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Recovery’s Long Road

Searching for light on a twisted street

illustration by jason raish

My story begins like most. An injury. A visit to the doctor. A medical procedure. Painkillers.

That was the late 1990s. There were pleasantries in the beginning, of course. A warm fuzzy feeling that is unmistakably benign. No pain. No worries. Nothing at all, really. I could lock and load and write for hours. I got really good at cleaning the house. I could suffer through bad cartoons on TV with my kids for hours.

It goes on for weeks, then months. Prescription after prescription of Vicodin. Percocet. Lortab. Oxycodone. Hydrocodone, usually 10mg each, several a day. Follow up visits with the doctor. He asks: How’s your pain? Bad still, I say, although it’s not really that bad anymore. My leg is sore after physical therapy for the knee surgery, but otherwise, not so bad.

What is bad is the way I feel when I run out. Real bad. Can’t sleep. Pacing. Self-soothing rocking motions, back and forth. Try to read but can’t focus. Try television, but now it always sounds too loud. Lights are too bright. Music becomes annoying. Terminal lethargy and restlessness at the same time. It’s always too hot or too cold. Never in between. A relentless sense of dread and despair. Weight loss. It’s difficult to bend over. You need to steady yourself with a railing when going up or down steps. You’re 45 years old and you feel 80. And a not-so-peppy 80 at that.

Plus, it works wonders on my depression. I seem to forget that I am even depressed when I take painkillers. I justify my drug use by devising my own self-medication process. Who needs a psychiatrist when you’ve got the magic pills? There isn’t an addict alive who doesn’t believe he or she knows more than their doctor when it comes to the magic pills. Those guys in lab coats; they don’t understand squat.

Then comes a second knee surgery. Ten days after that, an emergency appendectomy. More meds. Lots of meds. Endless meds. Later on, reconstructive hand surgery. Casted from my finger nails to my bicep. The pills flow like Hawaiian lava, red hot and deadly.

They make the pain go away. That’s good. That’s important. But time passes. At each follow up visit, doctors ask: What’s your pain level? Very high, I tell them. I’m lying now.

The most insidious aspect of opiates – as opposed to just about every other category of drugs and medicines – is that you develop a physical dependency on them. Not just psychological cravings like most underground narcotics, but a true and actual physical dependence that needs to be fed or your mind and body come crashing down.

Your body builds up tolerance to opiates over time. As time goes on, you need more for them to work. This is not psychological. It’s neurological. What were two pills a day become four. Four becomes eight. Eight becomes … the doorway to the dark passage.

Many folks, myself included, keep using for years just to avoid that three or four weeks of withdrawals; that’s how bad it is. Trade out ten years of your life for one month. Imagine the insanity. Welcome to the American Nightmare. That once warm fuzzy glow is now a burning fire of regret and remorse, now unable to shake the addiction, unable to live without it.

And when the prescriptions run out, you’ll do most anything to get to find more. Anything, anything at all to keep the withdrawals at bay. From the despair of long term addiction and its attendant guilt, shame and failure, inevitably come ideations of suicide. Which is kind of superfluous. You’re killing yourself already.

Nobody ever said addiction was logical.

•••

The National Institute on Drug Abuse, a branch of the NIH, estimates that more than 64,000 people will die of drug overdoses this year, the great majority of those being opiate-related. Maybe that’s a small sample size in a country of hundreds of millions. But that statistic is more than double from 10 years ago. The rise of the “super opiates” like Oxycontin and Fentanyl, each more powerful than the other, and the steady uptick in heroin use is one of our nation’s long running dirty secrets.

But not so secret now. Now that opiates killed Prince. They killed Tom Petty. And they killed a lot of people you’ve never heard of. Sons and daughters and brothers and sisters all. Caught in the trap.

There’s no official statistic to directly connect opiate use to the country’s surging suicide rates – the highest in our nation’s history --- but trust an addict on this one: They’re connected. But the death rate doesn’t tell the story of American addiction any better than the murder rate tells the story of American violence: Consider all the people still living through the nightmare, not quite dead. Living casualties in our schools, homes, workplaces and medical institutions.

•••

Standard opinion holds that addiction is a disease. I’m no doctor, so I suppose it is. But there’s no getting past this point: Someone with diabetes wakes up every day with diabetes. A drug addict does have a choice. You can simply not use it. You will feel like shit for weeks and never sleep and slog through work and every basic life skill and probably stop brushing your teeth or answering the phone.

