Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: Vicodin (page 2 of 6)

Addiction And Self-Care.

The new puppy with my friend P, who's helping me train her.

This is the new puppy I adopted two weeks ago. Her name is Flo. She’s 10 weeks old. You want to talk about unconditional love—there’s nothing like curling up and having a nap with a puppy. I’d never experienced it before. It’s different somehow from napping with a cat.

So last week I had an emergency D&C because I was basically bleeding to death. I had been scheduled to have one this week, tomorrow in fact, but my GYN called last Thursday morning and scheduled it immediately: my hemoglobin was so low that I was on the verge of needing a transfusion.

Question: How could an intelligent woman with two degrees and an IQ north of 130 possibly let her health descend to that state? How could I allow myself to bleed to death and not take care of myself?

Answer: Self-care has nothing to do with intelligence. Neither does addiction.

Here’s a story for you. My mother had a hysterectomy at my very age: 47. I remember being on the phone with her from my office at my first reporting job: she had been having horrible long periods, basically bleeding to death, and she hadn’t had a pelvic exam in seven years. SEVEN YEARS.

In the Al-Anon books it asks us: are we taking care of ourselves? Are we going to the doctor, the dentist, are we getting haircuts?

I go to the doctor. I sometimes put off the dentist. I get haircuts every other month. But do I really pay attention to my body? Is it a place where I actually live?

A lot of the time, it isn’t. A lot of the time, I’m living in some alternative reality I’ve created in my mind. I was, after all, raised by a woman who ignored her body so effectively that she made it seven middle-aged years without a pelvic exam and had to have a hysterectomy because of the grapefruit-sized fibroid tumors that grew inside her in the interim. All the while, the rhetoric that came out of her mouth was this Catholic stuff about the body being “the temple of the Holy Spirit.” Some temple: the curtain in hers was rent, the cornerstone broken, by the time she was 58.

This was my model for being a grown-up woman.

And my dad: I won’t even get into how well my dad ignored his body.

Physical exercise helps me pay attention to my body. But still: I was bleeding for three weeks! I just told myself it’ll stop sometime it has to stop sometime just be patient just wait it out i don’t have time to deal with this so IT MUST NOT BE HAPPENING, and in the interim my hemoglobin dropped to 8.5 (the low-normal level is 11.5; the standard level for transfusion is 8.0) and I was feeling “a little bit tired.” Yeah. I believe this is called something like psychosis: refusal to acknowledge reality.

So I go in for the operation and they tell me it’ll be conscious sedation and I know what conscious sedation is, because G is a person who knows her drugs: conscious sedation (also known as “twilight sleep”) is Versed (the drug that makes you forget what’s going on) and Propofol (strong sedative: Michael Jackson’s favorite candy) and fentanyl (the drug I was on—on? I was as tall as the fucking Empire State Building on fentanyl in August 2008). I had to have these drugs because it’s surgery and they were going to open the hood and scrape me out, and I didn’t want to have these drugs because I hadn’t taken drugs in more than two years.

My sponsor said, “Sometimes we have to do things we don’t want to do.” If the alternative is bleeding to death, I guess she’s right.

I was scared because I’d had two surgeries while I was un-sober. The first was an appendectomy that was torture because they couldn’t control the pain, they wouldn’t give me the shitload of drugs I’d have needed to control abdominal laparascopic post-surgical pain, so I just put up with it. It was horrible. And then I broke and dislocated my elbow in a bike-fall in 2006, and during the conscious sedation to put the bones back into the socket the ortho guy told my husband he’d never shot so much fentanyl into one person in his life. So I was afraid I’d be in pain.

But of course I was in no pain, because I’m now what physicians and pharmacists call “opioid-naïve.” I woke up in post-op feeling as though God’s own sunlight was shining on my face, feeling sheer gratitude to all the nurses, telling all the staff how thankful I was for their willingness to take care of me. The surgery had gone well and I had no pain. And I was sent home with a couple doses of Vicodin, which I took because later when the fentanyl wore off, I had shooting needly pains below my navel.

