Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: painkillers (page 2 of 3)

Fentanyl: The Drug The Kids Call “Fent.”

More about fentanyl… In gratitude for two years of freedom from it.

A 33-year-old upstate New York man is facing two years in state prison after pleading guilty Tuesday to selling the fentanyl patches that caused a teenager to overdose fatally when he sucked on them.

This guy, James Slingerland, apparently stole his father’s supply of patches after his father, who was being treated at home for end-stage cancer pain, was taken to the hospital. Of course when you’re taken to the hospital, you don’t bring your drugs with you because they give you drugs from the hospital pharmacy.

So Slingerland had this brainwave: he would nick his dad’s drugs and sell them for a bit of extra pocket change. Except the middle-man sold them to a teenager who then chewed one and died.

This is what a brand-name Duragesic fentanyl patch looks like.

Duragesic fentanyl

Brand-name Duragesic fentanyl patch, 75 micrograms.

Fentanyl is so strong it’s measured in micrograms, not milligrams. (A microgram is one-onethousandth of a milligram. Very small amount.)

Can you see the gel inside there? People squeeze the gel out and suck on it. I have a friend from Opiate Detox Recovery who used to call brand-name Duragesic patches his “ketchup packets.” Because he said as soon as he tore the envelope off the first one and saw how squishy it was, he knew what he’d do with it. He couldn’t stop himself. (It’s part of addiction, the not-being-able-to-stop-yourself.)

Aside from drastically increasing the risk of fatal overdose by sucking the gel (in other words, you can kill yourself by doing this), the other agents in the gel are also toxic to organ systems. The gel is NOT GOOD FOR YOUR LIVER when it is eaten. Please do not eat it.

I used to buy the generic Mylan fentanyl patches.

Generic fentanyl patch

Generic Mylan fentanyl patch, 100 micrograms.

This is exactly what my fentanyl patches looked like. 100mcg. Boy does this bring back memories…

In the news stories about the upstate New York overdose, the cops were saying fentanyl is “about 80 times more powerful than morphine.” Morphine is the gold standard against which other opioids are compared, and I’ve heard lots of different estimates bandied about. Truth is, they don’t really know how to measure how much more powerful than morphine fentanyl is, because of the varying rates of absorption. If you have not a lot of body fat, fentanyl will metabolize more quickly than if you have more body fat. If you have more body fat, fentanyl will hang around in your body longer and take longer to excrete, because it’s fat-soluble. If you work out, or if your temperature runs even a degree high, and you put a patch on your skin, fentanyl will be absorbed more quickly.

People have found all kinds of ways to warm up the patches so they’ll be absorbed more quickly—so the blood levels will “spike” and they’ll feel some kind of high.

And if you stick it in your mouth, where it’s the warmest in the body—where does the nurse take your temperature?—the fentanyl will be absorbed the fastest of all. If you fall asleep (“nod”) with it in your mouth—it can kill you.

For all the readers out there who get to this post by searching on phrases like “is it quicker to eat fentanyl patch or stick it”—THINK ABOUT WHAT YOU’RE DOING. Think about the people who have died.

Fentanyl is, if you’ll excuse my French, Nothing To Fuck With. It is only for opioid-tolerant patients with high levels of pain who are being overseen regularly by a physician.

Extra fentanyl worked wonders when I had an appendectomy and when I broke my elbow. For pain in the tissues, opioids do a crack job (to use a small pun). For neurological conditions, not so much. Fentanyl suckers (“Actiq” lollipops) are marketed for neurological problems such as headaches. In my experience all Actiq did for my migraines was make me not-care about them. They didn’t take away much pain—they just made me not-care about it.

And for addiction, they’re hell. There’s almost nothing harder to get free of than fentanyl. You want to up your tolerance, you’re in for some serious debt when you pay the piper, take it from me.

Fentanyl was my ball-and-chain for three years, until I hired a detox physician to help me get free. And two years ago this week I woke up free of fentanyl. I was on Suboxone for two more months—which is another story for another day soon—but I was free of fentanyl. Thank god.

Heroin Addicts Start With Prescription Painkillers.

