Opioids: My Story

 
In 2001, I asked my doctor for help to manage my chronic pain because of the car accident when I was almost 19. She is a wonderfully insightful woman, very professional, and a dedicated practitioner of medicine. For the first time in my life, I started using opioids. The opioid I started with contained 500mg of an opioid called hydrocodone and 200mg of ibuprofen three times a day. Over 15 years, my daily dose slowly increased until I took four to six tablets daily—each containing 1000mg of hydrocodone bitartrate and 200mg of ibuprofen—more than double from where I started 15 years prior.

The goal of most prescription medications is to treat the symptoms of a disease or disorder, not to cure it. Most patients hope for the outcome I described earlier, with zero symptoms and zero side effects. The worst side effect I encountered from my opioid use was occasional constipation. It was a side effect of ibuprofen that put me in the hospital in 2017. Ibuprofen can damage the lining of your stomach and harm your kidney function. Ibuprofen is in a category of drugs called NSAIDs or nonsteroidal anti-inflammatory drugs. NSAIDs increase the risk of heart attack and other heart problems by one-third. Ibuprofen, in particular, more than doubles the risk of a major heart event. I took 800mg a day because my options were limited to either a mix of the opioid and ibuprofen or acetaminophen.10  I tolerated this drug cocktail well for years. I could work without pain for the first time in many years. Why this combination of hydrocodone and Ibuprofen, you might ask? Using ibuprofen is the lesser of two evils. They offered me two choices, hydrocodone and 325 mg of acetaminophen or hydrocodone and 200mg of ibuprofen. With acetaminophen, some of the drug converts into a toxic metabolite that can harm liver cells. Taking too much acetaminophen raises the risk of liver damage, and in severe cases, it can lead to death. Taking too much ibuprofen, especially over a long period, will damage the lining of your stomach. That is exactly what happened to me.

I firmly believe ibuprofen and acetaminophen are more dangerous than hydrocodone. All can lead to death, but hydrocodone can be quicker. The familiar, ubiquitous, over-the-counter drugs can cause death as well; It takes a long time but can happen. Pharmaceutical companies advise that ibuprofen should not be taken daily for more than a week or two. At 200mg four times a day for fifteen years, it was harmful to me. I ended up with stomach ulcers, and it was not the opioids that were responsible. By the winter of 2015, I was taking four 1000mg/200mg tablets, plus I used a 10mg per hour 24/7 transdermal pain patch called Butrans. I used the patch because the pain would come back every night, right about when the opioid wore off, around 5:00 AM Every morning, pain and a sick feeling awakened me, like having mild flu. The patch stopped that from occurring. My issue was going into withdrawal every morning. I used a strategy to slow the buildup of opioid tolerance. Every few weeks I would lower my dose by half for two-four days, then ramp back up again slowly. It was my thinking that I was taking too much opioid medicine. Pharmaceutical companies told patients to take their opioid meds even if they were not experiencing pain. I suspected this advice from the beginning, as the major side effect was building a tolerance faster than need be. This advice led to far too many people becoming addicted.

On July 4, 2017, I pulled off the last Butrans patch I had. I stopped using a patch. I’d learned from a close read of the package insert, in very fine print, that use of the Butrans patch can also cause death.

I enjoy using my hot tub with a water temperature of 104 degrees. I also enjoy gardening out in the summer sun. The insert explained that if one allows the patch’s heat to go up a few degrees above average body temperature, it could release almost a week’s worth of a powerful opioid directly into the bloodstream in seconds. That much was certain to cause respiratory depression, which is the direct cause of opioid overdoses and death. You just stop breathing. Add to that, the copay was $115 per month. Later I learned that increasing the Butrans patch to 15mg per hour had a copay of $627 per month, yet it was the recommendation of a pain management specialist, not my doctor of 20 years. Why, after many years of working successfully with my M.D., did I find myself in the office of a pain management specialist where I was spending $250 for a 20-minute consultation? Compare the cost of the pain management specialist, $75 for office visits plus $627 copay for Butrans, to a copay of $20 for the office visit and a $10.49 copay for the opioid I had been taking for years. Do the math while asking who is getting rich off the pain of millions of chronic pain patients?

