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Volume III, Issue 4 (April 1998)
Delayed Onset Withdrawal - by Danny Sugerman
The Narcan Challenge - by Bao Dai
Beware--Phony Advocates - by Nancy Rose (DONT Secretary)
What I Know About Addiction - by Sean
Editorial from DONT Officers - Re: Censorship - Also see Cartoon on Censorship
New NAMA Chapter
New NAMA Column Next Month
Doctor's Column - What to tell friends and family regarding MMT
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Delayed Onset Withdrawal
by Danny Sugerman
I currently have a malpractice suit going against Sierra Tucson rehab for improperly
diagnosing third-stage methadone withdrawals as the flu. My retching became so violent,
I hit the fire alarm to get an ambulance to get me to a real hospital. I had been
forced, literally, into a lactone facility at the University of Tucson Medical Center
psych ward and detoxed from 150 mg to zero in 28 days, whereupon I was released into
the so-called care of my interventionist who himself had no experience with methadone,
and he proceeded to take me to the beautiful grounds of Sierra Tucson. Best looking
place I'd ever seen, but after 28 days in lockdown, a tree was a revelation.
Needless to say, I felt like road kill, but I was also puzzled that I hadn't puked or had diarrhea. I've done eighteen detoxes but none so fast and with only clonodine as a buffer. I hadn't slept or eaten in 12 days, and I'm wondering, after a 10-year run on methadone every day, seven days a week, what happened to the worst part? Maybe I had been granted a miracle.
Ten days later, I start puking. First, they call it "drug seeking behavior" because I was demanding Darvon, morphine sulphate or at least a Valium. Nothing. Second day, I'm still retching, but nothing is coming up, so now it's official: I have the flu, and I'm isolated from other patients. On the third day, I start shitting like a geyser, and all I want to do is sit down on a plastic chair in the shower (why detox facilities don't have tubs is a serious oversight as far as I'm concerned).
Now I know how the rumor "it gets into your bones" got started. My bones ached with a pain I have no words to describe. So, I keep trying to climb the fence surrounding the pool where there is a Jacuzzi, and I'm weak, and they're telling me to get back down or they're going to discharge me, to which I respond, "Promise?"
I shit in the Jacuzzi, I shit on the tiles around it, I shit on every gown and towel they had. I had given up on asking them for something to alleviate my suffering, but they would give me nothing. Zero.
Finally, I got admitted to the emergency room at Tucson General Hospital where I was given Demerol because of the pain in my stomach. Like magic, all symptoms stopped. They did a blood workup (no easy task--three anesthesiologists poking at my neck with needles--finally, they went the subclavian route), the verdict was "pancreatitis attributed to aggravated withdrawal symptoms." They told me another ten hours or less and I'd be dead--that my pancreatitis had begun throwing acid into my stomach lining and was burning holes, causing the blood-projectile vomiting.
It took more than four trips back to Sierra Tucson and the emergency room, and I cannot describe the pain, fear, confusion and anger welling up inside me. At Sierra, they would laugh at me, "so, you think you know more about detox than we do?" And enduring their ridicule I'd say, "yeah, for one, you've never done it--for two, I've done it eighteen times, and I know what works and what doesn't."
"Then how come you didn't know it was withdrawals when you started throwing up?"
"You're the experts--you're the ones who determined my detox protocol--I just assumed you'd be able to recognize the symptoms yourself. Obviously I was wrong. I'd never had anybody try and detox me so fast with no appropriate medication before, so how the hell was I supposed to know what was happening? Besides, I did tell you after two days, and you still didn't listen," so now I'm getting my revenge.
I'm looking for anybody familiar with this delayed onset of third-stage withdrawals--someone with credentials. Any help would be most appreciated--even hearing from anyone who went through a similar experience would be reassuring (send to Danny Sugerman c/o Methadone Today).
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The Narcan Challenge
by Bao Dai
The following is not intended to frighten anyone. There have, however, been some
rumors, and while like most rumors surrounding those plagued by scandal, it's probably
the case this one has been blown all out of proportion. Contrary to the charges by
some concerning pro-patient bias by this and similar periodicals, if the rumors are
false, they should be exposed as such.
Those readers who may have once turned an ugly shade of blue due to an overdose may be intimately familiar with Narcan. Most have probably at least heard of it. The chemical gymnastics are probably interesting to those who are inclined toward science and can be found in a PDR. Basically, however, what Narcan (naloxone hydrochloride) does is "knock the opioids" out of someone who takes it, at least for a given period of time. It's a narcotic antagonist mainly used to save lives in emergency rooms.
It also has another usage. That's called "the Narcan Challenge."
