Back on June 11, I wrote a diary titled Can I speak to the Dr.? I have a problem. I promised an update of things and the process. Here is that update.
One of the steps I have made is through a diary. The support, advice, information and the people who followed up on me as I began this process is humbling to say the least. Daily Kos is a vast repository of information on not just the politics of our time, but a wealth of insight seldom found in one place.
Today, the availability medications for pain relief is a godsend to so many people. In fact, they have enabled people afflicted with debilitating pain to live almost normal lives. Without a doubt, it enabled me to work and conduct other affairs of “life” in a somewhat normal fashion. I'm talking of back pain. There were the times of course that a “flare up,” would drop me to my knees and no amount or strength could overcome those events it seemed. By and large though, The narcotic pain medicines prescribed through the years was a net positive. However, there has been a cost. Using, to get that “high.” Hence, the diary and the process involved to fix my problem that was spiraling out of control faster and faster. A reality check if you will, that left to my own devices something bad, very bad was soon to come down. For all intents and purposes, I was a functioning member of society who just so happened to be addicted to narcotic pain medication. I was operating on borrowed time and sooner or later that debt was going to come due.
All weekend long after writing the diary and after the decision to finally do something; the one only thing on my mind was the appointment with my doctor. The withdrawal symptoms steadily increased through the weekend. Just make it to the appointment I kept thinking and then everything will be alright. Strange as it may sound, the mere fact that I had “come clean” with myself was a source of relief in and of itself. I also had support from my wife and sons.
So, why write about this in a diary? Couple of things really. Through the years I often contemplated (worried) what would happen if I were to get caught with the meds not prescribed to me? It could have happened very easily. You can draw the scenarios in your mind. Hell, a cop could have pulled me over for a simple thing of maybe not signaling properly, speeding or what have you and a set of circumstances could unwind to bring about a search. I could have been busted buying the drugs to feed the habit and found myself as one of the statistics in our “War on Drugs.” Would I have thrown my self upon the mercy of the court? Or, would I instead expunge every asset in my possession, in the hope of fighting my way out of a nightmarish scenario? On the other hand, I could simply plead insanity, for there was no doubt what I was doing was insane.
There are a plethora of “what if's.” However, there was one “what if” hypothetical that jolted me to reality. The real possibility of hurting someone innocent. Whatever my thoughts were that I could bring about my own demise was one thing. To be driving my car for instance and causing injury or worst yet the death of an innocent was a defining moment. Putting innocent lives at risk could not be justified.
The other thing? What's going on out there? What happens when the decision is made to go the other direction and seek help? Is my experience typical? Perhaps it's just one of those all to familiar refrains of...It depends? Depends where you live, depends on your insurance, depends on ethnicity...etc, so on so forth. For what it's worth, I am of the opinion that it really does “depend.”
The American Medical Association views a drug addiction as a disease, yet our laws and justice system view it as a crime. The issues are complex to be sure and to say that our War on Drugs has had any meaningful results would be asinine. Except for our prison population.
The United States incarcerates more people for drug offenses than any other country. With an estimated 6.8 million Americans struggling with drug abuse or dependence, the growth of the prison population continues to be driven largely by incarceration for drug offenses.
"Source: Justice Policy Institute, "Substance Abuse Treatment and Public Safety," (Washington, DC: January 2008)
http://www.drugwarfacts.org/...
And this. Our Republican couterparts are on the warpath. Suppose we could get them to focus on something that is costing us dearly, yet offers no real benefits.
Nonviolent drug offenders now account for about one-fourth of all inmates in the United States, up from less than 10 percent in 1980. The costs, of course, are staggering: State correctional spending now totals $52 billion a year, consuming one out of 14 general fund dollars; spending on corrections is the second fastest growth area of state budgets, following Medicaid.
As dark as that statistic is, check this article from Thinkprogress.org. The Private Prison Industry is a real growth business. Downturn in the economy? Not in the prison business. I had to think about that for a minute and say that phrase aloud. “The Prison Business.” A business of incarcerating people. Yeah, it's a WTF moment to be sure. Doesn't get any more American than that.
http://thinkprogress.org/...
Read this, it is from Corrections Corporation of America 2010 Annual Report. Grab a barf bag.
