Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: morphine (page 1 of 2)

Heart-Opener.

In yoga yesterday I could see evidence of my heart beating in my chest.

I had bent my back into supported Bridge Pose. Then I rotated my upper arms away from each other and watched my ribcage rise up like an arch. I could see the soft pounding of my heart. There it was, just an inch or so under the flesh covering the bones of my ribs, in the spot where it’s been beating for more than half a century.

I sometimes cry when I do yoga heart-openers. I spend a lot of time with my shoulders hunched in front of a keyboard, or else hunched against the criticisms my own mind levels against me. My massage therapist tells me my shoulders are cranked so tight because I hold my body like a boxer with her gloves up and her elbows drawn against her abdomen. She tells me to practice opening my chest. This un-swaddles my heart, which sometimes makes me cry.

//

I’ve had to make drastic changes in my life in the past few years. My life today looks little the way it looked three or four years ago. Change brings relief and it also hurts, and it flips me out that I might be making mistakes. And because I’m five years sober, I feel like I’m supposed to know better than to have that kind of fear—all that self-centered garbage I ask each morning to be hauled away from me. As if “God” were a garbage-man, or my personal errand-boy: Take it away!

So I not only have fear, I have shame that I’m feeling fear, and then ancillary shame that I’m asking God/HP to take the fear away. Which makes me hunch even further into myself. Shame Spiral, anyone?

I talked about this in yesterday’s Y12SR yoga meeting. It was Easter Sunday. The topic was gratitude that we’re even alive. One after another, people talked about losing parents, family, friends to addiction.

Sixteen years ago around Easter, I was 34 and driving out to my parents’ house every day to help my dad take care of my mother, who was dying of lung cancer. She had smoked three packs a day for 40 years. When she finally died on June 3 of that year, I was so mortally pissed off at God that I spent the next eight years trying to poison myself. I started by stealing a few of my dead mother’s morphine tablets and ended by committing my last felony prescription forgery in roughly July 2008. Great way to use my artistic skills.

I shouldn’t even be here typing this. I should have overdosed or gone to jail. I remember the first time I took some stolen morphine. I lay in bed feeling as if somebody had stacked a pallet of bricks on my chest. A heart-closing exercise. I would exhale, and it would be a long time before my body wanted to inhale again. It scared the shit out of me and I loved it: I wouldn’t have to feel the fear or the anger.

When I made it into recovery, one of my first feelings was guilt that I’d escaped the death sentence that killed both my parents.

People were talking in yesterday’s yoga meeting about how recovery is like the resurrection in the Easter story. It occurred to me that it was also interesting to remember some elements of the Passover story: we’d taken steps to mark ourselves as ones to be skipped over by the angel of death. Also, each of us in the room had escaped slavery—the root of the word addiction. And we get together to tell our stories, never forgetting that we don’t have to be slaves anymore.

I can see how helpful it might be for a group of people to have some kind of religious ritual to keep remembering that they’re chosen. How many times have I heard, during the course of a meeting, “I was supposed to live!—God has a plan for me”? If that’s true, then God discriminates.

I think God doesn’t have plans for my life.

The only plan is love. And it’s not even a plan, it’s a law of nature, and living with it is an exercise of bringing my little tiny (but enormously fucking perverse) will into line with that force. (Splinters are small, but they hurt like hell, right?) Love is the currency, the current of power, that God/HP/Whatever deals in. Bona fide love is pure, reliable, healing, life-giving, durable, like the sun.

If you think about it, there’s nothing we eat that doesn’t come from the sun. We actually EAT the sun every day, which is a fabulous image: Here, take a bite of this star! When we hug each other’s bodies, it creates electricity that comes, when the trail is traced back to its origin, from the sun.

Can the sun be improved upon? I wondered that the other morning. The sun hangs in delicate balance with the life on this planet, and if we tried to make the Star Experience better (say, get rid of clouds, so we can see the star more often), we’d only be screwing up on a grand scale. Sometimes I have to understand that life is fine as it is.

(It’s tempting to think that “God” puts signs in my way to remind me, but she doesn’t.)

Graffiti in my neighborhood.

Graffiti in my neighborhood.

