MAY 2016—I’m 68 and starting over, girls and boys, in every way but puberty. Three months ago—about two years after quitting heavy-duty prescription opioids cold turkey—I started on Suboxone. I’m still broke (“flat-busted,” as Mom used to say), living on less than a thousand dollars a month. I’m still weak from years of addiction, from December’s hernia surgery, and from fighting chronic pain. But here’s the thing: God is good, my mind is clear, and Love and Gratitude are more than Sunday-morning words again. So I’m picking up where I left off—starting with this shabby old neglected blog—and I’m promising that I will do one thing every day toward my well-being and yours, fellow citizens of Planet Earth. Here’s some recent history, to let you know how deep down we were and how far we’ve already come….
UP FROM ZERO ALTITUDE
RIGHT NOW, I’M GOING TO SPEND exactly fifteen seconds wishing that I could take a mulligan on August 23, 2010. Yes, I really would like a do-over for the day I decided my life would be better with the help of a minuscule amount of a perfectly legal prescription painkiller.
I did have pain, and it did interfere with my making a living, cooking a meal, cleaning the bathroom, going to church, and playing bridge with friends on Thursday evenings once a month. When I took one Vicodin tablet—the lowest strength available (5 milligrams of hydrocodone with 300 milligrams of Tylenol)—I could work, cook, clean, and socialize, and I could do those things within twenty minutes of swallowing a nifty little pill. Was it the worst decision I ever made? Would I unmake it?
I used to pretend I could. I call it the “I Want My Old Life Back” shuffle, and when I catch myself doing it, quick as a bunny I latch on to a more realistic fantasy, like winning one of those Rhine River cruises or being elected Supreme World Ruler. If I really believed that taking opioids ruined my life, then the rest of my life would amount to nothing more than fine-tuning my obituary.
The Reverend T. Merton Rymph once preached a sermon titled “Don’t Let the Second-Worst Thing That Ever Happened to You Become the Worst Thing That Ever Happened to You.” A mega-mistake might be that perfectly awful second-worst thing, but it’s the guilt and regret that can literally kill you.
Is my fifteen seconds up? Thank God!
The first year
It was a long time before I got whomped with the magnitude of that mistake. I was living in Omaha when I injured my spine and started taking small amounts of Vicodin—5 or 10 milligrams a day, three to five days a week. Dr. Schmidt was stingy with painkillers. Then I moved to Tucson and got assigned to Dr. Ross. If Dr. Schmidt was the Ebenezer Scrooge of narcotic prescribers, Dr. Ross was Santa Claus and all his little helper elves. For almost three years, she did everything she could to keep me abundantly medicated and almost nothing to keep me healthy.
An opioid is a drug derived from opium—natural, synthetic, or semisynthetic. Morphine, codeine, heroin, oxycodone, hydrocodone, and fentanyl are opioids. The strength of these drugs is sometimes measured in morphine equivalence. For example, fifteen milligrams of oxycodone equals ten milligrams of morphine.
I left Omaha with a prescription for 30 Vicodin tablets a month, equivalent to 5 milligrams of morphine daily. The first week I was in Tucson, Dr. Ross started me on 60 milligrams of oxycodone (equal to 40 milligrams of morphine) a day. Do the math: One day, 8 times the narcotics. But Dr. Ross wasn’t done making me comfortable. I still had pain. She couldn’t wait to get me on the fentanyl patch—plus, not instead of the oxycodone.
Less than a year later, between the patch and the pills, I was taking the equivalent of 450 milligrams of morphine every day. In eleven months she increased my opioid intake by a factor of 90, with never a cautionary word. One pharmacist questioned the dose, as did a few friends, who pointed out that I sometimes fell asleep standing up and didn’t I think I had a problem?
Dr. Ross told me to show my MRIs and CT scans to the naysayers. She also gave me a copy of the criteria for addiction drawn up by the American Psychiatric Association and the World Health Organization. According to these guidelines I wasn’t an addict, she said, because I didn’t take more than the prescribed amount, I didn’t lie about my drug use, I wasn’t experiencing negative consequences, and I wasn’t demonstrating bizarre behavior. Actually, negative consequences were quietly piling up and gathering interest in a sort of reserve account, the way sun worshipers accumulate cell damage that down the road might show up as skin cancer.
