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Gettin’ Clean in Eugene

The Growing crisis of opiate abuse in the Northwest

Opium has, and has always had, this country by the short hairs. But for myriad reasons, the dope epidemic in the U.S. tends to elude detection as the massive health crisis it is — reasons that are intricate and complex and interpenetrating, deriving almost in equal parts from public-policy myopia, bureaucratic mumbo-jumbo, political opportunism, inadequate social welfare, incompetent or absent education, rampant drug hysteria and the inexorable nature of addiction itself.

As an addictive substance, opioids are a total bitch. Seductive, elusive and exacting, junk presents itself as a physiological and socio-economic Catch-22. The reason for this, boiled down to the narcotic itself, is rather simple: Opium, and all its derivatives, is at once the world’s most perfect treater of pain and the most devastating of addictive substances. Homer referred to the nectar of the opium poppy as the “destroyer of grief,” and morphine, created in 1804 by Frederich Serturner, was named after Morpheus, the Greek god of dreams. French poet Charles Baudelaire, a smokehead, wooed opium as “his demon, his lover.”

Dope is also the perfect product — a drug dealer’s wet dream, for which the desperate addict will lie, cheat, steal, do anything to buy off withdrawal just one more day. Trust me: I know that of which I speak. I’ve bolted opiates any way I can — pills, powder, smoke, poppy tea — and I’ve done just about anything I can to get them. Like hobbling miles on dope-sick legs to beg 30 milligrams of morphine off a homicidal dealer with pinprick eyes and a dying cat on his hands. I’ve sold things I didn’t need; then sold things I did need; then sold things I said I’d never sell; and then sold other people’s things — sold myself, sold it away and sold out.

Are you, like me, a striver? An endless dreamer of better worlds, burdened with visions of strangled greatness? Rest easy, pilgrim, there is a solution — tap that vein of gold. Junk is the painless death of ambition. It swaps the humid crush of living for a temporary euphoria that is so triumphant it feels eternal. Dope turns mammal into vegetable, but it does so in such a way that your affectless metabolic stupor is protected by a scrim of tragic, romantic heroism — a synaptic glow of self-glamour, something marvelous and magical.

I fought that son-of-a-bitch for 15 years, and I’m still fighting. Thanks to a combination of medical care, pharmaceutical innovation, individual and group therapy, as well as a bunch of love and support that, in my mind, I burned up a long time ago, I’ve kicked it for now. I’d like to tell you that getting off dope makes me feel like a true Viking, and sometimes it does, but a lot of the time I still feel like shit — another victim of Post Acute Withdrawal Syndrome (PAWS), my cells slowly flushing drugs whose half-lives seem immortal. My body, my glands and my will to live are ever-so-slowly returning to normal functioning. It’s a struggle.

“It is not the intensity but the duration of pain that breaks the will to resist,” William S. Burroughs wrote in a 1956 letter published in the British Journal of Addiction. This is the creeping terror that haunts every recovering dope addict. We are a silent minority. And we are a growing minority. But, as with any minority, we have been misperceived, stereotyped, underrepresented and grotesquely vilified, often by ourselves. This, then, is my minority report. I earnestly hope it makes a difference. Because this is a matter of life and death.

 

Comfortably Numb

Hello, Eugene, is there anybody in there? Just nod if you can hear me: Is there anyone home? The reason I ask is, well, I’m worried about you, Eugene — and that concern extends to Oregon, the Pacific Northwest and this glorious country of ours in general. Have you seen the latest statistics on how many Americans are feeding the monkey these days? It’s scary.

A recent survey by the U.S. Substance Abuse and Mental Health Services Administration found that Oregon now has more people per capita abusing unprescribed pain killers — that is, pills purchased on the street or filched from grandma’s medicine cabinet — than any other state in the U.S. As a nation, 4.6 percent of us above the age of 12 are self-medicating with pain pills, which is a frightening enough number.

But get this: Most of the Northwest pegs in at well above the national average. Oregon tops the list with an estimated 6.37 percent of its peeps popping pain pills on the down low, followed closely by our northern neighbor Washington (third on the list, at 5.75 percent) and Idaho (fourth, at 5.73 percent). Colorado — which, in places, looks a lot like the Northwest — stumbles in at second in the country, with a straight-up 6 percent.

