What ‘Dope Sick’ Really Feels Like

See Author Article Here
By Brian Rinker

Detoxing off heroin or opioids without medication is sheer hell. I should know.

For many users, full-blown withdrawal is often foreshadowed by a yawn, or perhaps a runny nose, a sore back, sensitive skin or a restless leg. For me, the telltale sign that the heroin was wearing off was a slight tingling sensation when I urinated.

These telltale signals — minor annoyances in and of themselves — set off a desperate panic: I’d better get heroin or some sort of opioid into my body as soon as possible, or else I would experience a sickness so terrible I would do almost anything to prevent it: cold sweats, nausea, diarrhea and body aches, all mixed with depression and anxiety that make it impossible to do anything except dwell on how sick you are.

You crave opioids, not because you necessarily want the high, but because they’d bring instant relief.

Quitting heroin was my plan every night when I went to sleep. But when morning came, I’d rarely last an hour, let alone the day, before finding a way to get heroin. My first time in a detox facility, I made it an hour, if that. As I walked out, a staff member said something to the effect of “I didn’t think you’d last long.”

After my parents moved out of town, in part to get away from me, I would show up at their new home five hours away with big hopes of kicking the habit and starting a new life. But after a night of no sleep, rolling on the floor convulsing while vomiting into a steel mixing bowl, I’d beg them for gas money to drive the 300 miles back to where I lived and a little extra cash for heroin. I did this so often my mother once told me in frustration, “You show up, throw up and then leave.”

Going through “cold turkey” withdrawal is, not surprisingly, impossible for many. That’s why the medical community has largely embraced the use of methadone and buprenorphine — known medically as medication-assisted treatment, or MAT — combined with counseling, as the “gold standard” for treating opioid addiction. As opioids themselves, these drugs reduce craving and stop withdrawals without producing a significant high, and are dispensed in a controlled way.

“Detox alone often doesn’t work for someone with an opioid use disorder,” said Marlies Perez, chief of substance use disorder compliance at the California Department of Health Care Services, who estimated that it might be a realistic option for only 15 out of 100 people.

Studies have also shown that MAT reduces the risk of overdose death by 50 percent and increases a person’s time in treatment.

Yet even with strong evidence for MAT, there is debate over whether to offer MAT for people struggling with opioids. Some states, like California, have vastly expanded programs: The Department of Health Care Services has 50 MAT expansion programs, including in emergency rooms, hospitals, primary care settings, jails, courts, tribal lands and veterans’ services; the state has received $230 million in grants from the federal government to help with these efforts. But many states and communities hew to an abstinence or faith-based approach, refusing to offer MAT as an option. In 2017, only about 25 percent of treatment centers offered it.

Just as each person’s journey into addiction is unique, different approaches work for people trying to find their way out. Public health experts believe they should all be on the table.

Diane Woodruff, a writer from Arizona who became addicted to opioid medication prescribed for a bad back, described withdrawal like this: “If you’ve ever had the flu it’s like that but times 100.” Woodruff went through the sickness every month for five days until she could refill her prescription of OxyContin.

Other people described the sickness as if ants were crawling under their skin or acid was being injected into their bones. Woodruff was able to quit for good after she went cold turkey, sort of. She used kratom and marijuana to help with the detox.

Noah, a 30-year-old from San Francisco who asked that his last name not be used, said that MAT was a “miracle,” therapy adding, “It saved my life.” Noah spent five years on Suboxone, a brand-name formula of buprenorphine and naloxone, right around the time fentanyl began taking lives with impunity. Suboxone took away his craving for heroin, but he kept drinking alcohol and injecting cocaine and using other drugs for a while until joining a sobriety community. He finally weaned off MAT half a year ago.

“There’s no debate that MAT works — the evidence is clear,” said Dr. Kelly Clark, president of the American Society of Addiction Medicine. Opioid use changes the chemistry of the brain, sometimes permanently. Buprenorphine and methadone stop the withdrawals, diminish cravings and, when taken as prescribed, block the high from other opioids. These medications “tone down and reset the brain,” helping to “normalize” the individual, Clark added.

