Welcome back! This is Part II in a series on Opiates: Are There Any Good Answers? Last week, we heard from a professional, Dr. Doug. He gave us some good things to think about, didn’t he? This week, we visit with a young man who has actually experienced addiction. Let’s see what he has to say about Opiates, and you will find Dr. Doug’s response to this blog at the end of Will’s journey…
I have been asked to write a short piece about myself. More specifically, I have been asked to write about how I became addicted to opiates, what it took to become free of said addiction, and how I live a life without them. When I agreed to this, I thought it would be a lot easier, and yet, I must have sat in front of the computer screen for half an hour before coming up with this introduction paragraph (after thinking about it regularly for a few weeks). Even as I write this, I have no idea how I can possibly explain the details to someone who has never wandered down such a path in life. Addiction. Dependence. Withdrawal. The cycle of self-loathing, and the desire to just be free from life itself… No, that’s not right. Not life itself but, rather, all of the negative aspects of life. I wanted to exist free of the ever-crushing emotional pain of daily life. I wanted to be happy.
It all started because I wanted to be happy.
Many people reading this will immediately recognize the underlying depression to which I refer. Those people would be right. If it started anywhere for me, if there is a true beginning, it was with the untreated mental illness from which I suffered. The myriad of reasons for why I suffered do not matter, so much as the fact that I suffered. Daily. Constantly. I must have been only 18 or so at the time. For as long as memory serves, my mother had been taking various types of medications for various reasons. Primary among them being pain management. Opiates. Truth be told, I still do not know what made me do it the first time, but I stole her medication. Mind you, “she spent a LOT of time sleeping, and her bottle was huge. Surely she wouldn’t miss a couple, three pills.” So thinks the brain of a depressed teen. I was right, too. She didn’t notice for months. If I recall, the only reason she ever found out was because I was taking about a third of her prescription. By the time she knew what I was doing, I was taking as many as eight pills at a time. The good stuff, too. Percocet.
Just putting those words on the screen make me cringe with disgust. To think I could do something so horrible to one of the only people who has truly been there for me. Long story short, she confronted me, I lied, she provided proof, and I caved. There was crying, there were apologies and promises and plans made. Doctors were seen. Prescriptions were taken. And life slowly went back to normal. Until it fell apart again. I’m not really sure how many times we went through this until I was kicked out of the house… The hardest part of telling my story in such a short format is twofold: First, it happened over the span of nearly ten years (longer if you count all the years leading up to the first incident); Second, during that period, I also ended up becoming an alcoholic, as well as losing my teeth. All of them. Also, for all I know, I’m not even remembering the story correctly… But I digress.
The last straw came somewhat recently (about three years ago). I was more depressed than ever. Drinking when I couldn’t find pills. Sleeping as much as possible. I had suffered from suicidal ideation before, and this time was no different. My plan was simple: I would take a hollow needle with me to a forest, and I would walk in, stick myself, and then keep walking until I bled out somewhere. Animals would come eat me, and I would be gone forever. No more issues for my loved ones. The burden of me would simply vanish. Fate is a funny thing, whether or not one believes in it. The very person whom I had wronged so much came home just minutes before I was about to walk out the door. My mom convinced me there was still hope. I could live a happy life if I would just surrender myself to the fact that I was an addict, and needed help. So I did. I let her take me to the hospital. It was there that everything became clear to me.
I spent three days there. The best counseling I have ever received came not from those educated to provide it, but from the experience of sitting with people who truly had problems. People who could never hope to live a “normal” life. For all the things I thought were wrong in my life, I had SO MUCH MORE than any of my fellow patients could expect from theirs. I realized how much I took for granted: a loving mother, job prospects, even something as simple as the ability to form coherent sentences, or sleep peacefully through a night. There are people who will never have those things. Things I had. It was my three days there that twisted my thinking back around. Opened my eyes to the truth of my pain. Following my release, it was the support of friends and family, as well as medication, that kept me together. Many of these people have asked me if I think that having stricter regulations on narcotics would have prevented me from walking this path. It is a simple answer. No. Not at all. I wasn’t even the one with the prescription in the first place. The only thing that could have prevented me from doing what I did would be better access to mental health services. When seeing a therapist or doctor costs as much as a months pay (not even including the cost of medications), it seems inevitable to me that more people will end up the same way I did. Probably worse. I consider myself lucky. Not to say that it was easy getting to where I am. On the contrary, I still find myself thinking about the times when I would knock back some pills and be able to relax for several hours before reality set back in. Then I remember where that ended. It will always be a struggle, but I am not alone…
I was never alone.
