Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: withdrawal

To Use Suboxone, Or Not To Use Suboxone?

A reader writes:

Hi G,

I know there is no magic bullet or simple answer, but I thought you may have a suggestion for me. I’ve been taking perc or ox for five years, for the first 3 it was only 30-50mg/day but now it’s between 150 and 180.

Suboxone scares the shit out of me, but at the same time, every time I try to taper, I fail and I’m starting to go broke. I lost my health insurance.

I go to meetings 4 or 5 times a week, all helpful, but the physical part keeps me hooked.

I heard suboxone may be ok if used very briefly (like a month or less), as when taken for longer, the withdrawal is way worse than the oxy itself. I wish I could go to a 7-day detox or something, but I just don’t have the money and I don’t have insurance. I also freelance so I need to be able to work and I can’t lose more than a few days. 

Anyway, I started trying to find low-income or sliding scale suboxone programs in NYC, but it’s slow going and I don’t want to just get hooked on something else. I have read long term effects of suboxone are bad too.

I guess my Qs are:

if I were to do suboxone briefly, a few weeks, would I just then have the same withdrawal as I would going cold-turkey from the oxy anyway?

is there something else in my area (or anywhere) where someone could go for opiate detox that costs nothing or very little?

I want to be clean so bad, but every time I try to taper I just fail.

Any thoughts/suggestions appreciated – I know you’re not a doctor or professional, you just seem to have a lot of info and I know how we like to help each other. 

Thanks in advance.

B

Dear B,

There is no magic bullet, but in my experience there are simple answers.

The first was to know that I wanted to get clean. (Which you say you do.) First problem solved: I was telling myself the truth. The truth was, I was willing to do what it takes. And It Takes What It Takes.

The second was to ask for help. (Which you have. Keep doing it.) Nobody, but nobody, does this on his own. Even the people I know who don’t go to meetings have put together communities of other people trying to stay sober.

The third was to use my willingness and my growing community to decide on a path, and walk the walk.

For some people, Suboxone is the solution. They’ll tell you they don’t mind eating an opioid for the rest of their lives—it’s “like a diabetic taking insulin.”

In my opinion the diabetes analogy is worn out. I wanted my solution to be real freedom. When I reached out for help I met people who had shot heroin and who had gone bankrupt buying drugs over the Internet and who had drunk themselves into blackouts—people who drank and used to the excess I had, or worse—who were clean and sober. I wanted to break ties with all drugs that cause physical and psychological dependence. For me taking drugs is signing on for slavery. Just my reality.

I really wanted to go to rehab but I knew I couldn’t leave my kid for that long.

Here’s how I decided on a Suboxone taper.

I knew I couldn’t detox off full-agonists like oxy. Too alluring. (More truth-telling.) I needed to change all my habits. So I asked for help—I found a detox doctor who was willing to oversee a Suboxone taper for me.

I told him at the outset that I wanted to taper. When my resolve flagged, he reminded me that the project was to get free.

I put the taper in his control. I never had more than one week’s worth of drugs in my possession. He wrote out the taper, I wrote out the check, we shook hands. I waved the white flag and gave up.

I did what he and a bunch of other people—Dani, Allgood, Sluggo, Bonita, all online friends; and my new real-life sponsor and community—told me to do. I put my faith in the people who were sober and who told me I could be, too. I burned a script for more drugs. I went to meetings and opened my mouth and let myself cry on people. I kept collecting sober people around me.

Several weeks later I was drug-free for the first time in years.

And yeah, I ain’t a doctor, but I’ll offer this anecdotal caveat: if you’re taking 180mg Oxy, they’ll try to start you out at 8-12mg Suboxone (or maybe even more). But that would be increasing your tolerance. If you really want to get clean, you’ll start at 4mg and taper to 3mg within two days. You could do a 2-week taper, cutting to 1/4mg—the equivalent of 1 Percocet—at the end and have a relatively smooth landing.

Post-acute withdrawal.

I ain’t gonna kid you: staying clean was a slog. Tapering off suboxone was not nearly as bad as detoxing cold-turkey from fentanyl or oxy, but it wasn’t painless—I shivered, I kicked in my sleep, I sneezed 20 times in a row. Keep in mind, my tolerance was more than twice yours, and I’m probably a little smaller than you. I spent each day telling myself if I made it to bed without having stolen drugs (because yes: I used to steal drugs) or used anything, including alcohol, I was a success.

The best treatment for drug-cravings was vigorous exercise. It helps the body produce its private supply of morphine and dopamine. Dr. Steve Scanlan told me research shows people who exercise cut their recovery time in half. I made playlists that helped me drag my body around the neighborhood. Walk, run, cycle. Do pushups. Lift weights. Start small and grow bigger. I exercised, and my body and mind recovered.

Healthy. (Mostly.)

Healthy. (Mostly.)

A 180mg oxy habit is totally beatable. With a stick, my friend. Dude, if I can get clean, you can. I was on more than twice that and I’m free today. And I did not use insurance to get clean. But I paid what it took—the first of several critical investments I’ve made in myself over the past few years. Paying that doctor made me realize that, for a long time, maybe all my life, I’d withdrawn a great deal without putting very much back.

 

The most important information here: Get to a meeting. Tell them you want to get clean. Ask them to help you.

If you feel you need inpatient or other professional help, try Phoenix House, a large NYC-based treatment system with detox facilities in Long Island City. Or try the “free and affordable” resources listed on this website.

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.

Withdrawal, One Day At A Time.

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?

And now?

And 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.

How are you now?

