Treatment for Opiate [Heroin/Oxycontin] Addiction

I once a long time ago wrote a diary about this topic, being personally someone afflicted with opiate addiction, and it sparked very much interest, and got me started writing out against the so-called "War on Drugs".

With a group of drugs called Opiates or Opioids, namely Heroin and Oxycontin (oxycodone), growing very much into a new "boom" in the United States and across the world, this topic becomes even more important. When we took down the Taliban, that the year before we invaded Afghanistan changed it's policy to outlaw opium production (sucessfully), anarchy reigned. Now most of Afghanistan's economy comes from opium crops, and the Heroin that is produced along the Afghan-Pakistan border where Bin Laden was allegedly hiding, largely by Pakistani Intelligence that we support.

The situation in Afghanistan/Pakistan is very grim, and heroin is cheaper and more potent than every across Europe due to it (we get our high quality heroin in the United States from Columbia or Mexico.)

But this isn't a political diary. This is about the treatment for "the hardest drug", so that we may better understand it - and there is plenty of law along the way.

This diary as alluded lead to a ton of diaries posted in a series regarding the War on Drugs, and am the only one who pays any attention to the Dkosopedia Drug War Page. I am vehemently against the Drug War, better known as prohibition, but I do not necessarily support full legalization of all drugs. I certainly don't think tomorrow you should be able to buy, say, Heroin, in your corner drug store like candy. However, I think that that is more logical than our hypocritical, brutally harm inducing (to the user), brutally harm inducing (to society), corrupt, anti-freedom policy that currently stands (that "one pissed off liberal" just wrote another eloquent diary about, albeit largely about marijuana, #1 on the rec list.) For a round-up of just how many things are wrong with our drug policy, see my most recent diary on the topic.

It is in understanding treatment for Heroin addiction that understanding of important concepts such as "harm reduction" come from. The new DATA law is vvery interesting - as is how Congress illegally delegated their powers to the executive branch saying the DEA could pull the plug on the DATA (the law is explained in depth a bit later) whenever they wanted. Even though it was completely logical and effective, the anti-drug policies still shine through even in "compssionate" legislation such as this.

Another thing you need to know is that I myself am afflicted with opiate addiction, and have been in maintenance treatment as you will read for over 6 years now - but was nearly forced to lose it when temporarily moving to Australia, which would have induced a month-long withdrawal syndrome that is extremely unpleasant and a very high likelyhood of relapse. I say that not just from the statistics, which are intimidating to say the least, but knowing the "taste" that returns should I not get my medication. You will read all about it.

I am going to post the diary I wrote back then with some minor touching up. While you read it, consider the fact that heroin addiction is so hard to overcome that maintenance with other opiate drugs becomes necessary and how it would be easier and make more sense to just give addicts - most of which whom can't help themselves - what they need. Believe me, there is little to no joy in Heroin addiction. You just keep trying to feel normal.

Ok, let's get into it.

(A Personal Statement)

Let me get one thing out of the way: heroin has been stigmatized to no end, largely due to the needle use involved. However, due to the great increase of potency that heroin has had in the past decade or two, needle use is no longer necessary for those who aren't hardcore addicts. There is large growth in suburban sniffers and smokers, as well as large growth in use of prescription opiates (properly known as opioids, except for codeine and morphine, but I will use opiates anyway,) especially Oxycontin [generic name oxycodone], which spreads out to rural areas as well as suburban areas, and it's a HUGE problem. It's even hitting the rich - just look at Rush!

And then I continued, saying a bit about my personal opinion regarding drugs and thee morality associated with using them, and their relative dangers (to each other):

Now, back to what I was saying: is heroin (and other opiates) bad? Hell yes! I am not, nor will I EVER, advocate heroin use. But it's bad for one reason and one reason alone: the addiction/tolerance. Every single other reason is due to the drug war. Every last one. This is my opinion, and you are free to disagree. Let me also make clear that I am not downplaying the problem of addiction and tolerance: it's a HUGE, HUGE problem - as you will soon learn about. Now, a large group of street addicts are worthy of the stigma - there is no doubt there - just go to a crummy methadone clinic if you have any doubts. But there are also large groups of opiate addicts you have no idea existed. If you are so inclined, visit alt.drugs.hard [where mostly current users are], on usenet, and speak to some of these people. They are intelligent, thoughtful, friendly, and to some extent, as much as is possible, in control. Unfortunately that's still very little.

If you limit heroin to sniffing and smoking, let's just say that I would rather that than be an alcoholic. Alcohol causes permanent bodily harm, and even death. Heroin does not [overdose is a problem but could largely be controlled with legalization(at least for addicts) - by knowing what you are getting, and giving the cure for overdose out freely - and doesn't occur very often in those who aren't shooting. Yes, there is a CURE for overdose. The most common is naloxone, an opiate ANTagonist, which means it blocks opiates from working. You will feel like the worse kind of shit imaginable after getting a shot of that - but your life will be spared.] What else does alcohol do? It causes violent and other nasty behavior, for one. Opiates do not, except perhaps to those desperate to get what they need to feel normal. It causes far more deaths in car crashes, heroin doesn't impair your driving ability to THAT much of an extent - although it surely does - unless you are "nodding" (falling asleep.) It also has life threatening withdrawals - as do tranquilizers - heroin does not. It's just as addictive as smoked or sniffed heroin, and ALMOST as hard to get off of, in the long term. I just want to make the point that just because something is legal, doesn't mean it's "OK".

Let me say something again: I am not advocating opiate use! You WILL regret it! I promise you. You will be chasing that "virgin" high for the rest of your life, and might wind up unable to experience the pleasure you were once able to. It's not a fun life, and it's surely not glamorous. Let me also make it clear that there is no "soft" opiate (except, perhaps, opium.) Everyone starts, that is the people who aren't on the street, with "soft" opiates. It doesn't last - and even if it does, the differences between them and heroin are minimal at best. The thing that makes heroin so much different than other opiates is the so-called "rush" - it rushes your brain faster than any other opioid, and causes great feelings of pleasure, even after your tolerance is sky-high. Maintenance meds are different, and I will explain.

