Breaking free of 12-Step Dogma re Opiates and other Addictions

 

Was a professional beach volleyball player, very very active exercise bulimic, exercise addiction have had 4 foot surgeries, and big ones, 2 knee surgeries, and am now 56, 2 days away from 57. On and off opiates for 25 years, post operatively and when surgeries went south due to doctor malpractice.

Been thinking about opiate epidemic alot and the thread that runs through depression, despair and addiction, because I fell in that trap. I ended up taking an unusual way out, not the traditional dogma and so forth. I’ve been to so many different programs OA, AA, group therapy and hospitalization for same, surgeries from overexercise, and being that as an actor, thin was in..1970’s, Post Twiggy Lauren Hutton Culture, the opiates…well they snuck through the side door when cocaine was the main attraction. It follows, in this case, I needed an alternate egress of escape.

Same with my Tardive Dyskinesia (TD) I got from my atypical antipsychotic, one that they don’t prescribe much anymore it’s so neurologically aggravating, according to comparative studies of these products. I have these uncontrollable movements, also bad for pain, especially if you have it.

This conditions are one big knot of iatrogenic (Caused by drugs, medical treatment or medicine itself) disorders, particularly psych drugs. The fallout of all of it, especially the side effects of widely popular, highly profitable medication is the big elephant in the room. I hate to use this overused catchphrase, but it’s stigma. Even though the drugs caused these problems, I always felt I was the disease.

Just like with the opiate epidemic. Who wants to stand up and say that they never want to get high again but at the same time can’t imagine a life without  Even thinking about it is abysmal. Who wants to commit to quitting, something they can’t commit to? Plus, people are in legitimate pain, at least, I was.

There’s a whole new way of looking at Addiction and some of the limitations of the traditional, one size fits all, punitive ‘the program.’ Don’t get me wrong. If it weren’t for AA I might not be alive, but there are some things about it I’m glad I left behind.

Black and white thinking, for one. Paternalism, for two. Little digs at the soul such as “Once an Addict Always an Addict” not helpful to me.

On the other hand, the big book of AA is one of the most inspired texts on the planet. I believe it was a divine act, or Bill and Bob were savants of one sort or another. As Bobby Womack sort of sang in “Across 110th Street”  ( Tarantino’s “Jackie Brown,”) You never know what you’ll do until your back is…I’m going to go look that lyric up right about now. Music is Medicine to me.

Allison Strong

Faceless, Corporate CVS/Silverscript Part D Denying coverage of longtime medicine

I hate dealing with these huge corporations. They don’t care. We are numbers to them and they’ve decided my life is too expensive for them. Denial of benefits. Denial of expedited appeals process. Third party arbitrator that they own.

It happens to everyone. A medicine you really need is suddenly no longer covered. In my case, CVS deemed it not medically necessary for me to have Relistor, a drug I take when I really can’t go. I take tons of meds because of Tardive Dyskinesia and a microdose of Suboxone for Chronic pain, part of Tardive Dyskinesia.

Then I do an expedited appeal, and I’m denied again, and now……I’m sent to what’s supposedly third party arbitration, and it’s a phone number that nobody answers. Then I call Silverscript back, file a grievance and ask them when I will hear back on the grievance and they say, well, maybe thirty days. Then I ask about this third party arbitrator, Maximus, the one where no one answers the telephone, and there’s no timeline on when I might hear back from something I mail or fax. Just unbelievable.

 

I ask you…where do I lodge my next complaint?  This story about denial of benefits has been told time and again…..But I’m going to write about it….I just don’t know where.

 

Suicidal Bipolar Projects ‘Plan,’ and I’m in Hospital?

How else can I say it, title it?

allicat

You are my people. My resource.

You hear it first.

My life is messy.

It’s not the worst.

My BFF turned my life upside down.

You guys know I have chronic pain and was looking for a way out. I went Cold turkey for over a week. The worst pain I’ve ever had except for the 60 day flare in reaction to an ‘interventional pain management’ pain doc. Yeah, ‘interventional’ all right. Between me and my life. Between me and my pocketbook. Once back on, thought I could not get off. But I’ve been sick ever since. Hey, you play you pay.

Weak and sick I wanted to go to the ER and check for an obstruction. On the way gonna stop by my BFF’s. I’d packed my low sugar high fiber foods and protein Shakes with Pomegranate in them and Off I was gonna go. Except for one hitch. She’d called the cops and said I was suicidal. Cuffed and dragged off to the psych ward. Then she called my father and told him private stuff. She’s always hated my husband. Partly because he doesn’t have money and she thinks I could do so much better.

