Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: oxycodone (page 1 of 2)

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.

If this helped you, the best thing you can do is pass it on via the little social buttons below.

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.

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.

More and More Mail: How To Quit A Small Oxy Habit

Ran four miles in the Rhode Island countryside this morning. No place in Rhode Island is very far from the coast and the light here is different from home, somehow both brighter and more gentle. Using it to paint:

Henry, age 2. Almost done.

More mail from a young guy in the Pacific Northwest:

I am battling with an addiction from Oxycodone. Approximately 15-60mg a day, and I had a few questions for you. My first question was, how hard and how long do you think I will withdraw for? I have been using for about 9 months, and just finished college and would like to get my life started. Second, I was wondering if you think it would be a bad idea for me to get about 2-3 8mg Suboxone pills, and cut them into quarters, use those for about a week, and get off them to help me skip the physical withdrawal symptoms. Please, respond as soon as you can as I am desperate for help.

Last week I attended a regional prescription drug abuse summit in my town. The U.S. Attorney’s office and the DEA and Obama’s drug-control policy people were there, and they made a big deal about two drugs: oxycodone and Opana—chemical name oxymorphone, metabolite of oxycodone. It’s twice as strong as oxycodone and is said to be three or to eight times stronger than morphine (though most sources cite oxycodone as being 1.5 times stronger than morphine, so these equivalencies don’t make sense). At any rate Opana is stronger than its parent drug.

Oxycodone is a short-acting drug—its half-life is 3-4 hours, which means within 24 hours it pretty much clears the system.

Suboxone, on the other hand, has a 37-hour half-life. Which means it takes days and days to clear the body.

First thing to consider: one milligram of suboxone is equivalent to 30mg morphine, or about 20mg oxycodone. The reader wants to “get” 8mg tablets and cut them into 2mg pieces, which would be upregulating the opioid receptors: he’d be taking the equivalent of 40mg oxycodone, but if he doses every 24 hours, he’d be stacking up the drug in his blood because it takes 37 hours for half a dose to clear the body.

Second, “getting” a prescription drug is problematic (criminal, a felony in my state, actually) unless it’s prescribed. Don’t buy on the street, OK, dude? … Number one, addicts are powerless over drugs. I couldn’t have trusted myself to “get” Suboxone and use it responsibly. Suboxone is a kickass substance and the only way I could have used it successfully for any purpose was under a reliable doctor’s hawkeye supervision.

My experience:

  1. A 60mg/day oxycodone habit is beatable through quitting cold-turkey or tapering. The acute withdrawal will involve about 10-14 days of sweating it out and feeling like you’ve got the flu; after that, maybe another month of feeling like life is a drag, but aerobic exercise can work wonders to cut down on insomnia, restless legs, etc. … I know 60mg feels like a huge amount. But hear this: I used Suboxone because I was on 100mcg fentanyl per hour, which is equivalent to about 400mg oxycodone per day. I don’t mean to minimize your experience, but using Suboxone for a 15-60mg/day habit is, to use my lay buprenorphine expert friend Jay’s analogy, like shooting an anthill with an atom bomb. … When I first took Suboxone I was tempted to stay on it for life because at first I felt so super-well, but that feeling changed within a matter of weeks. And I can’t tell you how many emails I’ve had and posts I’ve read from folks who used Suboxone to get off drugs and now can’t get off Suboxone. Your decision, of course, but just sharing experience.
  2. Log onto Opiate Detox Recovery and find others who have quit and are trying to quit short-acting painkillers. ODR has a wealth of reliable information and real-life experience and was an enormous support to me when I was trying to get sober.

One last piece of experience: face-to-face help is so important. Go to a meeting of people trying to quit drugs, any drugs—alcohol, painkillers, cocaine, whatever. Get phone numbers, call the people you meet, ask for help. It’s impossible to quit alone. To that end, I hope others will weigh in on all this.

The summer after graduating college is a great time to get sober and “get your life started.” Getting sober and starting your life are the same thing, and better to do it now than later. I’m in awe of folks who quit in their teens or 20s. You have your entire life ahead of you to find out who you are and be that, instead of using drugs to hide. If you ask for help, you will meet people who will tell you that you CAN do this. Let me be the first.

Thanks for helping me stay sober today.

Back to the palette.

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.

 

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