Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: hydrocodone (page 1 of 3)

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.

Dear G: Am I An Addict?

So I’m responding to two emails I received in the past week: one from a stranger, and one from a friend.

This is gonna be a long post, so get your iced coffee and your orange-chocolate-chip biscotto (my favorite) and sit down.

The Stranger has been prescribed Percocet (oxycodone), OxyContin (also oxycodone), and the antidepressant Cymbalta (duloxetine) for the past six years.

The Friend has been taking a teensy dose of Klonopin, a benzodiazepine—an addictive class of drugs used as sedatives and muscle relaxants—for the past year.

Both of them asked me for advice.

(Before I go on, I have to remind y’all that I’m not a doctor. I just share experience here—please take what you need and leave the rest.)

The Stranger seems more confused than the friend. The Friend, who has seen his share of addicted folks but is not in any program of recovery and never before thought he was addicted to anything, reached out to me because he knows I write about addiction. And he knows I don’t bullshit.

The Stranger writes:

I think I’m an addict? Am I? Am I not? Why is it even important to know if I am or not? Well, to me it’s important because I am having a HECK of a time coming off these meds.

This person has been tapering off 60mg OxyContin plus 40mg Percocet—a total of 100mg oxycodone, which truthfully is not that big a habit. It’s not a tiny habit, a tiny habit is two or three Percocet (15mg) per day, but getting off 100mg oxycodone is eminently doable, even if you’ve been taking Oxy for six years.

So let me tell you about some of the things I’ve learned about how to tell whether you’re an addict.

Obsession

It doesn’t matter how much we use, or how we use, or when we use (only after noon, only after 5 p.m., only after work, only after we put the kids to bed, etc.). It matters what the drug-use does to our minds.

Quitting 15mg versus quitting 100mg is like the difference between somebody who drinks two glasses of wine every evening and someone who drinks a bottle. Is the person who drinks just two glasses—but who cannot do without those two—NOT an alcoholic because she only drinks two? No. It’s what the two does to her. It’s how she thinks of those two glasses when she’s not drinking them, as well as when she is.

(BTW heavy drinking, for women, is usually defined as more than one drink per day every day.)

Both these people can quit their habits. The person who drinks only two glasses might have a harder time quitting because she thinks, “I’m only drinking two.” Or the person who drinks a bottle might have a harder time because her body has become more physically dependent and she’ll get sicker when she quits.

If they both stick it out, they’ll start to see benefits. It takes time. It takes a lot of days of sheer commitment not to pick up, and that itself takes a lot of support. For which I’d say, yeah, try a 12-step program, but give it a real shot: get a sponsor, take the steps, do what you’re told. If you’re really powerless over your drugs, wave the white flag (Step 1). If that doesn’t work, there are other ways of getting sober, but I know best what has worked for me and that’s what I talk about here.

Getting Our Drugs

Alcoholics can just go to the store and buy their drugs. We drug-addicts usually have to lie and cheat to get ours. Alcoholics wind up doing weird stuff AFTER they’ve bought and taken their drugs. For example, how do you hide all those empties—they clink when you try to drag them to the curb or the recycling bin, etc. … Drug-addicts usually aren’t faced with these kinds of questions (unless you’re shooting, which leaves tracks that you have to hide). Our questions are more about how to get the drugs in the first place.

If we’re using illegal shit, we have to commit felonies to buy it.

If we’re using legal shit, we also usually have to commit felonies to buy it.

I committed I don’t know how many felonies to get my drugs. A lot. More than 10. Enough, probably, to warrant a prison sentence, because I committed them over and over, over time. They all expired this summer, which made me feel free, in a sense, but in another sense I can never make up for having committed them in the first place. I talked to a lot of people about how to make amends for having committed felonies that put doctors and pharmacists and my own family in danger. They all said, Change your behavior and stop doing it. Tell other people not to do it. So:

Don’t. Change. Dates. On. Scripts. It’s fucking dangerous and can hurt more people than yourself.

The Stranger is not yet committing felonies. But she’s doctor-shopping. She’s been to four doctors other than her regular doctor to get drugs to supplement her regular scripts. More and more states are enacting doctor-shopping laws.

//

The green Watson-387 hydrocodone tabs I used to chew when I was becoming an addict. Bitterness on the tongue.

The green Watson-387 hydrocodone tabs I used to chew when I was becoming an addict. Bitterness on the tongue.