Ok, that personal rant out of the way, I give you The Treatment for Heroin and Opiate Addiction:

The Basics

Well, in that personal statement, I have explained very much about the non-legal and non-political aspects of this, so I will largely try to keep this on topic. But there are many concepts I need to explain, first. I hope I am not boring you too much, and thank you for taking the time to read it. I promise I will get into something interesting.

I didn't tell you what maintenance is, for those who don't know, and it's a very fundamental concept to all of this. Maintenance is when you take another opioid instead of heroin, "maintaining" your addiction. At face value, that doesn't sound very productive. But it is, and I will now tell you why. At the current time, there are two maintenance medications: methadone, and buprenorphine[Subutex/Suboxone]. There was a third, LAAM, legally no different than methadone, which worked for a whopping three days, but it was pulled from the market (in the USA) because of lack of interest and the potential for heart attacks it causes (one of the few opiates, if not the only, to have such problems.)

So why is maintenance important, and a very necessary option for heroin and opioid addiction treatment? Why isn't it "trading one addiction for another"? Because depending on the study you are looking at, nevermind anecdotal evidence, your chances of success at long-term abstinence are anywhere from 5-15%. No one knows why this is, at least not yet, but even after the withdrawals are over, "the easy part" according to just about anyone, the hard part begins - long term abstinence. "Willing it" just doesn't seem to work - believe me, I have tried. Your brain seemingly gets rewired to treat heroin like the most basic of your biological needs, lasting anywhere from 6-12 months to the rest of your life. It's like trying to "will" yourself not so sleep, or eat, or fuck. Over the long term.

So that's why it's important, because your chances of abstinence are so low, and people just want to live normal lives (and buprenorphine is a HUGE step towards that goal, as opposed to methadone, I will explain.) The important question many must be asking themselves is what makes it any different than heroin? There is a world of difference between methadone/buprenorphine and heroin/other opiates. The first and foremost is the duration of action and the time to peak effects. They both prevent withdrawals for 24 hours (or more), meaning you will not be constantly running around looking for a fix, and you won't have the ups and downs of heroin - once stablized, you will essentially just feel normal - not high, not low. Your body will adjust to the drug and make itself work as if it wasn't there. Ideally, at least, there are some very unique people out there. The fact that it takes nearly 2 hours to reach peak effects means you just simply don't get high from these drugs - unless you are "niave" to opiates, that is, in which case you wouldn't be going into maintenance. As I said, it let's people live normal lives - people on methadone, undetectable, are lawyers, engineers, even doctors. You would be amazed.

Buprenorphine is different than methadone, and it's vital. I will get into the legal differences and implications in a minute, but let me get the final bit of basics out of the way. Buprenorphine is a "mixed opiate agonist/antagonist," well, actually, it's better described as a "partial opioid agonist." Describing this is beyond the scope of this diary. Let's just say there are several things about buprenophine that make it very different pharmacologically than methadone, which I will describe:

1 - It is a much weaker drug. It won't leave you with a sky-high tolerance to opioids.

2 - Following that, even though it's weaker, it has an antagonist effect - meaning it blocks other opioids from working (i.e. heroin.) - quite well in fact, but not as well as was originally believed

3 - Following THAT, It seems to fix what heroin broke, and anecdotal evidence clearly implies that you are often more sucessful getting off buprenorphine than methadone.

4 - Finally, the withdrawals of buprenorphine are mild at best in relative comparison to other opiates, especially methadone. Methadone withdrawals are a month of utter, utter hell.

There are two major downsides to buprenorphine, which I will also list for you.

1 - As I said, it's, simply put, "weaker." This means that it can't satisfy all addicts - although the specific tolerance and level of addiction of the addict seems to play only a small role in this.

2 - Due to it's opioid-blocking effects, the transition of getting on to buprenorphine from heroin or other opiates can be quite painful, especially if it's not done properly - and most doctors have no idea what the hell they are doing in this regard.

One final thing to say about buprenorphine - poorly understood, but it seems that it helps greatly with cocaine addicts. Getting into this is beyond the scope of this diary.

Well, I hope that's about it for the technical mumbo-jumbo. I hope you are sticking with it. On to some more relevant stuff.

The Law

So what is the law regarding maintenance treatment, and how has it evolved? When and how did buprenorphine come into the picture, and how is it different?

Let me start by saying methadone maintenance treatment has been around since the 1960s. It has very much proof as to it's effectiveness, as well as something very important: it is far cheaper, for society, to have an addict on methadone than on the streets on heroin. That's some food for thought for conservatives.

Methadone has some very strict laws regarding it's use. These laws vary from state to state, but under the Federal CSA (Controlled Substances Act, as amended, which is the federal law controlling almost all of prescription and illegal drugs,) only doctors with special certification, working in special clinics, can prescribe methadone. In most cases, "prescribe" isn't really the word. The users need to show up, every day, sometimes within as little as a one hour period, to get their methadone. Most clinics have a ridiculous rule that you must piss heroin positive in order to get on heroin - causing people who have been clean a few days but just can't take it to go out and get high needlessly. Only after testing clean and going every day for 6 months or more do you get any "takehomes." These takehomes start for weekends and work there way up, after several years, to monthly (in some cases.) Usually two weeks is about all you can expect. I don't know exactly how much of this is federal law, state law, or not law at all, unfortunately. I will look further into it if there is interest.

So the laws regarding methadone (and LAAM before it was discontinued,) are pretty harsh. It's hard to imagine anyone making it through that instead of just scoring a bag. Or getting screwed because of a momentary lapse of judgement. That brings us to buprenorphine, which comes in two forms - Subutex, which is just buprenorphine, and Suboxone, what is commonly used, which contains an extra ingredient - naloxone. This is added to prevent abuse. If taken normally, it does nothing. If injected, it causes massive withdrawals. This is what I am taking.

