Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: heroin (page 1 of 7)

On Shooting Smack “Only” Twice.

Heroin_bottle

Bayer’s phenomenal invention, which they touted as a “cure” for morphine/laudanum addiction. As Vonnegut might have said, “And so it goes.”

Last Sunday my local paper published an epic piece about four people who OD’d on heroin last year. The writer ran a journalistic marathon following these survivors to see how they fared. That’s hard to do, it takes dedication, and I respect him for it. One subject is doing well. Two are struggling. And one, a 21-year-old man, fatally OD’d in his own bedroom.

His mother found him. She is suffering the grief of the world, and my heart is with her.

It’s important in journalism to get facts right.

They got two wrong.

First, he quoted a person with active addiction saying that if you don’t share needles and don’t OD, then “heroin is the perfect drug.” The perfect drug!! Well, hell. OK, it’s easier to control not sharing needles, but not overdosing?? Good luck with that. Easier (but not impossible) not to OD with pharma drugs, because you know what dose you’re getting. Heroin’s a total craps shoot.

It’s easy to justify this quotation by saying, “The subject said it—not me.” But it’s the journalist’s responsibility to check facts and provide perspective to skewed opinions.

For example, in terms of not being “perfect,” you may as well write sex off the list of stuff you’ll be doing as long as you’re shooting heroin. Also, women have a decent chance of going into early menopause, meaning they’ll wind up with thinning bones at, say, 35. This isn’t guaranteed because how many of us have heard stories of babies being born addicted to heroin?—another reason heroin ain’t “perfect” by a long shot.

Second, and this is the one that bothered me more: they said the autopsy showed the young man had “only” two track-marks on his arm, “which likely meant that the young man was no addict.” Holy Moses, Allah, Jesus and Buddha. The writer had just talked about how much pharma shit the guy had blown through for YEARS. His addiction to expensive pills he could no longer get was what drove him to the street to buy heroin.

These errors are such a sad commentary on the pervasive ignorance of the press and other powerful voices in our society about what addiction is and how it works. Hopefully in his next piece  the writer will reach out to some expert voices to check out his speculations.


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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 than 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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The Treatment that Might Have Saved Phil Hoffman.

Cross-posted with AfterParty Chat.

Philip-Seymour-Hoffman

Late last week it was suggested that a cultural stigma against maintenance medications such as methadone and Suboxone helped kill Philip Seymour Hoffman.

This doesn’t make much sense to me given the fact that, shortly after he died, it was reported that buprenorphine was found in Hoffman’s Bethune Street apartment. Buprenorphine is a long-acting opioid the FDA approved in 2002 for opioid detox and maintenance. It’s used mostly for maintenance: it’s the New Methadone, but it’s much easier to get, because while methadone is approved for addiction-treatment only in a clinic setting, buprenorphine can be dispensed in a doctor’s office. Refills can be called in or faxed to pharmacies.

So how did Hoffman get his bupe? Either he was being prescribed buprenorphine for his opioid habit, i.e. he was “on maintenance”—as so many opioid addicts are: buprenorphine maintenance is a booming business in this country. Or else, as many heroin users do, he obtained his buprenorphine on the street.

Poor heroin users often cop street “bupe” to tide them over between fixes. But Hoffman was far from poor. So it’s speculation, of course, but I think it’s more likely he got his buprenorphine from a doctor. That’s what doctors do these days with opioid addicts: When we get honest about our addictions inside the exam room (and because Hoffman had spent 23 years sober and abstinent via 12-step fellowships, it may be fair to say he had practice in being rigorously honest) the doctors’ fear kicks in and they boot us into Suboxone clinics, where we’re prescribed upwards of 16mg of this very strongly-binding, fat-soluble drug that stays in our bodies for days before it’s excreted. In painkilling power it’s weaker than morphine or oxycodone, but in binding power—in its ability to stick to the body’s opiate receptors—it’s the second-strongest out there.