Then, of course, there’s always heroin. This year’s Threat Assessment and Counter-Drug Strategy released by the Oregon Department of Justice, and currently posted on the Lane County Sheriff’s website, finds that first-time use of smack by people 12 and older rose 54 percent from 2002 to 2010. The assessment also figures that heroin use and availability “appear to have increased in Oregon,” a state where “illicit drug use ... continues to exceed the national per capita average.”

Hello? Eugene? Oregon? Are you needing an intervention? And if you’re “only” popping, don’t think for a second that shunning the needle stops the damage done. Whether it’s in the form of Mexican cartel brown-brick tar passing up and down the I-5 corridor, or illicitly procured prescription drugs like OxyContin or Vicodin, junk is junk. And, just like Burroughs said, it doesn’t matter “if you sniff it smoke it eat it or shove it up your ass the result is the same: addiction.”

That’s right, Oregon: You’ve become comfortably numb.

 

Cure and Disease, Dis-ease and Cure

One of the more recent innovations in the pharmaceutical treatment-and-recovery phase of dope addiction was the creation and marketing in the 1980s of buprenorphine, an opioid agonist that can be administered in its pure form as Subutex or — combined, typically one-to-four parts, with Naloxone, an anti-opioid agonist that is meant to prevent overdoses — as Suboxone. When it seemed I had nowhere left to turn, and I was sick of being sick, my doctor turned me toward Suboxone treatment. (Even when I had insurance, this was an expensive way to go; a month’s scrip for Suboxone, with coverage and a $25 coupon, ran me $50. Minus insurance, my prescription cost upwards of $300 a month.)

Eugene-based physician Douglas Bovee, a board-certified specialist in internal medicine, is one of only three doctors in Lane County now certified to prescribe Suboxone as a pharmaceutical aid in opioid-addiction treatment. Federal and state oversight of physicians prescribing Suboxone is incredibly strict: Bovee is legally limited to maintaining no more than 100 patients on Suboxone, and when he first started with the drug his list was capped at a mere 30 patients.

As someone who’s long been concerned with understanding and treating addiction, Bovee says that one of the toughest issues now facing the medical community is “how hard it is to be a doctor and walk that balance” between relieving pain, on the one hand, and opening the Pandora’s Box of addiction on the other.

Bovee agrees that, physiologically speaking, a large share of the difficulty in treating opioid addiction can be chalked up to opium itself, which remains the king of all pain-relieving remedies. “There’s nothing remotely close,” he says of opioid-derived painkillers.

Beyond that, however, the tangle of concerns and complications that confronts anyone treating addiction is epic. Often it’s less a tangle than a mess of tentacles reaching out in every direction and grabbing hold of issues that run the gamut from patient confidentiality to public policy, from access to medical care to the reluctance — on the part of addicts, doctors and the general public — to care enough, or at all.

“We are charged, and we want to relieve pain, and we don’t want to hurt people,” Bovee says, apropos the Hippocratic Oath that is the centerpiece of medical ethics (i.e., “to abstain from doing harm”). “If we give too much pain medicine to somebody who’s not able to manage it safely, all kinds of bad things happen.”

In part as a response to growing concern over the issue of opioids and pain management, the Joint Commission on the Accreditation of Healthcare Organizations — a powerful Chicago-based nonprofit created in 1951 with enough political oomph to hold sway over the medical licensing process and Medicare reimbursement to hospitals — now demands that pain be measured on a patient-by-patient basis. This accounts for the common “How much does it hurt on a scale of one to 10?” question that patients are asked in emergency rooms. (And which any addict learns to answer, Spinal Tap-style, with “ELEVEN! IT’S AN ELEVEN!”)

According to Bovee, general awareness about the growing abuse of opioids would seem to suggest that doctors become even more cautious and observant when prescribing painkillers. Administering opioids should include careful monitoring of patients, he says, along with things like material-risk notices and informed consent agreements for people receiving painkillers. Nonetheless — with abuse, addiction and overdose on one side, and insufficiently treated pain on the other — many doctors, along with their patients, find themselves in a real pinch when it comes to treating pain.

