Obstacle Course

Man oh man oh man.

You know, it's been a very long time since I've had a real good reason to get pissed off about anything. Maybe that's what's been missing in my life; I don't know. I know I do well when I've got something to crusade against. And man, have I got one now.

So to recap: I have gone back to the methadone clinic and gotten back on the program. However, at the same time, I was ALSO doing heroin, to the point that the amount of methadone I was taking (40 mg) wasn't keeping me from getting sick anymore.

I decided I wanted to stop heroin. That was always the plan, and so I've had several long conversations with myself, building my emotional strength up, telling myself that this is not a moral failing, that I'm still a good person, but that I need to get myself back on track and get back to doing the things that are important to me, personally. And I had myself pretty comfortable in that belief. But I knew that if I were to go into withdrawal, that my resolve would crumble and that would be that. I know my own ability to withstand withdrawal, and it is not strong. Anyone who has experienced opiate withdrawal can understand without me saying another word; to anyone who hasn't, I couldn't explain it if I wrote for days. It is a unique misery and defies description.

I also knew that the only thing that would stop that misery before it started was methadone, and that I had put myself in a position where I would need a serious increase in dosage before I could stop heroin. And here is where the clinic system comes into play. State regulations say that the maximum increase in dosage that can be given by a staff member (other than a doctor) is 10 mg at a time. I was at 40 mg and knew that I would need at least 80 mg, probably 90, before I could quit heroin without getting sick. (I discovered this on Sunday, when I tried to quit. It took my whole dose, the half-dose I had hoarded, and the last two methadone tablets from my old hoard for me to make it through the night.) So the counselor gave me a 10-mg increase yesterday, and told me that since I was scheduled to see the clinic's doctor today (a formality for all new intakes), there should be no trouble getting the other 30 mg increase--for an increase that big, only the doctor could sign off on it.

The doctor is only in on Tuesdays between 10:30 and noon. I took an early lunch and went in to the clinic for my appointment. She was a small, late-middle-aged Indian woman, with gray hair, glasses, and a dot on her forehead. She asked me about my history with heroin.

"Well," I told her, "I had six years clean, nearly, and a couple of months ago I experienced a major depression and went back to heroin." I told her I'd been battling depression for a long time.

And here's where I should have known things were gonna go south: "Yes," she said. "Many times, depression in drug users is caused by the fact of being on drugs."

"No," I said, "I don't think that's it. I mean, I was depressed long before I ever tried drugs—I was depressed way back in CHILDHOOD, really, when I look back."

She dismissed that and went back to filling out her forms. "So you were clean for six years...without methadone?"

"No," I told her. "I was on methadone for about eight years. I was clean for nearly six of those years."

"And how long were you without any opiates of any kind?" she asked.

"I was off the methadone for....about eight months, I guess, before this relapse."

Under "Clean Time" she wrote "8 mo." And I thought, WTF??? Are you saying that even though i wasn't doing any non-prescribed opiates, that still doesn't count for you as "clean"? That's pretty much contrary to the whole point of methadone treatment--in fact, it plays right into the hands of the worst of the recovery movement, the ones who say you shouldn't be allowed to share at an NA meeting if you're in methadone treatment because "you're not really clean".

I let it go, though, and answered all her questions. She peppered them with observations about this culture, and how everyone wanted instant gratification, and how the younger generation has no concept of sacrificing their immediate pleasure for long-term good. Which I don't disagree with, entirely--but there was an undertone there of "aren't you weak-willed addicts lucky you have someone as wise as I am to tell you all these things?" And since I've spent the last week or so trying to convince myself that I'm not a bad person, that I have nothing to be ashamed of, it wasn't really the lecture I needed to hear.

And then... I told her that I had been using heroin along with the methadone, but that I wanted to stop heroin and would need an increase in my methadone dose so that I wouldn't get sick and go back to it. I told her I was currently at 50 mgs but needed to be at 80 or 90.

"Well," she said, "I can't just raise you up to that dosage...I'll tell you what I'll do. I'll give you ten mgs." Spoken in a tone of utmost benificence, the goddess bestowing her gift from on high.

"But...that's not going to keep me from getting sick," I said.

"Then you need to fight these cravings," she told me. "Think about what I said--about sacrifice, about strength of will...you need to fight through the discomfort..."

"I'm sorry," I said. "Have you ever experienced it?" Meaning withdrawal, and knowing the answer already.

