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