Russ Zimmer, a young journalist and writer of the series about prescription-opiate addiction that ran in a central-Ohio newspaper network, said the original idea behind the project was to write about the increase in heroin deaths in the region. The health department data showed that heroin-related deaths were indeed on the rise, but that “prescription painkillers had been head and shoulders above other drugs and growing for two or three years,” Zimmer said.

The big reason heroin was claiming more lives, Zimmer said: People start with prescription painkillers and then, either when they can’t find pills or can’t afford them anymore, they turn to heroin, which is cheaper.

Learning about addiction from horse’s mouth

In a series of six stories, Zimmer was able to quote only two addicts on the record. He said he’d spoken with five or six more off the record, and that it was difficult to find addicts who would speak at all because of the social stigma addiction carries in society.

“There’s this belief in society that addicts are people with lower moral fiber,” he said. “Some of the addicts I talked to bought into that themselves, which obviously isn’t helpful to them.”

Zimmer organized an informative video chat with two experts, which (I was thinking as I watched it) may have been even more informative if it had included a recovering addict on camera. What better way to learn about addiction than from someone who’s been there and back? But if it’s difficult to get someone to speak on the record in a newspaper, how hard would it be to get someone to speak on camera?

I would. The world needs to hear about addiction from addicts and from the families of addicts.

Zimmer himself has learned a great deal about addiction from doing this series.

He said last year, before the series ran, he’d written a story about a 19-year-old girl with a young child who had become addicted to prescription painkillers. She had one or two months clean; her mother told Zimmer about her hope for her daughter’s future and her ability to recover.

“Just a few weeks ago,” he said, “I opened the Sunday paper, where we run indictments, and I saw her name listed for obtaining dangerous drugs.” He said he learned she’d continued to use and had been sentenced to prison.

“That bothered me,” he said, his voice halting. “I’m not a grizzled veteran [reporter] or anything, but I’ve sat in on a lot of court hearings where the charges are unsettling and they didn’t bother me—but this bothered me. You hear about people falling off the wagon… She was a likeable person, and she wanted to do well. It just bothered me that her desire to do well wasn’t enough. It made me see how strong this problem is.”

Thanks to Russ and to the Ohio papers—the Lancaster Eagle-Gazette, the Newark Advocate, et al.—for doing this series and for raising awareness of addiction and recovery.

Addiction in the news : NFL QB Ryan Leaf pleads guilty to stealing drugs

NFL Quarterback Gets Probation for Stealing Drugs

Today’s story: A former NFL player is given 10 years probation and a $20,000 fine after pleading guilty to eight counts of felony drug charges, including obtaining a controlled substance and delivery of a simulated controlled substance.

The player is Ryan Leaf, former West Texas A&M University assistant football coach and four-year NFL quarterback (San Diego, Tampa Bay, Dallas).

What he did was, while he was coaching quarterbacks at WT in 2008, he’d visit injured players and steal their Vicodin. Pretty soon he was breaking into a player’s apartment to steal drugs.

Like many painkiller addicts, Leaf was introduced to opiates after surgeries for sports injuries.

Part of the long statement he made in front of the judge was this:

“You just don’t ever realize it until it becomes a psychological thing that takes hold of you,” he said. “It’s such an issue in this country and people don’t understand it. If I have to be the one to put a face on it I am more than happy to do it. I’ll do whatever I can.”

This made me wonder: why can’t more addicts be willing to be real about their addictions? Why is it always the famous (or semi-famous) people who get to represent what addiction is, and what it means to recover?

Why do ordinary people feel compelled to hide it? It’s too bad—my recovery has made my life so much better, and for that I’m grateful.

How to tell if your husband is addicted to his “meds”

Came across this piece in a Tennessee outlet, about the rampant rise in prescription opiate addiction. The story contained the stunning suggestion that DEA agents and doctors could learn a lot from interviewing former addicts.

I keep waiting for the stellar journalist who thinks to accomplish this simple task. I swear, it would have made this particular story 200 percent better. Because right after the WVU doctor suggested talking to addicts, the Tennessee doctor lists a bunch of “warning signs if you think someone might be addicted to or abusing prescription drugs” [see my edits]:

• Repetitive filling. Patzer [the Tennessee doctor] said some dependents or addicts could continue to refill their medications even though they might be free of pain symptoms. [Someone ought to warn the DEA.]

