Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: painkillers (page 1 of 3)

Prince.

Prince

I’ve been waiting to comment about Prince, because the tox screens aren’t yet in.

It’s not like it was with Philip Seymour Hoffman, who was found dead with the rig still in his arm and drugs all over the house.

But today the New York Times is running a front-page feature about Prince’s apparent addiction to painkillers. Associates have been saying since the day he died that he’d had hip surgery because of his acrobatic performances onstage, in high heels.

princesplits_1bi2hnl-1bi2hnq

Prince was a short guy—five-feet-two. He was slim and lithe, and he spent decades bounding onstage with guitars strapped around his torso. Guitars are basically pieces of solid hardwood. They’re heavy, man.

prince-guitar

And the high heels—they look awesome, but they hurt the whole body, not just the feet.

prince-high-heels

In the years I’ve been running this blog, I’ve heard from so many people who became addicted to painkillers because they felt the need to push themselves past the limits of their bodies. Speaking for myself, I sought treatment for two painful neurological conditions in the early 2000s, when OxyContin was being jammed onto the medical market. I was assured by high-level pain experts that there was little risk of my becoming addicted because I had “legitimate pain,” but within a couple of years I was being prescribed massive doses of fentanyl, and I was abusing it.

Not many people make it off fentanyl alive.

I’m able to manage my pain without dependency producing drugs, because I have learned to work within my limitations. It has been a frustrating and humbling experience. My constant pain reminds me every day that I have to take care of myself in ways that are different from what I learned as a kid, and also ways that are different from what the culture would have me do—which is take drugs.

When the CDC last month issued new guidelines for opioid prescribing, Center for Disease Control Director Thomas Frieden M.D. noted in the New England Journal of Medicine, “Initiation of treatment with opioids is a momentous decision and should be undertaken only with full understanding by both the physician and the patient of the substantial risks involved.”

Drugs are not inherently evil, but they carry particular dangers. We live in a culture in which these very powerful chemicals are prescribed by doctors, many of whom do not understand their powers. And that ignorance is then passed to patients, who then learn not to respect the powers of the chemicals.

In Prince’s case we still do not know the autopsy findings, but reports from associates serve to remind the public of the importance of considering one’s penchant for using substances to drive oneself past one’s own limits. The artist formerly and belovedly known as Prince was a true original—as a friend of mine put it, “his own freak.” He was also a human being and a businessman, and he wanted to keep doing what he was doing despite the limits of age and physical injury. Unfortunately the human animal is not built to jump off stage risers in high heels for more than three decades without sustaining chronic injury. However artistically independent Prince was, a little humility is called for to accept the limitations of the human body and mind.

I’ve always found it pretty ironic that when Pink Floyd was writing their song “Comfortably Numb,” the working title was “The Doctor.”

Come on, now
I hear you’re feeling down
Well, I can ease your pain
And get you on your feet again …

Can you stand up?
I do believe it’s working good
That’ll keep you going through the show
Come on, it’s time to go

Prince-1

 

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?

This site has always been add-free and fee-free. If this post helped you, please like and share.

Reverb10: Beautifully Different

[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—conduct the year’s final inventory—and to imagine possibilities for the coming year.]

Today’s prompt: Beautifully Different. Think about what makes you different and what you do that lights people up. Reflect on all the things that make you different—you’ll find they’re what make you beautiful.

When I was a kid I focused on the outward things that made me unfortunately different. I was fat; my teeth were abnormally crooked; my eyes were black and my skin olive-colored, Gypsy-style—in fact, it appears I have Roma in my heritage. And there were other differences. Whereas other girls spent recess on the playground jumping rope or doing hopscotch—being social—I read books and drew by myself. By the time I was in high school, I was making all my own clothes. I was a real oddball.

Also, I didn’t know how to get along with other kids. I was naïve; the mean girls got over on me, and I had one date in high school.

When I moved to college, my braces and that whole Geek-Squad reputation came off, and the dudes decided I was hot stuff. They liked my dark eyes and dark skin. They noticed my legs. They liked my sharp mind. Geek Catholic Girl Turns Instant Hot Chick. I didn’t take advantage of this because in my mind I was still a geek.

My entire family also still saw me as the Geek, and it remained absolutely boring and lonely at home. And in order to manage my increasing unhappiness about my family (which I never even realized was an alcoholic family until I was in my 30s), and to keep my feeling secret—especially my feelings of appreciation about myself; and to keep them secret not only from everyone else but also from myself—I started drinking.

I drank, in Steve Martin’s ancient words from the 1970s, to Get Small. And this morphed into a painkiller penchant when I started getting my headaches treated in my late 20s. The penchant turned into a full-blown addiction in my mid-30s.