I’ll really miss her. Foreign films, world affairs, someone intellectual, worldly and brainy to be around and another former disc jockey.

I think it’s a marketable story. What can I call it in seven words or less so that betrayal and paradox jump right off the page; promising a publisher clicks? Can I Sell it to Buzzfeed? Vice? Gawker? Who?  It’s got to be a rebellious type of publication. One that questions the system a tad.

The two publications I write for probably wouldn’t appreciate my caustic tone when I describe yanking the warden’s chains; claiming I’m a nationally published writer who is also in their daily newspaper, a mantle of credibility which happens to be true. People get starstruck.

The puzzlement on their faces was precious. Priceless.   Maybe it’s true. Maybe she’s here by mistake. Our mistake.

Where does this story of one friendship (probably a sick, codependant attachment) end and a new life of healthier pursuits and a more balanced set of associates begin?

Because it’s not really about what she did to me, it’s about why I attract people to my life sicker than I am. That’s what’s nuts.  Then I share my intimacies. Totally Bonkers.

All along I assumed she understood and she’d just been laying in wait to get me locked up somewhere.  She’s disapproved of my level of care and self care all along, right down to the cooler full of raw foods, low sugar fruit, protein and water I carry around.

Suicidal BFF with ‘Plan’ Projects; I land in Lockdown?

aquanotext

Cuffed and Dragged off thanks to my best friend. She’s the one with 200 tegretol to try to take her life a fourth time…but I’m the one carried away. So uncool.

I was sick. She called the cops to have me shoved into involuntary psych eval. I find out later that the cooler of fresh healthy raw foods I carry around as I’m prediabetic she calls that ‘crazy.’ My stomach problems are evidence of ‘crazy.’ My BFF NO LONGER IN MY LIFE. Sad. But she’s gotta go.

Suicidal Bipolar Projects ‘Plan,’ and I’m in Hospital?

How else can I say it, title it?

allicat

You are my people. My resource.

You hear it first.

My life is messy.

It’s not the worst.

My BFF turned my life upside down.

You guys know I have chronic pain and was looking for a way out. I went Cold turkey for over a week. The worst pain I’ve ever had except for the 60 day flare in reaction to an ‘interventional pain management’ pain doc. Yeah, ‘interventional’ all right. Between me and my life. Between me and my pocketbook. Once back on, thought I could not get off. But I’ve been sick ever since. Hey, you play you pay.

Weak and sick I wanted to go to the ER and check for an obstruction. On the way gonna stop by my BFF’s. I’d packed my low sugar high fiber foods and protein Shakes with Pomegranate in them and Off I was gonna go. Except for one hitch. She’d called the cops and said I was suicidal. Cuffed and dragged off to the psych ward. Then she called my father and told him private stuff. She’s always hated my husband. Partly because he doesn’t have money and she thinks I could do so much better.

I’ll really miss her. Foreign films, world affairs, someone intellectual, worldly and brainy to be around and another former disc jockey.

I think it’s a marketable story. What can I call it in seven words or less so that betrayal and paradox jump right off the page; promising a publisher clicks? Can I Sell it to Buzzfeed? Vice? Gawker? Who?  It’s got to be a rebellious type of publication. One that questions the system a tad.

The two publications I write for probably wouldn’t appreciate my caustic tone when I describe yanking the warden’s chains; claiming I’m a nationally published writer who is also in their daily newspaper, a mantle of credibility which happens to be true. People get starstruck.

The puzzlement on their faces was precious. Priceless.   Maybe it’s true. Maybe she’s here by mistake. Our mistake.

Where does this story of one friendship (probably a sick, codependant attachment) end and a new life of healthier pursuits and a more balanced set of associates begin?

Because it’s not really about what she did to me, it’s about why I attract people to my life sicker than I am. That’s what’s nuts.  Then I share my intimacies. Totally Bonkers.

All along I assumed she understood and she’d just been laying in wait to get me locked up somewhere.  She’s disapproved of my level of care and self care all along, right down to the cooler full of raw foods, low sugar fruit, protein and water I carry around.

I’m taking a note out of Prince’s Playbook: Methadone Light

 

prince

‘Boy Could He Play Guitar’  David Bowie “Ziggy Stardust.”

There are big barrier to Methadone light. First of all, Suboxone, which is what they give, is an opiate. Secondly, if the word got out about this better, much safer from overdose type of treatment, the jig would be up and Purdue, Endo and the rest would lose millions of dollars on something that’s killing us.  Very few of us afford it and if falls underneath the umbrella diagnosis code of opiate addiction, not something everyone wants to admit to. Oh, well. A few courageous docs are doing it while others tell me it’s illegal. The truth is somewhere in between.