A word about bizarre behavior: In 2012 I bought a pickup truck and rickety camper in preparation for a coast-to-coast peripatetic-minstrel sort of spiritual road show. While I was in my room planning my itinerary and writing songs and creating children’s activities, on two or three occasions a semitransparent woman who looked like Dorothy Parker wearing orthopedic shoes and a pillbox hat showed up with three young male assistants. She fed me material for my songs and the young men sat at desks doing something with data on old-school adding machines. Once she brought my mother-in-law, who had been dead for eight or ten years. I saw all this as divine approbation for my elaborate plans. Every month, when Dr. Ross dutifully asked if I were having hallucinations, I said, “Nope. Not a one.” I swear, it did not for a single moment occur to me that the extraterrestrial support from Dorothy and her pals was anything but God’s way of saying, “You go, Girl!”
Every month, Dr. Ross asked if I were still having pain. I always had pain. It was tolerable, but Dr. Ross seemed dissatisfied with anything short of rapture. I never asked for more drugs. I didn’t have to. She was determined to banish every pang, prickle, sting, and itch from my universe. I still don’t understand it. She wasn’t a kid. She came well recommended and seemed to know exactly what she was doing. But she’s only one of a dozen health professionals I’ve worked with since 2011 who have an appallingly shallow understanding of opioid addiction and recovery.
The five-percent-distortion factor
How did I feel during my adventure in near-painlessness? I felt “normal”—plus five percent. I felt the way I was used to feeling, but a little more so. A tiny amount of distortion can create a mountain of misperception.
I’m always forgetting to clean my glasses. One day not long ago, talking with a friend in my apartment, I interrupted our conversation to ask him if he saw smoke. “It’s really smoky in here,” I said. I was really quite concerned. I jumped up and started opening windows, and he said, “When was the last time you cleaned your glasses?” Just to humor him, I got out the rubbing alcohol and cleaned my glasses. Voila! No more smoke.
Why didn’t I listen to the pharmacist or my friends? Why doesn’t anyone? Because she feels fine. Because her very-credible doctor is matter-of-factly handing her a prescription every month. Because she’s not suffering. Because deep down, in a place so secret she can’t find it, she knows that without the drugs she would experience great emotional pain.
I’m not a fan of suffering. I bet hardly anybody wakes up on a sunny Saturday morning and thinks, “Nice day. Too nice. I really don’t deserve it. I think I’ll try to do some suffering today.” But suffering has a point. It lets you know something’s wrong and lets your imagination go to work on changing it. Opioids block that signal. As long as you have the drug, you don’t need to do the self-assessment and the strategizing and the praying and the honest communicating and the meditating that would reveal and ultimately solve the problem that created the suffering. You just need to take a pill.
Please understand: I wasn’t on a three-year high. I felt happiness and sadness, anger and remorse, the usual emotions, just not the usual intensity or range. I viewed myself, other people, my circumstances, and the events in my life through that five-percent-distorted lens. The fentanyl and oxycodone acted like a Kevlar vest. A metaphorical bullet might metaphorically knock me down and break a metaphorical rib, but emotionally I wouldn’t bottom out.
I honestly can’t tell you why I decided to quit. Maybe it was partly because I’d been on the planet for 63 years before I took my first pain pill, not counting the stuff they give you when they pull your wisdom teeth or yank out your uterus. In all that time I learned some stuff that didn’t fall out of my head when drugs started changing the way my brain worked. Something in me knew that I was still putting one foot in front of the other but I’d stopped dancing.
So I did a little research, and I discovered that fentanyl is 80 to 100 times more potent than morphine and 40 to 50 times more potent than pharmaceutical-grade (100-percent pure) heroin. I found out that most near-death cancer patients were taking lower opioid doses than I was.
At the time I quit, I was in my sixteenth month at what was technically a homeless shelter but was in actuality a swell deal—twelve women in a dormitory-style house built in 1927 for tuberculosis patients near the University of Arizona. The house smelled like old wood and chlorine bleach, as vintage houses do when thoroughly and rigorously cleaned and polished. It was the Downton Abbey of transitional shelters, though it wasn’t all that transitional; I could have stayed for two years with the option of applying for permanent residence.
Demographically, we were a motley crew. I was plain white bread. Everyone else was Hispanic or Navajo or Apache or black or Russian or gay or transsexual. Two women were on parole, at least two were on methadone therapy, and one was technically a man, but no one cared. She had her head on straight, and she was everybody’s favorite sister.