And for a day after, I had a headache. My body getting rid of the drug metabolites.

And then on Monday it occurred to me: I had felt so good, so grateful, because I was high. I was high. Why do the drugs have to make me feel so goddam good?

“Every feeling passes,” my sponsor says. “All the ‘good’ feelings, all the ‘bad’ ones—they all pass.”

And this morning my husband goes to the dentist because he has pain in his tooth and the dentist X-rays his jaw and discovers an abscess, he prescribes Vicodin, my very favorite beloved awesomest drug on the face of the planet, especially since I’m “opioid-naive.” I just had drugs in my body last week, I can remember in my body how niiiice they made me feel.

David Foster Wallace once said, You think you’re an atheist, you think you don’t worship anything?—let me tell you, everyone worships something. Listen to the way I talk about Vicodin.

So I call my sponsor and tell her: I don’t want to use the Vicodin that is now living in my house. She says, You know what you have to do. I say, Yes, I know.

Part of that is writing it here. The truth.

The truth is, if I listen to my body, what it really wants is not drugs.

What it wants is love.

In The God-Box: Two Guys Taking Vicodin.

P & P's sweet yellow lab, who I love and who loves me.

Last night went to a 50th birthday party for my friend P. This morning her husband (also called P) phoned to thank me for helping him in the kitchen. I didn’t do much: gave him instructions for browning his baked brie (under the broiler), taught him how to use his own convection oven, and oversaw the complex, gourmet task of heating the Costco frozen mini hotdogs wrapped in puff pastry.

Over the phone this morning, P said her husband was suffering from an infection in one of his molars. His jaw was killing him.

“Hasn’t the doctor given him anything for the pain?” I asked. “Codeine?” They’ve known I’m an addict since the summer day in 2010 that I told them at the Tate Modern in London, looking at Niki de Saint Phalle’s “shooting” paintings.

“Yes: I picked up a Z-Pac for him this morning for the infection,” she said. I sat there waiting for her to announce Which Drug he’d been given.

“And he also has Vicodin.”

Aha!

“But they didn’t want him to take it during the party last night.”

Of course. Because he’d have been drinking. Also, it might make him sleepy. Vicodin makes normal people sleepy, and sometimes nauseated. It makes addicts like me wake up and want to clean the entire fucking house from attic to basement, all the while sorting out three or four book chapters in our minds. “My house was never so clean as when I was using,” my friend L murmured to me the other day during a meeting when someone mentioned Vicodin.

Once upon a time, if a friend mentioned she had Vicodin in the house, I might have felt an immediate, overwhelming drive to invent a pretext for coming over right away, eagle eyes scouting around for the brown plastic bottle with the child-proof cap. They say you’re either moving toward a drink/drug or away from one, and today I didn’t have that compulsion—I had the memory of it, but not the actual feeling—so today I think I’m sober.

The reality is, drugs are everywhere, anyway. In order not to descend into insanity, I have to keep steering into some kind of solution.

“Has he taken any?” I asked.

“Yes,” she said, “but it’s not helping.”

“When did he take it?” I asked.

She handed the phone to her husband. He said he’d taken one 7.5mg pill two-and-a-half hours before.

“G, why isn’t it helping?” he asked.

Because the fucking drugs never take away all the pain, I thought. They just take away part of it and make you not-care about the rest.

“Because when you have severe acute pain, sometimes you need a bit extra to get on top of it,” I said. That’s what they taught me at the pain clinic: when a flare comes along, try to anticipate it and take a bit extra. I suggested he take one more, and then dose every 4-6 hours as it said on the bottle.

“Is that going to be OK?” he said.

“You don’t have a problem taking drugs,” I said, “so you’re not going to have any trouble. And that much Tylenol isn’t going to hurt you. Just don’t take more than that. And why don’t you try putting some ice on your face?”