Next, I weaned myself off what had become a daily dose of four 1000mg opioid tablets, one every six hours. I planned to take a little less until I could stop taking any. It did not go that smoothly. It was more like two steps forward, then one back. Some days, when I felt good, I would take none. After six weeks, I had only a dozen opioid tablets left. My body hurt. I felt pains I had not realized were there.

I had a runny nose that would not stop, so I used a prescription nasal spray to reduce it. The worst was over and the drugs were gone, but constant pain was back. The withdrawal from these drugs was unpleasant, like having bad flu, which lingered a little for weeks beyond the first six. Once clean, I was painfully aware of why I had needed to take painkillers for the last fifteen years. My pain was real and debilitating, making it very difficult to write again.

Before my experiment with self withdrawal (detox).11 So why did Big Pharma encourage daily narcotic drug use, whether one is experiencing pain? Was it greed and perverse incentives? But was there another reason, one that had nothing to do with patient pain? Was it all just a marketing ploy to get people to buy more drugs? There is plenty of evidence that it was simple, pernicious greed.12 

In 2007, Purdue Pharma agreed to pay $600 million in fines and other payments. Also, three executives from Purdue Pharma, its president, top lawyer, and medical director pled guilty to criminal violations and paid $34.5 million in fines. However, between 1995 and 2001, OxyContin brought $2.8 billion in revenue for Purdue Pharma. It stands to reason they made much more than that since 2007.13

Was this a battle won in the War on Drugs? No. The punishment in no way fits the wrongdoing. I learned from reading the transcript of a National Public Radio All Things Considered broadcast that the Sackler family, who owned Purdue Pharma received immunity from future opioid lawsuits in a bankruptcy proceeding lawsuit in the summer of 2021 presided over by Federal Judge Robert Drain in White Plains, NY. In return, they agreed to pay $4.3 billion and forfeit ownership of Purdue Pharma. The Department of Justice may appeal. I would not hold your breath. The Sackler family admits no wrongdoing and estimates they made more than $10 billion from opioid sales. I find it disgusting that they remain one of the wealthiest families in the world.

I do not recommend that anyone manage withdrawal on their own, the way I did. My doctor did not know what I was doing. I could have used help only a doctor can provide, but something inside me insisted I do this alone. Keep your doctors in the loop if you need to wish to manage withdrawal. It was important; I wanted to do it on my own to monitor and eliminate as many variables as possible. I wanted to feel the effects of withdrawal firsthand and did. Anxiety would overwhelm me for moments, then fade. The fear of impending depression was imposing and increasingly incessant. I worried about what I was going to worry about and learned not to do that. Having struggled with episodes of depression since I was twenty-five, far too many times there was good cause for worry. I have had it under control for many years. When intentionally going into withdrawal, I knew I must be cautious and responsible.

The intrusiveness of unstoppable suicidal ideation, the signature of my depressions, would be far more challenging to handle than withdrawal. Once it started, I could not turn it off; I had to outwit it until I learned how to outwit it. If you suffer from depression, the situation is not hopeless, although you feel that way. If you are depressed right now, exercise! The number one item on the list, the least expensive, is exercise. It is as simple as making your bed, going for a walk, riding a bike, getting your body in motion, and seeing your doctor. The things you may have stopped doing every day for weeks. With each bit of a step, you will feel a subtle but certain difference. You can manage depression. Until we find a cure (psilocybin therapy shows great promise) we will keep seeking ways to do so.