“It’s hard,” Bovee admits, noting that along with informed consent and management agreements there are further steps doctors can take to ensure safety — like requiring urine drug screens and maintaining “the free flow of information” between patient and doctor as well as among medical professionals and organizations, while at the same time respecting issues of patient privacy and confidentiality.

Professionally, nearly all physicians — and certainly those prescribing opioids or opioid agonists like methadone or Suboxone — are required by law to take a full day of pain-management education.

Bovee sums up this “tangle” of issues surrounding the use and abuse of opiated painkillers: “So there’s this very strong push in multiple quarters to adequately treat pain — all chronic pain, not just malignant. Then a whole bunch of new drugs came on board, with pharmaceutical companies pushing them very hard. Those products, with rare exceptions, are all opioids, which are addictive, and most of them can cause overdose death.”

The vicious cycle of dope: Around and around it goes. And there was an old lady who swallowed a cat to catch the bird who swallowed the spider to catch the fly that wriggled and jiggled and tickled inside her — but don’t ask why she swallowed the fly. Do you think she’ll die?

 

Better Off Than Dead

There are fates worse than death, and kicking opioids is one of them. I’ve heard people describe the withdrawals one suffers while kicking a chronic dope habit as being like a really bad case of the flu, and I say: HA! I’ve had the flu; it made me sweat and ache and poop and barf. Brother, the flu ain’t nothin’. 

The torment of dope withdrawal is truly indescribable, but let me give it a go anyhow: Imagine the worst hangover you’ve ever had, and then imagine being stuck in a dank basement and slathered with Vaseline while your head is ratcheted in a rubber vise and then, simultaneously, you are being mildly electrocuted, pricked with needles, alternatingly overheated and chilled while, still at the same time, everything you’ve ever done wrong is screamed repeatedly into your ears at ungodly volumes by a chorus that includes Satan, your mother, Geddy Lee, Fran Drescher and Gilbert Godfried.

I’d opt for being drawn and quartered any day — at least death comes eventually. Don’t believe me? I’ve still got a few very kind, very tolerant people in my life you could call.

Sure, I can almost hear all the dim-dick bootstrap baggers and draconian Darwin types lining up in the confederated raspberry mob to shoot back the stock mock-lament: “Oh, poor crybaby junkie, look how sick you get from STICKING A NEEDLE IN YOUR VEIN of your own damn free will! Shut up! Loser!” Hey, a lot of the time I feel the same way — because, honestly, show me a dope addict who doesn’t carry a hefty rasher of self-loathing, and I’ll plug every glory hole in the Republican wing of the House. But here’s the deal:

As an addict speaking to all you professional healers, counselors, policy wonks and hard-ass rugged individualists of the world, I’d like to say: Shit or get off the pot. You tell me I have a disease, and then you look at me with the eyes of a narc, crooning over my pupils and piss as I prevaricate and dodge just to get you off my back. I’m a human being. Just a little weak is all. Or was I born this way? They say it ain’t my fault, brother. Who really knows? 

Sure, addiction is a real son-of-a-bitch, a Gordian knot about as thick and unknowable as the world itself. But for the medical profession to cut that proverbial knot with the half-truth that addicts suffer from a “disease” — while making junkies who show up two minutes late to get their daily dose of methadone sit through an hour lecture as they get sicker by the minute, listening to all that “one day at a time” rote bullshit like a scolding in the principal’s office, until the second hand ticks relief and it’s all, Yes, ma’am, please, may I have my 10 grains of methadone. Fuck you very much.

Would you do that to a cancer patient? Would you do that to a diabetic? “Oh, excuse me, Joe, I’m really sorry but you’re three minutes late for your insulin injection. Please proceed along the blue line to room 666, where Mr. Persnickle will provide you with a 15 minute digression on the importance of diet and timing ... um, excuse me, Joe, you’re looking a little pale, are you listening? Anyway, after the dietary diatribe — and be sure to get those forms signed — we’ll just have you climb to floor six, where Mrs. Fussypants will ask you the Snickers Bar 20 Questions, and if you answer in the 80th percentile, she’ll toss you your syringe, which you can get filled ...”