The strongest is fentanyl, the drug that’s been cut into heroin and has killed nearly two dozen in my region alone.

//

812

Some publications are wont to report that opioid addicts—like Hoffman, like me—wreck our brains’ opioid receptors forever through drug-use. (This proves they don’t understand how the body’s painkilling system works: a great portion of the body’s opioid receptors actually reside in the gut. Which is why we get that lovely warm feeling throughout our bellies when we use painkillers or shoot heroin.) But there’s at least as much scientific and anecdotal support for the idea of neuroplasticity in recovery—the fact (it’s not just an idea anymore, it’s a fact) that the central nervous system is far more adaptable than we ever before believed and is evolved to use this resilience to recover from major traumas and illnesses, including addiction—especially if we help it by taking care of our bodies in basic ways, with exercise, good nutrition, and relaxation.

So the “old-school” idea is not 12-step programs, as these pieces suggest. “Old-school” is what I was taught as a kid: that once you lose brain cells, you never get them back, that our nervous systems cannot heal.

Still, these publications are putting the idea out there—and it is not a fact, it is just an idea—that if “most opioid addicts” don’t take maintenance medications forever to “correct” the “permanent damage” we’ve done through drug-use, we’re doomed to relapse.

//

Philip Seymour Hoffman just four or five years before he got sober, in his 1985 high-school senior-year portrait.

Philip Seymour Hoffman just four or five years before he got sober, in his 1985 high-school senior-year portrait.

The clearest example that this isn’t the solution exists in our states’ physician health programs (PHPs)—systems of recovery designed to help addicted and alcoholic physicians keep their licenses to practice. These programs vary from state to state but generally provide five years of continuous care and oversight. Success rates for PHPs are extraordinarily high—upwards of 80 percent of physicians finish five years of treatment and are able to keep practicing.

These programs ought to be considered models for our citizenry. But they remain off the radar because they’re rigorous, expensive and intensive—five years, as opposed to a 28-day rehab, or even a ten-day or three-day detox.

Also, studies of PHPs show that linking recovery to one’s work is one of the strongest incentives you can give an addict to take responsibility for healing. Addiction thrives in situations of un- and under-employment not because the poor are somehow more susceptible to addiction, but because the people affected don’t have enough, or any, productive work.

It’s sometimes said that PHPs are effective for “highly motivated” addicts. Which leads me to my last point. I find it astonishingly patronizing that some are suggesting that public prejudice against maintenance killed Hoffman. Hoffman was an extraordinarily intelligent, articulate, “highly motivated” man and consummate professional whose work, he said, required him to be extremely introspective and emotionally present. I find it hard to believe he would be so easily swayed by public opinion about his choices.

I can more easily see him protecting his ability to work.

To act with the depth of feeling and nuance that he managed required full use of his entire internal emotional range. And opioid medications—including buprenorphine—necessarily dull one’s range of feeling.

I think it’s more reasonable to suggest that Hoffman tried bupe and found that, while taking it, he couldn’t access his feelings to the degree to which he’d become accustomed.

To be sure, he likely felt a great deal of shame during his relapse. One of the more damaging aspects of some 12-step groups, in my opinion, is their focus on “sober-time”: to “come back” from a relapse after a sober period of 23 years—half one’s life—would have been not only extremely embarrassing for anyone but also physically difficult, given that the heroin available these days is wicked strong.

But no way could Hoffman have wrecked his neurology permanently by using heroin for less than a year. I think it’s likely he did what so many who use heroin do: he chipped heroin, then switched to bupe, thinking it might remove his cravings. In fact, buprenorphine reliably does this for many opioid addicts who take it.

But craving is a feeling, and you can’t numb feelings selectively. My bet is that, feeling not-high but not-normal—after all, he’d been sober for 23 years: he knew what His Normal felt like; he knew what it took for him to do his job with the precision and quality with which he was used to doing it—he said what so many of us say when we’re caught between a rock and a hard place.

