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

How To Cope With Addiction When We Also Have Depression

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When we think of addiction, our thoughts tend to turn to drug and alcohol addiction but addiction can relate to numerous different things; drugs, alcohol, food, exercise, pornography, gaming, social media, tattoos, self-harm, gambling, shopping – anything that we feel as though we’re not in control of, and has an impact on our mood and behaviours. Addiction can be incredibly difficult to cope with, particularly when the things we’re addicted to are often readily available. Depression and addiction can go hand in hand. Addiction can help us to cope with depression, but equally, depression can be caused or worsened by the things we’re addicted to.

Depression: Coping With Addiction
IDENTIFY TRIGGERS
In terms of addiction, triggers are any emotional or environmental factors that cause us to feel as though we need to use our addiction. It could be related to people, places, things, times of the year, or something else. Working out what our triggers are can take time, but once we know what they are, we can avoid them or learn ways to manage them.

HIGH-RISK SITUATIONS
High-risk situations are similar to triggers, but rather than being a specific ‘thing’, such as ‘seeing a person walking a dog’, they’re specific situations. This could be something like Christmas, seeing family, or getting a piece of negative feedback at work. Sometimes these situations can be difficult to spot until we’re in them, so it can be helpful to make a note when a situation causes us to feel like we need our addiction.

Once we identify these situations, we can make a plan for how to cope with them without turning to our addiction.

For example, if one of our high-risk situations is ‘seeing my auntie’, we might choose to see them less often, only see them in the company of other friends/family, and invite a friend to stay over for the night whenever we do see them, so that we’re not having to cope alone. We could also note down any alternative coping mechanisms we could use, so that we don’t have to think about them ‘in the moment’, and can just refer to our notes. It’s often helpful to write down a couple of different ideas because sometimes our first or second ideas aren’t possible or don’t work.

Depression: Coping With Addiction
CLICK TO TWEET

WORKING OUR HOW OUR ADDICTION HELPS US
If our addiction didn’t help us on some level, we wouldn’t keep using it. Something that can be really key when coping with addiction is working out how it helps us and then finding a healthy coping mechanism to replace it. It can sometimes be helpful to use the acronym ‘Hungry Angry Lonely Tired (HALT)‘ when thinking about the need that we’re filling, as these are common emotions associated with addiction.

ALTERNATIVE COPING MECHANISMS
Having a list of coping mechanisms that we can use when we want to turn to our addiction is helpful. We’re all different, and we all turn to our addictions for different reasons, so we will find that different coping mechanisms work for different people. As an alternative to our addiction, we could try things like watching TV, reading, walking, talking to a friend, drawing, writing, painting, listening to music, listening to podcasts, doing some breathing exercises, ripping up sheets of paper, drawing on ourselves, running, cleaning, self-soothing, doing some puzzles, singing, hugging a pet, dancing, playing with play-doh or contacting a helpline. Sometimes we’ll have to try a coping mechanism a few times before we can get it to work for us – practice makes perfect!

REMINDERS
There are times when we don’t see the point in fighting our addiction. It feels too hard. We’re too tired. There’s no point because we can’t do it so why even bother trying?!

At times like these, we have no interest in reaching out for support, or in using healthy coping mechanisms.

These times are very ‘high risk’, in terms of falling back into our addiction. Having reminders of why we don’t want to go there can help us to keep going. This could be in the form of photos on our phone, on the wall, or in our purse or wallet. We might have lists of ‘reasons to keep going’, or ‘things we want to do once we’re up to it’. There might have been a time when we had a particularly amazing day, and we might have a momento from that day that we can hold. A specific smell or taste could take us back to happier times that we’re hoping to replicate at some point in the future. Keeping little reminders in our house, bag, or coat pocket, can help us to keep going at times when we want to return to our addiction.

REFLECT
There are times when things go really well, and we feel like we’re beating our addiction. At other times, things don’t go so well, and it can feel as though our addiction is beating us.

It’s important to remember that a lapse is not the same as a relapse. Recovery is not a straight line. Whether things go right, or wrong, it’s important to reflect and learn from them.

If we’ve managed a difficult situation without turning to our addiction, then that’s wonderful progress! How did we do it? What coping mechanisms did we use? Is there anything that could be helpful to note down so that we know to try it again in the future?

If we’ve struggled through a difficult situation and turned to out addiction, then we haven’t failed, we’ve just had a wobble. Recovery is a learning curve, and we can learn as much (if not more) from our mistakes as from our successes. What went wrong this time? Was there a trigger that we weren’t expecting, or a high-risk situation that we didn’t know would be high-risk? Did anything go right? Can we think of anything we could do differently in future? Sometimes we have to try a coping mechanism a few times before we can get it to work. At other times, we might have tried a coping mechanism that didn’t work for us at all, so it’s not one that we want to try again.

This reflection can be really important because it can help us to keep moving forward. Some of us might find it helpful to journal this sort of thing.

Depression: Coping With Addiction
HONESTY IS IMPORTANT
One of the most important things when it comes to addiction is honesty. Honesty to others, and honesty to ourselves. Lying to ourselves and others is likely to cause a lot of problems, so even when it’s really difficult, it’s important to try and tell the truth.

SUPPORT SYSTEM
We don’t have to cope with addiction alone. Addiction can be incredibly strong, so we need to try and build up a strong support system to fight it with. Our support system doesn’t need to be massive, but it can be helpful to have a couple of friends or family members or organisations we can turn to when we’re struggling. Sometimes, it can be dangerous to stop an addiction ‘cold turkey’, so it’s often a good idea to reach out for some professional support on top of the support we get from our loved ones. We might also find that some medication, therapy or counselling from professionals is something that we need.

There are times when we struggle to let people help us. We might feel as though we don’t deserve it or we’re being a burden – but we do deserve support, and in the same way that if one of our friends were struggling, we’d want to support them, our friends will probably want to support us. There are times when it can be hard to reach out for support because we don’t have any hope, but there’s nothing wrong with letting other people hold our hope for a little while until we’re able to hope again.

SUPPORT GROUPS
On top of support from our friends, family, and professionals, we might find that support groups with others who have experienced similar addictions to us can be comforting and can help us to cope. Sometimes being around others who’ve experienced similar things to us can help us to feel less alone, and can give us some hope of things improving. There are different support groups for different addictions including alcoholics anonymous, narcotics anonymous, national self-harm network, sex addicts anonymous, overeaters anonymous, Beat support groups, on-line gamers anonymous, and gamblers anonymous.

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