This guy spent 10 years on buprenorphine after a devastating heroin habit. He took methadone to get off heroin, and he thought that in Subutex he’d found a painless stepping-stone off methadone. But bupe has given him all kinds of problems with his intellect, emotions, creativity, ambition, passion. He writes,
I cannot feel joy.
He jumped off Subutex two weeks ago and writes that he has already had a couple slips because he’s so impaired that he can’t stand it.
I have a loving wife, two beautiful sons, supportive friends, an ok job and yet I have been wanting to die for a few years now—not actively suicidal (you can’t be actively anything on long-term sub maintenance) but quietly hoping that fate would off me.
So, but here’s where it turns “most uncanny,” as Nigel said: In writing back, I mention I’ve spent tons of time in the UK, mostly in London and Yorkshire.
Nigel replies: he was raised near Kensington High Street (London), and he was educated at the Catholic boarding school, Ampleforth (York).
I know where Ampleforth is, I say, because I’ve been practically everywhere in the North from the Lakes to Robin Hood’s Bay, and all the dales and moors in between.
And I’ve lived in London. I tell him about a very unhappy, lonely winter I spent in London 15 years ago. “To combat a serious case of depression,” I tell him, “I used to push my son up Marloes Road toward Ken High Street and into Holland Park every day I could. I retain a great affection for Holland Park, and for a little tiny key-garden called Edwardes Square.”
Edwardes Square, West London. Photo by Londonholic.
Most Americans visit St. James’s Park, Regent’s Park, Hyde Park. Holland Park is an underrated treasure, appreciated mostly by Londoners, who, on warm summer nights, enjoy outdoor concerts and pick-up footie matches on the lawn. And friggin nobody knows Edwardes Square. I get blank stares when I mention it to anyone. It’s just a little tiny square in West London. When people get that far they make the cab fare worth their while by visiting Kensington Palace, the V&A Museum, the boutiques on the Kings Road. You can’t even get into Edwardes Square unless you live in one of the houses facing it. I myself couldn’t get in. But it was my little psychic refuge that long-ago early spring.
Nigel, however, says: his parents live off Pembroke Gardens Close, adjacent to Edwardes Square:
I know the area intimately.
He says he himself used to live on Marloes Road across from the Devonshire Arms.
Devonshire Arms pub.
(Nigel has lived in some fancy places. Not Belgravia, but still.)
I picture the Devonshire Arms: big corner pub; patio paved for pleasant outdoor boozing. (I never drank at the Devonshire Arms; I had my baby with me, always, and my codeine back at the flat.)
Nigel tells me,
My bedroom window overlooked Marloes Road, and I spent some of the darkest days of my heroin addiction in that ivory tower. I would have been there in 1998.
So. While I was struggling with killer postpartum depression the winter of 1998, walking several miles per day with my boy in a stroller, up Marloes Road and then Campden Hill Road to Notting Hill Gate, then west to the northern entrance to Holland Park—I was passing Nigel in his house every day.
G was rationing out her American codeine.
Nigel was banging his British smack.
And now here we are, on opposite sides of the sea, talking about how to live sober.
I miss writing on this blog. I used to file two or three blogs per week. That was before I got a job—several jobs, actually. I need to earn my daily bread, and I need to take care of my kid, who the other day flipped over head-first, fell on his head and shoulders, and was back-boarded off the soccer field (he’s OK but yes—shocking to watch the trainer test him for paralysis and hear her say, “We have to call an ambulance”). So sometimes the blogging goes by the boards. I’ve been filing a lot on my Facebook page, but you have to be my friend to see it. So, won’t you be my neighbor?
Been teaching writing to university students. An interesting experience: the last time I taught was four months before I got sober. The other day I was sitting in a meeting next to an acquaintance in recovery, a woman sober about two years who just got tenure at one of the universities in town, and I told her I was teaching again. “Teaching sober is AWESOME!” she said. This is someone who does not usually include the word “awesome” in her lexicon.
“I know!!!” I said. I am someone who usually does not speak with multiple exclamation points.