She, of course, chose to interpret the question to mean "any sort of struggle". "More than you know," she said. "Not with the drug use, of course, but..." She rambled on for another five minutes or so about "personal strength" and "will power" and "sacrifice for the long term", and then she let me go out to the window and receive my splendid, generous 10-mg increase.

As the doctor gave the new orders to the dispensing nurse, my counselor walked by. When she heard "ten milligram increase", she looked startled, then shot me a sympathetic glance.

The doctor went back into her office with a new patient, and my counselor walked over. "Only ten milligrams?" she said.

"And a lecture about 'personal strength' and 'will power'," I added. "But..whatever."

"Come see me tomorrow, if it doesn't hold you," she said, "and I'll give you another ten." She looked sad, as though she felt like she'd failed me or something.

So, let's review. You're a doctor in a program which is supposed to make it possible for opiate addicts to stop doing their drug of choice, by substituting a long-acting version of that drug which does not get the user "high" but which, at the proper dosage, will keep them from experiencing withdrawal symptoms and cravings for the other drug. (Most users, by the time they enter this program, are only using their original drug to avoid the withdrawal symptoms anyway; any enjoyment heroin gave them has long ago disappeared.) The ultimate goal of this treatment is recovery from opiate addiction, either with the continuing aid of methadone or without it, and the resumption of a healthy lifestyle and mental well-being.

So someone please tell me, in the name of all that is holy:

WHY would you, as the doctor, refuse the patient's request for an increase in dosage which will keep them from having to pursue other drugs? Even though, since methadone does not get the patient high, there would be no harm in granting them this increase?

WHY would you imply that the ability to ignore the PHYSICAL pain of withdrawal is a measure of their "strength of character"? Especially when it's been shown that addiction is a medical problem, NOT a character flaw?

And WHY, particularly, would you convey this message to an already-vulnerable population, individuals who are trying to overcome habits which are oftentimes WORSENED by their feelings of shame and guilt, especially as it relates to their own perceived "weakness"?

It was only after I'd gotten in the car and was driving back toward work that I started getting really angry. I tell her "I went back to heroin because I was depressed" and she tells me "of course you were depressed; heroin MADE you depressed!" What the hell kind of circular thought process is that? I've been depressed since I was NINE, for god's sake; would she like to argue that maybe my childhood depression was caused by my parents slipping laudanum into my Ovaltine???

And where the hell does she get off telling me about my character? She knows exactly one thing about me: that I'm addicted to heroin. Obviously she feels that this knowledge is all she needs to judge me as “weak”. By extension, addiction equals weakness in her world-view, and if there's anyone LESS-qualified to minister to addicts than a person who holds that belief, I can't think of them off-hand. Seriously. And what's worse--this is coming from a DOCTOR, a specialist, who supposedly has access to all the best information and research about the causes and effects of addiction--yet she chooses to believe that all an addict needs to get through withdrawal is "will-power". I'm hazarding a guess here that her M.D is NOT in chemical dependency!!! Nor psychology, nor biochemistry...Autoproctology, perhaps.

I would love to see this woman's reaction if she went to the dentist to get a tooth drilled, and he told her: “I see this a lot in people of your generation. Tooth decay is a result of not flossing, which shows a weakness of character. You can overcome this weakness by refusing your urge to ask for Novocain—you can just hang on through the pain. But you can take a baby aspirin a couple of hours before you come to the office...”

I am going to get my 10-milligram increase tomorrow, and I am going to see tomorrow night whether or not it will be sufficient. I WANT to quit—I am ready to quit—but I have to be able to keep up my normal life and activities as I do it. Which means I can’t be too sick to go to work, or sick enough to be noticed by anyone else. I have to be taking a dose of methadone large enough to make me feel physically normal. I hope I’ll reach that dose tomorrow or Thursday at the latest; my counselor, at least, seems sympathetic and willing to help. There's a grievance procedure at this clinic, and I'm thinking I may file one against the doctor. But once I get stabilized, I am going to start lobbying for laws that will allow methadone to be prescribed like any other drug--by a doctor, dispensed by a pharmacist--just like any other kind of MEDICINE, without stigma. The existing system is just ridiculous. If an addict comes to a medical facility and says “I am ready to quit—I want very much to quit, and I believe I can do it--but there is one last obstacle in my way which you can remove by giving me a higher dose of a medication I’m already taking”—how is it beneficial for ANYONE, in ANY way, for that addict to be told “no”? But it happens every day.

There’s more to my anti-clinic-system rant; I’ll spare you for now, but I think I’ve found my cause.