind of person” who was strong… and never would be that kind of person. In fact, she was taught she shouldn’t want to be that kind of person. It was just one of those choices in life—You’re either smart, or you’re strong. Pick one. You can’t have both.

This is the story of a girl who started, in tenth grade, having migraines that made her cry involuntarily, and still had to perform for her flute teacher with her right eye half-closed in pain—because her mom did not want the ten bucks spent on the lesson to go to “waste.”

And so she formed her priorities. And a lot of resentments and fears.

This girl grew up and the physical pain only got worse and worse… It wore her down and became entwined with the emotional pain, and though she knew she probably had “a problem” with medications she thought, Screw it, I’m defective, I’m broken, I’m physically weak and always will be.

Eventually she was told she had fibromyalgia and was, to her relief (and eventual delight), given opioid drugs to take every day, hydrocodone and morphine and OxyContin and fentanyl, one after the other, some times one with the other, and was told she might have to take them forever, because there is no cure for fibromyalgia or migraine—no one even knows what really causes them.

The drugs got stronger and stronger, more and more. They made her not-care about practically everything. That was what she wanted—not to care. She asked for the drugs, sometimes by name, and because she looked and sounded so professional and reliable, her wishes were granted.

This woman let stress and worry get to her so much that her muscles clenched, even in sleep, no matter how much medication she took. She came to believe “it would always be this way” and threw in the towel.

Then by the grace of God or HP or Whatever, she got sober. She asked for help.

This girl is now 46 and is two-and-a-half years off drugs and one year sober and is here to tell you: She can now do 50 pushups during a workout, can do three pull-ups without using her foot to help her up, and can do 13 dive-bombers (not the Hindu push-ups, the real thing) when on Day 1 she couldn’t do any.

Even her son trying to make the two abs into four feels strange for her… because she’s so used to the voice rooted inside that says, Those aren’t abs, who do you think you’re trying to fool, you can’t be that fit because YOU’RE G. You’re the one who fell off the monkey bars.

Well, not any-friggin-more she’s not.

HP told her last year to get going on the physical fitness… And she said OK, and went to any lengths just like she went to any lengths to get sober, and she’s finding that fitness in general is like a mathematical equation:

WILLINGNESS + EFFORT = RESULTS

And amazingly, she has LESS pain. The more physically fit she gets, the less pain she has. The more spiritually fit she gets, the less emotional pain she has—less often, and of shorter duration.

Because she is stronger. And because she has people around her, God/HP/Whatever bless them, who are willing to help her. Because she asked for help.

And now there are lots of possibilities going through her mind.

She is now thinking… What else do I think I can’t do, that I’ve always wanted to do??

This list is growing. She has found out that she’s hardly ever made lists like this before.

Wow.

Her fear still crops up

(what if i can’t do it what if i screw it up what if what if)

but she looks at the picture of her little baby abs and thinks, Wow. This gives her the guts to keep walking the walk. One foot in front of the other.

What do you think you can’t do? … I am here to tell you: You can do it.

Give it a shot.

Reverb10: 11 Things I Don’t Need

[Until 31 December I’m participating in reverb10, a month-long challenge to get bloggers to respond to writing prompts designed to help themselves and their readers take stock of the past year—conduct the year’s final inventory—and to imagine possibilities for the coming year.]

Topic: 11 Things. What are 11 things your life doesn’t need in 2011? How will you go about eliminating them? How will getting rid of these 11 things change your life?

How strong am I? I’ve always wondered.

Things to get rid of in 2011: Eleven teensy weensy character shortcomings…

Self-doubt. I want to cultivate self-confidence and, on a broader level, faith. To do this I’d like to develop my physical strength. As a kid I could never swing across the monkey-bars, and I’ve never been able to do a pull-up. I could never run or throw, and this meant I was chosen last for every team… Only in the past 12 years have I been able to run at least a mile. I plan to begin a physical training program in the new year that will integrate nutrition and exercise. I’m not worried about my weight—my weight is fine—I only want to know how strong and fit I am, and I want to carry on strengthening my recovery. I’m working with someone who knows about exercise and nutrition, and who knows me, in order to identify the best training regimen. I’ve never believed in my own physical strength, and now’s the time to test it out.

chocolateSugar. To run the railroad you’ve got to fuel the engine… Sugar is one of the poorest fuels. I want to get rid of it. I once went on the Liver Cleansing Diet. It was one of the most difficult diets I’ve ever been on—completely vegetarian for the first two weeks, and dairy-free for the whole thing. And NO SUGAR. Period. I remember my migraines disappeared. Do I have the discipline to exercise and eat the way I need to in order to control my pain? Will I ever know what it’s like to be entirely drug-free? Best of all: will I ever know what it’s like to enjoy truly good health?