When I first thought about quitting, I asked the former addicts how long I could expect to feel terrible. One said a few weeks; one said a few months. I guess I should have checked with people who weren’t on methadone, but it didn’t occur to me at the time. So on the strength of this dubious testimony, on a Sunday afternoon in late January 2014 I called a cab and checked myself into detox.
My advice for anyone who wants to shed a major drug habit is to first accumulate heaps of wealth. The only detox facility available to me was staffed by one nurse and a couple of nurse-assistants per shift. There were no physicians. Equally discomfiting, there was no heat. We had to wear scrubs and sleep on vinyl mattresses and go to meetings, and that was pretty much it. I left after a week.
Apart from the physical symptoms that take possession of your gastrointestinal system when it’s exorcizing toxins, the first few weeks were merely awful. The real agony began on the fifteenth day, when I woke up in a state of high anxiety, which got so much worse so quickly that I went to Dr. Ross and begged her to put me back on fentanyl so I could taper off. Any sympathy she might have had evaporated when she saw the detox wristband I’d failed to remove. She hustled me out the door with the assurance that all I needed was a good antidepressant. Seriously.
I had a prescription for the antianxiety drug Xanax but I couldn’t get my shit together for a two-block walk to CVS, so I made an ill-advised attempt to borrow half a Valium from another resident. I was overheard, reported, and evicted the same day. I stayed that night in a hospital and the next night in the No-Tell-Motel annex before a friend agreed to put me up for a month while I made arrangements to move back to Omaha. There’s a star in Heaven with her name on it—may it be many, many years before she has cause to claim it.
During that month I meant to learn more about PAWS—the acronym for postacute (or protracted) withdrawal syndrome—but it was too depressing. Opioids really screw up your brain chemistry. They mess with the pleasure receptors, so not only do you get anxious and depressed, the antidepressants and antianxiety drugs that used to help don’t do any good.
For a month or two I seemed to improve. Then the bottom fell out. I couldn’t concentrate. I could hardly take a shower. I couldn’t sleep—no relief there. I had no appetite, my body temperature fluctuated from arctic to Saharan, and if someone asked the inane question “How are you?” I wanted to stab him or her in the leg with a fork. It’s exhausting to be so anxious… to never be able to relax for a second because you feel like you have to manufacture your own oxygen so you can breathe.
Depending on the particular drug, the dose, and the duration, these symptoms can persist for months or years. The studies I read generally cited two years as the maximum length of time required for your body to return to normal, usually with the disclaimer that they’re just messing with you and some people suffer indefinitely—either because their brains are really, really whacked or because it’s exceedingly difficult to practice good mental hygiene when your entire consciousness is blighted.
Ninety-five percent of recovery involves doing stuff you don’t want to do, over and over and over. I went to AA meetings when I wanted to stay curled up in bed. I spent a lot of time curled up in bed. I was experiencing anhedonia—the inability to feel pleasure. It came in waves with no remission for weeks at a time. I tried guzzling margaritas, without success. I’m not sure what would have constituted success, but I wasn’t finding any. Several times a day I gave up entirely. I prayed, but only to ask God to take me to the celestial cottage or cell block or meadow where I’d find Mom and Dad and a few mongrel dogs I’d loved and lost.
Now and then I’d persuade myself that life would be easier if I became an alcoholic, though in general I drink very little. I’d buy a bottle of cheap vodka and mix it with fruit juice—for nutrition, you know. Here’s what would happen: I’d be given a prescription for Ativan or Xanax; it would work for a while; then it would stop working and I’d become so desperately anxious I’d boost the benzos with the alcohol. At that point I’d forget how many pills I’d taken in combination with how many shots of vodka or maybe tequila. I’d start worrying that I might have accidentally overdosed. My death would bring grief and shame upon my family. At last I’d call 9-1-1, spend a week watching television in a hospital, and soak up enough energy from my fellow inmates to feel well enough to go home. Back in my apartment, I slipped back into isolation, finding it almost impossible to summon the effort to make a phone call or take a walk. After five hospital admissions I lost track.