The following is a response from our guest DO blogger, Dr. Doug:
Addiction recovery has many faces, but the same theme. Dopamine release.
Online shopping, overeating, exercise addiction, drugs, alcohol or porn—they all stem from chasing to catch the original high and typically have a desired escapism. I stopped judging people many moons ago as we all have our own issues and our own demons. With a family history of polysubstance abuse, I was terrified to try drugs—didn’t want to know if I liked them so I just never started. Not everyone proceeds rationally in that effort.
This gentleman gave one of the most honest portrayals of his addiction recovery experience and as he said so well, ‘it will always be a struggle;’ a lifetime of work. As an osteopath, many patients who became addicted may have started down this path treating pain. That is not what the literature says, despite the media and politicians shouting that message from the rooftops. A stunning 48% of patients getting pain medicine on the streets do so to treat pain their doctors won’t treat. Opiate laws that set artificial MME ceilings actually increase heroin deaths as more and more patients go to illicit pain providers. Once the hydrocodone or oxycodone runs out, or is too expensive, heroin is there. It’s an excellent analgesic, but poorly controlled or regulated, particularly of late when laced with carfentanil—it’s simply deadly. Many of my addiction recovery patients are in pain and need to be treated.
More importantly, they need to be treated like patients, not drug addicts. They have the same epidemiologic risk factors as those patients not in their recovery shoes and too often all providers see is that ‘he’s an addict.’ Time and time again we are the first ones to do routine blood work looking for hepatitis, quarterly serology to monitor hepatorenal response to addiction recovery meds. We touch them via OMT and help the pain issues via non-pharmaceutical means or if we use meds we carefully monitor what we use.
In states with medical cannabis, the overdose rates are down 24.8% per the landmark study in JAMA in 2014. More importantly, my patients truly in recovery are blatantly honest about why and how they are using cannabis. Does that mean we are never duped? Nope, it’s part of the gig. Risk mitigation strategies implementing opiate/controlled substance agreements, pill/strip counts, prescription monitoring program utilization and comprehensive, three-phase urine drug screens (cups, ELISA immunoassay, and LCMS) are a must. Prove licit behavior to protect you and your practice, but detect and correct diversion. Everybody wins that way. Listening to these patients and asking what do you need and not simply giving them their Suboxone and sending them out the door goes a long way in preventing relapse. Openly communicating with their hepatolgoist, psychologist or counselor. Interestingly, the stricter we are the better. No one gets pain medicine without identifiable pathology and all patients receiving opiates get an opiate/controlled substance agreement, which includes two aforementioned protocols.
Everyone is treated the same and no one gets a pass because of who they know or even what they do for work. If a patient slips we tighten the regulatory noose and only a week of medication is given with urines tested weekly as they are now on probation and in need of more support, not getting kicked out of the practice. Comprehensive urines looking for metabolites to prove they are taking the medicine vs. scraping some into their cup to make it look like they are taking it help patients face the truth if they are diverting and most of my patients who are struggling to stay sober welcomed more regular visits and urines as it was an accountability they wanted and needed.
These patients want and need our help and only via the osteopathic approach emphasizing body, mind and spirit can we truly help them continue on the lifelong journey in recovery. Once we as providers (not to mention the press and the politicians) know they are in recovery and not ‘recovered’ can we see the disease for what it is and help these patients live day to day. Dr. Still abhorred pharmaceuticals and as the keepers of the keys in this country we have a responsibility to our profession, our patients and our community. Had this gentleman’s mother’s doctor done appropriate risk mitigation, his dance with addiction might have been avoided or at least identified earlier. The sooner intervention can be achieved, the sooner recovery can begin.
Dr. Doug wrote this article as part of a series of blogs for the Northwest Osteopathic Medical Foundation.