Pessimism. Changing habits of thinking is never easy… I read a post on Reverb10’s Twitter feed (#reverb10) today that talked about how the blogger was quitting Reverb, she had had it with the optimistic attitude of the prompts—she was dedicated to seeing the glass as half-empty. As a lifelong pessimist raised to think and behave that way since childhood by the Mother of All Pessimists, this post’s attitude was familiar to me, and also frightening. It was looking into a mirror. … I want to get rid of pessimism. I plan to become, instead of an optimist, a realist. I plan to ground my decisions in data, evidence, and reality-checks from trusted advisors. And then I plan to follow through and trust them. Act on the basis of that information, rather than on the habit of negative feeling and vague intuition. It takes true balls to reject pessimism. It will be such an important model for my son. … I don’t know yet how this will change my life—but I imagine it will put up a few clean windows in my mind.

Self-hatred. I can create a nurturing, healing environment in my mind, the way I do when my body is healing. I wouldn’t admit dirt into a physical wound—I’d protect it from an environment that would be toxic. … Karen Armstrong writes, in The Spiral Staircase, that an interpretation of the Golden Rule, from the Talmud, is, “Don’t do to others what you wouldn’t do to yourself.” What wouldn’t I do to myself?—I wouldn’t run myself down in my mind, speak in disrespectful tones to myself, slap myself upside the head, call myself names, swear at myself.

Impatience and absence. I go out of my head, almost literally, when I can’t bear to let life be as it is. When I feel like I’m slipping radically out of control, I lose my mind—or want to take something to get out of it. “Time takes time,” as they say, and this is something I often refuse to accept, as if the clock shouldn’t pertain to me. I intend to keep up my daily meditation practice to bring my awareness into the present.

Clutter. The physical manifestation of self-hatred and impatience/absence. Organization is simply bringing awareness to bear on my stuff…  Recognizing it as truly mine… And putting it away/getting rid of it because I care about myself.

Self-pity. “Thank you” is a simple, powerful prayer. A gratitude list is an immediate antidote to self-pity.

Hurry. I have this incorrigible habit of overestimating the number of tasks I can get done in a certain amount of time—say a day, or an hour. If I know it takes 10 minutes for me to get somewhere, I’ll shave five off to do something else and wind up late. Today I drove my son to his guitar lesson 20 minutes early—so instead of sitting with him in the car and having a nice chat, or reading together, I drove in a mad rush to the library to pick up a book. Pulling out of the library car park, we had six minutes to get to the lesson, and we made it on the nose. So I’m teaching my kid to lead a life of haste, and I’m also carrying on being addicted to the adrenaline-rush and drama of life on the run. What would I do if life were just calm, and I could relax? I might learn if I could get realistic about the number of jobs that fit into five minutes.

Passivity. Because I never feel like I get “enough” done, I procrastinate about work. I waste time on Facebook or Internet surfing, and I don’t adequately pay attention to scheduling my days so that I’m accountable to a timetable. So in 2011, I plan to use my electronic calendar and maybe check out the Action Method or some other project-management helper to help create incentives and move my projects along.

Perfectionism. Another habit I have is comparing myself with other people who appear more successful than I am at what I’m trying to do in my life—whether it’s blog, write a book, maintain a marriage, raise a kid, or ride a bike. Whatever—if you’re doing something I’m doing, I’m bound to compare myself to you, and you’re probably going to be the one standing on the pedestal. … And quite often I overestimate the number of tasks I can fit into a space of time because I want to do every task perfectly, and this makes me take too long to finish them. Including this blog post… This is where higher power comes in. The thing with me is, I Want Results. But I want the results that I want. If I want to get rid of perfectionism (which is to say, if I want to welcome myself to the human race) I need to put in the work and leave the outcome up to a power greater than myself.