I drank and used because I needed to make myself quiet. I am at my most uncomfortable when I am empowered. I come from a long line of chronically unhappy, unrealized housewives.  One of them, my grandmother—my mother’s mother, the wife of a violent alcoholic—is in a nursing home right now, dying of kidney failure. She is 97 and has, as far as I can tell, never been happy, never achieved any power over her own life. And has spent her life complaining about it.

This is the image I know, and the image I feel most comfortable with: the woman at home, taking care of everybody else, complaining about it.

One thing that made me get sober was my urge that I was damned if I was going to carry on that way. Being the martyr. I wanted to be different.

I am different. Today. One thing that makes me different from those unhappy dead and dying people in my family is that I’m getting help… And for that I’m grateful…

Identifying myself as a “sober person,” as I do whenever someone offers me something alcoholic to drink, marks me as different. I’m able to do this because I’ve gotten help, and because of that help I maintain contact with a power greater than myself that keeps away the obsession to numb-out.

For a long time (for a loooong time) I did not like identifying myself as an alcoholic or an addict at meetings—or anywhere—because I thought this set me apart from humanity and made me “different” in an ugly way. The word “stigma” means “to brand with a stick,” in essence “to mark with shame,” and that’s how I felt. I’ve been poked with sticks before, in that old childhood playground, and I’ve bloody well had enough.

Guinevere and son

Being Sober, being awake: Me and my son on Tower Hill, London, June 2010.

But when I began to meditate as part of Step 11, and brought my experience into the present moment, I looked around and had to admit that nobody was poking me with a stick anymore. When I identified myself as an addict or an alcoholic, I was saying what was true. This gave me a chance to share my experience in ways that might help other people. And guess what—more than 6 million Americans are abusing prescription painkillers. So there are a lot of people to help.

Today I’m five-feet-five, 120 pounds, olive-skinned, black-eyed, and brown-haired with a bit of gray. I’m a mom, a wife, a sister, and aunt, a friend. I write and make art. I play tennis, ride my bike, do yoga, and garden. And I’m a sponsor, a sponsee, and recovering from addiction.

Can we cure drug addiction with drugs?

So the National Institute on Drug Abuse has given $3.7 million to a professor at the University of Maryland School of Pharmacy to make the first drug in the U.S. and maybe in the world for cocaine addiction from an ancient Chinese herbal remedy.

Corydalis

Corydalis—in Chinese, yan hu suo

This is the pretty little herb: it’s called corydalis—in Chinese, yán hú suo.

The active ingredient in this plant is called l-tetrahydropalmatine, or l-THP. Professor Jia Bei Wang and colleagues from the pharmacy and medical schools are going to take five years to study whether l-THP actually works to decrease cravings for cocaine. Apparently clinical trials could start within the year.

It’s interesting: l-THP, as corydalis herbal extract, is unregulated and available for purchase on the Internet. I wonder what kind of “drug” they’ll develop from it… considering traditional Chinese medicine practitioners have, according to my encyclopedia of herbal medicine, been using corydalis root successfully since the eighth century?

More from my encyclopedia about corydalis:

A painkilling herb that stimulates the circulation, controls spasms and nausea, and has sedative and antibacterial properties. Research also suggests action on the thyroid and adrenal cortex. Used internally as a sedative for insomnia, and as a stimulant and painkiller, especially in painful menstruation, traumatic injury, and lumbago.

This seems to jive with current thinking about l-THP—apparently the same orientation that Prof. Wang has—which says that the chemical blocks dopamine receptors (which by all accounts would give it sedative action). There are research papers out there that also suggest l-THP is good at ameliorating effects of chronic opioid administration in animals (so what’s called good for the crack addict will also likely be called good for the smack addict).

Jia Bei Wang

Jia Bei Wang, Ph.D.

This is important recognition for the validity of traditional Chinese medicine and its potential impact on Western practice, and I’m real happy for Prof. Wang. 🙂

But personally: I’d be kind of reluctant to take anything on a regular basis that fiddled with my dopamine receptors. Just because I’m personally kind of reluctant to take anything on a regular basis at all anymore. (I take a couple of anti-epileptics at low doses for my migraines and fibromyalgia, in fact the doses are so low that the pharmacist questioned whether one of them was even therapeutic… I have mixed feelings about taking pills every day, but the fact is, despite recovering from addiction, I still have pain.) And also, fiddling with dopamine receptors is a dodgy proposition. Dopamine is the neurotransmitter that controls desire, appetite, creativity, sexuality and joy. Man o man, fiddling with that… But if that stuff isn’t present, you’re stuck in the pit of anhedonia, you’re dying to experience life, and that’s why you snort your lines, I can see why you’d want to figure out some fast remedy for the cravings.

And about those cravings: I was taught that you can’t solve a problem with the same thinking that got you there.

In other words, to solve a drug problem, drugs might not be the best solution…

But here’s another point: I know cocaine addicts (and heroin addicts and Oxy addicts and alcohol addicts and fentanyl addicts, you name it) who don’t have those cravings or that anhedonia anymore. While it might be great to find a pill that would get rid of cravings—I know there are many people for whom they never dissipate—why aren’t they studying what’s going right in those of us who no longer have them?