So what makes buprenorphine different? In 2000, under Clinton, the 106th Congress passed the Drug Addiction Treatment Act of 2000, otherwise known as the DATA. You can search Thomas for info on this, including the full text of the bill and the Yea's and Nay's. Unfortunately I can't link it, as it only keeps what is generated temporarily. The DATA amended the CSA (Controlled Substances Act) to allow normal doctors, who either meet certain qualifications or take an 8 hour class, and apply to the DEA and SAMHSA (Substance Abuse and Mental Health Services Administration), to prescribe Schedule III opiate agonists (opiate drugs), that are FDA approved for opiate addiction treatment (methadone is Schedule II - meaning this act doesn't apply to it.) You can get a regular prescription from a qualified physician, and fill it at your local pharmacy (alas, most local pharmacies, especially chains, are very reluctant to fill these prescriptions and in many cases will make up blatant lies.) The doctor is in full control of your treatment, and you can take home up to a month's supply as soon as he sees fit. This is a major step forward. Unfortunately, it has yet to spread to the streets, and only the upper-class drug addicts have been able to make use of the drug, and it's a real shame.

Methadone clinics are afraid to be put out of business, and have done everything they could to stonewall this and the FDA Approval of Buprenorphine for Opiate Addiction every step of the way. Now, even though this law was passed in 2000, there were no opiates that were Schedule III or above that were FDA approved for opiate addiction. Buprenorphine was in clinical trials for nearly two decades, being stonewalled every step of the way by everyone who had an interest in seeing addicts suffer or keeping the cash in the methadone lobby's pockets. It finally was approved by the FDA in October 2002, and available in pharmacies next January, 2 and a half years after the DATA was passed, despite ample evidence of it's effectiveness. Buprenorphine has been used in other countries with great success (although some abuse has been reported when heroin supplies ran dry, like in France,) for a long time. It is currently used in dozens of countries, including much of Europe, Canada, and Australia.

It's interesting to note that immediately before the FDA approved it, the DEA rescheduled it to Schedule III from Schedule V (the lowest.) Reading the petitions to the DEA was both fascinating and frightening, hearing misguided assholes demanding it be in Schedule II with things like Hydromorphone (Dilaudid) or Morphine. Luckily they decided not to put a stop to the whole thing by doing so, and they put it in Schedule III. They put both Subutex and Suboxone in Schedule III, which makes little sense, as Suboxone is specially formulated to greatly reduce any potential for abuse.

Now, let me finish this part off by saying that congress did something blatantly illegal when they passed this law - they delegated their powers to the executive branch, putting it into the law that the DEA can pull the plug at any time. While I find this unlikely at this time because this drug is used mainly for upper- and middle-class drug addicts, such as Rush I am sure (eventually at least,) it is still a scary thought. Even if they didn't put this little disclaimer in there, it would matter not, as the DEA could reschedule the drug at any time to Schedule II, putting it with methadone, and then the special provisions of the DATA would no longer apply.

I said some of the following in my recap, but it contains other important things I didn't say:

Why this is important

Well first of all, we are going to see a huge resurgance in hard drug use - if we haven't already. Poor economic times lead to this - nevermind the HUGE crop in Afghanistan, which, luckily (for US,) will flood Europe and Russia and very little will wind up in the USA. The Heroin in the USA comes from Columbia (East Coast) and Mexico (West Coast,) and small amounts from East Asia, mostly on the East Coast. But it's still a matter of supply and demand, and I can tell you that scoring heroin on the streets of New York has never been easier.

So with a resurgance in drug problems, we have two issues - the first being getting the people that need help, help. The second being the "war on drugs" might return as it started - and that won't be pretty. With drug laws being toned down or outright decriminalized in many places, I am afraid of a backlash. The homosexual "acceptance" has had a backlash - that's for sure.

In fact, the drug war bears a great resemblence to the evolution of homosexual rights, only the drug war is further behind. First, it was a crime. Then, it was a disease. Now, (for homosexuality,) it is a right - yet still viewed as a problem by most in society. I am waiting for drug users to reach the next step.

Drug law reform needs to be properly framed, and treatment as opposed to incarnation needs to be the only option. Sending low-level non-violent drug users to jail is not only counterproductive, but a huge waste of money, and ruins many, many lives. Here in New York the Rockefeller Drug Laws were laxed - which is a big step for us here, but it is far from what can be deemed "reform."  Somehow we need drug laws that will discourage new users, even though I personally believe it to be a civil right, many others do not. I think what I do with MY body is MY right. And if you disagree, I wonder why most feel that people can do what they want with their body when it comes to abortion, but not with drugs. If proper heroin maintenance is given to addicts, the problems of heroin addict to society would virtually dissapear.

Besides that, the drug war is a complete and utter failure. It causes crime, causes people to become homeless and poor, causes needless deaths, the repercussions are endless - and this is blatantly obvious. We cannot continue such a fundamentally flawed policy, whether you believe drug use is a right or not (the founding fathers seemed to think so, I might add.)

Why else is this important? Because as I said way up at the top, there is nothing more important in my mind than our civil liberties - and it is something that must be defended - it is the last door to full-blown tyranical fascism that needs to be crossed. We must fight tooth and nail to stop any futher incursions into our liberties as Americans. (BTW, look up "liberty" in the dictionary. Tell me if you can honestly say to me that currently applies to America.)

Perhaps in another edition I will write the history of the drug war and drug use in America - and how, seemingly, drug use wasn't really a problem until the government propagandized it and created prohibition, the correct word for the current situation. Alcohol prohibition didn't work, and drug prohibition is working far less. Ending drug prohibition would go a long way towards curbing crime on all levels.