Fuck it.

What he needed was not more drugs. What he needed was a better form of treatment, perhaps the best evidence-based addiction treatment system we have going: the time-consuming, attentive one we give to doctors, the people we trust to protect other people’s lives.

But because Hoffman was “just” an artist, he followed the cheap, easy, brief trajectory that ordinary people in this country follow.

Pills. Then heroin. Then Suboxone. Then heroin again. Then death.

Hoffman in perhaps the last photo ever taken of him, a tintype made by Victoria Will two weeks before his death.

Hoffman in perhaps the last photo ever taken of him, a tintype made by Victoria Will two weeks before his death.

Philip Seymour Hoffman.

philip_seymour_hoffman_wallpaper_6-1152x864

As Truman Capote, the role that won him the Academy Award.

As Truman Capote, the role that won him the Academy Award.

It’s being widely reported that Philip Seymour Hoffman died of a drug overdose. He was found in a West Village apartment with the sharp still in his arm and several bags nearby.

He had 23 years sober before he relapsed on painkillers and heroin in 2012.

In "Almost Famous," as legendary 1970s music critic Lester Bangs.

In “Almost Famous,” as legendary 1970s music critic Lester Bangs.

The news literally knocked the wind out of me and I cried, the way I cried the day I heard David Foster Wallace (another person recovering from addiction) hanged himself. My first thought in both cases was selfish: Now we never get any more of their brilliant work. 

My second thought was for their partners, and for Hoffman’s kids. Hoffman had—has? had?—three kids. “Young children,” they are described in the New York Times story. Village residents who saw him around the neighborhood are describing him on Twitter as a generous dude who was kind and unpretentious when he brought his kids to the coffee shops.

As the kind, unpretentious home-health worker in "Magnolia."

As the kind, unpretentious home-health worker in “Magnolia.”

I loved him in this role in “Magnolia.” There is a video circulating on Twitter, a clip from “Before the Devil Knows You’re Dead,” showing him being shot up with drugs and mumbling while he nods. The author of the Tweet wrote,

How art more than imitates life.

Well, sure. Those of us who used to nod out may remember how to act like that. It’s more challenging to really BE kind and unpretentious. I prefer to remember him in this role—the attentive nurse who helps Tom Cruise’s father die.

(There’s an even better scene here. The dying guy is played by Jason Robards, who was a recovering alcoholic. Robards’s character admits how shitty he feels about having cheated on his wife, and later Hoffman’s character takes pity on him in the extremity of the guy’s suffering and uses the morphine to put him out of his misery, kissing the guy’s forehead while he dies. A bunch of commenters blasted this scene by calling it for example, “white-knight pussy propaganda,” but to me it looked like two recovering drunks listening to the wreckage of the past—a practice that is sometimes criticized by those who hate 12-step-recovery as being holier-than-thou superfluous moral bullshit, but which can be very helpful for recovery if it’s done well.)


The fact is, Philip Seymour Hoffman’s work made him an extraordinary artist, but with regard to this disease, he was just an ordinary person with addiction. 

The illness of addiction is the most endemic and perhaps the most invisible in our society. It is connected with so many other illnesses—HIV, heart diseases, lung diseases, liver diseases, cancers of all kinds; and also depression, anxiety, and other mental illnesses—as well as car accidents, accidental shootings, murders, and other forms of death. PLEASE LISTEN: every 19 minutes an American dies of a drug overdose. Here in Pittsburgh two dozen have died in the past two weeks from a fentanyl-spiked cut of heroin. That cut is making its rounds to bordering states, and I wonder whether that’s what killed him. I’m glad fentanyl didn’t kill me

These numbers ought to be unacceptable to any sane citizen or leader—and remember, we elect the leaders.

As someone who writes and speaks about the dangers of this illness and the possibilities of recovery, news like this makes me feel at once nearly despairing and also recommitted to letting the public know that with appropriate help people with this disease can recover.