Teaching sober is, in fact, awesome. The best thing about it is that, having practiced Step 10 on a regular basis for four years, I now have a much better sense of what’s my responsibility and what’s not. Which enables me to relate to the kids (they’re kids: they’re just three or four years older than my kid) on a much clearer basis than when my head was wrapped up in films of fentanyl.
In other words, I have more confidence.
The root of the word “confidence” is the Latin fidere: fidelity, trust.
Sober, I can trust myself. At any rate, much more than I could when I was taking drugs.
It is 3 a.m. and I’m writing this because I got up to pee, checked my phone, and this email came in overnight. She is taking drugs to feel self-confident. She wants help.
The drug she is taking is Suboxone. She was using heroin for five months—“five long, brutal months,” she writes, “and even though that’s a short period of time compared to most people, I was really addicted”—and her doctor put her on Suboxone. Her doctor told her taking it for three months would lead to a lower “success rate” than taking it for at least eight. (I’d like to see the data behind the claim, and I’d like to know who financed the studies.) So she took it for a year—along with two antidepressants and a long-acting benzodiazepine.
No idea what kind of doctor she went to, but in fact family doctors and internists, who are generally ignorant about addiction and recovery, can prescribe Suboxone, a long-acting fat-soluble opioid that’s more powerful, milligram for milligram, than heroin. Just as family doctors and internists, who are generally ignorant about mental illness, can prescribe antidepressants—drugs that also change the brain, usually not for the better, according to Robert Whitaker, who wrote a comprehensive and almost universally acclaimed book on the subject of psych meds and mental illness. Any time-frame over six weeks is considered “long-term” treatment by most physicians and researchers, and lots of folks wind up on these drugs indefinitely.
My reader writes,
I have been living with the knowledge for about 18 months that Suboxone is this wonder drug. It turns out I didn’t know too much about it. I kept a couple of the film strips in case I felt like I was going to relapse. One day I took the Suboxone after about three months of being off of it and I felt so high that it scared me… so I tried it again after.
Of course she tried it again. She’s an addict, and she has drugs in her stash.
This person has a job, too. She’s a college student, like my students. She’s studying to be a doctor, “so I could go help people with the problems I had,” she writes. And since starting school in August, she’s been on “a Suboxone binge,” she says.
Not to get high, but because it gives me my confidence back.
She needs confidence. She has to make friends, she writes. “I became socially awkward after my addiction”—as though her addiction is “over”—“and I felt like I needed it to talk to people.” So now she’s back to taking it every day.
Just little, tiny pieces, probably like 1/9th of a pill a day, but I don’t want to take it anymore, and I want my confidence and ability to talk to people back… can you please help me?
I have news for whoever is reading this who thinks that one-ninth of a Suboxone pill isn’t a lot. If it’s one-ninth of an 8mg pill, then that’s almost 1mg of buprenorphine, and that’s roughly equivalent to 30mg morphine. Which ain’t nothin to sneeze at.
This 18-year-old girl (she is 18: she told me) is taking drugs simply because she wants to trust herself. She has a drug that gives her that fleeting feeling of self-trust. She knows it won’t last.
These emails I get from readers feel like silk threads that bind me to folks around the world who are desperate for help with their drug problems. It’s like each of these people is Spider-Man, firing out webs that reach around the world and go straight inside me and attach themselves there. And they pull.
To my reader: your addiction is not “over.” If indeed you were “addicted” to heroin, then you are an addict. Being an addict doesn’t mean you’re a low-life. It means you have an illness, and like anyone who is ill you need to learn to take care of yourself. To do this you must ask for help In Real Life. However scary it might seem.
On the other side of that reality of needing to ask for help is this problem my reader will most likely run into: she may go to her doctor and tell him that she stashed her films and she’s been using again. You know what may happen? He’ll decide she’s a “chronic relapser” and put her back on Suboxone, perhaps at a higher dose, perhaps for a longer time. She is 18. Her brain and central nervous system aren’t really even out of childhood.