Well, that's the heart of it. I then posted a conversation regarding AA/NA and/or abstinence-based treatment, but I will not include thatas it is quite long and not top priority in my opinion, there being more than enough information to digest here. If you want to see it, read the original diary, and look for the part about a post by "glibfidget".

I promised to include other treatment options (besides maintenance and abstinence) and certain "harm reduction" policies (the current strategy today), and I am going to deliver. Some of this is also from the comments that arose from the diary.

Besides abstinence and maintenance, there are essentially two other treatment options. One is called "Rapid Detox." It is nothing new, and I have never heard a positive word about this method except from those trying to sell it to you. This is what I had to say about Rapid Detox, as well as a mention about the other new potential option, ibogaine:

"It's absolute quackery"

It's for people looking for miracle cures - and it just plain doesn't work. It's been around for quite some time now, it's no "breaking" treatment. It also costs ridiculous amounts of money. [Thousands of dollars]

Someone coming out of rapid detox has the lowest chance of success at abstinence of all - 5% at best. You just can't close your eyes and wake up cured. It DOES work in that you don't experience withdrawals - but if you ever see one of these things, up close or filmed, you wouldn't even consider it. It's downright horrible. They put you to sleep and force your body to go through what it needs to to be clean compressed into a 6 hour period. There have been deaths, and I wouldn't be surprized if it's shut down eventually. On top of that, you have protracted withdrawal symptoms, more minor nagging symptoms that continue longer than they should.

I have yet to meet anyone in the "loop" that had anything positive to say about rapid detox.

The only other treatment they have is this stuff called ibogaine. Well, that's not exactly true - they have plain symptomatic treatment for withdrawals, but NOTHING works to cure heroin withdrawals. Nothing - save one exception. There is a blood pressure med called Clonidine that depresses one area of the brain that heroin does - but far from all. So it does help - in some people - but others report no help or worsening of symptoms.

Back to ibogaine...it's this stuff that makes you have something resembling an unpleasant acid trip. Apparently some people think that when you take it, it does something to you that makes you look at your life and no longer want drugs. It has had mixed reviews, but there are some reports of success in clinical studies, which I need to catch up on.

------------------

I will look for some further info on Ibogaine, including a link to a site possibly with info about it, and hopefully provide that. My opinion on it is it might be worth a try, but it's no miracle cure. I think we are mostly seeing the power of placebo here. But I will investigate further, it's overdue on my part.

I never did investigate Ibogaine all that much further. Perhaps I should.

Now for Harm Reduction - what SHOULD be the only motivation and logical outcome of any drug policy.

Harm Reduction

The current stragegy of the government, after much lobbying, is called "harm reduction." This means that while we still send people to jail, while they are using we will do what we need to reduce harm (to everyone involved.) This mostly includes:

1 - Education and Addict Outreach

2 - Needle Exchanges

Needle Exchanges have done extroadinarily well, at least here in New York (I am positive there are places that need to catch up on this.) They essentially allow addicts to trade used needles for old ones. The goal is preventing the spread of HIV - and there is plenty of evidence of it's effectiveness in this regard. Guiliani opposed the first needle exchange tooth and nail, but eventually relented. The other important thing needle exchanges do is take used needles - thus preventing, to a certain extent, spent needles in places they shouldn't be.

Many states, including now New York, have also taken the step of making needles over-the-counter, meaning you can just buy them without a prescription. They are fairly cheap, and this is an important step for the type of junkie who would rather not go to a needle exchange - or where there are none available (or available at the time the junkie needs the needle.) I hope the other states that haven't implemented this follow the lead.

As for addict outreach, it's not nearly what it should be. Street addicts, most homeless and have HIV, need to be hit on the head with a stick to really get through to them, and many are very fearful of going to jail. I hope to see improvement here in the coming years.

Well, that's it for now - again. Hope I have given you what you have wanted, like I did the first time.

The original diary can be found in the archives here, and a follow-up "advanced edition" may also be found in the archives here.

•  Tip Jar

  Why did I post this in the middle of the night? Argh, so stupid, defeated the whole point of doing this...

  Oh well, I hope the people that want to read it somehow.

  by nephalim on Fri Dec 01, 2006 at 12:37:47 AM PDT

  •  Excellent diary nephalim!

    Very well said brother!  Well researched and nicely done!

    Iraq Moratorium

    by One Pissed Off Liberal on Fri Dec 01, 2006 at 04:54:48 AM PDT

    •  Why thank you

      Good to see you. Want me to post it on My Left Wing?

      by nephalim on Fri Dec 01, 2006 at 04:59:29 AM PDT

•  A subject neglected

  I've never been through your experience, and feel totally inadequate to comment on it.  

  I do think, from several other things I have read, that the worst effects of opiates are: addiction, constipation, legal troubles - and estrangement from society, which demonizes drugs.  Otherwise, heroin addiction seems to be less dangerous than nicotine addiction, from which I suffer.  

  Your story is poignant - unfortunately, "society" spends less on your addiction than on imprisonment.

  I'm truly sorry for your predicament, and have no advice to offer - save psyciatric intervention;  a wide spectrum of new SSRIs are available which might ease your problem.  Or, not.

  Sympathy and love,
  Will

  by willb48 on Fri Dec 01, 2006 at 01:17:08 AM PDT

  •  Thank you, on several counts.

    There is no solution. And SSRIs are ineffective for me (nevermind addictive! - but I am not arguing they shouldn't be used at all because of that, just that it should stop being ignored, and perhaps that they are overused.) I appreciate the thought and advice, regardless.

    Thanks,
    Peter

    by nephalim on Fri Dec 01, 2006 at 02:04:23 AM PDT

    •  SSRIs

      SSRIs are technically listed as antidepressants, but it seems like they are being prescribed for just about anything these days. They made my anxiety worse when a doctor prescribed them for me, and then I had nasty withdrawal effects for nearly a month trying to get off them. I would say they should be used very cautiously if at all.

      by thursdays child on Fri Dec 01, 2006 at 02:55:31 AM PDT

      •  I had two experiences with SSRI's

        One was wonderful, the other was hell.