Scientists are frequently holding up fMRI scans and pronouncing dire conclusions about the “warped pathways” in addicts’ brains. Have they followed up on us after we get the kind of help you can’t get in a pill? (And I’m not just talking about the spiritual solution… though that’s part of it, for me and many others. I’m also talking about good nutrition, good exercise, good sleep, being part of community, and productive work—all the stuff you can’t patent and sell in a bottle.)

Scan me. I’d be curious to see whether my own dopamine and opiate pathways are still warped.

From painkillers to heroin: A new study

Surprise, surprise. A new study by some researchers at the State University of New York at Buffalo (UB) has shown that increasing numbers of heroin users became addicted after being given legal painkillers for pain.

The study appears in June’s issue of Journal of Addiction Medicine.

The researchers found that many pain patients first got hooked by using legal prescription drugs, and then they progressed to buying illegal opioids off the street. “Later, they purchased heroin, which they would come to prefer,” the study states, “because it was less expensive and more effective than prescription drugs.”

More effective, you ask?

OxyContin 80mg

OxyContin 80mg tablets

If you look at the study results: more than 90 percent of the participants had purchased street-drugs at some point, and not just tidy little pills—almost two-thirds preferred heroin to anything else “and more than half had used drugs intravenously.” Any drug used intravenously is going to be “more effective.”

It also depends on the “effect” you’re looking for. But in terms of either pain- or mood-control, IV is the most bioavailable route (meaning there’s less drug lost to metabolism—it all goes into the bloodstream), and it’s going to give the strongest “effect.”

As to why they’d choose heroin over pills—I’ve never shot up or bought anything off the street, but I understand from friends who have that it’s more difficult to shoot pills, especially pills with non-opioid agents such as Tylenol and especially fillers that clog up the works.

Another troubling fact reported in this study that all the other digests have missed: 74 percent of these pain patients said the physicians who prescribed them opioid painkillers for extended periods never asked them about any personal or family history of addiction before giving them the drugs.

One of the authors, Richard D. Blondell, M.D., a family medicine doc at UB, made a comment in the UB press release that kind of stuck under my skin:

I tell patients that addiction can be an unintended side-effect that occurs occasionally with the use of these medications. . . . Doctors need to be able to help them if this occurs, so doctors will need to monitor the use of these medications closely.

Those are my bolds. I wanted to know what he meant by addiction being “an unintended side-effect.” I mean, when I think of a “side-effect,” I think of those annoying flies-in-the-ointment that disappear when you stop treatment—nausea, insomnia, even sexual dysfunction. But addiction?—it’s permanent, man.

If you took a pill that caused permanent erectile dysfunction, would you call that a “side-effect”? … And ED isn’t even life-threatening. (Although I guess some folks might feel it that way…)

So I asked the good doctor: This seems a rather diminutive way of looking at addiction. Is this really the way you conceive of it? Many physicians do not understand the nature of addiction, they’re afraid of it, and this is why they miss the signs of it in their offices. … I also wanted to know how he proposed to “help” patients with chronic pain who develop addiction, since the solution for many a physician is to kick the addicted patient out of the practice.

I got a reply a few days later, via his PR flak:

Here’s the sensitive issue: many patients are afraid that physicians will shy away from treating “legitimate” pain if doctors are too worried about the risk for addiction. Many patients take these medications long-term without problems. We don’t want to stop that. On the other hand, some patients do develop an addiction which neither the doctor nor the patient ever intended to happen. The use of the word “unintended” is meant to be a non-judgmental term for this. It means that there’s no blame for the patient or the doctor; sometimes it just happens. When it does occur the doctor must recognize it and manage it with care and compassion. Blaming the patient, blaming the doctor, or “kicking the patient out” are not answers that accomplish anything constructive.

He didn’t quite get it.  He was focusing on the word “unintended.” I wanted him to talk about the word “side-effect.”

But it’s great that he’s getting physicians to talk about being non-judgmental and compassionate, and helping patients manage addiction. Blondell has another paper out in this month’s Journal of Addiction Medicine about how chronic pain patients who are addicted do better on steady doses of buprenorphine (Suboxone) rather than tapering doses to become opioid-free. It seems this guy’s orientation is to help some people with chronic non-cancer pain and addiction help manage their pain with some sort of opioids…

Looking forward to seeing how he thinks he can help pain patients with addiction “monitor” their use of painkillers so that they don’t abuse them. That’s one of life’s $64,000 questions.

And since Reckitt Benckiser has just been given the FDA go-ahead for their fancy new Suboxone film, it also seems like it’s time for me to get on the Suboxone story… a whole nother can of worms. Anybody out there with experience with Suboxone??

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