Let me tell you a story. When I started using legal drugs, I didn’t think I was an addict and I thought the amount of drugs I was being prescribed (45mg hydrocodone per day?—or something like) would last me frigging forever. I had spent the past two or three years trying to make thirty 10mg Watson-387 hydrocodone tablets last an entire month, and I’d always run out, because, of course, I Was In Pain, and the pain needed to be treated. When I scored ninety 15mg caps per month, I saw a road paved with those white-caps stretching to the horizon and thought life was finally perfect and I would be taken care of forever.

What happened was, in two months I needed 60mg per day.

By the end of that year I was being prescribed 150mg per day—ten 15mg caps. I would get a delivery of 300 15mg capsules each month. A delivery. The Man would come and deliver them. Personally, I think this qualifies as an official “shitload” of drugs, but just wait:

By the end of the next year another 120mg morphine (in the form of Kadian, a long-acting capsule) had been added to that, and in another six months I was given extra fentanyl lollipops. Pharmaceutical Tootsie-Pops. No: Dum-Dums, really. By that time I was a stone junkie, although I still had trouble believing I was, because I was still doing my life. Opioids don’t disable you the way alcohol and, say, meth do: I didn’t look drunk because I wasn’t drunk. I was just on a shitload of drugs, and when I ran out, I was incapacitated in every way.

And toward the end I always ran out.

Running Out

“When I would run out of the meds early,” The Stranger says.

People who don’t have problems taking their meds don’t run out. People who do have problems taking their drugs do run out.

“But I hate being high!!!”

“I LIKE feeling normal and sober!” she writes.

Oh, sweetheart, pleeeze. I hated being “high” too. I just wanted to be normal. I just wanted to have energy when I wanted, be relaxed when I wanted, be accepted.

“I never drink (hate the stuff!) or smoke marijuana, and I’ve never done any hard drugs.”

Solidarity, sistah. <fistbump> I am a Top-Shelf White-Collar Addict all the way.

By the time I detoxed five years ago, I hadn’t seriously drunk alcohol in more than a decade. I “hated the stuff.” And I’ve never done any street drugs. Ever. Never smoked cigarettes, let alone weed. Never danced topless on any frat bars, never stripped for the dudes, never screwed around. I’ve never woken up in anyone’s bed I didn’t actually have a relationship with.

By the end I had a kid, for chrissake, and I Took Care Of Him, and I did a good job, not the best job I could have done, because I was a stone junkie.

If you like feeling sober, then quit sooner rather than later. You will only feel more and more sober. The feeling of extra energy I got from pills was fake energy. If you can exercise at all, your body will soon start producing its own endorphins and you’ll heal.

But you will not start to heal until you quit putting extra opioids into your body.

Anxiety and Fear

One of the most helpful things I’ve ever heard was from my first sponsor, who told me that I needed to call anxiety by its right name: fear. “Because anxiety can be medicated,” she said.

But you don’t go to the doctor and ask for pills because you’re having fear.

The Stranger mentions fear over and over again in her email. It’s a signal of addiction.

The Friend’s email had none of that fear. He was balls-out about his concern: “I believe I have become addicted.” Which is the thing that made me think he wasn’t addicted: we addicts tend to keep second-guessing ourselves. Even when we ask for help, it’s usually: “I think I MIGHT be addicted,” or, “Am I addicted?”

But who am I to know for sure? I don’t know how much fear or obsession he has or whether he’s running out of his tiny dose of Klonopin each month and changing dates on scripts to get more. (I’m pretty sure he’s not committing that felony; after speaking with him, I don’t think he’s even running out.)

This is one of the aspects of addiction that needs a lot more research. If we’re going to treat addiction as an illness, we need clear diagnostic criteria so that it’s not a matter of self-diagnosis or self-identification.

Pregnancy

I’m not a doctor, and I’m not an addictions specialist, but I’m a mom and a woman and I wrote a book on pregnancy for which I did more than a little research, and my mind is made up about this: if at all possible, unless the mother’s life is threatened (which is to say, unless she’s already on a load of heavy drugs and gets pregnant and can’t detox without endangering herself and the pregnancy), women ought to get off their drugs if they want to get pregnant.

There are a lot of studies starting to come out about the “benefits” of buprenorphine over methadone in pregnancy, but most of those are for heroin addicts and/or methadone-maintenance patients who are already pregnant.

The Stranger has tapered down to 30mg of oxycodone per day. I hope that, before she gets pregnant—which she says she wants to do—she’ll quit entirely.

Because motherhood is damned hard work. And it’s best to do it sober. It is the single thing I wish I could go back and change: I wish I’d been entirely sober for my kid’s childhood.