I’m not suggesting Buprenorphine (as available as Suboxone) is without risk But has a ‘ceiling effect’ on Euphoria and respiratory depression (read: Overdose).

After a ton of phone calls I got an apt and detail wise, the sublingual film goes under the time. Go bye bye alcohol, benzos and all other drugs. I paid 12.00 for my first patch.

I had my first film last night. I had few good hours and then rebound pain so awful I told my husband that If I died in the morning that I was sorry. I think the dose might not be high enough.

More on this later.

Thanks to Opinionated Man and his support and encouragement

Chickencoop

Sometimes the truth hurts. And I was what Jason calls a Lazyass blogger. I think his articles are hilarious. I’ve actually printed and saved them all. He’s given my coverage on Prince and the last minute mission to save his life some reblogs so you can know that something is going on. There’s a drug with indications for pain that they are with holding from us. Making our decisions for us. But I didn’t write this to rant and rave I just wanted to thank Jason for the reblogs and let you know I’m on this story. Tomorrow my story about metabolism comes out and you can find it there as well as here.

Allison Strong

More on Prince ; Buprenorphine Mystery my note 2 Cornell MD

princetwoBelieve me, you’ll know as soon as I know.

There is this guy in our daily paper who offers answers to questions. I wrote my questions about buprenorphine. I can never get the spelling right.

One of the articles about Prince’s death dealt with the stigma of using one drug to treat a problem with another. But if he really had ruined his hips and was in pain, then he’d have needed pain care. You want to know what I think? He didn’t know who to trust. It’s tricky. You’ll see in this letter that I don’t know who to trust either.  So I wrote this guy at Cornell. I keep looking for more stories on this subject but can’t find any. Is there some conspiracy theory I’m unaware of? Could big pharma be THAT big to get in the way of generic 40 dollar a month w/o insurance priced Subutex? It’s been FDA approved for chronic pain since 81 so what’s the big issue with it? So I wrote a letter to this Cornell ‘ask the doctor’ newspaper guy at ‘ToYourGoodHealth@med.cornell.edu. If you want to know the deal as badly as I do and you never see his answer posted in my blog, feel free to ask him again these questions..It’s a public concern and a growing epidemic that some say could be solved with Suboxone, Bupenorphrine. Why Not? Why?

Dear Dr. Roach

I’ve had chronic lumbar pain for a decade. It’s impacted by a neurological condition called Tardive Dyskinesia that’s similar to Parkinson’s. I have uncontrollable muscle spasms and yelp. I’ve had every interventional pain management injection available and have spent thousands on physical therapy, pilates, herbs, eat an anti inflammatory diet, have done chiropractic, massage and acupuncture. I use mindful meditation while listening to music to. Still,  I need my meds. And hate that.

I don’t take short actings. I’ve made days-long medication ‘vacations’ to work my tolerance/dose down to 1/3 of what it was a year ago.  Even at a lower dose, the constipation is unbearable. Even on an all raw foods diet.

After a few ortho surgeries I’d been on high dose synthetics like Demerol and I had no constipation. When Prince died I read about the use of buprenorphine for chronic pain at the California “Recovery Without Walls” clinic. The use of a sublingual patch, a different way of taking it puts less strain on the liver and kidneys as they don’t have to metabolize it.  The few shreds of coverage I read in the Washington Post and said Bupenorphine  received FDA approval for chronic pain back in 1981. Yet one article about a D.C. based doctor recounted how she’d had to falsify patient’s diagnoses in order to get them treated and off of opiates for good. That’s what I want. If these synthetics truly are the second coming for long term noncancerous pain (Claimed by the newer “Butrans” transdermal patch) with a lower side effect profile and a ceiling on respiratory effects and overdose potential, why do the doctors using it claim there have been ‘challenges and conflicts’ preventing its’  widespread availability and use?

Why do some local doctors (often trained in other countries) insinuate that bupenorphrine would help my chronic pain while other doctors angrily claim it’s illegal to use it for that purpose? What are the downsides to this medication that I’m not hearing about? Allison Strong Hollywood Florida 954-922-4310

biszanta@hotmail.com

 

More on Prince & Buprenorphine Mystery my note 2 Cornell MD

princetwoBelieve me, you’ll know as soon as I know.

There is this guy in our daily paper who offers answers to questions. I wrote my questions about buprenorphine. I can never get the spelling right.