I exaggerate, of course. But let’s take a deep breath and walk it back a bit, and all ask ourselves: Do we really, truly believe addiction is just another disease, or is that the big pharmaceutical con rigged since the Harrison drug act? Am I sick, or are you just sick of me? Once a junkie, always a junkie. So take your Schedules 2, 3 and 5 and shove ’em down your pie-hole. My will is good, but my body wants dope. So let’s redefine this game, because good people are in pain, and good people are dying.

Walk it back, into the past century, when Rep. Francis Burton Harrison of New York blessed his country with an early Christmas present: the Harrison Narcotics Tax Act of 1914. In a very real and yet very Kafka-esque sense, the epidemic of addiction has been jumping forever through the hoops of this pernicious piece of legislation. Ostensibly a law set up to create a revenue tax on all phases of the distribution of narcotics, including coca (not a narcotic), there was a single clause in the narco act stating that a doctor was allowed to distribute opiates “in the course of his professional practice only.” Later interpretations determined that what this meant, exactly, was that doctors could not prescribe opiates for addiction, because addiction was not a disease but a moral defect, a character flaw.

Walk it back just a tad further, and you begin to smell the first righteous stink of a misdirected hysteria that would be fanned into a social and moral conflagration of epic reach: In 1908, President Theodore Roosevelt appointed Dr. Hamilton Wright as the first opium commissioner of the U.S. Wright, with Episcopal Bishop C.H. Brent marching in lock-step at his side, began a very public campaign against opium, attacking the lack of safeguards surrounding the drug, and he did so in racially charged language that claimed poor white American women were now cohabitating with Chinamen who’d seduced them with opium smoking; i.e. “coolies” were getting our women addicted to dope, pimp style.

And later, the drafters of the Harrison Act itself would fall back on that good-old antebellum bullshit that’s been proven to spark terror in the hearts of white men everywhere, by seeding public paranoia with rants in the press about about “drug-crazed, sex-mad Negroes” raping, once again, our virginal white women.

Somebody strike up the band.

Actually, most if not all of those poor white women had caught their monkey from very white, very misogynistic physicians prescribing opium for their “female problems.” Coolies and negroes, indeed; nothing like a chauvinist quack to stick it to the gals every time. It’s been estimated that by 1914, one in every 400 U.S. citizens was an opium addict — yes, a junkie, and most of these junkies were women.

 

Get Thee to a Clinic

Sybil (not her real name), a 35-year-old woman now living in Eugene, fell down the rabbit hole of addiction years ago. “I’ve had a long history with heroin,” she says, “but I usually would quit by moving — what they call a ‘geographic,’ which is when you move to a new place to get away from your connections. And I would just quit cold turkey; do it the hard way. But inevitably I would get back on [heroin] again.

“I went a long time without,” Sybil says about her dope habit, “but it just came back.”

Her last kick three years ago was the hardest, Sybil says, and “since then I have not used heroin.” But, as every junkie knows, it’s easier to get off dope than to stay off dope. “In the last year and a half, I started sneaking back on pain pills,” she says, noting that this was mostly in the form of Vicodin, Percoset and even methadone tablets bought off the streets. She had connections. 

But maintaining a growing habit via illicitly obtained painkillers can get pricey: A single tab on the black market (for lack of a better term) runs from $5 to $50 — typically, painkillers are priced per milligram (30 milligrams of morphine was costing me $30).

“It’s too expensive to remain a Vicodin addict on the streets,” Sybil says, “because you have to take too many, and they don’t last long enough. So I started taking methadone pills.”

It got to the point where, even on methadone, Sybil was continually running low on cash, “and I wanted to be able to maintain a job and live my life.” So she decided to check out the programs available at the local methadone clinic. “Essentially,” she explains, “it was the same thing I was taking anyway.”

Through the Oregon Health Plan (OHP), Sybil was able to sign up to receive methadone treatment at no cost and, after about a monthlong wait and a lot of paper and blood work, she was able to get into the program. “It was a big deal to get on it,” she says, “it” being the legal methadone distributed by health practitioners at the Eugene clinic. A big deal and, as Sybil soon learned, something of a curse and a blessing, at least in her experience.