I went to see my doctor and told her what I had accomplished. I asked if there were other, newer, inexpensive medications I could take as needed. We tried one and then another. I ended up taking one or two 500mg/325mg Norco hydrocodone as needed. Almost three years passed without having to increase the dosage of this prescription. My copay is $10.49 per month. The downside; the DEA did an 18-month investigation of my doctor. They came up empty. Science is working hard to eliminate depression and not just treat its symptoms. Pharmaceutical companies have a perverse incentive not to. They can’t make continuing profit from cures. The first step is to learn why it happens, which is not the same for each individual. Want to defeat your depression? Get busy helping us to find a cure and investigate psilocybin therapy.

The State of Michigan however established a Prescription Drug Monitoring Program (PDMP). Are PDMPs mandatory? Yes, mandatory use of prescription drug monitoring programs (PDMPs) is a legal mandate by the state for prescribers (and, in some states, dispensers). Prescribers are required by law to register with and use the state PDMP when prescribing (or dispensing) a Schedule II drug or other controlled drug.15 The program requires patients like me to submit to a monthly drug test to prove I am taking my opioid medication as prescribed. Until COVID hit it was a urine test. During COVID it became a saliva swab. I have passed the test approximately 36 times.16 I consider this an invasion of privacy and a necessary evil to continue using a medication that improves the quality of my life and enables me to write. I will continue to seek inexpensive alternatives to opioid medications. I will buy into or use the extraordinarily expensive “solution drugs.”

The program requires patients like me to submit to a monthly drug test to prove I am taking my opioid medication as prescribed. Until COVID hit, it was a urine test. During COVID, it became a saliva swab. I have passed the test approximately 36 times.

I wish I could get a dollar for each opioid painkiller I took, and I did not need it. This dangerous advice was not medically sound; it was a marketing ploy designed to sell significantly more opioid drugs to a trusting and uninformed public. It worked, and they are at it again with very high-priced “solution drugs” like methadone, buprenorphine, and naltrexone.17

I suggest it was simple, old-fashioned American marketing driven by greed. The pharmaceutical companies did it to sell-sell-sell more opioid drugs. It was not a well-meaning mistake but intentional, and it worked for Big Pharma. It worked in the same way that denying the addictive nature of nicotine worked for big tobacco. Big Pharma made billions from the manufacture and sale of opioids. People with actual conditions that warrant pain medication took more opioids than they needed in good faith. Some paid the ultimate price. And now Big Pharma stands to make more profits off of what I call "solution drugs" - Big Pharma drugs that cost fifteen to twenty times the price of the common opioids used for centuries to relieve pain. They are not a solution. They are making the cost of managing chronic pain so expensive it is out of the reach of most Americans. They are complicit in most opioid-driven deaths.18

The opioid situation is a complex issue. It has no single root cause; there is no single person, group, agency, industry, or organization at fault. All too easy to waste time demonizing the DEA, FDA, HHS, the pharmaceutical industry, the practice of medicine, capitalism, socialism, or the free enterprise system. All are flawed systems. All have overstated their authority. All can improve. None are static.

If you need to blame, blame yourself for looking the other way, allowing your government to run amuck, for waiting for someone else to do something. In my field, we can often identify an undesirable outcome, do a root cause analysis, and identify the cause of a poorly functioning system. Systems thinkers call problems such as this a systemic problem.

Am I taking opioids just because I have them? Sometimes, yes. Having to prove I am taking all of my prescriptions each month encourages me to take them, whether or not I need them. The outcome is I spend more than I need and I take more than I need.

PDMPs are expensive to set up and administrate and your tax dollars pay for them. Are they necessary? Isn’t this another example of punishing a vast majority of people to control the behavior of a small minority of irresponsible drug addicts? Isn’t that Socialism? I am not a drug addict. I depend on various things to survive, like water, air, potassium, and more to thrive. So do you!

Does some of the behavior of Big Pharma, the FDA19, the DEA, and other government agencies trouble you?19 The DEA does great work in so many areas. Fentanyl is the most dangerous drug making its way into our streets in my lifetime. It is going to be very difficult to control. They have their work cut out for them. The black market grew in proportion to the DEA’s efforts to destroy it. A reenactment of Hamburger Hill20 or Gallipoli.21 The FDA has a mandate. You can read it and download a document that explains it at FDA.gov. Google, What is the mandate of the FDA. Keep in mind there are countless other issues that should concern you regarding the FDA. For example, would it surprise you to know that the companies it regulates provide approximately 45% of the FDA budget?22

How do we rationalize punishing the vast majority of valid pain patients in an attempt to change the behavior of a minority of mentally ill people? Did DEA policy cause this crisis—not good people with chronic pain?

