Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: fentanyl (page 1 of 5)

Tom Petty OD’d On Fentanyl. And Other Drugs.

Petty02

Some people think fatal ODs have nothing to do with pain management—they think virtually all people who OD either bought street drugs or stole from other people’s prescriptions (“Medical use surely increased access to the drugs—but the people who got hooked tended to do so while using medication that was either prescribed for someone else or otherwise distributed illegally”). But damn, we keep hearing stories that show this is not true.

For every prominent person whose opioid abuse started with real pain, you can bet there are hundreds or thousands of people whose names have not been on marquees who started abusing drugs while seeking relief from what has increasingly become known, in coverage of the opioid problem, as “legitimate pain.”

The Los Angeles medical examiner today announced autopsy results for Tom Petty, who was found dead last fall: it was found that he died of a heart attack caused by an accidental drug overdose. His body had traces of three different kinds of fentanyl—which seems to be ubiquitous in ODs involving opioids, particularly heroin, these days, and which was prescribed to Petty for pain—and also oxycodone (the drug in OxyContin) as well as two different benzodiazepines (Xanax and Restoril).

As they used to say when I was a kid: Enough drugs to kill a horse. 

And a doctor (or doctors) prescribed them all.

He also smoked (see “emphysema” below). If he also drank, that would further have taxed his body’s ability to detoxify itself.

Petty’s wife and daughter issued a statement saying that Petty

suffered from many serious ailments including emphysema, knee problems, and most significantly a fractured hip. . . . Many people who overdose begin with a legitimate injury or simply do not understand the potency and deadly nature of these medications.

Which means it’s entirely appropriate that doctors’ prescribing practices should be more closely monitored. And doctors themselves—even pain specialists—need to get better education, especially in communicating with patients about real-life limitations.

Petty’s wife and daughter further said:

Despite this painful injury he insisted on keeping his commitment to his fans and he toured for 53 dates with a fractured hip and, as he did, it worsened to a more serious injury.

Sounds to me like a commitment not to his fans but to his ego. If he had been committed to his fans, he would have put his health first, so he could be alive today.

And maybe the doctors were a bit starstruck, too. Prince and Michael Jackson had the same problems: chronic pain that led to addiction, and doctors who fed their weaknesses.

“First doing no harm” in such cases would be to tell the patient that he has to quit smoking, and he Has To Stop Fucking Touring. Period.

A Different Prince.

Prince-pinned

Prince, pupils pinned v.01. (When you’re addicted to opioids, you can hide a lot, but you can’t hide your pinned pupils.)

When they said Prince had been saved by a shot of naloxone on the plane home from a show, I knew he’d been using something stronger than Percocet, and I was right.

I didn’t say this out loud, or write it here, because some people who loved Prince were screaming on social media that anyone “standing by to call him ‘addict'” were “haters.”

I don’t want to be a hater. I just want to tell the truth. I knew he was on something stronger than Percocet. He must have been, for a long time. Otherwise, the Tylenol in Percocet would have shut his liver down long ago.

“The decedent self-administered fentanyl,” the medical examiner wrote.

By all rights, I should have gone the way of Prince. For three and a half years I was prescribed fentanyl for migraine and fibromyalgia, and, as he did, I took too much (aka, “overdosed”). Many times.

Fentanyl is the strongest painkiller known. It comes in lollipops and in patches that you’re supposed to stick on your skin, but people who abuse the drug often suck on the adhesives. I did.

Mixed with heroin, fentanyl has killed dozens in the Northeast and Midwest United States.

Fentanyl is not as commonly prescribed for chronic pain as Vicodin, Percocet or OxyContin, for the simple reason that it’s much more lethal. Fentanyl is about 80 times stronger than morphine or heroin. From the variety of estimates given in the press and in professional literature, it’s clear that scientists have not even determined the precise bioequivalencies.

It’s just fucking STRONG.

Fentanyl’s particular pharmacologic qualities allow it to zip into the brain like a high-speed train, flooding receptors and stopping autonomic functions, including breathing.

Prince was apparently saved at least once by a shot of naloxone, or Narcan, a drug that kicks any painkiller off the receptors and reboots respiration. To help save lives in the opioid addiction epidemic, Narcan must be made more widely available.

