Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: opiate detox

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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To Use Suboxone, Or Not To Use Suboxone?

A reader writes:

Hi G,

I know there is no magic bullet or simple answer, but I thought you may have a suggestion for me. I’ve been taking perc or ox for five years, for the first 3 it was only 30-50mg/day but now it’s between 150 and 180.

Suboxone scares the shit out of me, but at the same time, every time I try to taper, I fail and I’m starting to go broke. I lost my health insurance.

I go to meetings 4 or 5 times a week, all helpful, but the physical part keeps me hooked.

I heard suboxone may be ok if used very briefly (like a month or less), as when taken for longer, the withdrawal is way worse than the oxy itself. I wish I could go to a 7-day detox or something, but I just don’t have the money and I don’t have insurance. I also freelance so I need to be able to work and I can’t lose more than a few days. 

Anyway, I started trying to find low-income or sliding scale suboxone programs in NYC, but it’s slow going and I don’t want to just get hooked on something else. I have read long term effects of suboxone are bad too.

I guess my Qs are:

if I were to do suboxone briefly, a few weeks, would I just then have the same withdrawal as I would going cold-turkey from the oxy anyway?

is there something else in my area (or anywhere) where someone could go for opiate detox that costs nothing or very little?

I want to be clean so bad, but every time I try to taper I just fail.

Any thoughts/suggestions appreciated – I know you’re not a doctor or professional, you just seem to have a lot of info and I know how we like to help each other. 

Thanks in advance.

B

Dear B,

There is no magic bullet, but in my experience there are simple answers.

The first was to know that I wanted to get clean. (Which you say you do.) First problem solved: I was telling myself the truth. The truth was, I was willing to do what it takes. And It Takes What It Takes.

The second was to ask for help. (Which you have. Keep doing it.) Nobody, but nobody, does this on his own. Even the people I know who don’t go to meetings have put together communities of other people trying to stay sober.

The third was to use my willingness and my growing community to decide on a path, and walk the walk.

For some people, Suboxone is the solution. They’ll tell you they don’t mind eating an opioid for the rest of their lives—it’s “like a diabetic taking insulin.”

In my opinion the diabetes analogy is worn out. I wanted my solution to be real freedom. When I reached out for help I met people who had shot heroin and who had gone bankrupt buying drugs over the Internet and who had drunk themselves into blackouts—people who drank and used to the excess I had, or worse—who were clean and sober. I wanted to break ties with all drugs that cause physical and psychological dependence. For me taking drugs is signing on for slavery. Just my reality.

I really wanted to go to rehab but I knew I couldn’t leave my kid for that long.

Here’s how I decided on a Suboxone taper.

I knew I couldn’t detox off full-agonists like oxy. Too alluring. (More truth-telling.) I needed to change all my habits. So I asked for help—I found a detox doctor who was willing to oversee a Suboxone taper for me.

I told him at the outset that I wanted to taper. When my resolve flagged, he reminded me that the project was to get free.

I put the taper in his control. I never had more than one week’s worth of drugs in my possession. He wrote out the taper, I wrote out the check, we shook hands. I waved the white flag and gave up.

I did what he and a bunch of other people—Dani, Allgood, Sluggo, Bonita, all online friends; and my new real-life sponsor and community—told me to do. I put my faith in the people who were sober and who told me I could be, too. I burned a script for more drugs. I went to meetings and opened my mouth and let myself cry on people. I kept collecting sober people around me.

Several weeks later I was drug-free for the first time in years.

And yeah, I ain’t a doctor, but I’ll offer this anecdotal caveat: if you’re taking 180mg Oxy, they’ll try to start you out at 8-12mg Suboxone (or maybe even more). But that would be increasing your tolerance. If you really want to get clean, you’ll start at 4mg and taper to 3mg within two days. You could do a 2-week taper, cutting to 1/4mg—the equivalent of 1 Percocet—at the end and have a relatively smooth landing.

Post-acute withdrawal.

I ain’t gonna kid you: staying clean was a slog. Tapering off suboxone was not nearly as bad as detoxing cold-turkey from fentanyl or oxy, but it wasn’t painless—I shivered, I kicked in my sleep, I sneezed 20 times in a row. Keep in mind, my tolerance was more than twice yours, and I’m probably a little smaller than you. I spent each day telling myself if I made it to bed without having stolen drugs (because yes: I used to steal drugs) or used anything, including alcohol, I was a success.

The best treatment for drug-cravings was vigorous exercise. It helps the body produce its private supply of morphine and dopamine. Dr. Steve Scanlan told me research shows people who exercise cut their recovery time in half. I made playlists that helped me drag my body around the neighborhood. Walk, run, cycle. Do pushups. Lift weights. Start small and grow bigger. I exercised, and my body and mind recovered.

Healthy. (Mostly.)

Healthy. (Mostly.)

A 180mg oxy habit is totally beatable. With a stick, my friend. Dude, if I can get clean, you can. I was on more than twice that and I’m free today. And I did not use insurance to get clean. But I paid what it took—the first of several critical investments I’ve made in myself over the past few years. Paying that doctor made me realize that, for a long time, maybe all my life, I’d withdrawn a great deal without putting very much back.

 

The most important information here: Get to a meeting. Tell them you want to get clean. Ask them to help you.

If you feel you need inpatient or other professional help, try Phoenix House, a large NYC-based treatment system with detox facilities in Long Island City. Or try the “free and affordable” resources listed on this website.

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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