She writes, in a voice that is perhaps not self-confident but certainly reaching toward self-awareness,
I don’t want to take it anymore.
“I don’t want to take it anymore.”
The famous scene with Peter Finch from the film, “Network.”
I’m mad as hell and I’m not gonna take it anymore.
Reader, there are two ways I might be able to help you. One is to suggest you call Alcoholics Anonymous or Narcotics Anonymous and get help from real people who have been through this (and worse). Don’t Take It Anymore.
The second is something I think I need to do for all the folks who write in, to me and to forums for drug addicts, saying they can’t quit Suboxone. And that is to write about Suboxone.
Went to a meeting yesterday. Topic: “One Day At A Time as a spiritual practice.”
Today is the third anniversary of the day I jumped off my medical detox. My detox doctor prescribed Suboxone to help me land my plane off a 30,000-foot level of Fentanyl. I spent two months on Suboxone—almost triple the time this doctor usually allows his patients to spend on that drug. He was very kind to me and one of my first acts of “recovery” was to repay his kindness by taking the drug responsibly—by showing him that I actually wanted to detox.
If you find it difficult to manage withdrawal by yourself, it might be good to find a doctor you can trust to help. The only way I managed detox was to turn the process over to someone else.
A lot of people come to Suboxone-detox doctors with heroin or Vicodin or OxyContin problems. Their supplies of pharma drugs have been erratic, and the quality of heroin is uncertain. They run out of money or their dealers run out of dope. So some people haven’t been on a steady level. Detox is somewhat easier if you haven’t been on a steady level: in the down-times, the body has a chance to regain some equilibrium, and there’s not so much physical damage to repair.
But I was on a fairly steady level, and the level was towering, the equivalent of 400-600mg of morphine per day. Crazy-high level.
I never thought I’d ever, ever—ever—be able to jump and land on the ground with both my legs intact. I’d tried. I’d gone into withdrawal (voluntarily, involuntarily) over the years, and gotten partway, only to be driven back to the drugstore to get the thing that would relieve the suffering of severe withdrawal.
In withdrawal from any drug on which the body becomes dependent (including psych-meds), the body and mind experience problems operating optimally. For opioids the physical problems include sweating, cramping, vomiting, goose-flesh, headaches, soaring blood pressure, insomnia, extreme deathly fatigue. It’s often the last two, which can hang on for ages and which affect psychological wellbeing, that drive people back to drugs.
Alcoholics go through sweating, racing heart, weakness, palpitations, tremors, seizures. The seizures can be life-threatening, which is why it’s sometimes better to do a medical detox from alcohol-addiction.
Mel Bochner, "Blah, Blah, Blah," 2009. Saw this at the Met last week and it reminded me of my kid's art.
And then there are the psychological disturbances. Confusion. “Anxiety” (otherwise known as fear). “Restlessness, irritability, discontentment,” blah blah blah.
In opioid withdrawal there can even be a kind of euphoria as the body begins to return to normal functioning. The senses come alive; food tastes good again; we walk into the kitchen and our mouths water; appetites return. There have been documented cases of spontaneous orgasm in opioid withdrawal. The body, no longer drugged and dulled, begins to produce the hormones that support normal sexuality—and the physical and emotional responses go a bit overboard for a while.
People in yesterday’s meeting were talking about One Day At A Time. I heard a saying that I’d heard long ago in a meeting: “You can start your day over at any time—even an hour before bedtime, you can start your day over.” I was reminded of how my friend and mentor Sluggo used to ask me, after I jumped and was feeling lousy and was facing a Thanksgiving holiday with family in the house—exhausted from detox, unable to look at cleaning the entire garret guest-space; upset, as always, at the grunge on the kitchen floor—Sluggo used to ask me,
How are you now?
I didn’t get this at the time. “I’m FUCKED UP NOW!!” I’d scream at her in my head.
I could have screamed it at Sluggo in real life (“IRL”) and she would have sat there, like, OK, so you’re fucked up now. She never tried to force solutions. She rocks at detachment.