The Challenge is handy in cases where a patient is going to be given some sort of analgesic which is a narcotic antagonist like Naltrexone, which is meant to block opioids so that shooting a bag of dope is a narcotic agonist/antagonist--drugs like Talwin or Nubain or Stadol--drugs which to the nonopioid-dependent person are (to varying degrees) good analgesics and can even pack an opiate-type of high but which have (to varying degrees) a tendency to send an opioid-dependent person into pronounced withdrawal.
The idea behind the Challenge is that a dose of Narcan will put a dependent person into almost instantaneous withdrawal, thus proving physical dependence on narcotics.
Presumably the Challenge was not designed as a lie detector, but unfortunately there are rumors--and it is sincerely hoped that these are just rumors--that the Challenge has found its way into some methadone clinics as a sort of "lie detector."
There are rare circumstances, for legal and/or safety reasons, the Challenge might seem like the only option. If it is utilized, no matter how irregularly in other situations, however, logic would dictate that the more paranoid and ill-informed the clinic, the greater likelihood that this method will be used on patients (probably on admission).
Reports of its usage are spotty and generally second hand. Suffice it to say that it's hard to imagine any clinician not into sadism, or suffering from extremely low self-confidence in his own judgment, or from paranoid delusions, using the Challenge on admission (or during the course of treatment) given that the federally-mandated dosing protocol pretty much removes the danger of overdose--even if some deranged con artist who is a narcotic virgin is willing to go through all the hassle and expense of getting admitted to a 21-day detox just to taste methadone so a few hours later he can experience a mild version of a high he could have gotten a lot faster from numerous other sources, including doctors, dentists and dealers. However, clinics who think MMT patients are seeking a "high" when they seek a 5 mg. increase in dose have the sort of mind set which might also see the Challenge as a "good way" of "verifying" the need to be detoxified.
If it is used with anything other than nominal frequency at clinics, the extent to which it's used and the circumstances are generally unknown. It's such a drastic procedure, however, the rumors should be dealt with, one way or another.
It would therefore be greatly appreciated if those who read this would, instead of shaking their heads in dismay (either thinking, "Oh my, how horrible" or "What nonsense, I've never heard of that") let this publication know whether or not they have ever heard of the "Challenge" being used and the circumstances of its use. If it's a non-issue, that's great news; if it's more prevalent than suspected, maybe something can be done about it.
Meanwhile, if you are ever traveling and for whatever reason your clinic did not make arrangements for guest dosing and you find a clinic nice enough to even consider dosing you, or if you ever need to enroll in a new clinic and they want to give you some sort of drug (other than methadone)--probably in the form of a shot--ask if it's the Narcan Challenge. If it is, it's now up to you to decide whether getting dosed (or enrolling at that clinic) is worth being sick as a dog for a couple hours to prove to the staff's satisfaction that you are an appropriate patient--after all, presumably if you wait a few days without ingesting opioids, you'll be sick enough that you can give them the show they apparently desire without the assistance of drugs.
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by Nancy Rose (DONT Secretary)
We are sorry to have to use this valuable space for the following, but this is
important! We have received some disturbing reports from patients at a particular
southeastern Michigan clinic--there is a man who is standing in the lobby or out
in front of this clinic charging patients 50¢ apiece for our newsletter!
He is passing himself off as a patient advocate, but he is not an advocate, nor does
he donate the money to the advocacy; he POCKETS IT. So, we are notifying all patients
and clinic staff that DONT advocates have NEVER stood in a clinic and charged
for these individual complementary copies of Methadone Today.
Because this newsletter is partially funded by a grant from the Drug Policy Foundation, and the rest of our money comes from subscriptions and donations, DONT officers donate copies of each month's newsletter to various Detroit area methadone clinics. The sad part of this is that the patients who paid this man 50¢ per issue thought they were donating to the advocacy group.
Subscriptions and donations are made payable to DONT and sent to the address on the back of this newsletter (if you can afford to donate, please send anything you can--whether it's a full subscription ($10 for 12 issues per year), a few dollars toward a subscription, or even 32-cent postage stamps will help!).
Every penny donated is spent on putting out the newsletter, maintaining web space for Methadone Today, and sending literature to policy makers, medical personnel, the media, the general public, and clinic staff to educate them and dispel the myths about methadone maintenance. Advocates are not paid an hourly wage or salary and often donate more than their time and services.
Please consider that it costs almost $1,000 per month to produce and mail an issue of Methadone Today (6,000 copies). The Drug Policy Foundation has been very generous to us, but we have to start carrying more of the load, and that means more donations must come from you if you want Methadone Today to survive.