In my firm opinion, their actions should not go unaccounted for. Today, some pharmaceutical companies have lost in court. But is losing in court just punishment? When billions of dollars are in play, a hefty fine and a little jail time by three executives does not deter, nor does it compensate, the millions of harmed people and their families. To me, it matters little if Big Pharma becomes bankrupt from the punishment they deserve. They are already bankrupt from a lack of moral decency and a clear lack of integrity. Our society cannot afford to allow such egregious, harmful behavior by corporations to continue to go unchecked for the sake of profit—just one man’s opinion? Hopefully not.

Was someone within the DEA complicit? Those DEA administrators, lawyers committed to prosecuting corporate crime were helpless. The decision to gut their departments came from high above their pay grade. If that does not reek of corruption and payoffs, then what does? DEA administrators could not stop this from happening, though a few tried—like the whistleblower, Joe Rannazzisi revealed when interviewed by Bill Whitaker of 60 Minutes.23

We know which former DEA attorneys sold out to work for these Big Pharma companies. Our system allows for such egregious behavior, but do you think it should? Answer for yourself and then act following the evidence, the money, the path of greed (or not), and your conscience. It seems to me, one day, DEA attorneys were fighting crime, and the next, they were committing a moral crime for a lot more money than we paid them as civil servants. Of course, their behavior was not illegal, but was it based upon greed? Should it be illegal?

I think we must hold these attorneys accountable for turning their backs on the American people. Should we shun and ostracize them for their corrupt behavior and have their bar cards revoked? We should allow no one to profit off the misery, pain, and illnesses of American citizens or other people worldwide. Their actions caused many people pain and, for some, their lives. Corrupt activities, legal or not, are sure to cause harm.

To my mind, this corporate and institutional behavior is reprehensible; it should make people sick; indeed, it does precisely that; sick of body and sick of mind. Big Pharma encouraged pain patients to take opioids, regardless of whether they were in pain, thus encouraging them to consume much more of a known addictive drug than necessary. Unethical? Illegal? The facts suggest it was the root cause of many patients developing a stronger dependence, which eventually led to addiction. I know this from my personal experience.

Remember, your tax dollars and personal pharmaceutical expenses are paying for it. You are getting robbed and made ill, and you do not know it, or you just accept it. These marketing methods did not help patients manage pain; they helped them ignore it. It likely allowed painful conditions to get worse. Again, we must ask, why would Big Pharma tell doctors to tell their patients to take pain medication in this manner, to take them, when you are not in pain?

I am certain I took more opioid medications than I needed and once dependent, I needed more and more. Something caught me in the spiral into addiction. Something had to change quickly.

A word about withdrawal. Movies and television programs often depict drug withdrawal and severe, unending, painful—almost impossible to endure. The well-established facts regarding opioid withdrawal tell a very different story. Opioid withdrawal can be uncomfortable but is rarely a dangerous condition. It occurs when a person with opioid dependence stops taking opioids. The withdrawal experience is authentic with any drug or substance. Stop consuming water, and you will become thirsty within hours or less. Continue not to ingest water in any form, and you will die in 3-4 days. When one stops consuming opioids, the body becomes thirsty for opioids. That is opioid withdrawal. The vital difference is, if you continue not to take opioids, you will not die; you will get better. People do not die from opioid withdrawal, but they get sick. How sick? It starts on the first day of withdrawal with a general feeling of being ill, sniffles, running nose. You feel you have caught a cold or flu.