Phillip-Seymour-Hoffman

seymour-hoffman

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Among Addicts, It’s A Small World After All.

The other day I get an email from an English guy who says he has a story about Subutex, if I’m still collecting stories about buprenorphine (I am still collecting them and will be talking to folks starting in May—if Suboxone saved your life and/or kicked your ass, please email me).

This guy spent 10 years on buprenorphine after a devastating heroin habit. He took methadone to get off heroin, and he thought that in Subutex he’d found a painless stepping-stone off methadone. But bupe has given him all kinds of problems with his intellect, emotions, creativity, ambition, passion. He writes,

I cannot feel joy.

He jumped off Subutex two weeks ago and writes that he has already had a couple slips because he’s so impaired that he can’t stand it.

I have a loving wife, two beautiful sons, supportive friends, an ok job and yet I have been wanting to die for a few years now—not actively suicidal (you can’t be actively anything on long-term sub maintenance) but quietly hoping that fate would off me.

I know what he’s talking about. So does my jump-buddy, Bonita, who kicked Suboxone days ahead of me in 2008. So do thousands of other people who have had trouble either being on or kicking buprenorphine, or both.

//

So, but here’s where it turns “most uncanny,” as Nigel said: In writing back, I mention I’ve spent tons of time in the UK, mostly in London and Yorkshire.

Nigel replies: he was raised near Kensington High Street (London), and he was educated at the Catholic boarding school, Ampleforth (York).

I know where Ampleforth is, I say, because I’ve been practically everywhere in the North from the Lakes to Robin Hood’s Bay, and all the dales and moors in between.

And I’ve lived in London. I tell him about a very unhappy, lonely winter I spent in London 15 years ago. “To combat a serious case of depression,” I tell him, “I used to push my son up Marloes Road toward Ken High Street and into Holland Park every day I could. I retain a great affection for Holland Park, and for a little tiny key-garden called Edwardes Square.”

Edwardes Square, West London. Photo courtesy of Londonholic.

Edwardes Square, West London. Photo by Londonholic.

Most Americans visit St. James’s Park, Regent’s Park, Hyde Park. Holland Park is an underrated treasure, appreciated mostly by Londoners, who, on warm summer nights, enjoy outdoor concerts and pick-up footie matches on the lawn. And friggin nobody knows Edwardes Square. I get blank stares when I mention it to anyone. It’s just a little tiny square in West London. When people get that far they make the cab fare worth their while by visiting Kensington Palace, the V&A Museum, the boutiques on the Kings Road. You can’t even get into Edwardes Square unless you live in one of the houses facing it. I myself couldn’t get in. But it was my little psychic refuge that long-ago early spring.

Nigel, however, says: his parents live off Pembroke Gardens Close, adjacent to Edwardes Square:

I know the area intimately.

Then:

He says he himself used to live on Marloes Road across from the Devonshire Arms.

Devonshire Arms pub.

Devonshire Arms pub.

(Nigel has lived in some fancy places. Not Belgravia, but still.)

I picture the Devonshire Arms: big corner pub; patio paved for pleasant outdoor boozing. (I never drank at the Devonshire Arms; I had my baby with me, always, and my codeine back at the flat.)

Nigel tells me,

My bedroom window overlooked Marloes Road, and I spent some of the darkest days of my heroin addiction in that ivory tower. I would have been there in 1998.

So. While I was struggling with killer postpartum depression the winter of 1998, walking several miles per day with my boy in a stroller, up Marloes Road and then Campden Hill Road to Notting Hill Gate, then west to the northern entrance to Holland Park—I was passing Nigel in his house every day.

G was rationing out her American codeine.

Nigel was banging his British smack.

And now here we are, on opposite sides of the sea, talking about how to live sober.

Most uncanny, 

Nigel writes.

Definitely a very small and funny old world.

Thank you, Nigel.

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