The demand for our facilities and services could be adversely affected by the relaxation of enforcement efforts, leniency in conviction or parole standards and sentencing practices or through the decriminalization of certain activities that are currently proscribed by our criminal laws. For instance, any changes with respect to drugs and controlled substances or illegal immigration could affect the number of persons arrested, convicted, and sentenced, thereby potentially reducing demand for correctional facilities to house them. Legislation has been proposed in numerous jurisdictions that could lower minimum sentences for some non-violent crimes and make more inmates eligible for early release based on good behavior. Also, sentencing alternatives under consideration could put some offenders on probation with electronic monitoring who would otherwise be incarcerated. Similarly, reductions in crime rates or resources dedicated to prevent and enforce crime could lead to reductions in arrests, convictions and sentences requiring incarceration at correctional facilities.
The full report is at:
http://www.justicepolicy.org/...
Go get them non violent offenders. That's money in the bank.
My journey to get get off the pain medications is a business too, as I soon found out. The resources available to the average person is confusing. There were plenty of places willing to take my money to “detox” me. By the time I met my deductible my out of pocket for such a program approached $2,000. Some would say that is a bargain. It is I suppose, if you have the money. Like everything else in America, it's all about the money. Our healthcare to our prisons is built on the premise that you can make money at another person's demise. Seems a bit skewed to me. But that's another diary.
The morning of June 13 at 11:30.
On that Monday morning June 13th in my Dr.'s office I tell all. Everything. Every last detail, with no holding back. I had written a letter several days in advance for him to read before the appointment time. It too detailed my usage. It was comforting that he understood. My fears of the Dr. kicking me to the curb, so to speak, were unfounded and he agreed that help was needed and congratulated me for coming to grips with the problem.
We talked. Pain can be complex and sometimes as he explained you can find yourself in a “pain feedback loop.”In short, the brain continually receives and sends out signals of pain. Even when no pain exists. Hadn't heard of that before, but it made sense. He continued and felt the best course of action was to see a specialist of sorts, someone who deals with the problems I described. A doctor that can address my pain, my propensity to take more than what is prescribed. A doctor that can prescribe a medication that takes me off the pain meds if need be. That medication is Suboxone. Evidently, this medication cannot be prescribed by just any physician. I'm not quite sure what to make of this stuff as of this writing and will wait to speak to the doctor.
There is a feeling that I am making progress though, considering how that previous week transpired. To keep me from going into withdrawal he prescribes methadone enough for 5 days, telling me, “that they should be able to see me rather quick.” “Probably sometime that week.” I am handed some Cymbalta samples, enough for one month. 'We'll try that for awhile,” he says “and see how it tackles the back pain.” I comment I have seen the commercials for this stuff and I joke that the possible side effects are worse than the problem we are trying to treat. Honestly, I have some trepidation, but he assures me that if they ran an ad for Aspirin today, the message in the ad would sound dire. What the hell, I'll take it I guess. We wrap things up and I thank him for his help and he informs me that scheduling will call and let me know when I have an appointment with this doctor.
Wednesday, June 15, around 10:30am I receive a call from scheduling and they ask me to call the clinic and confirm a few things. I immediately call the clinic and conversation turns to Suboxone. I'm told the Dr. does not prescribe it. In fact no one in the clinic does.
So I call back to scheduling and explain the problem. Remember, it's my doctor who is requesting a doctor who prescribes Suboxone. “She will talk to the doctor,” she says. Meanwhile, I call the insurance company and explain the events. Round and round it goes. Phone calls between clinics, my doctors office and the insurance company. Insurance is telling me they don't really have a list of doctors that will prescribe this drug and question the approach my doctor and I are taking. I guess the drug is pricey as hell and they don't like it. I seem to be spinning my wheels. I am trying to achieve outpatient services and detours is the common theme.. One is in “network,” but they don't do this or that. Out of “network” and the costs are prohibitive.
The next day, Thursday morning, June 16 a doctor is found that fits all the criteria. Appointment date July 6. I make another phone call, back to my doctors office. I explain that I will be running out of methadone before my appointment on July 6 and the doctor had only prescribed enough for 5 days. Will he write another script to carry me through to July 6? I get no response that day.