Enter the clinical supervisor, whom Sybil describes as “a New-Agey, smiley Nurse Ratched type,” a reference to the fictional “Big Nurse” character in Ken Kesey’s 1962 novel, One Flew Over the Cuckoo’s Nest. “She asked me a million questions, and she was totally impersonal about it,” Sybil says, recalling that the clinical supervisor seemed more concerned about “wrangling her computer into submission before she could get into anything like eye contact.”

As for the program and the clinic itself — at which addicts must show up daily (except Sunday) to receive their allotment of methadone, as well as submitting to urine analysis and attending group therapy and one-on-one sessions with counselors — Sybil realized immediately that she was on short notice. “From the very first moment I realized there were extreme rules,” she says. “The clinic is run by an older woman, a receptionist who answers all the calls and is all about the rules … There’s no talking, no cell phones, no anything allowed in the program.”

As anyone who’s attended any sort of recovery meeting knows, the stories you encounter can be hair-raising, horrifying, tragicomic and full of heartbreak. Sybil recalls sitting in group and listening to a guy from Portland whose insurance had run out: He’d been “titrated down in less than 20 days from over 100 milligrams to nothing,” she says. “No apologies.” So he’d relocated to Eugene, where he was “in group and still sick, and slowly trying to work back up to where he was. And he was scared.”

After group, Sybil tracked down the clinical supervisor, aka Nurse Ratched. “I said this is scaring me,” she recalls. “I told her about what I heard in group. She said listen to me very carefully: ‘Trust the methadone.’ And that was all she had to say to me.”

If addicts are asked to “trust the methadone,” however, the methadone clinic doesn’t always feel the need to trust them. For instance, Sybil is required to show up between 6 and 11 am Monday through Saturday for her liquid methadone. “If you are one minute late after 11, you are not dosed that day,” she says. On Saturdays, everybody gets a take-home for Sunday. “The thing is,” she continues, “anybody who is a minute late on Saturday [the clinic closes at 10 am on weekends] misses two days automatically. And if they don’t show up on Monday, then they’re kicked out of the program.”

Sybil says she’s been through several different recovery programs in her struggle to get clean and establish some modicum of a normal life; she also acknowledges that doctors and counselors often labor under the stringent laws regulating recovery programs, and especially those programs distributing medications. “The main issue I have with the methadone clinic is they don’t have the resources and they are overworked,” Sybil explains. “They don’t have the money or the resources to provide a proper recovery program.”

In order to cope with the mandated rigmarole of showing up every day to receive medication, and the toll it takes on her emotionally and otherwise, Sybil says that the methadone bureaucracy and the methadone itself “need to be separated in my mind.” She explains: “The punitive way they run the clinic, that’s not helpful to addicts. I mean, I’ve read B.F. Skinner’s work on rats and dolphins. Negative reinforcement does not work as well as positive reinforcement, especially for a disease.”

For Sybil, the main problem with the methadone program is that, under the rubric of “recovery,” a whole system has been erected to keep addicts controlled, surveilled and yet still dependent on the drug they’re struggling to kick. “This is supposed to be a recovery program, and yet it holds you back from being able to do the things that recovery’s all about, to make your life good,” she says — things that so-called normal people take for granted, like going on vacation or just getting to your job on time without being sick.

“And while you think you’re in a program that’s going to give you your dose,” explains Sybil, “and you think you’re going to lose that fear you have of not being able to get your dose, in fact you don’t, because you still have somebody holding it over your head. You have a new dealer. You have new demands,” she says.

“Anything could happen,” she adds, referring to circumstances — such as losing her OHP coverage — that might halt her current access to methadone treatment. “I’m not secure in my situation with methadone.”

Sybil offers a metaphor to describe the state of her recovery these days, which, in a sense, she has entrusted to the government. “It’s like you’re driving your car badly, so you give the keys to somebody else, and then they won’t drive you home.”

 

Catch-22

Dr. Jane Ballantyne is a professor of research and education at the Department of Anesthesiology and Pain Medicine at the University of Washington in Seattle, and considered one of the nation’s leading authorities on the subject of pain management. Ballantyne has been an outspoken critic of this country’s medical professions — or, more precisely, of the more indiscriminate and incautious members of the medical community, whose lack of oversight and care in prescribing opioids is one of the factors figuring into the current epidemic of overdose and death by painkillers. 