But know this: Whether you believe in the medical model of addiction or consider it a lethal character flaw, understand that nobody who becomes long-term hooked on opiates does it for fun. Nobody. It’s no party drug. Quite the opposite; it leads to isolation from any social engagement and human touch.

If you’ve got a friend or family member who is addicted, judge them as you will. But understand that they don’t want to be that way any more than you want them to be that way. They are living in a self-defeating cycle of more humiliation and reprobation and fear than you could ever dish their way.

And you do know an addict. I promise you: You know an opiate addict. You just may not know it. Yet. I could play a parlor trick and tell you that there are some painkillers in somebody’s pocket or purse within a hundred yards from where you are reading this, and I’d bet the ranch I’m correct. (Yes, I once had a gambling habit too.)

Opiates, from the low end 5mg Oxycodone and Hydrocodone – the generic and clinical terms that encompass all of the brand-name painkillers -- to powdered heroin, are no longer the realm of skid row greasers and basement freaks. They have infected every level of society, every workforce, every family. Teachers, doctors, clerks, drivers, accountants, lawyers, anyone, everyone. And the step from painkillers to heroin has never been easier nor more prevalent. And the reason is elementary:

It’s the economy, stupid.

Prescription painkillers are synthetic heroin. It all comes from the poppy fields of Asia, Africa and South America. Whereas heroin was for many decades associated with the Woodstock generation and back alleys and shooting galleries, it’s now on the streets of suburbia, sufferers crouched in the dark in their classrooms, cubicles and cul de sac split-levels.

Heroin has made its surging comeback for one simple reason: Painkillers are getting harder and harder to get prescriptions for, now that America’s opiate pandemic is making the front page and doctors are tightening their once loose scrip writing. And their street value is through the roof – one dollar for every milligram. So what happens when you are taking ten 10mg Oxycodone a day? Do the math.

What happens when you are taking eight 80 mg Oxycontin a day? You better be good at calculus to tally that bill.

So once you get past the stigma, and once you realize you don’t need to use needles, heroin is a profoundly cheaper – and often more accessible – alternative to pills. But there’s no way of knowing how strong it is, who made it, and if it’s real. There’s that drawback. But people, ordinary people, make that leap when they run out of pills. People who you’d never suspect would take such a step. Trust an addict on this one, too: Neither did they.

 

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I am not a doctor, nor a trained scientist. I don’t know what I know from academic studies and clinical trials. I know what I know from nearly a decade of addiction, three trips to rehab and endless sessions of therapy, counseling and meetings. I possess the wisdom of experience. And here’s what I know:

First, a lot of the platitudes are true. They always tell you that addiction ends one of three ways: Prison, institutionalization, or death. After experiencing the first two, I decided to get clean for good. And that leads to another platitude: You can only do it for yourself.

The first time I went to rehab was to save my marriage and my sister’s life. She needed a bone marrow donor and I was the match. I had both been praying that I would be the one to save her life, at the same time dreading what it would take to do so. So I went to rehab. My insurance covered it.
Rehab is really hard work. That is, unless you get to go to one of those treatment retreats in Sedona or Malibu where they put hot stones on your back and cucumber slices over your eyes and you spend the day doing art therapy and taking walks in the woods. That’s not what most folks get to experience, a soft landing from the existential dread of opiate addiction. We can’t all be Britney Spears.

Rehab is an endless cycle of inconvenience. Waking up too early, being tired all day, sitting in circles under fluorescent lights all day, talking about it with a bunch of other folks who are just like you. No matter how different they are, they are…Exactly. Like. You. Opiate addiction does not discriminate on the basis of age, race, religion, gender or socio-economic distribution. The Walking Dead, we are everywhere.

They ruined their families. Fucked up at work. Quit their hobbies. Started staying home all day and night. Rooting through medicine cabinets and dresser drawers of friends and family. Finding a reliable pain doctor to feed your habit and when he cuts you off, finding a reliable street dealer. Or two. Or three, just to be sure. Spent all their money. Started by borrowing some, then stealing it. And then you all end up in the same room, talking about it. For thirty days, sometimes longer.

After my first trip to rehab, my wife divorced me. Then my sister died before she ever got strong enough for the transplant. Then I went back to painkillers.

The second time I went to rehab was to save my job. It was an ultimatum from my boss at the Times-Picayune. I’d been arrested as a public nuisance. My insurance covered it again. Then I took a voluntary buyout from the paper. And I went back to painkillers.

The third time I went to rehab, I went to save my life. I had no insurance. I paid for it myself. That’s how you make it stick. You have to do it for you, not for somebody else. It doesn’t work that way. I have been opiate-free for seven years now. Yay, me.