        When I was in my 20s, I was feeling down, lacking motivation and never wanted to do anything. I was given Prozac. The shit worked, but in a way that I didn't expect - elevating my self-confidence to the point that all my original problems just became so clearly handle. Once the confidence was installed, I felt that it would be self-sustainable, and I stopped taking the drug.

        Ten years later, I had a series of panic attacks that were triggered by a combo of a new job and a venti frappicino habit. Panic attacks really suck - the first one is such a foreign experience. It doesn't feel like anxiety or even panic, because while the root cause may be "in your head," the physical manifestations and sensations are not - its is a physiological cascade. You think you are going to die. I was given Prozac again. Took it once, no problem, right? No way. This time the SSRI became the trigger for a series of bi-weekly attacks that were just disabling.

        It all worked out, but I would suggest that SSRIs be avoided by anyone with any anxiety issues. On the other hand, if your big problem is being too timid, or shy, that these drugs can change how you see the world so effectively that the drug is not needed anymore.

        by Kudos on Fri Dec 01, 2006 at 03:59:31 AM PDT

        •  As said more than once

          SSRIs are for straight depression only, in my opinion as a layman. Using them for anxiety or bipolar is a recipe for disaster and can elevate the problem rather than solve it. That, for sure, is how they are classically overprescribed as a mental illness panacea.

          The fact that they are addictive however is just that - a fact - one that has been described to the point that it can be quantified to specific symptoms - like feelings of electroshock. The drug companies tried to suppress this since their inception, they still are. Benzodiazepines (modern "minor" tranquilizers that almost completely replaced the "major" barbiturate tranquilizers) were sold as non-addictive. It took a while, but they are now acknowledged to be extremely addictive, withdrawals worse than opiates (and life-threatening withdrawal syndrome as well unlike opiates, more similar to alcohol.) All that and they aren't even all that great as medicines, more like an "aid" and not very potent, yet they are the most commonly prescribed medicines at least in the United States, probably worldwide.

          by nephalim on Fri Dec 01, 2006 at 04:25:11 AM PDT

          •  Don't go trashing the Benzodiazepines!

            When it comes to panic attacks, they work like nothing else. After fucking around with everything under the sun, I told my doctor that the only drug that broke the cycle of panic and worrying about the next one was Xanax. Not only that, but Xanax was also the only drug free from significant side-effects. I had to convince him (a doctor) to ingore the conventional wisdom about prescribing benzodiazepines for short term use only. Everything else was torture, and I wanted what worked. He relented, and changed to clonazepam. I have been taking 1 mg almost every day for the past six years, with no attacks.

            I don't consider myself addicted, but I am demonstrably dependent on beznodiazepines. There is no high, or any desire to increase my dose - which is fairly low. I've never felt "high" from this drug, never felt any desire to get a "high" and never got a rush after taking my dose.

            I feel normal - unless I miss a couple days. I literally become non-functional, the withdrawl is agonizing in a way I can't describe but to say after a couple days without my prescription, I could probably talk myself into armed robbery if I could get a couple pills. I went two months without the medication and I was miserable. My body needs. not my mind.

            Since then, I have accepted that I need to take 1mg every day if I want to live comfortably. Am I just rationalizing away an addiction with a dependecy?
            I don't believe a physical withdrawl syndrome indicates an addiction. Thoughts?

            by Kudos on Fri Dec 01, 2006 at 07:36:01 AM PDT

            •  Agreed

              I'm in almost exactly the situation you describe, also taking clonazepam, on the same low dose long term. I tried (or was forced to try) just about everything else first, but as you said, nothing works for anxiety/panic like benzodiazipines. Fortunately I found a doctor who looks at results rather than just following the conventional wisdom.

              by thursdays child on Tue Dec 05, 2006 at 02:03:56 AM PDT

            •  I should have chosen my words more carefully

              physical dependence doesn't equal addiction in modern medicine. But that comes and goes with a show of hands. They are also not considered a fun drug. It's the physical dependence and instant curing of anxiety that make them "addictive".

              What neither of you knows is that I too take clonazepam - in HUGE doses - I am talking 10-20mg at once. I wouldn't want to trade it, but it's certainly not 'fun'. Needing so much is horrible, and this has to change before I wind up strapped down to a hospital bed in a severe withdrawal syndrome.

              Over the long-term, benzodiazepines simply don't do anything. Your body adjusts, and as you put it you need it to feel normal. They aren't effective medicine except for naive (drug-wise) people for the short-term.

              Kudos, I don't think you are rationalizing it. You just take what you need. But it would take a very wise man or woman to tell you whether physical dependency ALONE equals addiction. I can't.

              However, I think it wasn't smart to get on them in the first place, perhaps. Now you have very little hope of ever getting off of them. Honest to God, most hardcore heroin addicts cringe at the thought of benzo withdrawal, nevermind in those with anxiety disorders. But if it truly did work for you like that, congradulations, what can I say.

              by nephalim on Tue Dec 05, 2006 at 10:14:24 PM PDT

•  'Harm Reduction'

  Starting Point for All Endeavors.

  What I find so problematic is America's delusional state, state of denial, and love of intoxication.

  I was watching an ad for kids' breakfast cereal and it struck me most forcefully as being presented as if addiction, cravings, etc. are good.

  A friend of mine is a drug counselor in England. She said that most of the young people (school age) who turn to drugs do so because they've never been taught social skills, which leads to emotional pain and a lack of tools, skills, to deal with it, so they turn to drugs.

  by LNK on Fri Dec 01, 2006 at 02:05:43 AM PDT

•  Nephalim, thank you for writing

  I always read and recommend your diaries ever since we first met in Thom Hartmann's chatroom.

  Is there any hope for addicts such as yourself to become completely clean, even with methadone treatment? I mean, can you ever wean yourself off of all drugs, even very slowly? Or is that even a goal?

