Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: painkiller addiction

Dr. Drew on Jeff Conaway: Opiate Addiction Is Deadlier than Most Cancers

My 13-year-old kid played one of the T-Birds in his middle-school production of “Grease” this week. My husband (a Brit) had never seen the movie, so I rented it and we sat down to watch it last night. I opened IMDB on my iPhone to look up a cast member’s name and saw that Jeff Conaway had died just hours before. Amazing.

Finally.

They’re saying he dosed himself a bit too high one day and aspirated, and the particles of fluid in his lungs became infected, which he didn’t notice because he was too out of it on whatever drugs he was taking, and he slipped into a septic coma before anyone found him.

Which just makes me wonder: did he have anyone in his life? I’ve read studies that show that addicts who have family who care about them are more likely not to go down this path.

I mean, God. Didn’t you just know Conaway’s drug-use was going to kill him?

Dr. Drew Pinsky. (video capture: HLN)

“Jeff was a severe, severe opiate addict with chronic pain—one of the most serious and dangerous combination of problems you can possibly interact with, and one I see all the time,” Dr. Drew Pinsky said on his show last night. Pinsky said he had treated Conaway for years. Conaway also appeared on Pinsky’s show, Celebrity Rehab, in 2008—another unsuccessful stab at rehab for Conaway.

 

“And we live in a time when opioids and opiate pain medication is so available and so readily passed out, that for someone like Jeff, who is a SEVERE drug addict—he never seemed to be able to get away from it,” Pinsky said. “The pain seemed to keep motivating him back to the opiates. I told him for years it was going to kill him.”

Pinsky and his co-host Mike Catherwood chatted about the “plague that is opiate-based painkillers” in American society. They talked about how, 10 years ago, they’d be surprised to see people in a 12-step meeting who were dealing with painkiller addiction—it used to be cocaine, meth and booze, all of which they say are now old-school.

“Now I have to search out people who AREN’T dealing with pill-popping,” Catherwood said. “I can fully understand how someone can convince themselves—as an addict you’re already defensive and you justify your use to begin with. Now you put a doctor’s signature on that and a stamp of approval—it’s Game On.”

How Painkillers Amplify Misery

Then he asks Pinsky whether, after an addict in pain takes painkillers for a while, the addict begins to “invent pain” in order to justify drug-abuse and whether the pain becomes psychosomatic.

Pinsky answers:

It’s not psychosomatic; it’s that the misery of pain is actually amplified by opiates. There’s an affective component of pain that the misery of it that’s deeply amplified by the use of opiates, in the addict brain, and so the drive goes up and up with time.

How extraordinary. I have never heard any professional articulate this interpretation. That was my experience: the longer I took pain medication, the more AFRAID OF PAIN I became. The less tolerant I could be of any pain at all. The misery-factor was multiplied.

By the same token, when I got off drugs, I could tolerate MORE pain.

This is counter-intuitive. You’d think it would be the other way around—that painkillers would help you tolerate more pain. But they actually lowered my pain threshold to nil.

There needs to be more research into how to treat addicts who have pain.

Addiction v. Cancer

Pinsky said something else that, from his position as a highly visible addiction professional, it might be predictable for him to say, but I’ve hardly ever heard anyone say it: that addiction is deadlier than cancer.

I just want people to remember: opiate addiction is a deadly disease, it kills people all the time, we are dealing with a fatal illness more likely to kill you than the vast, vast, vast majority of cancers—that’s a fact.

More than that: addiction CAUSES cancer, man. And the drugs that are killing us are legal. Let’s get that straight. Let’s get past the idea that these illnesses are separate. I watched my mother die of lung cancer, caused by her addiction to the legal drug she bought at the grocery store every week. She lost her hair, she lost her balance, she lost her mind to 30 years of nicotine abuse. She lost her life. We lost our mother; my son lost his grandmother. …

Then seven years later I watched my dad die of massive GI cancer caused by a lifetime of drinking.