I call him a couple hours later and the one extra has helped him get on top of the pain. “It’s just like you said,” he tells me. “It’s not all gone, but it’s not killing me anymore.”

Would P ever think of chewing the Vicodin? Hell no.

//

A couple days ago I get an email from a reader, a guy about my age. Dave from California. He’s sitting out in San Diego or somewhere waiting for spinal surgery, he’s got 16 years clean and sober, the pain is frigging driving him nuts. He NEEDS to make it go away. He thanks me for my post about Chewing Vicodin.

This post gets tons of hits. There are many, many of you out there, pills in your hot little hands, wanting to know “how to maximize the effects of Vicodin.”

“I have found myself wanting to chew the medicine,” Dave writes.

Would P ever think of chewing the Vicodin?—I ask myself again. Hell no: because P isn’t an addict. P can have one or two glasses of wine. He can choose which it’s going to be: one—or two.

“Sixteen years clean,” Dave writes, “and as soon as the pain gets too big I start to think I know a better way to take pills. Thank you. Keep doing what you do. It is a service for which I am grateful.”

//

If I had a dollar for every time someone has told me to keep doing what I do with this blog, I’d have a nice packet of dough. It’s very, very kind of people to say this. I’m grateful for you guys who read me. For the many people like Dave who check in and find help and who are generous enough to let me know about it.

Dave is having his surgery today. He’s going to be in a lot of pain. I’m holding him in the light. That’s how Quakers talk about praying for someone: “holding you in the light.” (I’ve been walking around these days, holding a bunch of people in the light. It’s quite a comforting thing to do, praying for someone else’s ass life besides my own.)

“Pain sucks, man, I know,” I write to Dave, “but one addict praying for another is a powerful thing.”

If you have a moment, maybe you’d be willing to drop a note in the God-box for Dave.

Why not also pray for P?—Actually, I pray for P, too, he and his wife are quite often on my gratitude lists, but I know P will be all right. It’s Dave I’m worried about. He’s dealing with two monsters.

Addiction and Recovery | In Your Eyes.

First, many thanks to the many people who took 45 seconds over the weekend to connect with me. Lots of great suggestions and feedback, which is valuable to any writer. Will take me some time to process—meanwhile, more always welcome.

Today I’m thinking about eyes.

Someone was telling me the other day about her adult daughter, who she said is living at home with her and is addicted to painkillers. First morphine, now Vicodin. “Now we have to get her off the Vicodin,” she said. Her nose was running. She kept taking a tissue out to blow her nose. A cold, I thought.

“Is she truly addicted? Is she acting out?” I asked.

“She sometimes gets violent,” she said. Then her eyes snapped to my face. “How do you know about this kind of thing?”

“I’m a drug addict,” I said.

“How?” she asked. She looked at my face, my clothes. I don’t “look like” a drug addict. So I told her “how.” She started to cry.

After she blew her nose the third or fourth time, I frankly looked into her eyes.

I’m used to looking at people’s faces and figures. I’m an artist and always on the lookout for subjects. I’m also a writer. In most of the stuff I’ve written or painted, I’ve focused on seeing inside people. Buildings bore me. Landscapes bore me. They don’t have eyes. They don’t have bones.

In my second book, I was hired to see inside a person who had died at a young age of cancer. To do that I interviewed people who had known her, including her parents and husband and surgeon, and I also studied many photographs of her face and figure.

To create an effective portrait or profile, you have to notice things about people. Seeing inside people can feel like an invasive act; it can in fact BE an invasive act. You have to be careful you don’t bring your own projections to the process of seeing. But total objectivity is a myth, and it’s impossible to leave yourself entirely behind.

What I saw when I looked into her eyes was: her pupils were pinned.

The light was by no means bright.

Right away part of me wished I hadn’t looked. Her family life was falling apart, she said; and I didn’t want to know that she herself might have a drug problem.