Sluggo is wise, and streetwise; she’s quite literally been around the world, and she’s seen and done a lot of shit. She’s lived in Tokyo and Paris and other places where supermodels live while they’re showing haute couture. She’s been held up at knifepoint in Chicago, trying to cop, shivering from withdrawal and exposure in an evening gown that she was supposed to be modeling. … After a lot of tries, she got “clean.” She got married, had a kid and now uses the 12 steps to stay sober and sane.
(I love her.)
Step 11 is Very Important to Sluggo. She knows how to meditate. Because she meditates.
Her question (“How are you now? And now?”) is about meditation. Meditation is about practice. The practice of meditation changes the body and nervous system. It counters paranoia, compulsiveness, anxiety, “restlessness, irritability, discontentment.” For people like us, it’s medicine.
After Sluggo asked me this question a few times, I began to realize that Right Now I was safe and well. “FUCKED UP!!” is a mean judgment that hides great expectations. “Safe” and “well” are facts.
At the meeting yesterday I was sitting next to a woman who said she had 40 days. From the sheepish look of her, she felt kind of bad admitting she had “only” 40 days. Murmurs around the room: “Awesome!” “Forty days rocks.” “Forty days is HUGE.” There was a guy there who had five days. Then people started talking about how we only have This Day, and how This Day can start over again at any time, so really we only have This Moment.
Always feel particularly alive August 29-31. Those were the days I spent in precipitated withdrawal, as fentanyl and Suboxone duked it out in my body.
I’m sitting right now in the same spot where I spent most of those two days: my side of the bed. The weather is the same—80 degrees, cloudless sky arching over the trees—but it looks entirely different today from the way it did for me three years ago.
Back then I was a writhing mess. My son, almost 11 at the time, didn’t know what what happening to me. He kept coming upstairs, asking, “Are you all right, Mama?” I told him I was having a bad reaction to a new medicine. Which was entirely true. And which left out all the rest of the truth.
How to Find a Good Detox Doctor
I’d wanted to go to rehab, but I knew I’d already been too absent from my son to justify being gone an entire month. So I got a detox doctor in the best way I knew, and in my opinion it’s still the best way: by word-of-mouth. I called the offices of a reliable rehab in the region, and when they refused to manage my medical detox on an outpatient basis, I asked who they recommended. They gave me a name; then I called my PCP and asked her, and she named the same guy.
I scheduled an initial consultation with this guy in July 2008. I told him I was a pain patient who was getting tired of the red tape involved in managing Schedule II medications, that I wanted to “reduce my tolerance” (this is how I put it to myself: I’d just reduce my tolerance and get back onto something like Vicodin, pull a feat that would impress my physician and enable me to continue receiving meds—just ones that weren’t so strong or so tightly controlled). I was afraid of how much pain I’d have once I started detoxing.
He said I’d be a perfect candidate for detox, that we could try it and see how it went.
While I sat in the waiting room I watched his patients come and go. The guys were huge, linebacker-types, or scrawny; almost everyone had tattoos; and of course I saw myself as Better Than All Of Them. What was a nice girl like me doing in a place like this? But everyone was quiet and respectful and when the detox doctor came out of his office, a little room in the back of a house on a main street in one of the poshest neighborhoods of the city, he reminded me of no one so much as Mr. Rogers. Actually, I’d met Mr. Rogers years before, and Mr. Rogers was shorter and thinner than this guy, but they both had the same humble, interested attitude: when you sat before either of them, they paid full attention only to you. And these huge biker-guys practically knelt before him like he was one of the prophets.
“He’s really working in the trenches,” the medical director of a big rehab nearby told me recently. “He’s always been on the forefront of treatment in the city. We need more guys like him.”
This medical director told me he estimates about 30 percent of all physicians prescribing buprenorphine for detox or treatment are “entrepreneurs”—physicians who are in Suboxone/Subutex treatment just for the money. They require twice-monthly followups, and they charge upwards of $300-$400 or even more per office visit. They make you pay in cash. And they prescribe large doses that are impossible for patients to quit by themselves. It constitutes exploitation.