BAM: dead within a month of hospitalization.

I press replay on Drew Pinsky’s clip and sit through another ad: this one for Ketel One.

“This is real vodka,” they say.

All this stuff is out there, just waiting to be picked up. And the solution, imo, is not about making drugs illegal. It’s about teaching people about addiction.

How To Detox From OxyContin And Other Opiates

OxyContin

OxyContin tabs in a candy-colored rainbow.

Dunno why, but I seem to have paid short shrift to sharing detox experience on this blog. Which is weird, because I’ve got so many stories about opiate detox and recovery.

Received an inquiry recently about how to detox.

What do you know about getting off of OxyContin?—the length of time it takes, how safe it is, and what could the consequences be of going off too quickly. Do you have any idea?

Yes, I have some idea. Thanks so much for asking.

First I must say that none of this is medical advice or a substitute for it. If you want medical advice, please consult a doctor.

From one addict to another. About the length of time it takes to get off OxyContin—this depends on a few factors:

  • The level of Oxy you’re taking. (It could be any other drug. Not to put too fine a point on it: with the exception of methadone, Suboxone and tramadol, an opiate is an opiate. Heroin is Oxy is morphine is Vicodin is dilaudid. Even fentanyl is pretty similar, though it’s fat-soluble. They’re all short-acting full-agonists—though their dosage equivalencies differ.) If you’re taking maybe up to 120mg of oxycodone, chances are you could taper just using Oxy, following some rules for tapering that are few but non-negotiable. If you’re on a level that’s a lot higher than that, you might need some help. However, only you can tell, right? You know your own limits. I’ve known people who have detoxed cold-turkey off 600-800mg Oxy.
  • The reasons you started taking pharma-grade painkillers in the first place. If you have pain, you’ll need to work on figuring out other ways of managing it. Many non-opiate treatments exist that may help, depending on the circumstances. It may take time, consultation with professionals, patience, and a process of trial and error.
  • Whether you’re taking the drug “as prescribed” (i.e., swallowing it whole), or “not as prescribed” (i.e., chewing/snorting/shooting). OxyContin is also a bit difficult to taper from because you can’t split them. So another factor is the strength of dose you have available to you. One of the cardinal rules of a taper is: swallow whole, on schedule. If you can’t take your proper dose of Oxy on time and swallow it whole (I mean what addict can?), then you may need the help of a reliable detox doctor. (Operative word here: reliable. How I chose my doctor: I called the most reputable rehab in town and asked if I could please pay them to run my outpatient detox. When they said No, I asked for the name of someone else who might do it. Then I called my primary care physician and asked for her top referral. When they turned out to be one and the same person, I knew I had my guy.)

Let me also mention that the person who asked today’s question apparently got the idea from this blog that Suboxone treatment was Not Good. I’d like to correct this impression: Suboxone can be a very effective tool if it’s used properly. I myself got off an enormous level of opioids using Suboxone and Subutex. The danger comes when vulnerable, fearful detoxing addicts are encouraged to stay on enormous doses indefinitely rather than to use it as they often want to use it—as a tool to claim their right to lower their chemical load.

Using Suboxone or another drug as a detox tool doesn’t necessarily mean we’ll be “substituting one drug for another.” I mean, in a sense we are, but only for a short period, and under a doctor’s guidance. This can mean all the difference between addiction and recovery. … When I was detoxing with Suboxone, I did not write the taper schedule, my doctor did. I had to visit him every week, and later every other week; I paid him $80 a crack, aside from what I paid the pharmacy for the weekly prescriptions, and it was worth every penny to get free. I keep the receipts for my detox doctor’s visits in the drawer of my nightstand. The equivalent of my parents burning their mortgage (which they did, literally).