From painkillers to heroin: A new study

Surprise, surprise. A new study by some researchers at the State University of New York at Buffalo (UB) has shown that increasing numbers of heroin users became addicted after being given legal painkillers for pain.

The study appears in June’s issue of Journal of Addiction Medicine.

The researchers found that many pain patients first got hooked by using legal prescription drugs, and then they progressed to buying illegal opioids off the street. “Later, they purchased heroin, which they would come to prefer,” the study states, “because it was less expensive and more effective than prescription drugs.”

More effective, you ask?

OxyContin 80mg

OxyContin 80mg tablets

If you look at the study results: more than 90 percent of the participants had purchased street-drugs at some point, and not just tidy little pills—almost two-thirds preferred heroin to anything else “and more than half had used drugs intravenously.” Any drug used intravenously is going to be “more effective.”

It also depends on the “effect” you’re looking for. But in terms of either pain- or mood-control, IV is the most bioavailable route (meaning there’s less drug lost to metabolism—it all goes into the bloodstream), and it’s going to give the strongest “effect.”

As to why they’d choose heroin over pills—I’ve never shot up or bought anything off the street, but I understand from friends who have that it’s more difficult to shoot pills, especially pills with non-opioid agents such as Tylenol and especially fillers that clog up the works.

Another troubling fact reported in this study that all the other digests have missed: 74 percent of these pain patients said the physicians who prescribed them opioid painkillers for extended periods never asked them about any personal or family history of addiction before giving them the drugs.

One of the authors, Richard D. Blondell, M.D., a family medicine doc at UB, made a comment in the UB press release that kind of stuck under my skin:

I tell patients that addiction can be an unintended side-effect that occurs occasionally with the use of these medications. . . . Doctors need to be able to help them if this occurs, so doctors will need to monitor the use of these medications closely.

Those are my bolds. I wanted to know what he meant by addiction being “an unintended side-effect.” I mean, when I think of a “side-effect,” I think of those annoying flies-in-the-ointment that disappear when you stop treatment—nausea, insomnia, even sexual dysfunction. But addiction?—it’s permanent, man.

If you took a pill that caused permanent erectile dysfunction, would you call that a “side-effect”? … And ED isn’t even life-threatening. (Although I guess some folks might feel it that way…)

So I asked the good doctor: This seems a rather diminutive way of looking at addiction. Is this really the way you conceive of it? Many physicians do not understand the nature of addiction, they’re afraid of it, and this is why they miss the signs of it in their offices. … I also wanted to know how he proposed to “help” patients with chronic pain who develop addiction, since the solution for many a physician is to kick the addicted patient out of the practice.

I got a reply a few days later, via his PR flak:

Here’s the sensitive issue: many patients are afraid that physicians will shy away from treating “legitimate” pain if doctors are too worried about the risk for addiction. Many patients take these medications long-term without problems. We don’t want to stop that. On the other hand, some patients do develop an addiction which neither the doctor nor the patient ever intended to happen. The use of the word “unintended” is meant to be a non-judgmental term for this. It means that there’s no blame for the patient or the doctor; sometimes it just happens. When it does occur the doctor must recognize it and manage it with care and compassion. Blaming the patient, blaming the doctor, or “kicking the patient out” are not answers that accomplish anything constructive.

He didn’t quite get it.  He was focusing on the word “unintended.” I wanted him to talk about the word “side-effect.”

But it’s great that he’s getting physicians to talk about being non-judgmental and compassionate, and helping patients manage addiction. Blondell has another paper out in this month’s Journal of Addiction Medicine about how chronic pain patients who are addicted do better on steady doses of buprenorphine (Suboxone) rather than tapering doses to become opioid-free. It seems this guy’s orientation is to help some people with chronic non-cancer pain and addiction help manage their pain with some sort of opioids…

Looking forward to seeing how he thinks he can help pain patients with addiction “monitor” their use of painkillers so that they don’t abuse them. That’s one of life’s $64,000 questions.

