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