But when dealing with fentanyl, the federal Drug Abuse Warning Network notes that EMS staff generally don’t have enough time to use Narcan “because this highly potent opioid can quickly cause death.”

//

ct-prince-photos-20160421

Prince, pupils pinned v.02.

I know how Prince would have felt when he was overdosing. He would have felt as if someone were stacking a pallet of bricks on his chest. Brick by brick, he would have exhaled, maybe closing his eyes, and it would have been a long time before his body wanted to inhale again. He might have wondered whether his body would remember to breathe.

He died alone on the floor of an elevator. Just sit and hold that image for a minute.

If he were in excruciating or intractable pain, which by many accounts he was, respiratory depression might, sadly, have come as a relief. For 30 years Prince performed acrobatic stunts in high-heeled boots, and the hip surgery he had about 10 years ago reportedly did not resolve his pain.

As a serious performer, Prince wanted above all to show up as the sequined spectacular of Paisley Park, The Purple One, The Artist. American society is competitive, and it values only what we’ve done lately, and those of us who grow up inside it—as children, being bullied by its bullies—learn to identify ourselves primarily with what we can DO. If we can’t perform, if we cannot work construction, sit for hours in front of a computer, carry our children—or sing the songs we ourselves have written and do splits with a hardwood guitar strung across our chest—without debilitating pain, we may begin to feel there’s little reason to live.

Often, our solution is to find a way to control or numb our feelings about the pain so we can do whatever the hell we want.

No: it’s up to scientists and physicians to find ways to control pain. We ought to surrender that job to them. When we play around with doctors’ tools, we risk our very lives.

//

My detox from fentanyl in 2008 was a hard, year-long slog, and it taught me my job is to find ways to treat my body so I don’t hurt it in the first place. We all need to live inside our mortal bodies and learn to accept their earthly limitations.

Drugs—the doctors’ and pharma corporations’ solutions to problems—give us the ability to power through pain, but at what cost?

To be sure, no one really knows what crossed Prince’s mind when he put the extra patch on his skin, plastered it inside his cheek, or sucked the extra fentanyl lollipop.

Ostensibly being a devout Jehovah’s Witness, he may have wished he could quit the drugs. His staff apparently called in an addictions specialist shortly before he died—a California doctor who was sending his son to Minneapolis to conduct an addiction intervention—so it sounds as if Prince, and/or the people who surrounded him, might have known he had a serious drug problem.

Not many people have ever taken fentanyl. Having unfortunately been there, I can say it’s beyond hard to quit. Anyone using fentanyl to feed their addiction—or even to numb chronic pain—is in dire straits and will be slowly backed against a wall. Whether quitting the drug and getting sober or continuing to take the drug to control pain—either decision requires a transformation of one’s life, an acceptance of real limitations, physical and psychological. 

Prince might have been saved by Suboxone—the partial-agonist opioid drug used in detox and medication-assisted treatment, which the California doctor’s son was reportedly bringing to Prince the day he died. In fact, Suboxone helped me detox—but I’m glad I didn’t wind up taking it indefinitely.

Ironically, Suboxone or Subutex may also have controlled Prince’s pain. But never again would he have been able to leap off risers and cavort in high heels.

//

Prince

Prince, pupils pinned, v.03.

I remember dancing with my hazel-eyed college boyfriend to “Little Red Corvette.” (Ahhh.) That song is like a scent that forever hangs in the hallways of my brain, preserving my personal history. Little Red Corvette.

Those memories get filed away, and we move on. Right?

In order to live, Prince would have had to file those memories of landing in splits and accept his body’s demand that he transform his idea of himself—that he find a different way to be Prince. And we still would have loved him.

The Prince is dead. Long live the Prince..

The Prince is dead. Long live the Prince..

This blog has always been free. If you like what you read, please share.

Prince.

Prince

I’ve been waiting to comment about Prince, because the tox screens aren’t yet in.

It’s not like it was with Philip Seymour Hoffman, who was found dead with the rig still in his arm and drugs all over the house.