All it takes to succeed is ruining your life, alienating friends and family, running through your savings, and a helluva lot of determination. And Suboxone helps.

There’s a drug on the market called Suboxone. Maybe you’ve heard or read about it, now that the opiate pandemic is finally as newsworthy as immigration, tax reform and whatever the hell else is going on in Washington these daze.

Suboxone is a combination of buprenorphine and naloxone. Together, they do an overhaul of your brain chemistry. They tamp down withdrawals, reduce cravings, reduce pain. Suboxone had become standard rehab treatment by my third trip. I’d never heard of it before then. And there’s a reason for that.

I went to see Dr. Brij Mitruka, a general practitioner in Algiers, for my “issues.” I told him how I started on painkillers and how I kept with it as a way of self-treating my depression. If you don’t feel anything, you don’t feel depressed. Pretty simple, right?

Mitruka says most of his patients have the same story. “Behavioral change is the primary objective with my patients,” he says. “It’s a matter of perception versus reality. Your body tells you that you are depressed; you take something for it. You go around and around, thinking it’s good for you. It energizes you. It relaxes you. You have to treat addiction first to find the true underlying reasons for depression or anxiety. Suboxone helps you do that. It separates the perception from the reality.”

Suboxone tears away the temporal jagged edges of withdrawals and cravings. And yes, the paradox of treating drug addiction with another drug is counter-intuitive. But Suboxone is not meant for long-term maintenance. In a program like Mitruka’s, you start with a dosage to knock down the immediate dread and remove the cravings and then ween down over time. Ween down to nothing. Ween down to real life, like all the Normies out there are living it.

“Addiction is a mental disease,” Mitruka says. “Giving up a daily habit is a long process.”

And that’s where a second paradox comes in: Suboxone is intensely regulated by the FDA and the DEA. Consider this: Any MD can write you a prescription for painkillers. Any dentist can write you a scrip for Percocet. Psychiatrists, some RNs and even some veterinarians can write you a scrip for painkillers – that is, if you have a vet who is predisposed to helping you kick withdrawals.

There are roughly 60 physicians in the greater New Orleans area licensed to prescribe Suboxone. That’s all. And that’s a lot considering how small a market this is. And convincing them to treat you is no easy feat. They are in high demand, pardon the pun. They are the Holy Grail for addicts who really want to quit. (Note: For a list of Suboxone-licensed doctors in the New Orleans region, go to suboxone.com. Be advised: You will likely be required to enter a treatment program before they agree to work with you. They’re generally not up for wasting your time or theirs.)

But here’s how stupid it can be: A friend of mine just had a tooth extraction this summer and was written a prescription for 45 Vicodin. A tooth extraction. Forty five pills. That’s insane. He took a couple the first day and then sold the rest. And so it goes.

And that brings us back to the economy. The Pharma Nation. “It’s a big lobby,” Mitruka says. “The people who make Oxycodone, Oxycontin – they are depressing this new medicine.”

Indeed, with wider distribution, Suboxone could put a serious dent in the multi-billion dollar painkiller industry. And there are other similar drugs coming to market with the same neurological promise as Suboxone. One drug protocol leads you down a path to perdition and slowly chews down your humanity. The other one halts and then reverses those effects.

Guess which one you can find on any commercial block in the New Orleans area, in any medicine chest, at any gathering of humans?

Nobody ever said addiction was logical. Nor its cure.

•••

I wanted to write this story ten years ago. I was still bouncing in and out of rehab, fighting all along the way, destroying things and people around me. I wanted to share my story and maybe tell people: You are not alone. Because nothing – nothing – feels lonelier than addiction.

At the time, I was still working at the Times-Picayune. My editor told me: We think our readers have heard enough about your personal life. And that’s certainly true. I am the king of TMI. They didn’t want an admitted addict confessing in their pages.

So I finally found a place to tell my story. I wrote this not to regale you with my tales of woe and triumph. I wrote it to try to tell you what it’s like to be there if you never have. To maybe help you understand the mind – and actions – of the addicts around you. To know that there are options beyond the traditional 12 steps and cold turkey methods of recovery – although those do work for some folks. And mostly, to tell you that the statistics you read about or hear on TV, now that opiate addiction has claimed its rightful place as an American pandemic, are much more than statistics.

They are your friends and your family, your classmates and your workmates, whether you think you know one or not.

Trust an addict on this one. You do. Handle with care. Handle with love.


 

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