//

Lately I’ve been having some experiences in human love that have given me a glimpse of the vast purity and beauty of this superhuman power source. My son is one big part of these experiences. So are some close friends of mine, and the people in my recovery community. All these people provide me with perfect opportunities to give away love, and like the Bridge Pose, this cracks my heart open. And what I give comes back, multiplied.

Of course, I don’t think I “deserve” even the human part of the experience, much less the “divine” one. So, in case it’s not real, or in case I lose it (because guess what? nothing lasts, goddammit!!), I run around with my shoulders hunched. Or I force them back and paint on a tough mask that makes me look bitchy, arrogant, aloof: Throw anything at me, man! Take away whatever you want, I’ll survive, I don’t fucking need ANYBODY!

Fake power. Meanwhile inside the mask, G is hunched: small, scared, in need of arms around her, even temporarily.

Before I got sober I had little idea how to take care of myself when feelings like these struck. I’d try to make them go away by numbing them with drugs. Now, instead, I run with the dog, throw a dinner party for my old friend Nancy whose husband just had cancer surgery (successful!), start the painting another friend asked me ages ago to make, do mental push-ups by studying another language, engage the help of a smart no-bullshit therapist, give my students and their work my attention, compile playlists of beautiful music, ride my bike on this city’s long river trails, make lists of people and things I’m grateful for, practice yoga, take photographs and post them to share the world’s beauty, etc.

I also go to meetings, for the same reason people celebrate Easter or Passover or any holiday, and for the same reason they go to coffee houses and dog parks and book clubs and yoga studios: because I’m part of the tribe of Homo sapiens, and the desire for community is practically encoded in my cells. Because my heart needs to be around other beating hearts. Because cracking my chest open helps me exchange a little more love, which plugs my life into a great big socket of power.

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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.

Reader Questions: Addiction, Chronic Pain, and Drug Maintenance

A reader had some questions about my interview with Dr. Scanlan, a physician who conducts opiate detox in the Florida pill-mill hot-zone:

It would have been helpful if Dr. Scanlan had addressed those opiate addicts that became that way after dealing with chronic pain. If there is no long-term maintenance, how will they stay off of opiates? Maybe a different way to address that is how will they get pain relief? “Buprenorphine is now the 41st prescribed drug in the U.S.” Where is OxyContin, Fentanyl and morphine? Most opiate addicts became that way because of being prescribed pain medication for legitimate chronic painful conditions. Are they included the 5% of addicts that may need maintenance? Or are we just discussing the ‘recreational’ users?

These are good points. Many people do become addicted after seeking treatment for serious chronic pain conditions. For the last 15 years or so there has been a big push in the medical community to recognize pain as the Fifth Vital Sign, and to treat it aggressively with appropriate drugs. Along with treating more pain with more opioids comes the risk that more people will become addicted. Simple math.

I agree—those of us with chronic pain have to strategize about its treatment in order to avoid turning back to opioids. Speaking from my own experience, an important part of this strategy is recognizing that opioids are not the only solution for pain relief. They’re certainly not the best long-term solution for chronic nonmalignant pain.

If you have chronic pain and addiction, I’d like to ask, what have you done about your pain?

As for your other questions: Where are OxyContin, fentanyl and morphine in the list? Oxycodone in all its forms is quite high on the list, though not as high as hydrocodone, which is the top-prescribed drug in the U.S., bar none. Second on the 2009 list (the most recent) were cholesterol maintenance drugs, then amoxicillin (a trusty antibiotic). Codeine is also way up there, and lots of people get addicted via codeine cough syrup or Tylenol #3 for headache, for example. (I knew one professional person who always carried a bottle of codeine cough syrup in their bag—their way of dealing with stress.) See this Forbes piece for one explanation that includes good sources. …

Vicodin is being prescribed like a version of extra-strength Tylenol these days. People go in to have a tooth pulled or to have a wound stitched and are given 30 or 60 Vicodin. It used to be that they’d get 3-5 tablets, but physicians are so used to writing in counts of “30” or “60.” With that supply of a drug that strong on hand, the “addiction switch” (as I think of it) can get turned on within a matter of weeks. Then, when they beg but can no longer get any more refills from their doctor, they turn to other sources to keep the lights on.