  How much does your treatment cost and do you have to cover the costs yourself?

  Hugs to you and your wife.

  by pucklady on Fri Dec 01, 2006 at 02:07:39 AM PDT

  •  Anyone can hope..

    It surely has happened. A liberal estimate is that you have a 15% chance of success, the other end being around 5%, generally speaking, coming off heroin or methadone or buprenorphine (little difference in relapse rates whether you have been on maintenance or not short term - the relapse rates for those coming off of long-term maintenance (6 months to 1 year+) has not been adequately studied.) Those studies never follow for the long term, and many addicts relapse months or years later, so even that liberal estimate gets whittled down.

    What works for a lot of people, the people that do succeed, is admittedly NA/AA. What makes it work is the spirituality and faith that replaces the hole in yourself. Unfortunately this doesn't work for me - to be completely honest I find the belief in God to be quite a bit absurd. It isn't something you can force. Your likelyhood of success depends on you and your personality. If not God and the brotherhood of NA/AA and becoming something - you become a person with a "disease".

    Heroin addiction is not my disease. It usually isn't speaking from personal opinion. It is merely a symptom.

    The real disease is the key, and to be quite honest my hopes aren't high. My new marriage has kept me from falling completely off the wagon - and will continue to, as I consider my life with her more important than a hit of heroin or whatnot - but without maintenance treatment I can say from personal experience that the cravings would become overwhelming. Heroin becomes your crutch, and unless you can find another one - and one equally powerful - then you won't succeed. Or cure the underlying condition (i.e. depression or PTSD - Post Traumatic Stress Disorder increases your chances of heroin addiction someodd 30 times - and someodd 70% of female heroin addicts have been sexually assaulted/molested.) When the underlying condition is of the nature that it can cause heroin addiction is not easily treatable.

    It shows the failures of our society. America has some of the highest rates of drug use. We are a very disfunctional society. It saddens me to say it, but it's true.

    by nephalim on Fri Dec 01, 2006 at 04:00:46 AM PDT

    •  EMDR

      Thanks Peter for such a thorough post. I will go back to read your others.
      I too am an addict ( caused by treatment for chronic backpain), I have been treated by a wonderful addictions specialist with both buprenorphine and later suboxone which I was able to wean off of in a week. A week from hell, but at least it ended. What it didn't end, and will never help end, is the craving for the high. I still play around with scripts that I have access to when ever I have a medical procedure where I am given the option to use. It is insane, but that is me.
      The one image that I go back to is the one that pushed me into treatment the last time. I came within a wisker of sideswiping a state police cruiser while using methadone. I was saved by whatever there is in the universe that is bigger than me and I was aware that I had a chance to do the right thing. It is that wisker of an inch that kept me out of prison for vehicular homicide and scared the shit out of me.
      That doesn't end my cravings. I have been successful with hypnotherapy and have learned a type of EMDR  that I can self administer when the cravings interfere with my daily life and they are most helpful.
      It isn't a cure but it  is the best that I can do in the moment because that is all we really have - just this moment and to 'think it through' as I learned in AA.

      by tallmom on Fri Dec 01, 2006 at 04:59:49 AM PDT

      •  Thank you

        And thank you for sharing, too. I hope not for an ambiguous notion of success, but for your happiness.

        It's not crazy that you "play with scripts". That is something that is largely unavoidable, but you can't just give up either. It's really tough to know what to think and say.

        May I enquire about EMDR?

        by nephalim on Fri Dec 01, 2006 at 05:12:01 AM PDT

        •  Back at you too

          It is a daily struggle isn't it?
          The idea behind the hypnotherapy that I mentioned as it ties in with EMDR is the repitition of either eye movements to reprogram the brain waves to alter our memories or tapping on certain areas of the upper body. EMDR has been very successful for folks with PTSD.
          The tapping works in a similar way but on a deeper level. You repeat certain statements that you choose to change your energy while tapping on cheekbones, chin, upper chest and the like. It only takes five minutes or so and I truly believe ( as this is the secret ) it does the trick for me.
          Finding a therapist that works with hypnosis & addictions can be very valuable.
          IMHO.
          Have a great day Pete

          by tallmom on Fri Dec 01, 2006 at 05:31:40 AM PDT

  •  And thank you..

    It is very much appreciated. It makes me happy that you remember me, and enjoy my writing.

    by nephalim on Fri Dec 01, 2006 at 04:01:38 AM PDT

    •  Off the subject

      How does the addiction community feel about the addicted character on Heroes? Amused? Insulted? It seems he got off heroin relatively easily until forced to use again. Based on your narrative, it wouldn't take much "forcing" to cause a clean addict to use again.

      Congratulations on your marriage, btw. I remembered you had a sweetheart back in the chatroom. I called her "wife" for convenience in my original post. May the love of a woman be the "virgin high" that you have spent your life chasing.

      by pucklady on Fri Dec 01, 2006 at 06:44:14 AM PDT

•  Prohibition doesn't work

  That's already been proved with alcohol. We would be better off treating drug addiction as a health problem rather than a crime. It seems a waste of productive lives to put people in prison for minor drug offenses when they haven't harmed anyone (except maybe themselves, and that really shouldn't be a legal matter).

  Thanks for writing this very interesting diary. I will have to go back and check out the previous ones you mentioned.

  by thursdays child on Fri Dec 01, 2006 at 02:42:49 AM PDT

  •  It's a travesty of justice

    that for most drug addicts, the legal (artificial) consequences of their use are far more destructive than the disabling effetcs ihnerent to the drug abuse.

    by Kudos on Fri Dec 01, 2006 at 03:24:36 AM PDT

    •  Summed up perfectly..

      That is the essence of it in a nutshell. Well said.

      by nephalim on Fri Dec 01, 2006 at 04:02:33 AM PDT

    •  in cases I've known

      the legal problems came because my friends needed more and more heroin to reach the same high...their toleracne continued to rise. Then they needed more and more money to buy the amount needed to reach that place...hence the legal problems.