Like a cold or flu, on the second day, it gets worse, and that familiar achy all-over feeling deepens; you are tired and often very irritable. The body is regaining its natural ability to experience pain; you can feel every ache and pain in your body; even some pains you didn’t know you had. The physical withdrawal symptoms subside on the third or fourth day, while any chronic pain you may have been managing returns to prior (pre-opioid) levels. At this stage, less than a week from your last dose of an opioid, most physical withdrawal has all but ended. But the psychological aspect of drug withdrawal lingers for years. Your character and presence of mind are now your best allies. Professional help can become your best friend, as can your family, in most instances.

The opioid withdrawal timeline varies a little from person to person. Withdrawal has everything to do with what we call the half-life of a drug or substance. The half-life of a drug is the time it takes the body to eliminate half a dose. Most opioids have a short half-life of just a few to several hours. Oxycodone’s half-life is 3–5 hours, while methadone (often used to treat opioid dependence) has a much longer half-life of 8–60 hours. The longer the half-life, the slower withdrawal symptoms appear and the longer they last. Take 100mg of oxycodone, and 3-5 hours later, 50% has left your body.

What happens after 50% of the oxycodone leaves your body? The process continues. In a second half-life period, with oxycodone, another 3-5 hours, 75% has left. In the next half-life period, half of what remains, 2.5% leaves. The process of elimination continues every 3-5 hours of abstinence until your body eliminates virtually all but a trace of the drug. What lingers indefinitely is the memory of how good you felt when you took the drug. That is where the hard part of recovering from a drug dependence lies in your head. You may need the help of a well-trained therapist. I think it becomes a battle between your brain, which is hard-wired to seek pleasure, and your mind, which is your most powerful ally in winning any internal conflict. You are not powerless. To think so is setting yourself up to fail.

I have used OxyContin to illustrate this concept but make no mistake, depending on the drug or substance withdrawal can be much worse and much longer. For example, because the half-life of methadone can vary between 8 and 60 hours, from the last dose, the onset of withdrawal occurs as soon as 8 hours or as long as 60 hours.24 Dependency does not cause or trigger physical symptoms; withdrawal from the drug does. We all live with drug and substance dependencies—everyone.

With most drugs, withdrawal symptoms are the most intense a day or so after a person stops taking the drug or substance. Withdrawal symptoms may become more severe for a short time, often a few days to less than a week. However, this is a short-term phenomenon, as a drug or substance leaves the body. It is essential to note that as a drug or substance leaves the body, the dependency also decreases, as do the withdrawal symptoms.

During withdrawal, the body does a miraculous job of self-healing. The more serious problem goes on in the mind of an opioid user (Or any drug. Only time frames and intensity vary). The critical success factor is addressing the psychological aspects of dependence, an individual’s understanding, and ability to take responsibility for their actions, play the largest role. That is where recovering addicts need the most help for the longest period.

Using other addictive drugs to treat drug addictions is simply replacing one addiction with another, often setting up the patient for a very difficult withdrawal (recall methadone) and doing so at very substantial costs, costs that the vast majority of former addicts simply cannot, and are potentially never going to afford. Unless things change.

 

10     Google Search, August 9, 2020, FDA, https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020716s012s013s014s015s016lbl.pdf

11     Use of the term detoxification has been replaced with Withdrawal Management because detoxification does not translate well to other languages. NCBI, Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. https://www.ncbi.nlm.nih.gov/books/NBK310652/

12     Zachary Siegel, The Opioid Crisis Is About More Than Corporate Greed, The New Republic, July 30, 2019, https://newrepublic.com/article/154560/opioid-crisis-corporate-greed

13     Barry Meier, In Guilty Plea, OxyContin Maker to Pay $600 Million, May 10, 2007, New York Times, https://www.nytimes.com/2007/05/10/business/11drug-web.html

14     The Sacklers, Who Made Billions From OxyContin, Win Immunity From Opioid Lawsuits, 2021, Host A Martinez with Brian Mann, All things Considered, National Public Radio, Updated September 1, 2021, https://www.npr.org/transcripts/1031053251#:~:text=More%20Podcasts%20%26%20Shows-,Sackler%20Family%20Wins% 20Immunity%20From%20
Opioid%20Lawsuits%20In%20Purdue%20Pharma,liability%20for%20the%20opioid%20crisis 