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What I Know About Addiction
by Sean Francisco
I have read the last fifteen issues of this publication. I have not agreed with
all of the things I have read, but truth be known, I agreed with more than I thought
I would. I figured it would be a tissue for a bunch of whining junkies. This is a
big step for me--I admit I was wrong. I find within it a lot of a commodity that
is in short supply. . . .truth.
It is a funny thing about the truth--when faced with it, most people bury their collective heads in the sand, no matter how much they demand it. So, with this in mind, I promise you I will tell the truth. Friends, you may not believe it.
I am not an addict; I have never been a drug user. I seldom drink. I have never been in rehab. I vote Republican or Libertarian. The truth is, I know more about the ravages of addiction than I should. Both of my parents and my brother were addicted to one thing or another.
My father died in 1994 at the age of 62. He spent most of those years abusing himself with alcohol and abusing me with venom and terrible guilt and humiliation. My brother died later in 1994. I found him dead with a needle in his arm and a bullet in his brain; I loved them both.
My mother spent most of what you could call the span of years that were supposed to be my childhood with an addiction to alcohol or prescription drugs and later what she could get from the street. I love her and thank God she is still around.
Our relationship was the most rocky of all. You see, she was a junky. She used "bad drugs"; they weren't prescribed by the earthly god we call "DOCTOR."
I spent the early years of my life precariously balanced between seeking my Dad's approval or looking for a little recognition from my Mom on those occasions when she was straight. I remember a scared little boy of five desperately trying to wake up his mother as she slept on the couch with an empty pint of vodka and an open bottle of Equagesic. That same little boy would be overjoyed when his Daddy came home after working second shift, only to be disappointed when Dad was drunk . . . .again.
But hey, I had my dog, Duke. He didn't drink, or call me fat ass, or smack me for spilling a glass of milk.
Coming home from school was always a let down. You never knew what the mood in the house was going to be. Sanctuary was Thursdays. Grandma picked me up from school on Thursday! We went to McDonalds; she drove like a jet pilot, and we had fun. Grandma was always interested in the new picture I had done in art class. She was the goods!
I never let on what was going on at home. I always put on the happy face. Even in my grade school years, I was one hell of an actor. In my fantasies, my grandparents would show up one day and take me to live with them. It never happened. Maybe God doesn't always give you what you want, but I think he gives you what you need.
My only really happy times were spent at the home of my grandparents. My grandmother was, in my eyes, a saint. Hell, she still is. She is the only person that I would never think of disobeying! My grandfather was a little harder to reach in those days. The truth is, I was a little afraid of him. He worked a thirteen-hour day at his pharmacy, and a kid just doesn't understand.
Now, he is the hero that saved my life. The night after I found my brother's body, I was sitting in my living room with a half-drunk bottle of Jim Beam, and a Colt Government Model .45 in my hand. I held on to the thought "grandpa's coming", and it got me through the night. He showed up the next day after a marathon drive from Michigan.
I cannot begin to thank him for all the things he has done for me. I probably would have written me off, long ago. I cannot say how much I love him. He is just such a special man. I treasure him, and KNOW how lucky I am to have him. I only hope HE knows how I feel. I try to say it in my own way. But, I am a stubborn cowboy. . .still working on that.
So, as I look back on all the times I spent putting on a front that said "My mom and dad are the Bradys", I still feel a little pain. I am glad I have my pain, because where there is pain, there is also feeling, and where there is feeling, there must be hope. My hope is that I can start to put more of these feelings to rest and move away from the legacy that a lifelong association with addiction has given me. I can't sustain a relationship for more than the life span of a fruit fly, I eat too much, I smoke too much, and I am ALWAYS right. The gift that addiction has given me is an inner reserve of strength that comes from somewhere deep in my guts.
I live in the desert now, in Tucson, far away from my childhood in Michigan. It has taken me nearly ten years and 2200 miles to learn some of these lessons. I have learned what addiction really is, not what the so-called "establishment" would lead us to believe. I have learned that methadone is just a tool to help those who need it, not a crutch for a bunch of junkies. Hopefully, I have learned a little bit of understanding.
So, in the end, I thank God for my mom and dad, and my grandparents, and all the lessons I may have learned along the way. They have made me the man I am now. "Methadone Today" has given me the insight and understanding to see things a little bit differently.
I welcome any comments or input from people with similar experiences. You can reach me at firstname.lastname@example.org or in care of the editor of this newsletter. -- Sean Francisco
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Editorial From DONT Officers
Methadone Today/DONT has received a number of reports about one
particular Michigan clinic. Patients report that when DONT advocates drop
off a stack of free, complimentary copies of Methadone Today, the clinic's
owner has his staff rush out to the lobby and confiscate them.