• Using it up too fast. A patient becoming dependent or addicted could begin to will always use the prescribed amount faster than directed by the doctor, Patzer said.

• Alcohol pairing. Taking the medication while drinking alcohol or smoking pot or even cigarettes could also be an indicator of abuse or addiction.

• Looking lethargic. If the patient seems over sedated, it could be is a sign of taking too much [when you take an opiate “as prescribed,” you don’t nod off]. Patzer said, though, that some addicts actually seem energized despite taking depressants.

These are clues from the physician’s point of view. What wife can tell whether her husband is “filling repetitively” or “using it up too fast”?

If I were asked to add a few clues, I would give these:

• Does she talk too fast? Opiates in particular, in high doses, speed up the speech and make a normally shy person more gregarious. This is the Superwoman aspect of opiates, well-known among addicts.

• Does he jump up and down through supper? Opiates destroy the appetite. If he can’t sit still and eat, and keeps leaving the table, he’s probably sneaking off to use.

• Does she have strange bruises? Opiates skew a person’s sense of balance and dull pain. I used to bang into furniture all the time without even knowing it until I saw the bruise later.

Does she have secret hiding places? If there are spots in the house where she won’t let you go, then that’s where she probably hides her stuff.

I need also to say that some addicts simply don’t understand they’re addicts. Especially those seeking pain relief. For years I sought treatment for two pain conditions, constantly increasing my dose in search of relief, and trying to “function.” I didn’t understand that my desire to “function” at such a high level was itself a compulsion that was part of my addiction.

The addict in the drugstore

Stopping by the pharmacy yesterday afternoon, I walked to the counter at the back of the store and that’s when I saw her. I recognized her immediately. The addict.

It wasn’t her fishnet knee-highs that told me, or her messy black hair, or her bare navel. It was the color of her skin.

Also the way she fidgeted.

And the way she trained a keen eye on the three pharmacists whose heads knocked together, scrutinizing a printed paper script behind the counter. The way she bit her fingernails, and tried not to rock on the balls of her feet.

I had handed my script for Topamax to the technician and was lining up my questions since it’s a new medication for my migraines. I was also distracted by the fact that this was one of the pharmacies where I used to get my drugs. Used to sit in one of the vinyl chairs and keep an eagle eye trained on the pharmacist, just like this woman.

She was standing next to me, black curly hair unkempt, green T-shirt riding above a slack belly, fingertips with bitten nails constantly adjusting black-fishnet knee-highs. She looks like an addict, I thought latently, and told myself I was wrong. Then I looked at her face, the colorlessness of her cheeks, the dark circles beneath her haunted eyes, and I was sure I was right.

The staff came to a kind of agreement and the head pharmacist (whose face I recognized) brought the script back to her, and I heard her breath draw in between clenched teeth. Because she knew she would not get what she was so obviously desperate for.

I’ve had multiple pharmacists working over one of my scripts in days gone by. And the four words she spoke were words that I myself used to try to inflect with neutrality and intelligence:

“Is there a problem?”

The pharmacist said the doctor’s intent had been clear: he MEANT three per day, but he had not written a total count, so they could not fill the prescription. They could not write it in; they could not call him, he could not fax a new one, because the drug called for was (I was not surprised to hear him say) “a Schedule II narcotic” and federal law prohibited any of those changes.

She’d have to take the script back to the doctor and get him to write a new one.

I remembered being in similar binds: my physician forgetting to sign the script, specifying the wrong dosage, the wrong total amount, the wrong date. Every detail on a Schedule II opioid script has to be letter-perfect. When you’re in desperate straits, sweating, withdrawing, it’s difficult to focus on the details. You just want what you want.

As the technician processed my Topamax order the girl snatched her script and left the pharmacist speaking in mid-sentence, not even bothering to hide her rage. Two minutes later, outside, I looked for her, hoping to talk with her, but of course she was gone.

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