“The main educational message that needs to get to clinicians,” Ballantyne told me by phone from Seattle, “is that opioids are addictive and dangerous and therefore, in terms of pain treatment, should be reserved for inpatient use, where there is good supervision and safeguards, or for patients whose suffering is so extreme that palliative treatment, with all its attendant risks, is acceptable.”

When it comes to the conundrum facing doctors and patients who seek to treat, and manage, pain with opioids, Ballantyne says Catch-22 “is exactly the right term.” The euphoric effects of opioids, she notes, “are very seductive,” and for many patients “the tendency is to chase the memory of that blissful relief even though after a while they don’t get such good relief” from pain.

This leads to a double-bind scenario, where the snake of addiction begins eating its own tail. As Ballantyne notes, when certain patients become dependent on opiates, “they feel terrible if they don’t take them, which both patients and prescribers interpret as need. Even though they’re not getting good pain relief and they’re living in a fog, they are terrified of the alternative.”

As Burroughs himself said about the addict’s terror of going without: “The face of evil is always the face of total need.”

As for the private and public health threat opioids pose, Ballantyne argues that one of the most disturbing factors is the issue of drug availability — both in terms of escalating drug abuse and in treating those already hooked. “The basic fact is that the proportion of users who become abusers is fairly constant,” she says, adding that the percentage hangs at about 12 percent. “So the more usage and availability there is, the more overdose and death rates will go up.”

Beyond the forces of supply and demand in the economy of narcotics, Ballantyne excoriates those doctors who play haphazardly with the risks. She also says that, to a large degree, medical professionals are incapable of addressing, much less accepting responsibility for, the mess they’ve made. “The medical community is not quite ready to face the fact that it has created a lot of opioid- dependent individuals who need a special type of care,” she explains. “There is very poor availability of the type of care they need.”

And it is here that the Catch-22 of opioid use is aggravated by the compound error of years upon years of poor policy, poor planning and poor funding: “Neither pain centers nor addiction centers are either geared or willing to treat these patients,” Ballantyne says about the access to adequate care for the addicted. “The pain centers will not take on patients with admitted addiction, and the addiction centers will not take on patients with pain.”

Ballantyne points out that prohibition, both actual and de facto — along with the further criminalization of drugs and those who abuse them — tends to veer from or avoid altogether the issues of addiction and recovery. “In general, I think the ‘drug wars’ have been a disaster,” she says. “The lesson of Prohibition is quite telling.” She notes that, as criminal activity and the black market in the U.S. 1920s and ’30s made booze more available, alcoholism rates started rising toward pre-Prohibition levels.

“That was when it was recognized that Prohibition did not solve abuse but did encourage criminality,” Ballantyne explains. “Exactly the same thing happened with drugs, but in the case of drugs nobody dares lift the restrictions, and you probably can’t now.”

When it comes to treating opioid addiction, Ballantyne argues for a multi-pronged, multi-dimensional approach that can include (but is not limited to) pharmaceuticals. “All addictions are different, but in the case of opioid addiction it is fairly well established that opioid-maintenance treatment produces the best outcomes,” she explains, while also cautioning that “maintenance alone is not enough.”

Although Ballantyne agrees that opioid agonists like methadone and Suboxone “are useful tools,” she says recovery shouldn’t rely solely on the quick fix of a pill. “There needs also to be counseling and/or group support.”

Bovee, who practices medicine at the South Hilyard Clinic, agrees that a more concerted and holistic approach is required in successfully treating addiction. Again, he is one of only three physicians in Lane County waivered to prescribe Suboxone or methadone to addicts — one doctor maintains a relatively small recovery practice, while the other two, including Bovee, can maintain up to 100 Suboxone patients at any given time. Add to this his estimate that there are less than 300 patients in the county currently on methadone, and the enormity of the problem begins to rear its ugly mug. 

“I would estimate that there are at least a thousand people in Lane County who would benefit from opioid-agonist treatment,” Bovee says. In an effort to decrease what he — and anyone familiar with our dope crisis — calls “the list,” Bovee recently signed on to work with Lane County’s methadone program.