You have to be careful to get a good detox doc.
My detox doc didn’t take insurance, but he’d accept a check or a credit card, and his fees were by no means outrageous: $110 for the first visit, and $80 for followups. He usually conducted 3-week detoxes for which he saw patients once per week, but because my drug-use had reached such a high level, he agreed to allow me to go more slowly. My entire two-month detox came to less than $700. By contrast, rehab stays cost tens of thousands of dollars.
The day I was scheduled to start my detox was the Friday before Labor Day. He prescribed something like 10 or 15 Suboxone tabs, gave me detailed directions about how to take them, and gave me his cell phone number in case I had problems.
Because fentanyl hangs around so long in the body’s tissues, and because it’s the only drug that can fight with buprenorphine in the body, I should have waited longer to take the Suboxone. But I took it too soon and wound up in precipitated withdrawal, which means the fentanyl and Suboxone were competing for space on my opiate receptors. Eventually the Suboxone won and kicked the rest of the fentanyl off. But it put me more deeply into withdrawal than I’d ever experienced. I couldn’t sleep but I couldn’t raise my body; I couldn’t stand long enough to take a shower. Of course I could not eat. I couldn’t even tolerate the smell of food without retching. (Severe opioid withdrawal makes the world smell like rot—people often forget to mention this; they mention the goosebumps and the gut-cramps and the sweats, the yawning and sneezing, but this is moderate opiate withdrawal. Severe opiate withdrawal makes the world smell like it’s covered with invisible black mildew. And it absolutely prostrates the body. Nothing works anymore.)
I spent two days like that. And on the third day, a Sunday, yeah. I rose again.
Today I had a massage early and then spent the rest of the day with my son, cleaning his room (school starts tomorrow; his desk was piled with crap from a summer spent drinking San Pellegrino—those little foil tops from the cans—plus gum wrappers, various art supplies and drawings, tangles of earbuds, Nerf darts, tools, and scraps of paper and metal and wood and wire from his handmade projects. I put the drawings to one side and put everything from desk, dresser, and floor into three paper bags, then told him he’d have to sort it out by the time I take him to Milwaukee, otherwise it would go into the trash. “Are you serious?” he said. We ran errands, I took him to his guitar lesson, we picked out some yarn for me to make him some felted socks. We went to Trader Joe’s, where I saw a little boy about 4 come out holding his mom’s hand, five or six stickers plastered across his forehead. I laughed out loud, and he smiled proudly.
The air was hot and smelled of bus exhaust and late-summer grass.
I didn’t care about this stuff when I was using. None of it: not the crap on the desk or cleaning it off, not teaching my son how to take care of his space. Well—I cared about spending time with him, but even that was compromised by my addiction, and there was nothing I could do about it, short of the hard work of getting clean and sober.
My son is a funny guy, and we have a lot of inside jokes; we use silly voices to tell stories, and both of us are very observant. We’re always noticing something: a funny bumper sticker, somebody’s hippie outfit, the numbered purple protractors that people are pasting on bridges and light poles around our city. “I saw another one,” my son said as we pulled out of Trader Joe’s.
“Where?” I asked.
“Back there,” he said.
“Where?” I said again.
“Back there,” he said.
“Yeah, BUT WHERE?” I said, then I realized he was having me on. I ruffled his long hair.
Most of all I feel free today. I am more myself than I ever have been.
If there’s anyone reading this who is wondering if it’s possible to get off a shitload of drugs or quit a destructive habit, I’m here to tell you, it’s not only possible, it’s the best thing you can do for yourself and your world. Make the investment.
This is the song I played “over and over / and over again” while I was detoxing… it came up on random play today, so here it is for you.
There’s no telling where I’ve been, How I returned here, how much I have seen
So glad to see the NYT covering addiction issues. Something that needs to continue, in order to bring addiction into the national public health discourse. But:
Lots of complaints in the comments section about how problematic this story is.
Here are a few I found.