The following day, Friday June 17 and another phone call to my doctor's office explaining the situation. No response throughout the day and the anxiety level is on a steady climb upwards. Fear is on the increase as well, as I know I will start to feel the effects of withdrawal. I still have to work and maintaining myself under these circumstances is becoming more difficult.
Is he getting the messages? Is the doctor ignoring me, or is it the staff that is not getting the message through? I'm inclined to think it is his staff. Either way, I am frustrated.
Monday, June 20th I am feeling very lethargic and the two cups of coffee is not giving me the boost I had hoped. Get in the shower, you'll feel refreshed, I think to myself. I force myself into the car and head off to work. All the while I try and process what I am feeling. Am I thinking rationally? Because I wasn't prescribed enough methadone, can I justify getting some pain meds to carry me through the day? My thoughts of getting some pain meds is foremost in my mind. Shit! Maybe that two grand and 7 day detox was what I should have done to begin with. I'm second guessing myself again.
No, I will stick with the game plan and if I can just get the methadone, I'll be fine.
At 9am, as soon as the doctor's office opens, I call and explain that I am now out of methadone. I wait all afternoon. At 4pm that afternoon, I call back. I find that the doctor has not received ANY of my requests, and the fact that it is late in the afternoon, I am instructed to call back tomorrow.
From last Thursday I have been asking that this be attended to and I am exhausted. So is my patience.
In every life a little rain must fall. The last couple of weeks, a deluge has been raging. I am reminded of the character Lloyd Bridges plays in the movie Airplane where he comments “I guess I picked the wrong week to quit smoking.” and the other quote, “I guess I picked a wrong day to quit drinking.”
A little humor can ease the pain I say. Here's my quote:
I guess I picked a wrong time of the month to quit abusing pain medication.”
I only say that because of the events that take shape.
When I finally made the decision to come clean with my usage of pain medication, I had no way of knowing that my employer was going to tell me that come mid July, they would no longer be able to pay my salary, unless some “big sales orders” come in. I am sure my creditors will understand and will grant me a reprieve; the bill collectors will be put on hiatus in sympathy to my dilemma and in fact will call to offer their condolences.
I mention this next part to give some background, as I deal with the process of coming off pain meds. I have it easy compared to many. My tribulations pale miserably in comparison. There is a much larger story here that involves my beloved sister.
Her story of our healthcare system, it's costs, the pain and quite frankly the pure hell she has endured is a diary I have been begging her to write. The wonderful people of Hospice are just now coming to her aid and hopefully she will find the strength to publish it soon.
My younger sister has cancer and lives with my 85 year old mother. Mom actually cares for her. Wednesday, June 15 mom goes in for surgery, her lungs are filling with fluid and they are not sure why. She ends up in ICU for a couple days and they eventually release her on the following Tuesday the 21st. At first they think it's Mesothelioma, then they're not so sure. My sister is besides her self at the news. Her physical pain is unrelenting, but her mental anguish is palpable. She depends on mom for so much and she is worried sick. I tell her everything will be fine, but I don't really know.
Back to the phone call to my doctor's office
Spent a good portion of that afternoon at mom's bedside waiting for my doctor's office to call back.
I feel like hell and keep looking at the phone to see if I somehow missed that call. I ask mom to excuse me for a moment. I tell her I need to make a phone call.
As I said, I am exhausted. When the doctor's nurse comes to the phone I “beg” not to wait. I just don't have the strength to try and explain everything that is going on. Some 15 minutes later she calls back and says to come in and pick up the prescription, but to do so before 5:30pm when they will close. It's 4:30pm and I tell her I will be there in 30 minutes. I head back up to mom's room and tell her I need to leave for awhile and I will be back later.
I arrive at the office and a young lady behind the desk instructs me to fill out and sign one of those patient agreement forms (2nd one in 3 months) and that I will only get my prescriptions from one pharmacy etc. etc. I mention, I filled one out not to lo...and before I could finish the sentence, a tone of arrogance spills from her lips “if you want your prescription, you must fill it out.” I think my blood pressure spiked pretty good when I heard that. But whatever.
I filled the form and signed it. Again.
I have not doctor shopped. I go to the same pharmacy. I feel dirty getting my medication prescription.
