Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: Oxycontin (page 1 of 4)

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.

Sanjay Gupta’s TV Special and G’s SAMHSA Fellowship.

Thanks to Sanjay Gupta and CNN for this evening running “Deadly Dose,” about the skyrocketing problem of painkiller misuse and addiction in the U.S. since 2000.

Dr. Gupta brought Bill Clinton onto the show as one of his primary sources. Clinton had been friends with a young man who had overdosed from a combination of prescription opioids and booze. “I’m sure he never knew that he was turning the lights out,” Clinton said. Gupta focused mainly on accidental overdoses: at one point Clinton said,

People are dying in large numbers every year because they do not know that if you drink four or five beers and then pop an Oxycontin, for example, it shuts down the part of your brain that tells your body to breathe while you are asleep.

At one point, however, Gupta interviewed a guy who didn’t identify his name but allowed his face to be shown on camera—a guy who had begun taking Vicodin for back pain, and who eventually climbed up to taking eight to 10 “eighties,” or 80mg tablets of OxyContin, per day. Which would be up to 800mg—”without loss of ability to function,” he said. Of course, because when our bodies develop tolerance to opioids, we can function pretty much as well as most people—opioids are not like alcohol that way.

Gupta is breaking new ground in outing this subject, which garnered him overwhelming praise and a tiny bit of criticism on the Twitter live-chat (#DeadlyDose) from folks unwilling to consider that the prescribing of opioids may need to be more strictly regulated. During the show I found myself wishing he could call the problem what it is–addiction—and not just “accidental overdose” or “prescription misuse.” The guy who was using 10 “eighties” was definitely not accidentally doing so. I kept hammering away on Twitter: “Doctors need to learn to spot signs of addiction.”

Because I’ve done so many live-chats, for example with The Fix‘s staff and associates, I’m used to live-Tweeting, and I was one of three people Gupta himself retweeted to his 1.5 million followers during the show:

Which is cool because one of my jobs in the next year is to get more media attention for recovery from addiction. I’ve been so damn busy but I’ve meant to tell you that, the day after my 48th birthday, on Halloween, the Substance Abuse and Mental Health Services Administration (a branch of the federal Department of Health and Human Services) emailed to say I am the recipient of a year-long fellowship, which comes with a cash award and training in Washington, D.C. to help me become “a voice for recovery.” Which, they acknowledged, I already am because of this blog and the other writing I do.

And I owe you, my dear readers, a great deal of thanks. You flock to this site for “news, reviews and straight talk about addiction and recovery,” and you show there is an audience out there who wants reliable information and good stories about this illness. You rock.

Community Is Expensive, Drugs Are Cheap

One magazine I sometimes read is More, whose content is designed to help women in midlife. This month they’ve got a long feature on how women with migraines are being deluged with painkillers.

The drugs are “transforming” the migraines from episodic to chronic daily headaches. I’d thought this was my own private anomaly. (This view is part of growing up in an alcoholic family: everything is “personal,” we don’t have anything in common with anyone else, and we Don’t Talk About It.) I’m sometimes forced to take triptans every day for weeks, and this is not good for me but I do it anyway. It’s a common problem for women.

The piece mentions a review of medical-insurance claims published in 2009 that found “almost 20 percent of the opioids prescribed in this country are dispensed to relieve the pain of migraines and headaches.”

But the source wasn’t cited. So I did a little checking and turned up the study, which appeared in the journal Pain (144:20-27). Psychiatrists at Washington University School of Medicine in St. Louis examined insurance claims for opioid painkillers, since self-reports of opioid use are pretty unreliable (we forget; we lie; etc.). They were looking at people who were “chronic” painkiller users (with more than 180 days of opioid use—which means I was a “chronic” user way back in 1999); “acute” users (less than 10 days), and non-users. Some startling results:

  • Chronic users made up only .65 percent—a tiny sector of the total population, but they used almost half of all the painkillers appearing in the claims
  • They had significantly more physical and psychiatric problems than people in the other two groups
  • Women made up more than 63 percent of the chronic users, and they used more of the medical services, especially as they got older
  • More than one-third of all the chronic users—and many more women than men—had mental health disorders.
  • Opioid abuse was twice as common among women than men, while men had twice the rate of alcohol problems.

Classic: We don’t have to drink, because we have our drugs! I can’t tell you how many women I’ve known who had this experience. I think of it as professionalizing our addictions. Being a drunk is low-class—Hurstwood crashed in the Bowery flophouse. But popping those pristine purple pills (which is the way I always remember OxyContin—like little amethysts) is moving it uptown.

And what do the drugs do for us emotionally? Do the scientists ever ask about the kinds of pain the drugs numb out?

Questions for a future interview.

The researchers are calling for pain programs to offer treatment not just for the “physical disease state” but also for the emotional problems that go with the appearance of chronic pain.

The way I hear this is, in order not just to cover up the symptoms but actually to heal, people in pain need other people to listen to us. We need community.

But healing the emotional problems is expensive. It’s a lot cheaper to give out drugs, even Prada drugs like OxyContin. Methadone and oxycodone (both of which I’ve taken; methadone is strong and cheap, I remember my shock when I bought 90 pills for five bucks) are a lot less expensive than the kind of help people might need to really heal. A study in the journal Headache (2010;50(7):1175-1193) last year found that in just six years between 1997 and 2003, U.S. methadone sales shot up by 824 percent, and oxycodone sales rose 660 percent. And this investigative story published in Salon and picked up by AlterNet the other day reported that the DEA has for the past 10 years been rubber-stamping gargantuan increases in production of opioid painkillers despite evidence of massive diversion from Florida to Maine and into the Ohio valley.

Insurers no longer want to pay for long-term treatments that involve patients talking to actual people (this story is trending in the New York Times today; there have been others talking about how psychiatrists only have time to give out drugs and can’t afford to listen to their clients).

It’s expensive to pay a real person.

From an interview with Gabor Maté that I’m going to run later on (stay tuned):

G: Do you think addicts can truly recover? You’re a proponent of harm-reduction for a certain percentage of addicts.

GM: The answer is absolutely yes. Precisely because we’re not isolated human beings. It very much depends on a supportive context. And if you talk to people who have made it, what was the one quality that was always there for them? Community.

The best solution is to build more community. Connection heals.

This site is free. If it helps you, please pass it on by using the buttons to share on social media.

Older posts
Visit Us On FacebookVisit Us On Twitter