One of the articles about Prince’s death dealt with the stigma of using one drug to treat a problem with another. But if he really had ruined his hips and was in pain, then he’d have needed pain care. You want to know what I think? He didn’t know who to trust. It’s tricky. You’ll see in this letter that I don’t know who to trust either.  So I wrote this guy at Cornell. I keep looking for more stories on this subject but can’t find any. Is there some conspiracy theory I’m unaware of? Could big pharma be THAT big to get in the way of generic 40 dollar a month w/o insurance priced Subutex? It’s been FDA approved for chronic pain since 81 so what’s the big issue with it? So I wrote a letter to this Cornell ‘ask the doctor’ newspaper guy at ‘ToYourGoodHealth@med.cornell.edu. If you want to know the deal as badly as I do and you never see his answer posted in my blog, feel free to ask him again these questions..It’s a public concern and a growing epidemic that some say could be solved with Suboxone, Bupenorphrine. Why Not? Why?

Dear Dr. Roach

I’ve had chronic lumbar pain for a decade. It’s impacted by a neurological condition called Tardive Dyskinesia that’s similar to Parkinson’s. I have uncontrollable muscle spasms and yelp. I’ve had every interventional pain management injection available and have spent thousands on physical therapy, pilates, herbs, eat an anti inflammatory diet, have done chiropractic, massage and acupuncture. I use mindful meditation while listening to music to. Still,  I need my meds. And hate that.

I don’t take short actings. I’ve made days-long medication ‘vacations’ to work my tolerance/dose down to 1/3 of what it was a year ago.  Even at a lower dose, the constipation is unbearable. Even on an all raw foods diet.

After a few ortho surgeries I’d been on high dose synthetics like Demerol and I had no constipation. When Prince died I read about the use of buprenorphine for chronic pain at the California “Recovery Without Walls” clinic. The use of a sublingual patch, a different way of taking it puts less strain on the liver and kidneys as they don’t have to metabolize it.  The few shreds of coverage I read in the Washington Post and said Bupenorphine  received FDA approval for chronic pain back in 1981. Yet one article about a D.C. based doctor recounted how she’d had to falsify patient’s diagnoses in order to get them treated and off of opiates for good. That’s what I want. If these synthetics truly are the second coming for long term noncancerous pain (Claimed by the newer “Butrans” transdermal patch) with a lower side effect profile and a ceiling on respiratory effects and overdose potential, why do the doctors using it claim there have been ‘challenges and conflicts’ preventing its’  widespread availability and use?

Why do some local doctors (often trained in other countries) insinuate that bupenorphrine would help my chronic pain while other doctors angrily claim it’s illegal to use it for that purpose? What are the downsides to this medication that I’m not hearing about? Allison Strong Hollywood Florida 954-922-4310

biszanta@hotmail.com

 

Washington Post re: Prince, Buprenorphrine, barriers to access, stigma

prince

You guys….there’s a story here and it’s bigger than we know. There’s a better drug for pain, and we have no knowledge of it and even less access to it. Prince was going to go all the way to California for it. You know what killed Prince? He ran out of time and stigma. I’m having some of the same problems. The side effects are killing me. I take less than prescribed. Somedays I excruciatingly don’t take any in order to keep my dosage down. But the side effects. Buprenorphrine is cleaner, doesn’t go through your digestive tract, doesn’t burden the kidneys and even has a ceiling on how much it can affect or slow down your respiration, so it’s way safer. What is the deal????????????????? No one is talking.

By Maia Szalavitz

PostEverything

May 9

Maia Szalavitz is a journalist and author, most recently of the forthcoming “Unbroken Brain: A Revolutionary New Way of Understanding Addictions.”

Prince performs at halftime of the Super Bowl in 2007. (JEFF HAYNES AND ROBERTO SCHMIDT/AFP/Getty Images)

Prince’s greatest music hit the radio while I was going off the rails during my own opioid and cocaine addiction. The young man who gave me my first injection was a massive fan and played “Kiss” for me around the same time he introduced me to the needle. I was soon hooked on both Prince and injecting.

That’s why it hit me especially hard when I learned that this musical genius’ overdose death occurred a day before he was due to start treatment. This tragedy makes clear that what likely killed him, and is killing so many others, is not just addiction itself, but the stigma we attach to it and, even worse, to the most effective treatment for it.

If we really want to stop the overdose epidemic, we need to get serious about providing the only treatment known to reduce the death rate by 50 percent to 70 percent or more: indefinite, potentially lifelong, maintenance on a legal opioid drug like methadone or buprenorphine. The data on maintenance is clear. If you increase access to it, death, crime and infectious disease drop; if you cut it short, all of those harms rise.

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Prince was supposed to see a doctor, known for using buprenorphine to treat addiction, just a day after his death. But most patients — even most celebrity patients — do not actually get this sort of evidence-based care.