The reason I chose to taper off drugs using Suboxone is that I was on such an enormous level—more than 100mcg/hr of fentanyl. I was prescribed one patch every two days, and because I did not always take them as prescribed, I used a bit more than that. Fentanyl is a crazy-strong drug, it’s what they give you when you go in for surgery, and this level is roughly equivalent to 400-600mg morphine or oxycodone per day. Somehow my lizard-brain knew it was going to be impossible for me to taper off that level of fentanyl, or get enough of another drug to equal that level so that I could taper. And anyhow, I’d never been able to taper off a full-agonist—a drug that plugs into the receptors and stimulates them fully, like heroin, oxycodone or morphine.

Read Dr. Scanlan’s interview about Suboxone: it has a long half-life, which means it doesn’t create as much of a buzz as the short-acting drugs like oxycodone. As long as you keep tapering, and you have a doctor willing to help you keep the taper short, you can get free with Suboxone.

How safe is detox?—Opiate detox is not life-threatening. In contrast to alcohol withdrawal and detox from benzodiazepines (Valium, Xanax, etc.), both of which can cause life-threatening seizures if done too quickly, detox from short-acting opiates can be done safely at home. A “cold-turkey” detox happens in two phases:

  • Acute detox, which lasts 10-14 days or so (depending on level of use), in which the body excretes the drug and, in doing so, experiences signs of active withdrawal such as runny nose and eyes, sneezing, goosebumps, shivering, loose bowels, and restless legs and arms (kicking). All this means the body is healing.
  • Post-acute withdrawal syndrome (PAWS), which lasts an indefinite period (depending on level of use and how well we take care of ourselves), in which the body’s opiate receptors heal and the body learns to produce endorphins again. Most people find exercise and good nutrition help a great deal, as does some kind of support plan.

I can hear some folks out there thinking, “I think I’m endorphin-deficient.” I love hearing people register this claim. I used to believe this about myself before I got on drugs like fentanyl. Then, after I got on drugs like fentanyl (and morphine, and OxyContin, and whatnot), I used to believe that I’d MADE my body permanently endorphin deficient, so I should just stay on the drugs forever. Addiction lizard-brain. … Today I lift weights and cycle 30 miles and play tennis. I do all this having been diagnosed with two painful neurological disorders. I’m not bragging here, I’m just saying: I’m NOT endorphin deficient. If I can get off this stuff, I think anyone can.

The consequences of going off “too quickly”?—There is no “too quickly,” imo. If one is addicted, the only dangers are not quickly enough, or not at all. However, if your level of use is high, and you have kids and a job and still want to function during detox (as I did), it might be worth it to slow the detox down. I’ve always compared detox to learning how to land a plane. Not that I’ve ever landed a plane. But I imagined being in the pilot’s seat, and taking direction from the tower (higher power/physician/recovery community, etc.), and telling the tower I needed either to make a quick-and-dirty landing or a long slow smooth landing.

You can do either one safely. The first takes a lot less time, but it might be a rougher ride. The second is much smoother, but there’s more time to worry about whether you’re gonna crash. Which is why it’s helpful to get support, not only from a doctor but also from a community of people who have been through similar stuff.

Detoxing was one of the best decisions I ever made. It was the start of a new life.

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Reverb10: Achievement Addiction

[Until 31 December I’m participating in reverb10, a month-long challenge to get bloggers to respond to writing prompts designed to help themselves and their readers take stock of the past year and to imagine possibilities for the coming year. I think of it as conducting the year’s final inventory…]

Prompt: Achieve. What’s the thing you most want to achieve next year? How do you imagine you’ll feel when you get it? Free? Happy? Complete? Blissful? Write that feeling down. Then, brainstorm 10 things you can do, or 10 new thoughts you can think, in order to experience that feeling today.

