Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: prescription drug addiction (page 1 of 2)

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.

More and More Mail: How To Quit A Small Oxy Habit

Ran four miles in the Rhode Island countryside this morning. No place in Rhode Island is very far from the coast and the light here is different from home, somehow both brighter and more gentle. Using it to paint:

Henry, age 2. Almost done.

More mail from a young guy in the Pacific Northwest:

I am battling with an addiction from Oxycodone. Approximately 15-60mg a day, and I had a few questions for you. My first question was, how hard and how long do you think I will withdraw for? I have been using for about 9 months, and just finished college and would like to get my life started. Second, I was wondering if you think it would be a bad idea for me to get about 2-3 8mg Suboxone pills, and cut them into quarters, use those for about a week, and get off them to help me skip the physical withdrawal symptoms. Please, respond as soon as you can as I am desperate for help.

Last week I attended a regional prescription drug abuse summit in my town. The U.S. Attorney’s office and the DEA and Obama’s drug-control policy people were there, and they made a big deal about two drugs: oxycodone and Opana—chemical name oxymorphone, metabolite of oxycodone. It’s twice as strong as oxycodone and is said to be three or to eight times stronger than morphine (though most sources cite oxycodone as being 1.5 times stronger than morphine, so these equivalencies don’t make sense). At any rate Opana is stronger than its parent drug.

Oxycodone is a short-acting drug—its half-life is 3-4 hours, which means within 24 hours it pretty much clears the system.

Suboxone, on the other hand, has a 37-hour half-life. Which means it takes days and days to clear the body.

First thing to consider: one milligram of suboxone is equivalent to 30mg morphine, or about 20mg oxycodone. The reader wants to “get” 8mg tablets and cut them into 2mg pieces, which would be upregulating the opioid receptors: he’d be taking the equivalent of 40mg oxycodone, but if he doses every 24 hours, he’d be stacking up the drug in his blood because it takes 37 hours for half a dose to clear the body.

Second, “getting” a prescription drug is problematic (criminal, a felony in my state, actually) unless it’s prescribed. Don’t buy on the street, OK, dude? … Number one, addicts are powerless over drugs. I couldn’t have trusted myself to “get” Suboxone and use it responsibly. Suboxone is a kickass substance and the only way I could have used it successfully for any purpose was under a reliable doctor’s hawkeye supervision.

My experience:

  1. A 60mg/day oxycodone habit is beatable through quitting cold-turkey or tapering. The acute withdrawal will involve about 10-14 days of sweating it out and feeling like you’ve got the flu; after that, maybe another month of feeling like life is a drag, but aerobic exercise can work wonders to cut down on insomnia, restless legs, etc. … I know 60mg feels like a huge amount. But hear this: I used Suboxone because I was on 100mcg fentanyl per hour, which is equivalent to about 400mg oxycodone per day. I don’t mean to minimize your experience, but using Suboxone for a 15-60mg/day habit is, to use my lay buprenorphine expert friend Jay’s analogy, like shooting an anthill with an atom bomb. … When I first took Suboxone I was tempted to stay on it for life because at first I felt so super-well, but that feeling changed within a matter of weeks. And I can’t tell you how many emails I’ve had and posts I’ve read from folks who used Suboxone to get off drugs and now can’t get off Suboxone. Your decision, of course, but just sharing experience.
  2. Log onto Opiate Detox Recovery and find others who have quit and are trying to quit short-acting painkillers. ODR has a wealth of reliable information and real-life experience and was an enormous support to me when I was trying to get sober.

One last piece of experience: face-to-face help is so important. Go to a meeting of people trying to quit drugs, any drugs—alcohol, painkillers, cocaine, whatever. Get phone numbers, call the people you meet, ask for help. It’s impossible to quit alone. To that end, I hope others will weigh in on all this.

The summer after graduating college is a great time to get sober and “get your life started.” Getting sober and starting your life are the same thing, and better to do it now than later. I’m in awe of folks who quit in their teens or 20s. You have your entire life ahead of you to find out who you are and be that, instead of using drugs to hide. If you ask for help, you will meet people who will tell you that you CAN do this. Let me be the first.

Thanks for helping me stay sober today.

Back to the palette.

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.

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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.”

OxyContin All Over the News This Week

Aside from this week’s usual tally of car-stops producing bags and piles of pills, OxyContin is making more headlines.

The Matrix: OxyContin Chiefs Lose Court Bid to Gain Re-Entry to Medicare

Well well well. A federal district judge has affirmed a 2007 Department of Health and Human Services censure of three former top executives of the corporation that makes power painkiller OxyContin, preventing the men from gaining involvement in government-financed health care programs.

Monday’s decision refused efforts by the corporation, Purdue Pharma, either to overturn or to reduce the 12-year ban on the execs’ participation in Medicare and Medicaid. The execs and Purdue Frederick (an affiliate of Purdue Pharma) pleaded guilty in 2007 to criminal charges of misleading physicians and patients by claiming for five years that OxyContin was not as addictive as other opioid painkillers.