But today the New York Times is running a front-page feature about Prince’s apparent addiction to painkillers. Associates have been saying since the day he died that he’d had hip surgery because of his acrobatic performances onstage, in high heels.

princesplits_1bi2hnl-1bi2hnq

Prince was a short guy—five-feet-two. He was slim and lithe, and he spent decades bounding onstage with guitars strapped around his torso. Guitars are basically pieces of solid hardwood. They’re heavy, man.

prince-guitar

And the high heels—they look awesome, but they hurt the whole body, not just the feet.

prince-high-heels

In the years I’ve been running this blog, I’ve heard from so many people who became addicted to painkillers because they felt the need to push themselves past the limits of their bodies. Speaking for myself, I sought treatment for two painful neurological conditions in the early 2000s, when OxyContin was being jammed onto the medical market. I was assured by high-level pain experts that there was little risk of my becoming addicted because I had “legitimate pain,” but within a couple of years I was being prescribed massive doses of fentanyl, and I was abusing it.

Not many people make it off fentanyl alive.

I’m able to manage my pain without dependency producing drugs, because I have learned to work within my limitations. It has been a frustrating and humbling experience. My constant pain reminds me every day that I have to take care of myself in ways that are different from what I learned as a kid, and also ways that are different from what the culture would have me do—which is take drugs.

When the CDC last month issued new guidelines for opioid prescribing, Center for Disease Control Director Thomas Frieden M.D. noted in the New England Journal of Medicine, “Initiation of treatment with opioids is a momentous decision and should be undertaken only with full understanding by both the physician and the patient of the substantial risks involved.”

Drugs are not inherently evil, but they carry particular dangers. We live in a culture in which these very powerful chemicals are prescribed by doctors, many of whom do not understand their powers. And that ignorance is then passed to patients, who then learn not to respect the powers of the chemicals.

In Prince’s case we still do not know the autopsy findings, but reports from associates serve to remind the public of the importance of considering one’s penchant for using substances to drive oneself past one’s own limits. The artist formerly and belovedly known as Prince was a true original—as a friend of mine put it, “his own freak.” He was also a human being and a businessman, and he wanted to keep doing what he was doing despite the limits of age and physical injury. Unfortunately the human animal is not built to jump off stage risers in high heels for more than three decades without sustaining chronic injury. However artistically independent Prince was, a little humility is called for to accept the limitations of the human body and mind.

I’ve always found it pretty ironic that when Pink Floyd was writing their song “Comfortably Numb,” the working title was “The Doctor.”

Come on, now
I hear you’re feeling down
Well, I can ease your pain
And get you on your feet again …

Can you stand up?
I do believe it’s working good
That’ll keep you going through the show
Come on, it’s time to go

Prince-1

 

Dear Policymakers: Get Addicts To Help You Protect Public Health.

Read my piece at The Fix today about David Kwiatkowski, the hepatitis C–infected hospital tech indicted last month for stealing drugs from operating rooms. He is suspected of stealing syringes of fentanyl, injecting himself, then refilling the vials with saline and sticking them back on the drug-carts—in ORs in 18 hospitals across the country. OR staff then unknowingly used dirty needles on healthy patients. So people in this guy’s wake are testing positive for hepatitis C.

The indictment and the subsequent news stories were only about the drug-thefts—how sneaky he was, how messed up he was, how the staffing agencies kept hiring him out even though he was fired from several hospitals and found passed out in at least one hospital bathroom under the influence of fentanyl. Empty syringes were found in his lockers and clothes.

What interested me was the intersection of addiction and public health. Here was a guy who was in the depths of addiction, using the same drug I’d used. He used on the job, as I did. But I used alone in one room of my house. And this guy knowingly put the health of hundreds, if not thousands, of other people in danger.

How could that happen? What were the gaps in the system? How could they be fixed?

My medical sources for this story were amazing.

Dr. David Smith, founder of the Haight-Ashbury Free Clinic, back in the day.

David Smith, M.D., founded the legendary Haight-Ashbury Free Clinic in San Francisco. He’s worked with street-junkies for years and is now starting to work with white-collar dopefiends like me and Kwiatkowski. It’s always interesting interviewing these guys because they sometimes know so much about drugs. I can sometimes tell which ones of them are also addicts, and it was my sense that Smith is a recovering addict, and I was right. (He’s open about it.)