      I think it is a crime that people are sent to jail rather than rehab. It has been shown that it is cheaper and more effective to send people into treatment rather than jail, so why isn't this done?

      Some of the brightest and most talented people I've ever met have been addicts and it makes me so sad to see them die rather than get the treatment or help (harm reduction) that they need.

      by Loonesta on Fri Dec 01, 2006 at 06:15:43 AM PDT

•  Ibogaine link

  http://ibogaine.org

  My own experience was with a dose much lower than used for addiction treatment, and not unpleasant.

  Several friends who were strung out show all indications of a successful cure.

  alas, ibogaine is itself a Schedule I Controlled Substance. The only US research license was issued in 2005 for a study on using it to treat cocaine addiction. Completed, but not yet published.

  There's been a few thousand underground treatments to date. For 1 in 5, a single dose works. For 3 in 5, opiate use stops, but is resumed after a few months (at a much lower level), retreatments do the trick.

  by ben masel on Fri Dec 01, 2006 at 03:11:01 AM PDT

  •  It's legal in Canada if I am not mistaken

    Yes?

    Good to hear from you again Ben. We need to keep in touch. I wish I stayed in the loop the past year, I would have helped your campaign any way I could have.

    I have heard good things about Ibogaine - no horror stories yet either. But relapse months later seems to fit the mold, sadly.

    by nephalim on Fri Dec 01, 2006 at 04:16:46 AM PDT

    •  Relapse

      From the viewpoint of the surrounding community, a treatment with eventual relapse is still a win, in that property crimes are averted for a while.

      Success rates are best for those who use Ibogaine to get off Methadone, as they'e generally already stabilized the rest of their lifestyle, ie jobs, housing, non-using friends.

      You back in NYC? I can still arrange introduction to the folks on the Ibogaine scene.

      by ben masel on Fri Dec 01, 2006 at 10:22:59 AM PDT

      •  I'm in Australia at the moment.

        But will be home eventually and we'll talk. I'll drop you an email.

        by nephalim on Tue Dec 05, 2006 at 10:04:26 PM PDT

    •  Canada

      The molecule is legal, but it's not approved as a medication.

      by ben masel on Fri Dec 01, 2006 at 10:43:46 AM PDT

•  Thanks. Good diary

  Have you read Infinite Jest?

  by abbeysbooks on Fri Dec 01, 2006 at 03:21:19 AM PDT

  •  Can't say I have.

    I will look into it, but you are free to give me a blurb.

    And thanks!

    by nephalim on Fri Dec 01, 2006 at 04:14:02 AM PDT

    •  The book itself is an addiction

      It is to the 90's what Gravity's Rainbow was in its time. It is all about addictions. All kinds.

      by abbeysbooks on Fri Dec 01, 2006 at 04:52:44 AM PDT

•  I work in drug research

  at a nonprofit that does research into AIDS, HIV, and drug use.

  This is a very important topic.

  Here's a simple question:

   Wouldn't it be nice if no one went to jail for smoking pot, and no one got out of jail who had raped kids?

  Here's another

  Why do we keep funding project DARE when we know it does no good?

  (The director of DARE once said "I'm not saying it's effective but it's state of the art".  

  One more

  The federal government has funded at least nine major studies regarding syringe exchanges.  ALL showed that they slow the spread of HIV and do NOT increase injection.  So, why don't the feds. fund any exchanges?

  One study I worked on showed that in one neighboorhood in Brooklyn where there were 2 needle exchanges, less than 1% of young adults had even heard of them, and the people who had heard of them injected BEFORE they knew about the exchange.  How can a syringe exchange spread a message of injecting is OK, if no one who doesn't inject knows they are there?

  Thanks for writing this diary, recommended.  I hope more attention is paid here to this war, which is just about as stupid as the war in Iraq, but has lasted a lot longer.

  by plf515 on Fri Dec 01, 2006 at 03:41:02 AM PDT

  •  Luckily syringes are over-the-counter now

    in most states, in limited supply. But street addicts often can't even come up with the dollar for a needle. It's so sad. They should give out single needles for free at pharmacies, that would be a good health initiative.

    As for needle exchanges, for sure. There is no glory in having to go to one of those, that's for sure. There was one a block and a half from where I worked, and no one even knew it was there - save the addicts. And it works.

    On an interesting political topic, Rudolf "Liberal" Guiliani opposed the very first needle exchanges tooth and nail as mayor of New York, stationing police officers to arrest their patrons. This is the type of man we are dealing with. Liberal my ass. Being from Brooklyn I am sure you know all about this.

    Thanks to you - and to everyone for their wonderful comments.

    by nephalim on Fri Dec 01, 2006 at 04:13:10 AM PDT

    •  Depends on the state

      Also, many pharmacists refuse to sell needles to people they deem 'undesirable' - mostly the more obvious injectors.

      by plf515 on Fri Dec 01, 2006 at 04:31:18 AM PDT

•  It's not about character

  As long as the myth that it's about character is allowed to exist we're going to have a war against drugs.

  Our best argument in the war against drugs is to compare addiction to obesity.  As weight becomes more of a problem for more people we get more people more willing to listen to a more reasonable policy on drugs. (more=mores or morals)

  It's about chemicals.

  by wroughtnharv on Fri Dec 01, 2006 at 03:53:29 AM PDT

  •  Character.

    This is being disproved more and more every day. I mentioned in an earlier post that people suffering from Post Traumatic Stress Disorder are 25 to 30 times more likely to become heroin addicts, and that 70% of female heroin addicts were sexually assualted/molested.