Within the nine years of my heroin use, I tried to get sober many times: detox, residential rehab, and with morphine and methadone under the guidance of a health care professional. For me, Suboxone didn’t prove the answer, although (to be fair) I never took it as prescribed under the supervision of a doctor. I was ambivalent and incapable of following directions, let alone a treatment plan. I didn’t want to be shackled to another opioid or have to check in with a health care professional every week or month or have to go to counseling — even if all that could have helped me to function better. (A common critique of methadone or buprenorphine is that it is just replacing one drug for another.)

But Suboxone ultimately kick-started me into sobriety. One day in December 2008, I tried one more time to detox successfully off heroin at my parents’ house. To make it easier, I had a couple of pills of Suboxone, illegally obtained. So, after the body aches and that weird feeling when I peed, the buzzing ball of anxiety began to grow in the pit of my stomach and, just when life began to seem unbearable, I crushed one of the Suboxone tablets up and snorted it off my dresser. Unbeknownst to me at the time, when Suboxone is crushed, it releases an anti-tampering chemical that sends the user into full-on withdrawal.

I spent the next three days shut up in a room as my body and mind began to unravel. I barely slept and there was plenty of diarrhea and vomiting. After the worst of it was over, I apathetically roamed my parents’ house, not sleeping for two weeks. Then, I joined a sobriety community and haven’t touched an opioid in 10 years.

MAT was not the escape route from addiction for me, personally, and I have mixed feelings about these medications. But with tens of thousands of opiate overdose deaths each year, it makes sense that people struggling with addiction and facing the terrifying specter of withdrawal have every option available.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

FDA’s Opioids Adviser Accuses Agency Of Having ‘Direct’ Link To Crisis

The Guardian Article Here

The Food and Drug Administration is sacrificing American lives by continuing to approve new high-strength opioid painkillers, and manipulating the process in favor of big pharma, according to the chair of the agency’s own opioid advisory committee.

Dr Raeford Brown told the Guardian there is “a war” within the FDA as officials in charge of opioid policy have “failed to learn the lessons” of the epidemic that has killed hundreds of thousands of people over the past 20 years and continues to claim about 150 lives a day.

Brown accused the agency of putting the interests of narcotics manufacturers ahead of public health, most recently by approving a “terrible drug”, Dsuvia, in a process he alleged was manipulated.

“They should stop considering any new opioid evaluation,” said Brown. “For every day and every week and every month that the FDA don’t do the right thing, people drop dead on the streets. What they do has a direct impact on the mortality rate from opioids in this country.”

Brown, an anesthesiologist who chairs the FDA committee of specialists advising the agency on whether to approve new opioid painkillers, said he no longer had confidence in repeated assurances by the FDA leadership that it was taking the epidemic seriously and prepared to put public health above the commercial interests of drug makers.

“I think that the FDA has learned nothing. The modus operandi of the agency is that they talk a good game and then nothing happens. Working directly with the agency for the last five years, as I sit and listen to them in meetings, all I can think about is the clock ticking and how many people are dying every moment that they’re not doing anything,” he said. “The lack of insight that continues to be exhibited by the agency is in many ways a willful blindness that borders on the criminal.”

Brown’s comments echo criticisms by US senators who have condemned the FDA for what they say is its “complicity” in the epidemic, for approving the powerful painkillers that drove the crisis and then failing to use its powers to protect the public as the death toll escalated.

Four US senators wrote to the head of the FDA, Dr Scott Gottlieb, late last year urging him not to allow Dsuvia, a powerful opioid pill, on to the market because it was “to the detriment of public health”.

Dsuvia is a branded narcotic sufentanil pill, a more potent version of fentanyl, made by Californian pharmaceutical company AcelRx. The signatories included Senator Joe Manchin of West Virginia, whose state has the highest rate of opioid overdose deaths in the country.

“This puzzling and unacceptable course of events is unfortunately reminiscent of previous FDA processes and practices that contributed to the opioid epidemic,” the letter said.

The FDA’s credibility has been badly damaged by the opioid crisis amid accusations that at times it behaved less as a regulator overseeing the pharmaceutical industry than a business partner of drug manufacturers. The agency helped unleash the epidemic two decades ago when it approved the sale of a high strength narcotic pill, OxyContin, as safer and more effective than other painkillers on the say so of the manufacturer, Purdue Pharma, and without requiring clinical trials. Since then the FDA has approved other opioids for wide prescribing even as evidence mounted the drugs were addictive, open to abuse and often not effective for long-term use.