Smith knew a lot about drugs.

“Fentanyl is a very addicting drug,” Smith said. Healthcare workers, he said, are at greater risk than others of abusing fentanyl because it’s a common drug in surgical procedures. Healthcare workers steal it from ORs. Smith told me about a patient of his who ate a patch and had a heart attack.

He told me about a truck driver who was prescribed fentanyl for chronic pain, who put on too many patches and passed out behind the wheel of his truck, fortunately before he started the engine. The department of transportation tested him for drugs and he passed—because fentanyl, a synthetic opioid, is not on the standard five-panel drug test.

“But he had fentanyl patches on his body,” Smith said, “so he was mandated into drug treatment.” We need to test for prescription drugs, he said.

Society is focused on illicit drugs, but the biggest growing problem is prescription drugs, and they fall through the cracks.

He told me about another patient, a registered nurse, who ate a fentanyl patch and died. Addiction among nurses has not been studied as much as addiction among doctors. Smith’s wife founded the first nurses’ addiction-treatment program in California. These professional programs have fantastic success rates. If only all addicts could get the kind of healthcare that doctors (and politicians) get.

I’m working on a story now about addicted nurses and doctors. If you’re a nurse or a doctor addicted to opioids, and you’d like to speak (either under your name or anonymously) about your experience, please email me at guinevere@guineveregetssober.com.

Richard Garfein, USCD epidemiologist.

My second source, Richard Garfein, an epidemiologist at UCSD (and a really smart guy on whom I might have one of my little geek-crushes), used to be a CDC worker who would visit hospitals to figure out how patients got infected with hep C. It was when I was talking with him about how to change public-health policy that I had a brainwave:

What if hospital administrators and public-health officials got recovering addicts to tell them what the gaps were in the system?

“If you’re trying to protect your house from theft,” I mused to Garfein, “who better to hire than a thief?” I had already told Garfein I was an addict, so he knew he had one on the phone. One who could talk policy.

“Huh—you want to stop internet hackers, you hire a hacker,” he murmured. “I think that’s a really excellent recommendation. If you are doing a study that involves prison inmates, you have to have an inmate on your committee. There’s a lot to be gained by talking with people who have been on the other side.”

He emailed me this morning:

I fully agree with your message that users should be included among the stakeholders working on the solution to this program.

Hire me! I want to say. Hire me!

Do I need an MPH for this? Makes me want to go get one.

Suboxone: Addiction, Recovery, And Self-Confidence.

Hi folks, good to be with you again.

I miss writing on this blog. I used to file two or three blogs per week. That was before I got a job—several jobs, actually. I need to earn my daily bread, and I need to take care of my kid, who the other day flipped over head-first, fell on his head and shoulders, and was back-boarded off the soccer field (he’s OK but yes—shocking to watch the trainer test him for paralysis and hear her say, “We have to call an ambulance”). So sometimes the blogging goes by the boards. I’ve been filing a lot on my Facebook page, but you have to be my friend to see it. So, won’t you be my neighbor?

Been teaching writing to university students. An interesting experience: the last time I taught was four months before I got sober. The other day I was sitting in a meeting next to an acquaintance in recovery, a woman sober about two years who just got tenure at one of the universities in town, and I told her I was teaching again. “Teaching sober is AWESOME!” she said. This is someone who does not usually include the word “awesome” in her lexicon.

“I know!!!” I said. I am someone who usually does not speak with multiple exclamation points.

Teaching sober is, in fact, awesome. The best thing about it is that, having practiced Step 10 on a regular basis for four years, I now have a much better sense of what’s my responsibility and what’s not. Which enables me to relate to the kids (they’re kids: they’re just three or four years older than my kid) on a much clearer basis than when my head was wrapped up in films of fentanyl.

In other words, I have more confidence.

The root of the word “confidence” is the Latin fidere: fidelity, trust.

Sober, I can trust myself. At any rate, much more than I could when I was taking drugs.

It is 3 a.m. and I’m writing this because I got up to pee, checked my phone, and this email came in overnight. She is taking drugs to feel self-confident. She wants help.