Indeed, most people concerned with opioid addiction don’t know that they should be looking for maintenance, or they avoid it thanks to the stigma against long-term medication treatment — research shows that maintenance patients experience prejudice and discrimination from family, friends, health care workers and employers. Even I perpetuated the stigma myself in the past, in an anti-methadone op-ed in the 1990s. At the time, I thought that simply having experienced addiction qualified me as an expert and incorrectly relied on anecdote, not data.

For both methadone and buprenorphine, access is highly limited. Only 30,000 physicians are licensed to prescribe buprenorphine, but most who are licensed don’t prescribe it and each is currently limited to seeing 100 patients. When used for addiction treatment, methadone is regulated to an extraordinary degree — it’s illegal to prescribe outside of those rundown clinics, and NIMBYism keeps them located in poor neighborhoods.

Minneapolis fans: Prince’s legacy ‘will live on’

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One day after music icon Prince was found dead at his suburban Minnesota compound, music fans were still in shock, as memorials grew. (McKenna Ewen/The Washington Post)

To top it all off, the 12-step support groups that addicted people are urged or even required to attend as part of treatment often see people on maintenance as not “really” in recovery.

These practices are deadly. We’ve got to get over the idea that medication for opioid addiction simply “replaces one addiction with another” and doesn’t count as getting better. To do so, we need a far better understanding of what addiction really means.

In many people’s minds — due to concepts popular in the ’70s and early ’80s — addiction means physically needing a substance to function and becoming physically ill when deprived of it. From this perspective, the biggest barrier to quitting is suffering through the nausea, pain, shaking and diarrhea that accompany withdrawal. And, from this point of view, people who are on maintenance treatments are actually “still addicted.” But this definition of addiction was dropped by experts long ago.

One reason this view fell out of favor was the rise of crack cocaine. Cocaine and stimulants, like methamphetamine, don’t cause physical withdrawal symptoms — if addicted people suddenly stop taking them, they don’t get physically ill. However, they absolutely experience irritability, anxiety and craving that is every bit as intense and likely to lead to relapse as that associated with alcohol or opioids. This makes stimulants like crack highly addictive.

Though we tend to think otherwise, physical withdrawal isn’t the main barrier to abstinence; instead, craving and the sense that drugs are essential for emotional survival are at the core of addiction. In my own case, I put myself through withdrawal from heroin addiction at least six times. Never once during these attempts did I relapse while ill. Instead, I returned to drugs after withdrawal illness had passed — not because I felt physically bad, but because I had convinced myself that “just once” would be okay.

So what is addiction if it isn’t defined by tolerance or withdrawal? Psychiatry, through its diagnostic manual, the DSM, sums it up as compulsive behavior that recurs despite negative consequences. This means that maintenance helps users conquer their addiction by replacing addictive compulsion with physical dependence.

Craving, obsession, intoxication and consequences are gone; tolerance and steady dosing mean that patients are not impaired and can drive, care for families and work. What remains is a physical need for the substance to avoid withdrawal.

And such dependence isn’t harmful, per se: We’re all physically dependent on oxygen, food and water, and some of us (like yours truly) are physically dependent on antidepressants or other types of medication. If the consequences of physical dependence are positive, it’s not addiction. Which is why I don’t sit around dreaming of Prozac, yearning for my next dose, taking more and more and hiding my obsessive behavior.

Of course, like any other addiction treatment, maintenance doesn’t always lead to recovery. Indeed, as with abstinence-only treatment — though at a lower rate — relapse is the most common outcome.

Importantly, however, unlike in abstinence-only treatment, patients benefit from maintenance even during relapses. That’s because, whether or not people continue taking other drugs in an addictive fashion, the tolerance provided by maintenance pharmacologically makes overdose death much less likely.

The ongoing use of other drugs during relapse explains why so many people see maintenance as a failure and maintenance patients as being constantly high — but retaining relapsers in treatment is a feature, not a bug. It reduces mortality, disease and crime and keeps patients in health care.

Unfortunately, most families and friends of addicted people don’t understand this. They tend to seek abstinence-only inpatient rehab because maintenance is stigmatized, and the media rarely highlights its dramatic reduction in mortality. Instead, we hear about relapse or people selling their maintenance medications on the street. Ironically, that street market exists primarily because we don’t make maintenance accessible enough. Maintenance drugs wouldn’t be valuable if people who wanted them could get them, whether or not they are ready for abstinence.

Prince’s death was awful enough. A man lost his life, we lost a great artist — and we also lost the chance for him to model and destigmatize the best treatment we currently have for addiction.

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