For Bovee, one of the key roadblocks for addicts seeking to get off dope is access to recovery programs, or the lack thereof. “The Lane County methadone program has a long waiting list,” he points out. “It’s, again, a year. That’s why I’m going back to work for them — to shorten that list.”

 

Shaking Hands With My Monkey

You’d think kicking dope was easy, the number of times I’ve tried. For me, there’s something about the awe-inspiring pain and discomfort of withdrawal that makes surviving it doable, at least compared to enduring the aftermath of withdrawal, when — still feeling like a pig shat in my head — the elastic mundane inanity of normal, everyday life becomes just a little too torturous.

Remember what Methadone Sybil said? “I went a long time without, but it just came back.”

It. Not I went back to it, but “it” came back for me. Like disease in remission. Like bad karma. Like Jack Nicholson in The Shining.

The trajectory of long-term opioid addiction is similar to house odds in Vegas: You may feel victorious every now and again, but the general trend of loss is downward. It has to be. That’s how Caesars Palace stays in the black while comping rooms and passing out free gin-and-tonics to veteran high rollers. And it’s why dope is such a viciously entrenched part of our consumer culture. As Burroughs noted, you don’t sell junk to the addict; you sell the addict to junk. The first hit’s always free, baby.

Eventually, addicts arrive at a point in their addiction where getting and staying high becomes more depressing than uplifting, and just downright horrifying in general, because, as an addict, you are trapped by the lesser of two evils — on the one side, maintaining an expensive and now dreary habit, or kicking cold turkey on the other. For me, that’s where Suboxone came in.

Actually, before Suboxone came surrender, that exhausted point where I tossed the bullshit aside, threw up my hands and chirped for help — in the form of counseling, both group and individual, and from the medical community at large.

I was on Suboxone for more than a year. It didn’t get me high, but it kept me from getting sick. A semblance of normality seems to be the reach of Suboxone. But the stuff ain’t cheap. When my insurance coverage ceased, I began paying upwards of $300 a month for Suboxone, and decided to do a quick and rather abrupt reduction before I ran out of money altogether.

Rapid reduction is far from optimal. Cutting back on Suboxone by halves, and in half the suggested time, I got sick as hell, and the pharmaceutical half-life of Suboxone (how long it stays in the system) has ensured that it still kicks my ass on a regular basis. There’s a chance I may not feel “normal” for a year, but I’ll take it. Clean is clean.

Suboxone is a far from controversial drug. A lot of folks in recovery, and especially many of those in Narcotics Anonymous, consider any sort of pharmaceutical crutch in recovery to be a cheat. So there’s that. Also, the symptoms of Post-Acute Withdrawal Syndrome — which can persist for months thanks to the long half-life of Suboxone — are, for some people, a persuasive argument that the cold-turkey straight kick is a better way to go. Some bloggers (see Suboxonetalkzone.com, for example) have accused Reckitt Benckiser Pharmaceuticals Inc., which makes and distributes both Suboxone and Subutex, of pulling Suboxone tablets (the medication also comes as a dissolvable film) from the market — not, as Reckitt Banckiser officials claim, because the tablets pose overdose risks to children but because Suboxone is due to go generic, and the company wants to keep a stranglehold on the market.

I don’t have the answers to these allegations and, for my purposes here, I’ll leave this particular controversy to another story. Suboxone worked for me — far from perfectly, but perfectly enough. “There is no silver bullet for opioid dependence treatment, and outcomes vary from patient to patient,” Tim Baxter tells me. Baxter is global medical director for Reckitt Benckiser, the Big Pharma company based in the U.S. out of Richmond, Va., that makes and distributes Suboxone, Baxter proved more than forthcoming when answering my questions, so I have no Big-Pharma cudgel to wield here; like any patient, whether before treatment or in retrospect, I simply wanted to know more about what I’d been taking, and why.

Suboxone may not be a “miracle drug” but, scientifically speaking, it does qualify as an elegant and sleekly brilliant instance of Occam’s Razor in action. Buprenorphine, the main ingredient in Suboxone (and the only ingredient in S                             ubutex) is a partial opioid agonist that binds to the brain’s opioid receptors while simultaneously blocking other opioids. In so doing, Baxter explains, buprenorphine “produces less maximal opioid effect than full opioid agonists such as oxycodone, hydrocodone, morphine, methadone and heroin” — the good stuff that gets junkies high, in other words.