15     DEA Regulations for Communicating Controlled Substance Prescriptions to Pharmacies, Prevention Solutions@EDC (Educational Development Center, Accessed December 10, 2021, https://preventionsolutions.edc.org/services/resources/mandatory-use-prescription-drug-monitoring-programs

16    Charles V. Preuss; Arun Kalava; Kevin C. King, Prescription of Controlled Substances: Benefits and Risks, National Center for Biotechnology Information, Last Update: August 31, 2021, https://www.ncbi.nlm.nih.gov/books/NBK537318/

17    NIDA. 2021, April 13. How much does opioid treatment cost?. Retrieved from https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-much-does-opioid- treatment-cost on November 29, 2021,

18     Andrew Kolodny, MD. AUG 2020 issue. Accessed January 27, 2021. How FDA Failures Contributed to the Opioid Crisis, https://journalofethics.ama-assn.org/article/how-fda-failures-contributed-opioid-crisis/2020-08

19     Pam Belluck, Biogen Slashes Price of Alzheimer’s Drug Aduhelm, as It Faces Obstacles, December. 20, 2021, NY Times, https://www.nytimes.com/2021/12/20/health/alzheimers-aduhelm-price.html

20     Battle of Hamburger Hill, Last Edited September 21, 2021, Wikipedia, https://en.wikipedia.org/wiki/Battle_of_Hamburger_Hill

21     Gallipoli campaign, Last Edited November 25, 2021, Wikipedia, https://en.wikipedia.org/wiki/Gallipoli_campaign

22     C. Michael White, Why is the FDA Funded in Part by the Companies It Regulates? May 21, 2021, UConn Today, https://today.uconn.edu/2021/05/why-is-the-fda-funded-in-part-by-the-companies-it-regulates-2/

23     You can watch the broadcast; it aired on October 1, 2017. It was titled “Ex-DEA Agent: Opioid Crisis Fueled by Drug Industry and Congress” Accessed September 13, 2020,

https://www.cbsnews.com/news/60-minutes-ex-dea-agent-opioid-crisis-fueled-by-drug-industry-and-congress/

24     CLINICAL GUIDELINES AND PROCEDURES FOR THE USE OF METHADONE IN THE MAINTENANCE TREATMENT OF OPIOID DEPENDENCE, Last Modified August 2003, https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-meth-toc~drugtreat-pubs-meth- s1

 

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Quotes on the subject of "The War On Drugs"

  • “The pejorative term ‘abuse’ used in connection with diseases of addiction has the adverse effect of increasing social stigma and personal shame, both of which are so often barriers to an individual’s decision to seek treatment.”
    ― Joe Biden 1942 ― present
  • “The amount of money and of legal energy being given to prosecute hundreds of thousands of Americans who are caught with a few ounces of marijuana in their jeans simply makes no sense - the kindest way to put it. A sterner way to put it is that it is an outrage, an imposition on basic civil liberties and on the reasonable expenditure of social energy.”
    ― William F. Buckley Jr. 1925 ― 2008
  • “Penalties against possession of a drug should not be more damaging to an individual than the use of the drug itself; and where they are, they should be changed. Nowhere is this more clear than in the laws against possession of marijuana in private for personal use…”
    ― Jimmy Carter 1924 ― present
  • "The war on drugs has made government more powerful, citizens less free, and hasn't helped users or addicts."
    ― Victor Mitchell 1965 ― present
  • "We cannot continue doing the same thing and expect different results."
    ― Otto Perez Molina 1950 ― present
  • “The war on drugs is wrong, both tactically and morally. It assumes that people are too stupid, too reckless, and too irresponsible to decide whether and under what conditions to consume drugs. The war on drugs is bankrupt.”
    ― Larry Elder 1952 ― present