The FDA was also embarrassed by revelations that officials responsible for opioid approvals were taking part in “pay to play” schemes in which manufacturers paid to attend meetings to draw up the criteria for approving prescription narcotics.

Donald Trump’s opioid commission identified the failure of the FDA and other federal institutions to properly regulate opioids and their manufacturers as an important factor in the epidemic.

After Trump appointed Gottlieb, the new FDA chief admitted the agency “didn’t get ahead” of the crisis and promised “dramatic” action. He said he favoured examining not only whether an opioid worked but whether it was needed and whether the risks of it feeding the epidemic outweighed benefits for patients.

But that commitment has been called into question by the slow pace of introducing new practices and regulations – and by the approval of Dsuvia, a potent pill developed with the US defense department.

An advisory committee rejected the drug in 2017 over safety concerns. The senators said that they were “deeply troubled” that when Dsuvia was resubmitted for consideration the following year, the FDA excluded members of the agency’s drug safety committee from the hearing. The senators also said they were concerned because the decision was made when Brown, a strong critic of Dsuvia, was absent at a professional conference in San Francisco.

“There’s no question in my mind right that they did that on purpose,” he said. “The FDA has a lack of transparency. They use the advisory committees as cover.”

The FDA is not required to follow the decisions of its advisory committees but has been wary of going against their decisions since 2012, when the agency created a political storm by overruling a decision to reject Zohydro, an opioid 10 times more powerful than regular painkillers.

Doctors and specialists on the committee questioned the safety of the drug and the need for it given the epidemic. The senior FDA official at the hearing, Dr Bob Rappaport, who was head of the agency’s opioid approval division, angered other members by telling them there had to be “a level playing field for business”, which was widely interpreted as putting the right of pharmaceutical companies to make money ahead of public health.

Brown described a breakdown in confidence and trust between his advisory committee and FDA officials responsible for opioid approvals. He characterized them as out of touch with the consequences of the epidemic and locked into a view promoted by drugmakers that those who become hooked are to blame for their addiction not the pills or prescribing practices.

Brown blamed the problem in part on “cozy, cozy relationships between the pharmaceutical industry and various parts of the FDA”. Since a change to the FDA’s funding in the 1990s, the agency division responsible for opioid approvals relies on the drug industry for 75% of its budget. The agency denies the money buys influence.

The FDA declined to respond to Brown’s specific criticisms.

Gottlieb has previously defended Dsuvia by saying it is required for use in circumstances where other drugs cannot be administered, such as a battlefield. The FDA chief promised “very tight restrictions” on its distribution to stop the drug appearing on the illicit market. He insisted the FDA had “learned much from the harmful impact” that prescription opioids have had.

But Brown remains skeptical.

“Nothing is fundamentally being done to effect change in the regulation of opioids. If the FDA continues to encourage the pharmaceutical industry to turn out opioid after opioid after opioid, and the regulation of those opioids is no better than it was in 1995, then we’ll be cleaning this up for a long time,” said Brown.

Chris McGreal is the author of American Overdose: The Opioid Tragedy in Three Acts

Opioid Expert Accuses FDA of ‘Willful Blindness’ After It Approves Powerful New Painkiller

National Addiction News Article Here

An expert tasked with helping the Food and Drug Administration weigh potential new opioid drug approvals is openly calling out the agency for what he alleges are its continued missteps in handling the opioid crisis. In an interview with the Guardian Thursday, Raeford Brown claimed that the FDA has failed to learn from its past mistakes by approving the drug Dsuvia last year, the tablet form of an opioid painkiller up to ten times more potent than fentanyl.

Brown, a professor of anesthesiology and pediatrics at the University of Kentucky, was tapped to chair the FDA’s Anesthetic and Analgesic Drug Products Advisory Committee in 2018. One of the committee’s duties involved recommending whether or not Dsuvia should be approved. (The FDA rarely goes against the recommendations made by its outside committees.) Ultimately, the committee voted 10 to 3 for its approval. But Brown alleged to the Guardian that the approval process had been manipulated, and that the FDA has still largely avoided taking any serious action to curtail the role of legal opioids in the crisis.

“I think that the FDA has learned nothing. The modus operandi of the agency is that they talk a good game and then nothing happens. Working directly with the agency for the last five years, as I sit and listen to them in meetings, all I can think about is the clock ticking and how many people are dying every moment that they’re not doing anything,” he told the Guardian. “The lack of insight that continues to be exhibited by the agency is in many ways a willful blindness that borders on the criminal.”