A Florida corner-store pain clinic.

I’ve been told that, once you cross the Georgia-Florida border on I-95, the signs for places to score pills start appearing on the roadside, and they follow you all the way down the coast. It’s said that there are more “pain clinics” than McDonald’s restaurants in Broward County—and three times as many clinics as Starbucks outlets.

Dr. Scanlan’s patients, just like all addicts, have become addicted in all kinds of ways. In addition, he practices in this hotbed of pill-mills, some of which dispense painkillers without following good medical practice. These people may or may not be “recreational” users (from my experience, people who are taking 300-600mg of oxycodone each day are no longer engaged in “recreation”), but they’re still suffering from a problem they can’t control.

A Florida strip-mall pain clinic.

I don’t think Dr. Scanlan was talking about pain patients in particular as being in the five percent of addicted people who may need drug maintenance. Scanlan and others, such as Dr. Gabor Maté, some of whose patients live in extremely difficult circumstances—people from street conditions who continually relapse and can’t get sober-time not only because of the inherent power of the disease but also because of the corollary circumstances that go along with certain manifestations of it (homelessness; joblessness; criminality; needle-use; prostitution; etc.)—believe in drug-maintenance to help this set of people stop harming themselves first of all.

The way I understand Scanlan’s comment about drug-maintenance is, he thinks this option gets promoted (by greedy drug manufacturers and well-meaning but largely ignorant policy-makers who have little or no personal experience with addiction) as a “cure” for all addiction—when he many others know that there are non-drug solutions that are less costly to the individual’s physical health and also their wallet, and to society. He’s a living example, and he’s trying to bring that solution to the people who come to him asking for help.

 

How To Detox From OxyContin And Other Opiates

OxyContin

OxyContin tabs in a candy-colored rainbow.

Dunno why, but I seem to have paid short shrift to sharing detox experience on this blog. Which is weird, because I’ve got so many stories about opiate detox and recovery.

Received an inquiry recently about how to detox.

What do you know about getting off of OxyContin?—the length of time it takes, how safe it is, and what could the consequences be of going off too quickly. Do you have any idea?

Yes, I have some idea. Thanks so much for asking.

First I must say that none of this is medical advice or a substitute for it. If you want medical advice, please consult a doctor.

From one addict to another. About the length of time it takes to get off OxyContin—this depends on a few factors:

  • The level of Oxy you’re taking. (It could be any other drug. Not to put too fine a point on it: with the exception of methadone, Suboxone and tramadol, an opiate is an opiate. Heroin is Oxy is morphine is Vicodin is dilaudid. Even fentanyl is pretty similar, though it’s fat-soluble. They’re all short-acting full-agonists—though their dosage equivalencies differ.) If you’re taking maybe up to 120mg of oxycodone, chances are you could taper just using Oxy, following some rules for tapering that are few but non-negotiable. If you’re on a level that’s a lot higher than that, you might need some help. However, only you can tell, right? You know your own limits. I’ve known people who have detoxed cold-turkey off 600-800mg Oxy.
  • The reasons you started taking pharma-grade painkillers in the first place. If you have pain, you’ll need to work on figuring out other ways of managing it. Many non-opiate treatments exist that may help, depending on the circumstances. It may take time, consultation with professionals, patience, and a process of trial and error.
  • Whether you’re taking the drug “as prescribed” (i.e., swallowing it whole), or “not as prescribed” (i.e., chewing/snorting/shooting). OxyContin is also a bit difficult to taper from because you can’t split them. So another factor is the strength of dose you have available to you. One of the cardinal rules of a taper is: swallow whole, on schedule. If you can’t take your proper dose of Oxy on time and swallow it whole (I mean what addict can?), then you may need the help of a reliable detox doctor. (Operative word here: reliable. How I chose my doctor: I called the most reputable rehab in town and asked if I could please pay them to run my outpatient detox. When they said No, I asked for the name of someone else who might do it. Then I called my primary care physician and asked for her top referral. When they turned out to be one and the same person, I knew I had my guy.)