Why? The owner has to read the newsletter before the patients at the clinic can read it, so he can monitor and censor any articles that do not pass his approval! There have been two or three issues so far that did not reach the patients, nor were the newsletters returned to Methadone Today.
This newsletter exists so that patients may have a forum in which to express their views, comments, success stories, complaints, or whatever else they feel like writing about. The newsletter is also meant to teach and inform patients and others, i.e. medical staff professionals, police, lawmakers, family members of patients, etc. We talk about how methadone has saved many addicted persons' lives; dispel long-standing myths about methadone, and inform patients of their rights.
Clinic staff, family members, and anyone else interested in methadone treatment have always been welcome to write an article or respond to our newsletter. We do not feel clinic owners (or anyone else for that matter) should censor OUR--the patients'--newsletter. What exactly is this particular clinic owner worried about? Is he concerned that the patients will become too well informed about their own medical treatment?
Even though this clinic owner has not been available to take our calls, the very least he could do is return the newsletters --then DONT members could pass them along to patients in other clinics! Patients at this or any other clinic can receive Methadone Today by writing to the address on the back of the newsletter. Following is a letter from a patient at this clinic:
Dear Methadone Today,
Today, while in line at my clinic, I noticed the guard reading a copy of your newsletter (February 1998, Vol. III, No. II). I asked him for a copy, and he gave me one. Other people requested a copy also, so the guard put out a stack for patients to take while standing in line.
When it was my turn to dose, the nurse noticed my copy of the paper and asked me where I got it. I told her, then she proceeded to yell to the guard, "No, no, no!" He was not to be giving out copies of your newsletter to us. Grabbing my copy, she showed me the front page and pointed out the excerpt from Dr. Dole's interview, stating, "The goal is not abstinence--the goal is to become functional." She then said, "That's ludicrous." So because of the opinion of and statement by Dr. Dole who, according to your paper, is one of the foremost authorities regarding methadone and one of the people who invented the concept of methadone maintenance for opiate addiction, my clinic decided to deny us the opportunity to read your newsletter.
Does anybody else see this as censorship? What are they afraid of? Apparently they think that we're incapable of reading anything without being influenced by it--that without their watchful eye and guidance, we might actually form our own opinions and think for ourselves.
Granted, they don't have to give out free copies of your newsletter to us, but the point is that they have been every month until this article came out. So where are all the extra copies going? In the garbage more than likely. Why? Because this clinic feels the need to save us from ourselves? After all, your newsletter is run by the patients, for the patients, isn't it? I find the action taken by this clinic to be what I would call "ludicrous."
Any ideas, comments, or suggestions on this situation would be welcomed and appreciated, although I'm sure we won't be allowed to read the March issue either. Although I would like to sign my name and divulge the clinic's name, I fear retribution as it is now. We're supposed to have rights (I've been told), but this is just one example of the many ways this particular clinic suppresses ours.
Editor's Note: We are aware of this situation and have had many comments from patients regarding the matter. This clinic is not giving you Methadone Today free; they have not paid a subscription fee. You are receiving the newsletter from Methadone Today via the Drug Policy Foundation Grant, donations and subscription fees. A very simple way around the censorship issue is to send for a subscription to Methadone Today. It is only $10 per year to have the newsletter sent directly to your home, and you can avoid having your reading material censored.
Another option is to become involved in our advocacy group, or you can form your own. It is sad that you were afraid to give your name for fear of retribution, but it is a very good reason to become involved in advocacy.
To those of you have not donated to the newsletter, now would be a good time to do so. The last two issues were 6-page newsletters, and there were extra expenses involved in producing them. Please do your part and send a donation no matter how small--it will all help. Thank you - Your Patient Advocates
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New NAMA Chapter
Methadone Today/DONT would like to welcome Chicago NAMA to the growing
list of NAMA Chapters. Chicago NAMA President, Andrew Richardson, says, "Patients
of Illinois, contact us if you need our assistance. We are here for the patients'
needs. We would like very much to have you as a member of our organization. Please
contact us for more information about membership at: Chicago NAMA, 3244 Eschol Avenue,
Zion, IL 60099."
Watch for New NAMA Column Next Month
This year NAMA will have been in existence for ten years; our accomplishments are impressive because of the support and assistance we have received from patients and professionals. We cannot allow ourselves to become apathetic because we expect someone else to do it. The spirit of NAMA has always been driven by the principle that we saw something wrong and we had to correct it. - Joycelyn Woods, Exec. V.P., NAMA
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