In 2017, Dsuvia was actually rejected for approval by the FDA, with the agency calling for additional safety data from its maker, AcelRx. But the vote by the panel convened last October occurred while Brown was unable to attend—a decision Brown contends was intentional. Brown had long criticized the potential approval of Dsuvia, a stance he says the FDA was well aware of.

“There’s no question in my mind right that they did that on purpose,” he said. “The FDA has a lack of transparency. They use the advisory committees as cover.”

Brown isn’t the only one who had trouble with how the FDA ultimately approved Dsuvia. In a letter sent to the FDA last October, senators Joe Manchin (D-WV), Edward Markey (D-MA), Richard Blumenthal (D-Conn), and former senator Claire McCaskill (D-Miss) criticized the agency over Brown’s absence during the panel vote. The senators also criticized the FDA’s decision to not fully include another panel of experts, the Drug Safety and Risk Management Committee, in the approval process of Dsuvia.

Soon after its approval in November, FDA chief Scott Gottlieb went out of his way to tamp down criticism. In a statement, Gottlieb said that there were “very tight restrictions being placed on the distribution and use of this product.”

Dsuvia is a form of the opioid sufentanil, taken as a tablet that dissolves under the tongue. It’s currently approved for people with moderate to severe pain who haven’t responded to other treatments. The drug is supposed to be administered only in medically-supervised health care settings, such as hospitals and emergency rooms, by approved medical staff.

But sufentanil tablets like Dsuvia can still potentially be abused or improperly dosed to patients, according to the National Institute for Health and Care Excellence in the UK. And there’s still the possibility they can end up in the black market. The European Union approved a similar tablet version of sufentanil made by AcelRX, Dzuveo, last summer.

Brown, for his part, doesn’t buy Gottlieb’s assurances. And he thinks until the FDA has gotten its act together, no new opioid drugs should hit the market at all.

“They should stop considering any new opioid evaluation,” Brown told the Guardian. “For every day and every week and every month that the FDA don’t do the right thing, people drop dead on the streets. What they do has a direct impact on the mortality rate from opioids in this country.”

The FDA as well as AcerRX have not immediately responded to a request for comment from Gizmodo on Brown’s accusations.

We Now Have an App for Detecting Opioid Overdoses

“And that could save thousands of lives since over 130 people die every day due to opioid overdoses, according to the National Institute on Drug Abuse.”
See App Article HERE

My area of focus when studying Clinical Neuropsychology was Substance Use Disorders, & I’ve gotten some hands-on experience in clinics specializing in Vivitrol and Naltrexone treatments to maintain a clean lifestyle for many people on the road to recovery from addiction.

There always seems to be a new types of technology that are designed to help the modern-day addict who happened to may have overdosed ….again. The last pretty innovative gadget was then device picture below. A pocket-size Narcan dispenser that is user friendly to almost any age group that can follow simple spoken directions.

The “The app, called Second Chance, was created by researchers at the University of Washington. By using sonar to monitor a person’s breathing rate – one of the main indicators of an overdose – the app can determine whether a person is overdosing from up to three feet away. And if the phone owner is using opioids all by themselves, the phone could save their lives by automatically reaching out for help.

“The idea is that people can use the app during opioid use so that if they overdose, the phone can potentially connect them to a friend or emergency services to provide naloxone,” said co-corresponding author Shyam Gollakota. “Here we show that we have created an algorithm for a smartphone that is capable of detecting overdoses by monitoring how someone’s breathing changes before and after opioid use.”

And that could save thousands of lives since over 130 people die every day due to opioid overdoses, according to the National Institute on Drug Abuse.

On top of monitoring sound waves, the app as well as monitoring the person’s movement to see if they have lost consciousness. For now, it can’t interact with phone owners, but this is something the creators will look toward in the future.

“When the app detects decreased or absent breathing, we’d like it to send an alarm asking the person to interact with it,” Gollakota said. “Then if the person fails to interact with it, that’s when we say: ‘OK this is a stage where we need to alert someone,’ and the phone can contact someone with naloxone.”

So the smartphone could become the tool that health officials have been desperately seeking to combat the opioid epidemic. ”

-The Website

Suicide Flashbacks

This fucked me up. It is almost an actual play-by-play of my failed suicide attempt. Except I got the cap off, & nothing fell on the floor. Dramatics are on point.