Purdue paid $700 million to settle criminal charges and liability suits. From the time it gained FDA approval in 1995, Purdue has made $3 billion from OxyContin sales.

(I mean, at this point, I feel like bolding every graf.)

Neo of the MatrixYou know what: I was a pain patient at a major university pain clinic and taking OxyContin in 2004 or 2005, when these guys and their enormous sales force were deceiving docs. Also: I was a health writer and researcher, and I interviewed a Purdue spokesperson about OxyContin and DEA hypervigilance around pain clinics. I was a helper in the great pro-pain-treatment movement of the 200s. … I don’t think I talked with the Purdue guy about OxyContin’s special long-acting “matrix,” as they called it, but I remember hearing about it from my physician. I also remember gaining the impression from talking with sources at that time (policy people, other physicians, pain experts, etc.) that OxyContin was somehow engineered to evade all the tricks those nasty addicts had up their sleeves.

Trinity of the MatrixThe pill was purple. At least, the one I was prescribed was purple. 60mg? … I remember thinking, What’s to prevent anyone from just smashing through the matrix? If you know what I mean.

There were already stories in the news about “hillbilly heroin” and in a pain clinic these stories go unmentioned. It is unfortunately taken for granted that you will consume your medication “as prescribed.”

I also remember reading Purdue’s literature claiming that OxyContin lasted 12 hours from dose to dose in clinical trials but I can testify that, when taken “as prescribed,” OxyContin did not last more than eight hours and usually lasted no more than six.

(Big rationalization for those with addiction not to use it “as prescribed”: if it’s really a short-acting drug, what the hell?—every act of drug-use or drinking ends with this statement: What the hell. Or even What the fuck. Usually, just “fuck it.”)

IMO, OxyContin (as it was manufactured in the 2000s) is a big letdown in terms of long-acting pain control. In terms of addiction, it’s the most widely abused prescription painkiller known to humanity. Speaking “anecdotally,” of course. But judge for yourself: visit ODR and look at the 10 years of stories filed in the Pain Meds section, and see how many people have come looking for help for a problem with “Oxy” and “OC.” Some of these people are taking short-acting preparations of oxycodone, but many are using OxyContin, and they’re buying it both legally and illegally. These people usually do not have Small Problems. Usually, they are taking anywhere from 300-700mg and up.

I’m glad these guys are not being allowed back into government-sponsored healthcare.

You can read more about the rulings at the New York Times and Courthouse News.

In other news…

OxyContin Use Increases Risk of Fracture and Heart Attack

Elderly people taking OxyContin have a higher risk of broken bones, cardiovascular emergencies, and other problems requiring hospitalization, according to a study in the current issue of Archives of Internal Medicine (Vol. 170, No. 22, Dec. 13/27, 2010).

Investigators at Brigham and Women’s Hospital in Boston studied medical records of about 13,000 arthritis patients on Medicare with a mean age of 80 in Pennsylvania and New Jersey from 1999 through 2005 to compare three classes of painkillers: nonsterioidal anti-inflammatory drugs (NSAIDs, such as ibuprofen/Motrin), coxibs (such as Celebrex), and opioids. Opioids sent more people to hospital than NSAIDs. The abstract is here.

Another study in the same issue by the same principal investigator looked at the side effects of five opioid drugs—codeine, hydrocodone (Vicodin), oxycodone (OxyContin), propoxyphene (Darvon/Darvocet), and tramadol—in chronic pain treatment for older patients (mean age of 79).

Finding: “All-cause mortality was elevated after only 30 days for oxycodone users and codeine users.” Those who were given hydrocodone, Darvocet or tramadol had lower risks of “safety events” that sent them to hospital. Here is the abstract.

Darvocet and tramadol are somewhat weaker opioids. Hydrocodone in my experience isn’t as weak, but it doesn’t cause as much disorientation (“high”) as oxycodone or codeine.

The researchers say they can’t draw conclusions about what’s causing these risks and that these findings need to be studied more, since painkillers are being prescribed more and more for chronic non-cancer pain.

Scientists don’t work by anecdote and intuition. …

This made me think of my own fracture. I wasn’t 80 years old, I was only 41 or 42, but I dislocated and fractured my elbow when I was on opioids. I was riding my bike, 10 pounds of computer and waterproof pack strapped to my back in the rain, and I was in a rush, and because I was numbed out I wasn’t being careful—I was being selfish; I was trapped in my own head; I wasn’t being mindful—and I tried to be a hero and slide up a disabled ramp with a one-inch lip in heavy traffic, and the tires slipped and I fell off my bike and I broke my fall with my right arm. Except for childbirth, I never felt such pain in my life.

Through all the drugs the pain ripped through my arm and I sat there on the wet sidewalk with a useless branch dangling from my shoulder.

Did you know that bone bleeds? My arm was black from the elbow to the pinkie.

Eight weeks of recovery and PT. Plus the havoc it wrought my family.

Opioids wrench your sense of balance. Opioids wrench it literally, and addiction wrenches it in the metaphoric ways.

Final news bit: my husband comes home today after a week away in the UK taking care of his family.

Yay. 🙂

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