Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: overdose (page 1 of 2)

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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A Different Prince.

Prince-pinned

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

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

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

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

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

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

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

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

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

It’s just fucking STRONG.

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

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

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

//

ct-prince-photos-20160421

Prince, pupils pinned v.02.

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

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

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

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

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

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

//

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

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

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

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

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

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

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

//

Prince

Prince, pupils pinned, v.03.

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

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

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

The Prince is dead. Long live the Prince..

The Prince is dead. Long live the Prince..

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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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Middle-Aged White Women: Why Are We Dying?

Selfie of G. I'm 51, and I'm in the demographic that's dying fastest from painkiller addiction.

Selfie of G. I’m 51, and I’m in the demographic that’s dying fastest. I have six years in abstinence-based recovery from painkiller addiction.

The New York Times is all over the “narcotic epidemic” this week.

Probuphine

First we had a story about the recommendation for FDA approval of Probuphine, the implantable plastic matchsticks saturated with buprenorphine. The story was mostly about how sticking this drug inside our bodies would reduce overdose deaths from heroin, prevent us from selling buprenorphine (Suboxone) on the streets, and keep us compliant with taking our doses.

The trajectory of the story (“Let’s cure all addicts with this drug!!”) was saved by a CDC physician and a West Virginia University doctor, both of whom said we can’t just implant these sticks into people and send them on their merry way.

But you know what?—that’s exactly what will happen. Because that’s exactly what has been happening for two decades with SSRIs, which were approved for major depression, were never intended for lifetime use, and were recommended for use concurrent with psychiatric therapy. But the NYT has run stories about, gosh, therapy is so expensive! And to get SSRIs you no longer have to see a psychiatrist. You can go to your PCP, who most likely isn’t qualified to treat depression.

But you’re probably diagnosing yourself, so hey.

And you know what else?—the FDA will approve Probuphine for opioid addiction, but dollars to donuts it will be prescribed off-label for other stuff. Also, doctors will up the doses—off-label. Because that’s what happens with drugs. Doctors aren’t bound to prescribe only for approved uses. And they don’t. And doctors usually don’t know much about the drugs they prescribe. Most doctors who prescribe buprenorphine have no idea how strong it is.

I bet you a dollar that many people with opioid addiction who try Probuphine will wind up with permanent bupe implants.

Because doctors know how to get us on this stuff, but they never know how to get us off.

BIG News: Whites Are Dying Of Overdoses.

omg, AND!!: whites are now dying of overdoses faster than blacks. Which is HUGE news.

Because guess which race makes up the majority of the NYT’s audience—and that of the other major media outlets (except AlJazeera).

For the past five or six decades, black heroin addicts have been dying from overdoses (and ancillary illness and crime), and their communities have been bombed out by the war on drugs, but their deaths and mass incarcerations have not spurred the kind of critical, apparently sympathetic spotlight that the media is now turning on white overdose deaths.

The headline (“Drug Overdoses Propel Rise in Mortality Rates of Young Whites”) says young people are dying fastest, but when you get to the graphs, you can see that among women, the age group that’s dying fastest is 45-54—my age group.

Deaths from drug overdose. Source: NYT.

Deaths from drug overdose. Source: NYT.

Eileen Crimmins, a professor of gerontology at the University of Southern California, said:

For too many, and especially for too many women, they are not in stable relationships, they don’t have jobs, they have children they can’t feed and clothe, and they have no support network.

It seems weird that they spoke to a gerontologist for this story, but in fact among white women it’s the older ones of us who are dying fastest.

We have no support network. She says.

Recovery is all about building a support network. It’s also all about finding out how we can contribute to society, which is how we earn a living.

It’s strange that the Times didn’t put these two stories together. After all, the thinking in one (“painkillers are killing whites”) leads directly into the other (“Probuphine will save painkiller addicts’ lives—because everyone knows dopefiends can’t stay off drugs any other way”).

That is the way treatment is headed, by and large.

There is no reliable science to show that people addicted to opioids have a tougher time staying off their drugs than anyone else addicted to any other drug, as long as we have access to a support network. But the popular idea is that we painkiller addicts have wrecked our neurology for good.

And this is the line scientists will take because their research is funded by pharma. This is the line pharma will take because it will sell more drugs. This is the line physicians will take because prescribing drugs takes less time in the consultation room and helps them avoid the time-consuming work of actually getting to know patients. And this is the line journalists will take because they don’t bother to challenge their “expert” sources’ thinking.

So why are we dying?

Painkillers kill pain—physical and emotional. They numb the human being.

In a larger sense, to get at the real cause of why we’re dying, we could ask what we’re numbing out. What is the pain that we’re bombing out with drugs?

That’s a discussion I’d love to participate in, and that would not only keep people alive in a minimal, technical way but rather help them thrive and also cultivate people’s overall long-term quality of life.

Update, August 2016

You know how I talk above about Probuphine being used off-label? Well guess what—this blog is now getting hits from people searching for “Probuphine off-label.” In the words of Pete Seeger, When will they ever learn?

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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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