    Addiction itself isn't a disease - it's a symptom of a disease - and that subtle yet profound difference is lost on many.

    by nephalim on Fri Dec 01, 2006 at 04:05:20 AM PDT

•  How much of the drug war

  really has to do with maintaining the prison-industrial complex, I wonder?

  by echo on Fri Dec 01, 2006 at 04:00:04 AM PDT

  •  Actually

    I just heard on Air America yesterday that prison rates are up to a new all-time high. I think it's one in thirty or something thereabouts are in the prison system (prison, probation, or parole.)

    No other civilized country in the world has such high criminal conviction and encarceration rates.

    Don't think you are safe smoking Marijuana either. They arrest someodd 500,000+ people a year for that "crime". (Needless to say not all go to jail, however.)

    by nephalim on Fri Dec 01, 2006 at 04:07:44 AM PDT

•  Walking away

  When I had to live on painkillers due to a back injury I depended on them to funtion after a while. I decided after a few years of this to STOP! Was it easy? FUCK NO!

  I still ran a business by the grace of God and somehow made it through. It took about a week to feel somewhat normal and another to feel toally normal.

  Things are CLEAR again now...I would not go for treatment because I believe it nurses the additction and I ddidn't want a record.

  If you have this addition now FORCE yourself to start cutting down. Take 1/2 instead of a full pill.

  After a bit of time this will make it much easier to walk away from them. The high of the "doing it yourself" is the best part. It will take some time but you will have a new lease on life.

  P.S I painted my kitchen through the withdrawl stage lol. Even though I had to sit down every few minutes it was a huge lift!

  by dynamicstand on Fri Dec 01, 2006 at 05:15:22 AM PDT

•  A good organization to give to in this area

  is Families Against Mandatory Minimums -- they work to reduce or eliminate the mandatory minimum sentences for drug crimes.  They also help some of the more obvious cases get out of jail.

  One such case is that of a black pariplegic.  He was on a bus in the south.  Police found cocaine on the bus.  ALl the other passengers said "It belongs to the black cripple".  He was sentenced to (I think) 25 to life.  

  FAMM (with a lot of help from my wonderful younger brother) got him out.  What did he do when he got out?
  He started an organization that helps the families of people in jail.

  by plf515 on Fri Dec 01, 2006 at 05:39:04 AM PDT

•  Some facts I know

  Whatever the addiction, you can be free of it. I was a junkie from age 16 to 22, I went cold turkey ( except for booze and pot). I was a alcoholic from age 25 to 33. I again went cold turkey, this time completely. I could never of stayed clean without the support of several 12 Step groups.
  After getting clean I worked in the recovery field as a crisis counselor at a world known hospital. I was also very active in raising money for a local Alano Club, and a 12 Step recovery home for men.
  None of this is easy, and it can't be done alone, but it can be done. The use of maintence drugs like Methadone should only be used as a stepping stone to being totally clean. ( Methadone does lots of damage to the body, more than Heroin )
  The worse withdrawls I have ever seen anyone go thru was from a combination of Methadone, Valium, and Xanax. Misguided Doctors can be worse than the drugs for recovery.
  If a person is lucky enough to have what is referred to as " A Moment of clarity ", they have a chance. It takes a deep soul searching, and a willingness to have your ego completely smashed.
  Not everyone , no matter how low they go, is willing to do what it takes. The amount of surrender needed to recover means one must look at the roots of the cause, however painful.
  The causes are as plentiful as apples on a tree, but well known. When taken to the end all the causes are based in fear. Fear of losing something, fear of gaining something, fear of love, or fear of lack of love. Between fear and shame the fight for self is one of the most enlightening experiences there is.In fighting to find that same self, one must surrender that same self.
  I will end this by recommending several books. In the book " The Road Less Traveled ", the first paragraph says ( paraphrased )," Life is difficult, once you accept that fact, it gets easier". A must read for my own recovery. The second book is much harder to read and it is called " The Dark Night of the Soul", written by a Mystic Saint, St. John of the Cross. The final and third book that helped me is the "The Twelve Steps and Traditions" aka the 12 and 12 of A.A..
  My email address can be found by clicking on my sn, and I am willing to talk one on one with anyone who is serious about recovery.
  In the 12 and 12 there is a line that goes " At first, rebellion dogs our every step ". When one is done with the rebellion of the soul, it takes work, surrender and nurturing to repair the damage.

  by OneCrankyDom on Fri Dec 01, 2006 at 05:55:47 AM PDT

•  I've been wondering

  My pain management doctor has been talking about switching me over to methadone from oxycodone.  She is really making sure she takes care of things well in advance before they even begin to get out of hand because I'm only taking two 7.5 mg pills per day spit in half to four doses now and I never go over.  (Taking tramadol between doses makes all the difference!)

  Anyway, I know my prescriptions would be marked with "for chronic pain," but I worry about what my medical records are going to look like on a list as things like that get less and less private.  I also assume I'll be able to still get 30 days of meds because of my doctor's specialty but I'm curious about it.

  by Progressive Chick on Fri Dec 01, 2006 at 06:06:21 AM PDT

•  A Good Friend Of Was Addicted To Heroin....

  ....but has now been clean for five years or so.  Thing I learned about all that, is when someone is maintaining their addiction, as in not really getting high, just staving off "sickness", you can't really tell at all.  Dude was high functioning, had a job, last person in the world you'd ever expect to be a Heroin addict - except that you'd find messed up spoons hidden neatly everywhere, and tiny blood spots around his pad.  At one point, he had told me that he had been clean, and wanted to come visit my girlfriend and I for Christmas.  What he failed to tell me was that he was planning to use the opportunity to get clean.  Our sofabed was down in the middle of the living room for a week, and he got clean.  That wasn't the last time, though.  The last straw came when he went on a wedding cruise with his family, and did the same thing.  They checked him in somewhere, and try as I might, it's been years since I noticed some bent up silverware anywhere in his house.  Either he got REALLY good at hiding it, or actually went clean this time, and I'm pretty sure it was the latter.  

  by tkmattson on Fri Dec 01, 2006 at 06:43:00 AM PDT