Please don’t miss your kid’s.

The boy, age 3.

The boy, age 3.

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Also, please visit my new site: Recovering the Body.

Trapped on Suboxone: A Woman Who Can’t Say No.

My comrade-in-arms Jason Schwartz, who blogs at Addiction & Recovery News, has a good post today on harm reduction. I filed a comment on his post and was compelled to cross-post it here, in greater detail, just because I have to start sharing this information I’ve been collecting or I’m gonna burst.

A Suboxone film.

A Suboxone film.

I’ve been interviewing people who are part of the new state of American harm reduction: Oxy and Vike addicts who are “stabilized” on enormous doses of Suboxone. (If you’re part of this trend and want to share your story, please email me.)

Over the weekend I spoke to a woman who, for a 50-75mg/day Percocet habit, was prescribed 16mg Suboxone per day. She had emailed me in desperation for advice about how to quit. She’s been at this level for 7 years. She has gained 75 lbs. and has gone into menopause. She feels emotionally dead.

I can’t tell you how crazy it makes me when I hear 1) that doctors are “treating” a 75mg Percocet habit with 16mg buprenorphine (you don’t need to atom-bomb a small Oxy habit; this is how to quit); and 2) that harm reduction advocates think these prescribing practices improve people’s lives.

An ad for a Florida Suboxone doctor. Suboxone ads promising to "free" people from addiction crowd the back pages of city alternative weekly newspapers and are posted on signs across the hillsides of poor urban neighborhoods.

An ad for a Florida Suboxone doctor. Suboxone ads promising to “free” people from addiction crowd the back pages of city alternative weekly newspapers and are posted on signs across the hillsides of poor urban neighborhoods.

Here are her Suboxone doctor’s prescribing practices: she has a five-minute visit with him every two months—via Skype. (This is one of the “good” doctors—one of the ones who doesn’t charge exorbitant cash fees for twice-monthly visits.) And when she told her doctor she wanted to quit taking Suboxone, this physician told her that, if she wanted to quit , she would one day just “forget” to take it and then she would be done.

“I think he just doesn’t get it,” she said.

He’s never taken it, so he’s in this la-la land that people can come in with an addiction and take Suboxone, and boom—they’re cured.

She’s desperate to get off Suboxone, but she knows she can’t do it by herself. She looks back at her previous Percocet habit with longing and regret—withdrawal from that level would have been comparatively easy.

She recently had surgery, and the anesthesiologist and nurse told her that they’re seeing more and more OR patients on bup—it’s the new wave. … After her surgery she took 2 Percocet every 4-6 hours as directed, and within five days a devastating withdrawal descended upon her. She described it as a band of fire belted around her abdomen, along with all the other symptoms of withdrawal, magnified. She managed to abstain from Suboxone for almost two weeks, hoping she could stick it out—and it only got worse, despite taking 3-4 Percocet every 3 hours.

In the end she couldn’t hack it. Within half an hour of taking one strip, the belt of fire disappeared.

I told this woman that there are public health experts and media mouths who think she’s better off because she’s no longer doctor-shopping or significantly threatened with overdose. I asked, How would you respond to them?

“I’ve lost my freedom to choose,” she said.

I’ve lost my personality. I’m more quiet and withdrawn. I feel like part of me is dead. And I’m a slave to it. I have to have it. I’ve lost the ability to say no.

A woman caught in a system that doesn’t let her say no. Don’t we call that “rape,” or “coercion”?

Suboxone revenues, 2005-2011. A curve generally thought of as "exponential."

Suboxone revenues, 2005-2011. A curve generally thought of as “exponential.”

And, please, Jason, let’s talk about the money. Reckitt Benckiser pulled in $1.4 billion from Suboxone products in 2012. A Harvard researcher who is looking at American Suboxone prescribing and reimbursement tells me much of it is paid by Medicaid.

So, though my middle-class, employed, insured source gets her Suboxone through Cigna, and though her doctor does not accept Medicaid or other public assistance, taxpayers—you—are indeed underwriting a great deal of this system.

It’s mostly poor people who are trapped on this drug.

Reckitt and Titan (who is developing the implants—the ones recently rejected by the FDA for not delivering enough drug to to the patient) see Oxy and Vike junkies, along with heroin addicts, as a deep mine of insurance and taxpayer revenue, just as Purdue saw pain patients—potential OxyContin buyers—10 years ago.