Pinned pupils are a sentinel indicator of opioid ingestion. A runny nose is a sign of opioid withdrawal. You can hide many of the rest of the signs of opioid drug-use—itching; mania; somnolence (sometimes you can hide this); lack of appetites for food, exercise, sex. You can hide some of the signs of withdrawal—sweating; gut cramps; goose-bumps. You can try to hide a runny nose, but you cannot hide pinned pupils.

Here are my pupils in August 2008, two weeks before I detoxed:

Guinevere's eyes two weeks pre-detox, August 2008.

I look desperate, lost. Dull. Fading away.

When we “get clean,” when we detox from drugs or alcohol, when we recover from any illness, our bodies show the effects.

Last week my friend Dawn shot some photos of me. She has a big-ass camera with lots of pixels. One of the first things I noticed when I looked at the proofs was my pupils. Big, dark pupils. Also: healthy skin. No amount of money can buy these when you’re wrecked.

G's eyes, October 2011.

//

There are a few things about people’s bodies that tell their stories without their speaking. I look at a person’s mouth. I look at hands. (The nails, the shapes of the bones, the skin stretched across hands say a great deal about a person’s physical and emotional life. I love looking at hands.) And of course, the life of the eyes is extremely difficult to control. They are almost literally windows. If two people look long enough into each other’s eyes—in real life (“IRL”)—even without speaking, they will break down in tears or some other expression of deep feelings, because the act is so intimate. That intimacy of eye-contact is hard-wired into us. It’s easy to avoid online.

If you look closely enough at the photo of my eyes (click image for full size) you can even see a reflection of Dawn.

//

I was thinking over the weekend that many of us addicts and alcoholics get tired of admitting our addictions. “It’s not all I am,” people say. “My addiction is not my whole identity. There’s more to me besides.” True. But I was thinking about how there’s a certain freedom for me these days in being “out.” In not hiding. It allows me not only to help others, but also to accept who I am more fully.

Which means I can move more readily toward the person I am becoming.

What does your body say about you? How much do you try to hide?

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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Prescribing Opiates For Mood Disorders

A reader called “Rapture” wrote the other day, in response to one of my most popular posts (“Chewing Vicodin Was the Start of My Problem”):

I struggle with how to think about my use of narcotics. When I have a supply of them, I take them as they would be prescribed–I suffer from PTSD and find relief in narcotics, but no doctor supplies them for psychological pain, even though the mind/body split was discounted ages ago. 

So when i have them I take 4 10/325 percs a day; if I have vicodin 7.5/325 I might take 6. That’s it. I started doing this maybe 10 years ago by taking one darvon/darvocet with a 1 mg ativan that I am prescribed for my PTSD–I was gang raped as a young child. Over the years I realized that I simply FELT BETTER if I took one every 6 hours.

Much of my stress comes from not being able to find a doctor willing to prescribe me the pills. I have been taking a reasonable dose for 10 years and am not about to try to increase it. Sometimes I just don’t understand how people can take so much and get so addicted because I can barely find enough pills to buy.

I don’t know whether I’m an addict and I don’t really care. I just don’t understand why I can’t find a doctor who will understand that I need these to feel like myself. I am in my early 40s, I have a wonderful family, am a PhD at a large research University–I am a responsible citizen and completely functional, actually more functional on the pills than the awful days I don’t have any.

“Rapture”: I’m sorry to hear about what happened to you in childhood.

There are two ways I think about what Rapture describes.

The first is by using the medical model: I feel “bad,” I must “need something” to make me feel “normal.” When presented with a problem, the medical model usually looks to a drug or a device. Something external to oneself. 

There are folks who believe in such a phenomenon as “endorphin deficiency syndrome” or EDS. The idea is that some folks are just born with a hampered ability to produce endorphins, the body’s natural opiates. I haven’t seen literature that proves such a condition exists. It’s a theory at this point, and in the U.S. it’s not widely accepted (it’s hardly accepted at all) because of the ideology that “narcotics,” as Rapture calls them, are evil—”drugs are bad” and “narcotics” tempt people into becoming “evil junkies.” That’s the American narrative.