Suboxone, unlike Subutex, also includes naloxone, an opioid antagonist that “reduces the medication’s attractiveness for deliberate misuse,” Baxter adds. Misuse, as I understand it, includes shooting the stuff up. When Suboxone is taken as prescribed, he says, “the naloxone has no effect.”

Here’s the aspect of Suboxone treatment that appealed to me — and, by extension, might appeal to a good number of addicts currently recovering under the strictures of a daily methadone program: “As a result of the Drug Abuse Treatment Act of 2000,” Baxter says, “patients can now receive treatment confidentially in a doctor’s office, enabling individuals who may not have sought help previously to access treatment in their own community, often from their own doctor.

“Because the medication is approved for at-home use,” Baxter continues, “patients can continue their daily lives while under a doctor’s care, in much the same way that other chronic diseases are managed, such as diabetes, asthma or hypertension.” This is a huge step in the ongoing development of recovery therapies because — as we saw with Sybil’s bucking against the allegedly patronizing ways of the county’s methadone clinic — it bestows upon addicts a level of respect, maturity and responsibility that can go a long way in “recovering” a normal life.

Of course, Suboxone also carries risks. Remember, we are talking addiction here, and one aspect of a strong recovery program involves the addict’s learning to take his medication in a regular and responsible manner (veteran junkies would abuse Pepto-Bismol if it were illegal).

Baxter, like everyone involved in the field of recovery I spoke with, insists that medication alone is a poor substitute for tackling recovery from all possible angles, and according to individual need. And, when it comes to getting off buprenorphine itself, the same idea appears to hold true. 

“There is not a one-size-fits-all approach to discontinuing Suboxone,” Baxter says, adding that the decision to stop “should be made as part of a comprehensive treatment plan. The important factor is to ensure that appropriate counseling takes place and a relapse plan is established.” 

 

Manifest Destiny

Is there something about the Pacific Northwest that pushes so many of its sodden, mist-enveloped denizens to seek solace in chemical nirvana? I think so, though I have as proof only the kind of anecdotal evidence that wouldn’t stand a snowball’s chance in hell among scientific types. But, considering the fact that, not all that long ago, homosexuality was considered an aberration, African-Americans were constitutional property and only three-quarter human, and addiction to opiates was considered, by law, a moral failing, I say fuck science. Science blew up the Holy Ghost in Nagasaki. Science ain’t got no soul.

The soul of the Great Northwest is wicked and scorched, tangled by a gruesome haunted history that stretches back much further than those spavined pioneers huffing their luggage over the Oregon Trail. The trees have secrets here — secrets smothered in moss and swallowed by the ocean. Make no mistake: A forest is still a jungle, even if you’re more likely to die of hypothermia in the Hoh Rainforest than die of thirst. We Northwesterners might have beat back nature for the time being, but nature will get the last laugh. The early natives counted on it.

A dank, gothic miasma suffuses the Pacific Northwest; it’s got something to do with the way Manifest Destiny ran dry against our cold, rocky shores, and the way anyone who tapped the Calvinist spirit and stuck around at the ass end of the continent became a victim of waterlogging and too little sun. We are underdogs here, losers who seek a smug sort of comfort in our chronic defeatism. Francis Farmer. Ted Bundy. Kurt Cobain. Suicide rates are high in states like Oregon and Washington, and in a strange sense, offing yourself instead of, say, traveling south to sunnier climes, seems almost redundant. We are immaculate dead here, zombies of the fungus.

Opiates, which wax a mausoleum sheen on a life lived in failure, offer a means of achieving physiological stasis for seasonally affected sad-sacks who don’t have the wherewithal to budge from the toadstool of life. Sure, it’s a risky means, with shitty odds, but our culture as a whole isn’t all that great at preparing individuals with tools for coping with the vapidity of our consumer culture.

Am I saying addiction is not a disease? By no means. Statistically, I was a goner in utero. I was a loaded die. But if we continue to ignore the cultural and social factors that compel dissatisfied people like me to strive, ignorantly, to feel normal, we’re going to continue to have dirty needles on the one side, and Sandy Hook on the other, with everyone else trapped in-between.