Let me also mention that the person who asked today’s question apparently got the idea from this blog that Suboxone treatment was Not Good. I’d like to correct this impression: Suboxone can be a very effective tool if it’s used properly. I myself got off an enormous level of opioids using Suboxone and Subutex. The danger comes when vulnerable, fearful detoxing addicts are encouraged to stay on enormous doses indefinitely rather than to use it as they often want to use it—as a tool to claim their right to lower their chemical load.

Using Suboxone or another drug as a detox tool doesn’t necessarily mean we’ll be “substituting one drug for another.” I mean, in a sense we are, but only for a short period, and under a doctor’s guidance. This can mean all the difference between addiction and recovery. … When I was detoxing with Suboxone, I did not write the taper schedule, my doctor did. I had to visit him every week, and later every other week; I paid him $80 a crack, aside from what I paid the pharmacy for the weekly prescriptions, and it was worth every penny to get free. I keep the receipts for my detox doctor’s visits in the drawer of my nightstand. The equivalent of my parents burning their mortgage (which they did, literally).

The reason I chose to taper off drugs using Suboxone is that I was on such an enormous level—more than 100mcg/hr of fentanyl. I was prescribed one patch every two days, and because I did not always take them as prescribed, I used a bit more than that. Fentanyl is a crazy-strong drug, it’s what they give you when you go in for surgery, and this level is roughly equivalent to 400-600mg morphine or oxycodone per day. Somehow my lizard-brain knew it was going to be impossible for me to taper off that level of fentanyl, or get enough of another drug to equal that level so that I could taper. And anyhow, I’d never been able to taper off a full-agonist—a drug that plugs into the receptors and stimulates them fully, like heroin, oxycodone or morphine.

Read Dr. Scanlan’s interview about Suboxone: it has a long half-life, which means it doesn’t create as much of a buzz as the short-acting drugs like oxycodone. As long as you keep tapering, and you have a doctor willing to help you keep the taper short, you can get free with Suboxone.

How safe is detox?—Opiate detox is not life-threatening. In contrast to alcohol withdrawal and detox from benzodiazepines (Valium, Xanax, etc.), both of which can cause life-threatening seizures if done too quickly, detox from short-acting opiates can be done safely at home. A “cold-turkey” detox happens in two phases:

  • Acute detox, which lasts 10-14 days or so (depending on level of use), in which the body excretes the drug and, in doing so, experiences signs of active withdrawal such as runny nose and eyes, sneezing, goosebumps, shivering, loose bowels, and restless legs and arms (kicking). All this means the body is healing.
  • Post-acute withdrawal syndrome (PAWS), which lasts an indefinite period (depending on level of use and how well we take care of ourselves), in which the body’s opiate receptors heal and the body learns to produce endorphins again. Most people find exercise and good nutrition help a great deal, as does some kind of support plan.

I can hear some folks out there thinking, “I think I’m endorphin-deficient.” I love hearing people register this claim. I used to believe this about myself before I got on drugs like fentanyl. Then, after I got on drugs like fentanyl (and morphine, and OxyContin, and whatnot), I used to believe that I’d MADE my body permanently endorphin deficient, so I should just stay on the drugs forever. Addiction lizard-brain. … Today I lift weights and cycle 30 miles and play tennis. I do all this having been diagnosed with two painful neurological disorders. I’m not bragging here, I’m just saying: I’m NOT endorphin deficient. If I can get off this stuff, I think anyone can.

The consequences of going off “too quickly”?—There is no “too quickly,” imo. If one is addicted, the only dangers are not quickly enough, or not at all. However, if your level of use is high, and you have kids and a job and still want to function during detox (as I did), it might be worth it to slow the detox down. I’ve always compared detox to learning how to land a plane. Not that I’ve ever landed a plane. But I imagined being in the pilot’s seat, and taking direction from the tower (higher power/physician/recovery community, etc.), and telling the tower I needed either to make a quick-and-dirty landing or a long slow smooth landing.

You can do either one safely. The first takes a lot less time, but it might be a rougher ride. The second is much smoother, but there’s more time to worry about whether you’re gonna crash. Which is why it’s helpful to get support, not only from a doctor but also from a community of people who have been through similar stuff.

Detoxing was one of the best decisions I ever made. It was the start of a new life.

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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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