The drug she is taking is Suboxone. She was using heroin for five months—“five long, brutal months,” she writes, “and even though that’s a short period of time compared to most people, I was really addicted”—and her doctor put her on Suboxone. Her doctor told her taking it for three months would lead to a lower “success rate” than taking it for at least eight. (I’d like to see the data behind the claim, and I’d like to know who financed the studies.) So she took it for a year—along with two antidepressants and a long-acting benzodiazepine.

No idea what kind of doctor she went to, but in fact family doctors and internists, who are generally ignorant about addiction and recovery, can prescribe Suboxone, a long-acting fat-soluble opioid that’s more powerful, milligram for milligram, than heroin. Just as family doctors and internists, who are generally ignorant about mental illness, can prescribe antidepressants—drugs that also change the brain, usually not for the better, according to Robert Whitaker, who wrote a comprehensive and almost universally acclaimed book on the subject of psych meds and mental illness. Any time-frame over six weeks is considered “long-term” treatment by most physicians and researchers, and lots of folks wind up on these drugs indefinitely.

My reader writes,

I have been living with the knowledge for about 18 months that Suboxone is this wonder drug. It turns out I didn’t know too much about it. I kept a couple of the film strips in case I felt like I was going to relapse. One day I took the Suboxone after about three months of being off of it and I felt so high that it scared me… so I tried it again after.

Of course she tried it again. She’s an addict, and she has drugs in her stash.

This person has a job, too. She’s a college student, like my students. She’s studying to be a doctor, “so I could go help people with the problems I had,” she writes. And since starting school in August, she’s been on “a Suboxone binge,” she says.

Not to get high, but because it gives me my confidence back.

She needs confidence. She has to make friends, she writes. “I became socially awkward after my addiction”—as though her addiction is “over”—“and I felt like I needed it to talk to people.” So now she’s back to taking it every day.

Just little, tiny pieces, probably like 1/9th of a pill a day, but I don’t want to take it anymore, and I want my confidence and ability to talk to people back… can you please help me?

I have news for whoever is reading this who thinks that one-ninth of a Suboxone pill isn’t a lot. If it’s one-ninth of an 8mg pill, then that’s almost 1mg of buprenorphine, and that’s roughly equivalent to 30mg morphine. Which ain’t nothin to sneeze at.

This 18-year-old girl (she is 18: she told me) is taking drugs simply because she wants to trust herself. She has a drug that gives her that fleeting feeling of self-trust. She knows it won’t last.

These emails I get from readers feel like silk threads that bind me to folks around the world who are desperate for help with their drug problems. It’s like each of these people is Spider-Man, firing out webs that reach around the world and go straight inside me and attach themselves there. And they pull.

To my reader: your addiction is not “over.” If indeed you were “addicted” to heroin, then you are an addict. Being an addict doesn’t mean you’re a low-life. It means you have an illness, and like anyone who is ill you need to learn to take care of yourself. To do this you must ask for help In Real Life. However scary it might seem.

On the other side of that reality of needing to ask for help is this problem my reader will most likely run into: she may go to her doctor and tell him that she stashed her films and she’s been using again. You know what may happen? He’ll decide she’s a “chronic relapser” and put her back on Suboxone, perhaps at a higher dose, perhaps for a longer time. She is 18. Her brain and central nervous system aren’t really even out of childhood.

She writes, in a voice that is perhaps not self-confident but certainly reaching toward self-awareness,

I don’t want to take it anymore.

“I don’t want to take it anymore.”

The famous scene with Peter Finch from the film, “Network.”

I’m mad as hell and I’m not gonna take it anymore.

Reader, there are two ways I might be able to help you. One is to suggest you call Alcoholics Anonymous or Narcotics Anonymous and get help from real people who have been through this (and worse). Don’t Take It Anymore.

The second is something I think I need to do for all the folks who write in, to me and to forums for drug addicts, saying they can’t quit Suboxone. And that is to write about Suboxone.

If you have a story you want to tell about how Suboxone either helped you or kicked your ass, please email me at guinevere (at) guineveregetssober (dot) com.

Older posts
Visit Us On FacebookVisit Us On Twitter