JUNKe Life


Narcotics Agreement with Personal Physician
March 12, 2006, 6:06 pm
Filed under: JUNKe life

Aha, six months have gone by in an opiated phase. Who’d have known that first little dabble of a treat would develop within weeks into a full blown dependency again? Well, I should have, for one! It’s sorta funny watching oneself getting deep into a habit. The psychological stages are quite distinct – from having a bit of a blast, to a detached denial, to acceptance of being a “user” again, to nihilistic disregard to the obviousness of going deeper and deeper, until the sense of imprisonment looms ever-present. Wired again! with a habit to maintain, and that’s that.

Jumped on methadone fairly quickly to try and nip it in the bud. After having been through the cycle many times, and having seen dope consume so much of my life, I really didn’t want to get into all that crap again. So I tried to quit, only to find myself doubly wired. Clearly recognized the futility of trying to stop through my own resources and requisite will power. I might score a whole bunch – certainly enuf to self-wean at current dose – only to find myself at double that dose a week later, instead of half as much as had been my intention. So, I didn’t need to spend years of risk to convince myself of the need to go on a program in order to get off again. I was quite obvious quite early on that I’d have to get myself down to the methadone clinic.

A few more hits…

Part of me wanted to stretch out a few more weeks of using beforehand. Scoring large supplies every two weeks, so there was no immediate imparative why I couldn’t go another two weeks cycle of using before signing the dotted line. Might as well go two more weeks, ah heck, what’s another two weeks. After all, I’m gonna be stopping, so I might as well “enjoy” a bit more.

Ah yes, but am I enjoying myself? The savings built up over the past two years of not using are rapidly evaporating up my arm. My partner becoming highly stressed because she has move “investment” in a non-using future – her being in contact with her future and doesn’t want to cause them further distress. After year’s of using, the veins still available for injection are getting limited to a few old faithfuls that aren’t being as faithful as they once were. That makes for some damn unpleasant injecting sessions. A bloody painful process, with screams of anguish and howls of frustration.

Ah but there’s a good hit at least a couple times a day, and that is sufficient reinforcement to continue struggling through the process yet another day. Why bother quitting tomorrow, when there’s still a few more good shots left in us, right? What’s a couple more months before we stop? Because inevitably we will, so it ain’t no big deal if it ain’t tomorrow, right?

But tomorrow is just a little bit harder than yesterday, and the $50 per week is now $50 per day, and that’s getting just a bit much. As the bummer of it all encrouches, it just makes that extra powerful hit all that much more welcome. Hell, throw an extra pill into the mix! We’ll cut back a bit in the morning. Oh this is getting complicated again, isn’t it? I realize I’m doing little else but managing my habit now, and looking forwad to little else but doing an extra whack and kicking back – for an hour or two. And the sofa accumulates another cigarette burn, and friends and neighbours start becoming acquaintences, their visits get in the way of our cooking up the next hit, we just don’t have the time for casual conversation.

The price ya gotta pay…
The toll is not just financial, and accompanying loss of plans for the future that our savings represented. We start looking and feeling like shit. Afterall, these fucking pills aren’t designed to be hit, and all their powder and grit is deadly shit accumulating in the capilliaries of our lungs, and breathe comes in short supply. First visit to the hospital emergency. Which institution is next? The nut house or the pennitentiary?

When maintaining means constant daily criminality what sort of life is that? It is just a bit too dangerous and so damn complicated, and for what? The hit I know I can live without? Hell, it wasn’t so long ago I was happy and content to be “clean” – but that’s becoming more distant every day.

The methadone doctor takes us on. And then for punishment of not being able to make a scheduled appointment (despite 24hr prior notification) he gets rid of us. The last time we took a year to slowly wean from 50 to zero with this doc and he said “you’re doing it right”. This time he threatens us with immediate cut-back to zero in two weeks, all because we couldn’t arrange substitute transportation for our broken down car from our home 100km in the woods to his office in the city. When “best practices” say to retain patient’s in therapy, self-righteous quacks can get away with sentencing their patients to the streets and their multitude of risk. We left the doctor’s care more wired than when we started with him.

A couple more months of trying to figure out an alternative to the clinic. Damn nearly anything is preferable to the ball-and-chain of attending the clinic everyday for observed dosing. Now its getting real expensive, and increasingly risky that something bad is gonna come down fast. Too fast to handle.

First visit to a doctor in three years…

I hadn’t been to a doctor for over three years. Living rurally one sees for oneself the horrible lack of physicians in rural areas. It is a real crisis. Finally we found a doctor 150km miles from home. And friendly physician of days past. In the midst of a physical we pop the possibility of a morphine weaning program?

Right off she says, “Yes, I can help you”. Imagine that! A doctor who says they’ll help. That’s all we’ve been asking – “plese help” – over and over and over again. The doctor suggests we write out our own six month weaning program and says she’ll do the necessary prescribing. Starting at 90mgs of morphine three times a day…
Here’s the plan… Six month morphine taper schdule

Goal of taper: is to start at sufficient dose, and by periodic drops in dose, eventually wean of to nothing.

Process: to wean slowly in order that the body is able to stabilize at each reduced level, prior to initiaing a further reduction. By reducing slowly, the body is never put into an opiate deficiency state of discomfort. Were reductions to occur too quickly, eventually due to the cumulative effect of repeated drops, eventually the patient would be at a dosage level which would be insufficient to fullfil their dependency, thus putting the patient at risk of supplimenting from with opiates that are not prescribed.

Patient Committment to successfully fulfill taper goal: to take doses regularly every eight hours so a steady state of opiate level is maintained, thus not stressing the system with a feeling of opiate need. To only take the opiates prescribed by the taper doctor, and not suppliment with outside-of-program doses.

Expectation: Patients understand the weaning process and feel comfortable that this taper schedule has sufficient dosing with small enough reductions spread out over sufficient time to enable them to wean off of opiates entirely without their bodies being stressed. They believe that if they adhere to the schedule that this taper will work.

Date of start: March 10, 2006

Completion date: September 7, 2006

Initial dose: 90mg slow release morphine x 3 daily

Initial pharmacy pickup: twice weekly (Tuesday and Friday)

TAPER SCHEDULE

March 13 – March 27 3xdaily at 90mg
March 28 – April 10 3xdaily at 80mg
April 11 – April 24 3xdaily at 70mg
April 25 – May 8 3xdaily at 60mg
May 9 – May 22 3xdaily at 50mg
May 23 – June 5 3xdaily at 40mg
June 6 – June 19 3xdaily at 35mg
June 20 – June 29 3xdaily at 30g
June 30 – July 10 3xdaily at 25mg
July 11 – July 20 3xdaily at 20mg
July 21 – July 31 3xdaily at 15mg
August 1 – August 10 3xdaily at 10mg
August 11 – August 21 3xdaily at 7.5mg
August 22 – August 31 3xdaily at 5mg
September 1 – September 7 3xdaily at 2.5mg
September 8 – September 14 minimal percocet if needed

For our own well-being and for the sake of maintenence/quitting science, we intend to strictly adhere to the taper schedule.  The last time we were on methadone we strickly adhered to methadone maintenence therapy by the book, and it worked very well.  From a two year stretch maintaning at 120mgs daily of methadone, then two years weaning down to zero, totally painlessly without any emotional or physical distress.  It is all about feeling in control as a patient – not being forced to doses one feels uncomfortalbe about – and going slowly.  Never reducing until the body is totally comfortable at current dose, so that it is never phsically stressed.  Never reducing until one feels emotionally confident with the idea of going off the stuff.

And so it goes…