A number of potential achievements blizzarded through my brain when I read this prompt:

  • write my next book
  • write my business plan
  • submit the stories I have lined up on my editorial calendar
  • create the paintings that have been rolling around in my mind
  • become truly physically fit
  • create my brand
  • be featured in O magazine (or similar)
  • win Pulitzer prize/Nobel Prize for Literature (or similar)
  • sell film rights, be played by Julia Roberts (or similar)
  • win mass approval, not have to try anymore; Finally Rest Assured

You can see where my mind goes when asked to consider the word “achieve.” Never mind the words “accomplish,” “ambition,” “approval,” “attention,” etc. (Interesting that they all appear under the A file)

“Achieve” = from the Old French “achever,” to come or to bring to a head.

Definitely fantasize about resting at the top of the pile. The “chief.”

I like the feeling of being at the top. I like the feeling of imagining being at the top. The feeling of imagining being

(free happy blissful complete)

(rich famous)

(safe loved safe safe safe)

Brigflatts Meeting House garden

The garden at Brigflatts Quaker Meeting House, Cumbria, England (1675), seen through the meeting house doorway.

at the top is what used to power me through the work. Sometimes still does. I would finally reach the garden, and I could rest there, and Never Have To Try Again.

When I would get to the end of the tunnel on a project and none of that lasted—when I couldn’t make it stay—that’s when I would come down with migraines, I wouldn’t be able to sleep, I’d go to the doctor, secure drugs, and numb myself out. Basically what was happening was, I was living in the future, and when the future suddenly morphed into Now, I’d fall apart.

This is a longstanding habit of mine. Two longstanding habits—three, actually:

  • living in and for the future, for future feelings (I can’t wait to be free/happy/blissful/complete!!!—when I achieve X This Will Finally Happen And I Will Have To Strive No More!!)
  • becoming sick when my expectations are not met, and
  • numbing out because I’m sick, because I can’t stand my feelings. Lots of people addicted to prescription painkillers have the same experience.

So, the thing is. No matter how much my grasping ego may want all that other stuff on the first list? The most important thing for me to “achieve” in 2011 is to stay inside each day. And to make sure each day is a sober day. As my friend Mr. Sponsorpants (I wish I did not have to refer to him by that name; alas) writes, “If, by the end of the day, you don’t drink or use or kill yourself, you win, and the rest of this crap will just have to work itself out. Sobriety is ALWAYS the priority.”

Getting Fit: A Goal

I have committed to a 90-day program of fitness for 2011. My friend Angela, the former pom-pom-girl/non-cheerleader/prom-court-queen/etc. and now-entrepreneur/mom/wife, has committed to being my official coach. So get ready to see updates in the new year about this project. …

Despite the fact that I’ve just critiqued the idea of “achievement,” I still hold with Goals. They keep me moving. They keep me outward-focused, not focused on my own gratuitous status. One goal I have for myself in the new year is to do one unassisted pull-up.

“G,” my friend said to me, doubtfully, this morning as we knitted in her living room, “pull-ups are wicked-ass hard. They’re especially hard for women because they require a great deal of strength right here,” and she pointed to those muscles whose names I do not know, the ones that connect our shoulders to our boobs. (Anyone?)

Well, so be it. I’m going for it. I want to do one pull-up before I die. This is a goal I have. I was always the kid who could not do the Flexed-Arm-Hang in the Presidential Fitness Test, and then I was the teenager who could not run one lap around the football field and got called “Old Lady” by the asshat gym-teacher who, instead of actually teaching fitness, chose instead to be best buddies with the girls who were already fit and demean those of us who perhaps most needed her help. (I guess “asshat” reveals an unmined resentment. Huh.) And then I was the addict who did not exercise but instead took drugs to control her pain. I’ve discovered in the last six weeks that almost total lack of exercise and a generally shitty diet knots up my muscles and makes it hard for me to sleep.

Fitness is a critical component of recovery. I want to discover what it does.

As for Angela. I thought it incredibly generous that she should offer to be my coach. I told my sponsor how nice she is.

“Isn’t that a surprise?” my sponsor said archly. “It’s always a surprise to find out that popular people become popular usually because they are nice.”

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