In reality, there’s nothing “evil” about addiction, except, in my opinion, the horror of the experience itself. Addiction is an illness that involves genetic predisposition activated by adverse stresses, usually in childhood, and by chronic exposure to chemicals that ease the feeling of stress. Rapture has one thing right: the drug is not the problem—the drug is the solution. It only becomes a problem when it stops “working.”

Which leads me to the second way I think about Rapture’s experience—through my own, which raises a few red flags.

Percocet tablets. Rapture takes four of these per day to feel better.

Red Flag No. 1: Tolerance. Apparently the starting drug, 10 years ago, was Darvocet (which contains propoxyphene, a weak opioid) and the dose was 1 tablet per day. Over time this increased to 4 Percocet (or “percs,” as Rapture calls them: pet names, in my experience, are a sign that we have become emotionally attached to our drugs) or “maybe” 6 Vicodin, and “that’s it,” Rapture writes. So why shouldn’t Rapture be able to get an above-board script for these drugs?—after all, Rapture writes, while taking them, “I simply FELT BETTER.” And then Rapture asks for people’s thoughts.

Well, gosh.

I can only offer my own experience. I spent maybe four years taking one or two 10mg Lorcet each day, to “feel better.” Lorcet is a Vicodin equivalent. It was prescribed to me for migraine and intractable chronic daily headache, and I wasn’t about to increase my dose because of the same reason Rapture states: I could hardly ever get any more than that.

When I got more than that, I took more. When I got 60 tablets per month, I took at least two per day. I had pain, and I also had depression, and I simply FELT BETTER on the drugs. I slept better; I worked better (I could work for five or six hours in one spot, without moving—this is what I expected of myself). And just like Rapture, “much of my stress” came from the uncertainty of my supply.

When I had intractable pain all over my body in 2002, I visited a pain clinic and received my first prescription for 15mg hydrocodone, compounded as a single agent (no Tylenol!), to be taken four times per day. I thought surely I’d survive forever on this amount. It seemed an ungodly amount of medication. And in the beginning, it lasted the whole month. Then, gradually, my body built a tolerance, because it was undergoing chronic exposure to these drugs. Tolerance is always a problem with “narcotics.”

Red Flag No. 2: Self-monitoring. Tolerance is one problem. The constant monitoring of how I felt, and whether I “needed something,” was the other.

When I detoxed, it took me ages to get past the constant evaluation of how I felt, and whether I needed something, which started with taking that one pill every four hours. Is it wearing off yet? Do I need to take another one? This so eroded my ability to think and feel independently that I’m still getting over it. I no longer continually evaluate how I feel… But I still have a tendency to look outside myself for “the fix” to whatever it is that I’m feeling.

Red Flag No. 3: Criminality. And then there’s the problem of buying the Percocet or Vicodin on the street. Or stealing them. Or forging scripts. Or however Rapture is getting them. … When I committed crimes to get drugs, this made me a thief and a liar. In active addiction I constantly told myself that I needed to operate outside the bounds that applied to everyone else, because my case was “special.” … I get the feeling, from what Rapture writes, that this is also Rapture’s way of thinking. I can only speak for myself: it led me down a pretty dark road.

I don’t believe that people have to be off all drugs of any class to be totally “clean.” (I don’t even usually call myself “clean,” because I don’t like the implication that those who take drugs are “dirty.”) I buy that some folks might need to take some sort of medication indefinitely to do their lives productively.

I’m just not sure opioids are the best solution—they’re no kind of solution for me, anyhow. 

There are other ways of boosting endorphin production in the body. They usually involve taking care of our bodies, minds and spirits. Search on “endorphins” in this blog—or start at this post, about insomnia (a sign of depression). And there are reliable, evidence-based ways of dealing with PTSD.

I really want to know what others think about what Rapture is asking: Why shouldn’t folks who “feel better” on opiates be able to buy them legally? Please comment below, or email me.

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