And since Reckitt Benckiser has just been given the FDA go-ahead for their fancy new Suboxone film, it also seems like it’s time for me to get on the Suboxone story… a whole nother can of worms. Anybody out there with experience with Suboxone??

Fentanyl: The Drug The Kids Call “Fent.”

More about fentanyl… In gratitude for two years of freedom from it.

A 33-year-old upstate New York man is facing two years in state prison after pleading guilty Tuesday to selling the fentanyl patches that caused a teenager to overdose fatally when he sucked on them.

This guy, James Slingerland, apparently stole his father’s supply of patches after his father, who was being treated at home for end-stage cancer pain, was taken to the hospital. Of course when you’re taken to the hospital, you don’t bring your drugs with you because they give you drugs from the hospital pharmacy.

So Slingerland had this brainwave: he would nick his dad’s drugs and sell them for a bit of extra pocket change. Except the middle-man sold them to a teenager who then chewed one and died.

This is what a brand-name Duragesic fentanyl patch looks like.

Duragesic fentanyl

Brand-name Duragesic fentanyl patch, 75 micrograms.

Fentanyl is so strong it’s measured in micrograms, not milligrams. (A microgram is one-onethousandth of a milligram. Very small amount.)

Can you see the gel inside there? People squeeze the gel out and suck on it. I have a friend from Opiate Detox Recovery who used to call brand-name Duragesic patches his “ketchup packets.” Because he said as soon as he tore the envelope off the first one and saw how squishy it was, he knew what he’d do with it. He couldn’t stop himself. (It’s part of addiction, the not-being-able-to-stop-yourself.)

Aside from drastically increasing the risk of fatal overdose by sucking the gel (in other words, you can kill yourself by doing this), the other agents in the gel are also toxic to organ systems. The gel is NOT GOOD FOR YOUR LIVER when it is eaten. Please do not eat it.

I used to buy the generic Mylan fentanyl patches.

Generic fentanyl patch

Generic Mylan fentanyl patch, 100 micrograms.

This is exactly what my fentanyl patches looked like. 100mcg. Boy does this bring back memories…

In the news stories about the upstate New York overdose, the cops were saying fentanyl is “about 80 times more powerful than morphine.” Morphine is the gold standard against which other opioids are compared, and I’ve heard lots of different estimates bandied about. Truth is, they don’t really know how to measure how much more powerful than morphine fentanyl is, because of the varying rates of absorption. If you have not a lot of body fat, fentanyl will metabolize more quickly than if you have more body fat. If you have more body fat, fentanyl will hang around in your body longer and take longer to excrete, because it’s fat-soluble. If you work out, or if your temperature runs even a degree high, and you put a patch on your skin, fentanyl will be absorbed more quickly.

People have found all kinds of ways to warm up the patches so they’ll be absorbed more quickly—so the blood levels will “spike” and they’ll feel some kind of high.

And if you stick it in your mouth, where it’s the warmest in the body—where does the nurse take your temperature?—the fentanyl will be absorbed the fastest of all. If you fall asleep (“nod”) with it in your mouth—it can kill you.

For all the readers out there who get to this post by searching on phrases like “is it quicker to eat fentanyl patch or stick it”—THINK ABOUT WHAT YOU’RE DOING. Think about the people who have died.

Fentanyl is, if you’ll excuse my French, Nothing To Fuck With. It is only for opioid-tolerant patients with high levels of pain who are being overseen regularly by a physician.

Extra fentanyl worked wonders when I had an appendectomy and when I broke my elbow. For pain in the tissues, opioids do a crack job (to use a small pun). For neurological conditions, not so much. Fentanyl suckers (“Actiq” lollipops) are marketed for neurological problems such as headaches. In my experience all Actiq did for my migraines was make me not-care about them. They didn’t take away much pain—they just made me not-care about it.

And for addiction, they’re hell. There’s almost nothing harder to get free of than fentanyl. You want to up your tolerance, you’re in for some serious debt when you pay the piper, take it from me.

Fentanyl was my ball-and-chain for three years, until I hired a detox physician to help me get free. And two years ago this week I woke up free of fentanyl. I was on Suboxone for two more months—which is another story for another day soon—but I was free of fentanyl. Thank god.

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