The problem with hospitals, when you’re on Medicaid, is that you’re going to get the budget economy treatment. Physicians who specialize in drug rehab are by and large at Betty Ford or Sierra Tucson. The health professionals I dealt with treated my symptoms as they would any other form of depression and anxiety. I’d see people with bipolar and schizoaffective disorders come to the hospital after they had for whatever reason gone off their drugs. In 24 or 48 hours they’d be remedicated and ready to take on the world. But we all went to the same groups, where we were lectured to and often scolded about mental illness, relationships, diet, exercise, and coping skills. The secret to recovery, we were told—as if it were a recent discovery, a major breakthrough in the science of emotional wellness—was this: “Think good thoughts.”
I don’t own a television, so watching the hospital TV was a small treat… although when the evening news consisted almost entirely of refugees slogging through the Balkans on their way to Germany I remember feeling something like envy. At least they knew what they wanted. My heart broke for the parents of little kids who got sick during their long trek and had nowhere to sleep except on cold, soggy roadways, but despair is despair even when you have a warm bed.
As a parent, you don’t outgrow the instinct to protect your children. I felt toxic, and I didn’t want to infect the people I loved. When I talked to my younger grandchildren, I felt as if some of my dreadfulness would ooze from my pores and pollute their innocent sweetness, even on the phone at a distance of thirteen hundred miles. This is common among recovering addicts, which is why AA is a godsend. There were many, many times when I felt safe only in AA meetings. That’s where you find people who accept you in all your fearsome ugliness.
My last hospitalization, aside from hernia surgery last December, was in June 2015, about 15 months after quitting opioids. I was so anxious I couldn’t sit still. The underqualified, minimally trained staff urged me to use “coping skills” until I wanted to make a really unladylike and anatomically impossible suggestion about coping skills. After nine days with no improvement I was sent to the Salvation Army’s Mental Health Respite shelter, where I stayed for two godawful weeks.
Back in my apartment, eighteen months into recovery, I started feeling more energetic. I was still depressed and anxious all of the time, but I went to more AA meetings, called more friends on the phone, walked more, ate more. Then, WTF, right before Christmas I went to the hospital with a strangulated hernia. I had surgery December 29 and spent almost two weeks on IV opioids.
Even at the low dose I was allowed, the addiction grabbed me by the throat. “Remember me?” it said in its raspy sadistic voice. Wow. I talked to my psychiatrist and my family doctor about Suboxone, pretty sure I didn’t have the strength for another round of PAWS. Both doctors were supportive. I started Suboxone in late January 2016—a little more than three months ago.
Things are better now. I have more good days than bad. I remember what pleasure feels like, even—dare I say it?—happiness, not all the time, but enough to keep me fueled up.
Nowhere to go but up
There are a few people in the world I can count on to track me down and use tweezers if necessary to pull me out when I fall through the cracks. They’re friends from high school, and while I was trying to be small and not bother anybody, they wouldn’t leave me alone. It’s not as if they didn’t have anything to do with their lives except rescue me, but it felt that way from where I sat.
They prayed for me. They had their friends pray for me. I knew that if I ever again experienced a moment’s joy it would be by the grace of God. I’m not sure how that works, precisely, because if this unremitting wretchedness had been given to me as some kind of lesson, what was I supposed to be learning? I had no idea what I’d done to deserve it. I still don’t.
I know only that whatever level of strength and peace I’ve risen to has given me the energy to be of service. God is opening doors and inviting me on adventures. If I choose to not open those doors and to not seize those adventures, then I will experience the suffering that always accompanies denial of one’s core self. I believe that if we hoard our gifts and suppress our talents, those choices weigh us down until they bury us.
In 2010, not long before I turned 63, I was fairly contented and relatively productive. Four years later, at almost 67, I felt as though I were emerging from a dream and had awakened old, exhausted, and emotionally stuck in adolescence. What immediately presented itself was the need to claw my way out of the deep, dark hole I’d plunged into.
Now I’m on level ground—redeemed from despair but not relieved of all responsibility for making miracles. Ground level might give me freedom from the tyranny of fear and regret, but I don’t think any of us is meant to make a modest furrow and plant a little row of seeds at zero altitude. Level ground might be the place to fit my wings but not to finish my assignment. If I’m to spiritually thrive and do my job, I need to recognize the favorable winds and act on faith that, by the grace of God, I can navigate the stratosphere and soar across the sky. If that sounds grandiose or just flat impossible, it’s okay with me. How will I know my limits if I don’t begin with the assumption that I haven’t any?