And, finally, let’s talk about how “people can’t abuse Suboxone.”

melted_suboxone

A melted Suboxone film, ready for injection.

 

People can and do abuse Suboxone.

Addiction Is Not A Crime.

So today the op-ed page editor of my city’s paper emailed to say the (very personal) essay I sent him a few weeks back will run this weekend. It’s about how addiction is an illness, not a crime, and it tells a bit of the story of how my parents died of the consequences of their addictions and how I got sober.

The timing of this piece’s publication is a little ironic, because yesterday I was prescribed hydrocodone for a cough that has lasted for more than two weeks.

Drugs really do work for the purposes for which they’re intended. At least, some drugs do. Opioids (known by cops as “narcotics”) are very good at two things:

  1. Dulling some kinds of pain
  2. Slowing autonomic responses—breathing, gut motility, etc.

For this stuff, opioids work wonders, fast. Twenty minutes after I took my first dose, my cough was 80 percent gone.

I had been coughing so long and persistently that I felt as though I were being stabbed in the solar plexus. Even my butt was killing me because every time a spasm hit, my whole body would tense, and I have trigger points in my glutes. The pain of which I used to try to numb out with huge doses of drugs and which I now treat through yoga and aerobic exercise. But when you can’t breathe, it’s hard to do vinyasas or run three miles.

I saw my doctor last week. I’d been through a course of antibiotics, which hadn’t worked. We were speculating it was a virus after all. She looked at my chart. “So, you were on opioids for a long time, right?” she said. “And remind me—do you think you were dependent, or were you addicted?”

“Oh, I was addicted,” I said mildly.

“So you probably wouldn’t like to take an opioid,” she said doubtfully.

“Is there anything else that might work?” I asked.

She prescribed steroids and told me to take Delsym. Which didn’t work. We had another frank discussion about the possibility of my taking an opioid cough syrup.

Her concern did not make me feel like a criminal. I’ve spent time with doctors in whose presence I felt like a criminal, or like a bad person, or like a plain pain in the ass. It’s to be expected: active addiction leads us to deceive ourselves and others, and people feel betrayed. They take it personally.

But in speaking with my PCP yesterday, I felt as though she were looking after me. It seemed to me that she was weighing the risks of two different illnesses against each other—my respiratory problem, and my addiction—and trying to figure out how to treat one without exacerbating the other.

Imagine what it would be like if most doctors demonstrated that attitude. It would be easier for so many more people to get help.

Just because a person has addiction, does that mean they can never be trusted again? Or that they have to suffer?

//

The dog makes me happy. Beyond happy, really. How did I live before this dog came along?

On the other hand, I spoke to a friend this afternoon who said that, over the phone today, my voice sounded different from normal.

“You sound HAPPY,” she said. “I don’t mean high. You just sound different. You haven’t sounded very happy lately.”

In fact I haven’t been very happy lately. I haven’t exactly been sad; but I have major problems and big life-questions going on here, I’m holding the rudder with one hand and reading the map with the other, and the seas are throwing a lot of spray on deck. I’ve been squinting against the sea-salt.

I took two prescribed doses of hydrocodone cough syrup today. And even at a prescribed dose, this stuff definitely adds almost like a layer of duck down in my head and body. It makes it hard for me to feel at the depth and complexity to which, over the past two or three years, I’ve become used to feeling my life. 

And that’s only at a tiny dose.

Even a small dose makes me not-care to a certain degree. I can see how, at mega-doses, I’d wind up saying, most of the time, just, Fuck It.

Looking back, I can’t believe the enormous amounts of drugs I used to take. It appalls me. How could I have felt anything at all? … I don’t think I did feel much, except fear. I seriously compromised my usefulness in this world.

But: just writing about it in this way, I can now recognize the degree to which I’ve begun to forgive myself. I used to beat the shit out of myself for my mistakes. Now, after some deep inward examination, and after making ongoing reparations for the past four years, I can see that I’m practicing more compassion for the person I was. She wasn’t a criminal. She was pretty ill. She was operating under serious limitations, biological and psychological, and she did the best she could.

//

I’m still tempted to beat the shit out of myself. Here’s one way I know my new compassionate response is not too lenient: when newcomers sit in front of me and tell me all the mistakes they’ve made, I don’t beat the shit out of them. I show them compassion.

It’s kind of the converse of the Golden Rule. If I’m supposed to love others as I’d love myself, then maybe I can also treat myself with the same compassion I show others.

Look for my op-ed this Sunday in the Pittsburgh Post-Gazette and let me know what you think.

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