Problem 1: The Diabetes Analogy
Man, what a tired analogy. Let’s either get rid of it, or take it all the way. Right now, people only take it up to the point where diabetics inject insulin—implying “real” addiction treatment should be about drugs. Then they miss a critical part: most cases of diabetes these days are Type 2, which indeed has a genetic component but is largely influenced by poor “lifestyle” factors: smoking, drinking, and obesity. These problems are all related to addiction, and they all have underlying psychological drivers about alleviating stress.
Another critical part missed: in the vast majority of cases of diabetes, the pancreas never recovers its function, whereas in the vast majority of cases of opioid addiction, the opioid receptors do recover their normal functioning—if, at some point, when the recovering person is ready, they’re allowed to remain abstinent for a while.
Both addiction and Type 2 diabetes can be considered the result of unfortunate genetics and poor lifestyle choices. As for treatment: insulin doesn’t “cure” diabetes. While no drug or treatment could restore the function of the pancreas to normal, treating the cause of diabetes would address the underlying compulsions—the addictions—so people wouldn’t continue to smoke, drink, and eat compulsively.
The diabetes/insulin analogy drives the ending of the NYT story, where Suboxone comes in to save the day for a 53-year-old patient on bupe maintenance. This sets up Suboxone (and, implicitly, other future Miracle Drugs), as the magic bullet that can “cure” addiction simply by “blocking cravings.”
Problem 3: The Split Between Medicine and Psychology in Recovery
It’s important that med schools are starting addiction-medicine residencies—this helps to educate more doctors about addiction. Nora Volkow makes a good point when she says it’s a “very serious problem” that general practitioners lack knowledge about addiction—this is true, and leads to the corollary thought that it might actually be best to spend the money training primary-care physicians in addiction, rather than create more specialists. PCPs are on the front lines; they’re the ones prescribing, for example, the most Oxycontin and Vicodin. They could do with more education about addiction.
And it’s important to think of recovery from addiction as the management of a chronic problem, the way high blood pressure and diabetes are managed. (Addicts have been thinking of the problem this way for a long time. 🙂 )
But why should we automatically think about addiction as EITHER a medical OR a psychological problem? Why can’t its treatment involve both disciplines, as well as others? Most active and recovering addicts and alcoholics are able to articulate the experience that addiction involves not only their physical response to the substance or behavior, but also a psychological component—we use/drink/eat/gamble/have compulsive sex to alleviate “stress.”
“Bringing Respectability to Addiction Medicine”?
In the third graf the writer mentions a guy named David Withers from a rehab called Marworth (a physician? addiction specialist? the writer does not tell us… aha! quick Google search reveals he’s an M.D. and associate medical director at Marworth). Withers says that the establishment of residencies in addiction medicine is “the first step toward bringing . . . respectability and rigor to addiction medicine.” What a slap in the face for the many doctors in America already dedicating their practices to addiction medicine. Be interesting to hear what, for example, Dr. Drew thinks of this (as of this morning he hasn’t yet tweeted on it). I intend to call my local, renowned rehab and speak to the well-known medical director about this statement.
"Already an award-winning blog, Guinevere Gets Sober is as good as it gets. As a professional with two degrees and a track record of success, Guinevere’s viewpoint reflects the reality that not all addicts fit the stereotypes. She has the guts to take a public stand for addiction advocacy and rehab success. She fights to reduce the stigma that prevents people from seeking treatment, and with a blog like this, she is surely succeeding."
When in 2008 I decided to recover from addiction, I started writing under the pseudonym "Guinevere." An ancient name meaning "white" or "fair," Guinevere is Welsh for my given name, Jennifer. And Queen Guinevere—though lovely, powerful, and rich—still lied and cheated to satisfy her desires.
A writer by habit and profession, I started this blog to examine issues of addiction in the culture. I'm especially interested in reducing social stigma that prevents people from getting timely help, and in supporting the many people who write to me looking for help in reducing their chemical load in life.
I love books, film, and art, and I review all of these here, along with the ongoing appearance of addiction and recovery in the news ... and of course I tell great stories.
Please share your comments here, or email me at guinevere (at) guineveregetssober.com.