Now with the antidepressants having done some good, seeing this is really screwing with me. I can see the stress I saw in my boyfriend’s eyes, the almost word-for-word dialogue before he carried me to the bathroom, the reality of how she really isn’t just screwing around. That’s me.

I promise new Snowboarding & Suicide Series posts are on their way.  I was working on one when I saw this, & I need a minute. Dab pen time.

“Break The Silence For Suicide Attempt Survivors” A TedTalk

“Research shows that 19 out of 20 people who attempt suicide will fail. But the people who fail are 37 times more likely to succeed the second time. This truly is an at-risk population with very few resources to support them. And what happens when people try to assemble themselves back into life, because of our taboos around suicide, we’re not sure what to say, and so quite often we say nothing. This causes further isolation”

Quote from https://www.ted.com/talks/jd_schramm?referrer=playlist-the_struggle_of_mental_health&utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare
I love this quote.

There is so much truth in this quote. After I survived, I almost did the exact same thing 5 days later. I was still scared to tell most of my support system & was not the least bit grateful or happy to still be alive. Half of the time I did not know how people would react, & half of the time I worried I would be committed to a Psychiatric Ward for Observation. There is massive stigma even around mentioning suicide, let alone discussing a failed attempt. It is hard to decide to live. You can do it, though!

02 Snowboarding & Suicide Series: Identifying Depression (How It Took A Suicide Attempt To Show Me I Was Depressed)

*Just some of the symptoms of depression.
I always recommend doing some research yourself because depression looks different to each person.

Depression is a fickle bitch and her face looks different to everyone she meets. Sometimes you don’t even know her real name until she is eating at your table and sleeping in your bed. Sometimes she is loud and the center of attention… locking you in your room and cutting all ties, chaining you to the bed. Sometimes she is like a mom that pretends she’s cool and hip but really can’t let loose. Always nagging at you if you do anything that might be off the beaten path. Whether she restrains or reminds you, she is there.

It turns out I have high-functioning depression.


I really don’t know how I didn’t know I was so depressed at the point of killing myself. I have a B.S in Psychology, I am in Psi Chi – the International Honor Society in Psychology.. I scored in the top 1% in the nation on my Psychology exit exams and have some internship and doctorate training in Clinical Neuropsychology under my belt. This is kind of my thing. I had no idea how bad my mental state had gotten.

I have always had high-functioning anxiety, and some episodes of depression, but I was always convinced that I didn’t need antidepressants or anything – but my xanax is always by my side.

I was able to hold down a job, and manage to get through each day good enough to make myself believe that I was fiiiiiine. Sure, I had no sex drive, didn’t get out of bed if I didn’t have work, barely slept and didn’t do a goddamn THING unless I took a piece of my (prescribed) Adderall. I was getting by.

Why wouldn’t I be anything but happy?
I was number 1 in sales, case commissions, and wine club sign ups for 5 straight months. I was living in Oregon with my amazing boyfriend and our dog child. I was financially secure & had a great support system. What is there to not be happy about?

The thing I didn’t realize until after I tried to kill myself was that it was not that I wasn’t happy… I was numb. Going through the motions. I felt nothing at all. That’s why swallowing the pills and the actuality of how close I was to dying never really sunk in. It didn’t it even feel like it was me that tried that. TOTAL DETACHMENT. I just got back to my life as though it didn’t happen. My boyfriend knew better than to push it but I knew he was worried. Things had to change soon & I knew that, but where do you go when you can’t even grasp the heaviness of the situation and feel any emotion towards it?

The moral of the story is to check in with yourself. Yeah, some stuff in life is going to suck because that is just how it goes. But this shouldn’t be the norm. If you notice that shit that used to get you all excited sort of has a blunt affect then maybe do a little reflecting on how things are going in general.

Laziness, and regular tiredness are not the same as not showering or leaving your bed for three days with the excuse that they are your days off. Every daily situation shouldn’t feel like a hassle you want to escape from, I didn’t realize that wasn’t normal until the Lexapro finally kicked in and I actually had an enjoyable time GETTING HEALTH INSURANCE yesterday. Enjoyable and Health Insurance usually aren’t in the same sentence. That was eye-opening.

Regularly check in with yourself, your habits, and your feelings.