Last week when I received my last prescription for methadone, my regular pharmacy did not have it. I ended up going to another store pharmacy within the same group about 10 miles away to have it filled. This time instead of driving there, I decided to call ahead to see if they had it in stock. “No is the answer they do not.” I ask if they have a way of checking other pharmacies in their system? They check 6 other locations and none have it available.
At this point I am still in the parking lot of my doctors office making calls, this time to a different pharmacy company altogether. “No we don't carry that either.” I am informed by the pharmacist that it does not come in that milligram size and hasn't for quite sometime.
Back to the doctors office. I explain the situation to the “friendly” young lady and am told to wait for my Dr.'s nurse. She eventually arrives and tells me there is nothing wrong with the way it is written.
I explain my phone calls I have been making and the information one of the pharmacist imparted. She reluctantly takes the script and says, “she will check.”
About 15 minutes pass and she comes back out and informs me that the only place that will have it, is a Wal Mart on Thursday, Friday at the latest and I will just have to wait. So, here it is Monday and we are approaching 6pm and I have not had any methadone for 24 hours and she wants me to wait till Thursday, possibly Friday. As it is, I have scaled back the dosage and I am feeling like crap. It's all so needless and I am at the mercy of people who just don't seem to care.
I know methadone stays in your system longer, but this is unacceptable. I have reached the end of my patience. I am doing everything in my power to stay off the pain meds.
I let loose. Have the Dr. rewrite the damn thing with the correct milligrams and the problem will likely be solved tonight, I tell her. She proceeds to tell me it's late and the “Dr. has other patients he is seeing right now.” “You are just going to have to wait. “They will have it on Thursday.” No, I will not wait! I have been calling this office since last Thursday to head off a foreseeable problem and for whatever reason it has not been addressed. I'm sorry you feel put out, but your answer to wait till Thursday is not acceptable. She finally relents and says “she will try to catch the doctor between patients, if she can” and is “offering no guarantees.”
Thanks. I appreciate your effort I tell her, hoping that my touch of honey after the dose of vinegar will be noticed.
About 20 minutes later she returns with a new script. I notice the dosage is half of what was prescribed last week. When I tell the nurse this, she says, “that's what he wrote it for and it's not going to be changed.”
I just shake my head. I'm done arguing. But, I tell her I am going to call the pharmacy just to make sure they have it. She says “it doesn't matter.” “If that is your regular pharmacy you MUST get it filled there.” (I thought I was done arguing.) At any rate, I ask if they don't have it, what then? “You do not go elsewhere, the doctor prohibits it.” Hold it! Didn't you earlier tell me to go to Wal Mart which I don't use? She is undeterred, “the doctor is very strict about this.”
I call the pharmacy to make sure anyway. They do have it in stock. It's all a moot point. I leave to go pick it up.
On the way there I'm doing the math in my head and I figure I will have to cut back my dosage from the original script. I'll have to make some adjustments, but I should make it. The new norm.
I decide not to call back and ask for the proper dosage. I'm tired of waiting for the phone calls that are not returned. I'm tired of begging for help. The humiliation. The arguing. Of not being in control of my life. Someday, but not today.
Methadone. I have come across other people who use it for pain management and they say it is better than the other narcotic pain medications they were on before. I'll have to say that so far I am getting good results and there is no “high” and I sleep much better. Overall, I feel better than before. More back pain through the day and some days are a real bitch. The jury is still out in some respects. However, one verdict has come in for me personally. The direction I am going now is far preferable than just 3 weeks ago. I'm thinking of acupuncture too. Spoke with some people who swear by it for their back pain.
I have kept to a strict regimen with the methadone dosage and counted out every pill and timed everything down to the July 6th appointment. I have been tempted to stray when the methadone wasn't there and I am not about to break my promises. “To thine own self be true.”
This has been such strange territory for me going through this process. Even writing about it here has me feeling uneasy at times. For some reason I thought when I made the decision to come off the the pain meds it would be a fairly organized simple process. It has been anything but that. Granted, the job thing came into play, mom into the hospital etc.
And maybe that's really the whole point. Most things in life are not smooth and predictable.
Right now for me anyway, it's just one step at a time.