And now?

And now?

Dreaming About Drugs Or Drinking—What To Do About It?

I’ve had a couple drug dreams lately. It’s been a stressful time—school let out, my kid is home all day, I’ve had to negotiate lots of scheduling issues with my partner. Transitioning into summer is always hard—in fact, any transition is hard for me. Addicts, in general, do not like transitions. I’m the kind of person who likes to eat the same things at the same time of day; I order the same menu items from the few restaurants I go to; I wear the same clothes—dependable ones that look good on me—until they wear out.

The other night I dreamed I had a bunch of fentanyl patches. Part of me doesn’t want to describe what I tried to do with them, because I don’t want to give anybody ideas about how to abuse medication (especially fentanyl, because abusing it can kill you), and I also don’t want to send anybody into euphoric recall. … But another part of me wants to tell you how my senses responded in the dream. Because it helps to be honest with people about what I used to do, and how it used to feel.

When I first detoxed off fentanyl, back in November 2008, I had drug dreams pretty often. It seems to me they happened almost every night, but I don’t think they were actually that frequent—it just SEEMED like they were. My using dreams back then were frantic: in the dream, I’d be searching through stuff in the house, looking for something to make me feel better, and when I found it, my whole body would yearn toward the drugs. (I tried thinking of a better and less corny word than “yearn,” but this is what it felt like. “Yearn” comes from an old Germanic word meaning “eager.”) My whole body bent itself toward the stuff it knew would make it feel better.

It was partly a chemical thing: withdrawal just takes time to get through, and during withdrawal it’s very hard to sleep. Sleep-deprivation is one of the things that prevents a lot of people from making it through to the other side of withdrawal—it’s hard to function during the day if you can’t sleep at night, and when your body knows what will make it easier, it naturally gravitates toward that.

But it was also partly a psychological thing. Pavlovian. I’d trained myself to cope with problems (and also joyful situations) by using drugs. I’d managed the way I felt with chemicals, instead of allowing the feelings to pass. I didn’t want the painful feelings to persist, so I used chemicals to get rid of them; I didn’t want the joyful feelings to leave me, so I used chemicals to try to prolong them—or else to get rid of the fear of the joy leaving me. Of course, in the end, the drugs stopped working, but I clung to the hope that they would work again someday—which is the delusion of addiction, and the insanity, the breakdown of health and wholeness.

And when I’d wake up from the dream, I’d feel mortally disappointed that I hadn’t actually found drugs, that I was on my own again, trying to manage life by myself. (This was before I learned to depend on another power than my own will.) Sometimes I’d cry.

I hadn’t had a dream about using drugs for a long time before I had one a couple weeks ago. In the dream I found these fentanyl patches. Brand-new, shiny-clean, pure drugs. But somehow in the dream I couldn’t touch them. I’d try to touch them and they’d dissolve from view, disappear. Then I’d pull my hand away and they’d reappear. Ephemeral.

So this dream wasn’t actually about USING drugs… it was about the temptation, and the presence of drugs in my mind and consciousness. The fact that my addiction is always with me. The aliveness of it. I don’t exactly imagine it, as they say, “doing push-ups in the parking lot” while I’m at meetings. But as Eminem raps,

This f*cking black cloud still follows me around
But it’s time to exorcise these demons
These motherf*ckers are doing jumpin-jacks now

It’s around. It’s not Gone.

I was sick for a long time, and it takes a lot of discipline to recover from a chronic sickness. People who undergo treatment for cancer, diabetes, hypertension, and other illnesses have to organize their lives around managing their problems. And I don’t buy the argument that people with addiction caused their own problems and people with other illnesses didn’t. Many people with obesity and diabetes today have made a hefty contribution to their problems through their reluctance or refusal to face the fact that they eat too much and they eat foods that cause ill-health. It’s being shown that cancer and hypertension are caused by the disastrous ways Americans eat and drink and use their bodies—or don’t use them.

Blaming is useless, but figuring out the cause-effect relationship leads to the ability to strategize about solutions.

So what do I do when I dream about drugs? Today I first of all wake up and send up a statement of thanks to the Higher Power Of The Day (today my HP is Time) that I didn’t actually use. And then I let it go. My friend Arlene in L.A. used to tell me all the time, when I was newly detoxed, “This Too Shall Pass.”

Life is not about what you feeeel, baby girl,

she’d say, and she was right.

When I was newly detoxed and dreaming about drugs, I used to cling to those feelings of maybe Finding Something Someday. Today I try to let it all slide off me. I hand it over to Time, which will eventually make me forget. I hand it over to Love, which will help me take care of my body and spirit. I hand it over to Common Sense, which tells me:

It’s just a dream.

What do you do when you dream about drugs or drinking?

Sayings from the rooms: The only meeting you’re late to

I’ve heard this one before and I heard it again today at the 7 a.m. meeting…

They say:

It’s not alcohol-wasm;

it’s alcohol-ism.

I also heard this one this morning, which I thought was great…

They say:

The only meeting you’re late to

is your first meeting.

Big Ben in London

Two years ago was my last day of daily active addiction. August 28, 2008. The next day,

I committed to detox…

The Suboxone threw me into precipitated withdrawal

and I kicked superhard, in my bedroom, for two days, until

on the third day I could drag myself out and start eating again.

Precipitated withdrawal isn’t like “normal” kicking. It’s like

all 10-15 days of normal kicking packed into two.

I need to remember these facts.

It took me three weeks before I made it to my first meeting…

Two days after my son’s 11th birthday.

Late, but much better late than never.

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