The Junkie in the OR in Mens’ Health

As I have mentioned a number of times, I will look at the keywords that people use to find Suboxone Talk Zone to get ideas for posts on the days that nothing is pressing. You can look at the keywords yourself by clicking on the Feedjit widget on the lower right column, on the ‘watch in real time’ link. It is fun to see people checking in from all around the world. One of my other blogs was ‘picked up’ by Stumble Upon once, and I got about 8000 hits in one afternoon– not much for the ‘big guys’ but pretty cool for me! I watched in real time as people logged on every few seconds– you can see where they live, the site they arrived on, the posts they clicked on, and how they left. Give it a try– it is pretty cool.

Anyway… tonight there was a keyword for ‘anesthesiologists’ and ‘addiction’. I don’t remember exactly what other words were there… but a bit of history for those of you who don’t know me… I used to do a few other things before becoming a psychiatrist. I started out working as a neurochemist, doing research for a PhD from the Center for Brain Research at the University of Rochester in upstate NY. I then went to med school there in the mid-1980s– now two of my kids go to college there, and it is always a freaky thing to visit them and remember going to classes in the same buildings! I swear I haven’t aged a bit! After college I went to the Hospital of the University of Pennsylvania, or ‘HUP’, and Childrens Hospital of Philadelphia, or ‘CHOP’, to do a residency in anesthesiology. A few years later I moved back to Wisconsin, where I was Chief of Anesthesia for a number of years (about 10) before losing everything to addiction.

I looked like I had it all; I loved learning about science and the brain and I loved medicine so things came to me rather easily, and I got high marks in my classes. I loved being an anesthesiologist– I loved the excitement of running to codes, racing in to the hospital for emergency C-sections or stat intubations, relieving pain on the labor floor using epidurals… talk about feeling ‘in control’! Plus there was that big bucket of money to carry home every night…

I had a ‘problem’ with codeine cough syrup in the early 1990’s; I took it for a cold and started prescribing it for myself, eventually utterly disgusted with myself for being unable to stop taking it. I became so depressed that I eventually had one of those wonderful spiritual moments that some addicts are lucky enough to have, where I realized that I had to let go and listen to others. Of course it was much more difficult than I make it sound; many, many fights with my wife, many attempts to quit, and a deep depression… I always remember the time I walked around the block and heard a bird singing and cussed at it– that was when I realized how depressed I was. After my spiritual awakening I attended lots of AA and NA meetings, and the urge to use was lifted– it was a miracle in my life, one of three things that I consider to be my own private miracles.

I worked the steps– worked them constantly– and things got much, much better. My social anxiety went away. I was elected Chief. I felt so much gratitude. And I made money.

I was snorkeling in the Bahamas in 2000, just turned 40, and my son hurt his neck and was having severe pain and muscle spasms. I looked through the drugstore, one of the few on the island of Eleuthera, and found codeine sold over the counter. It had been seven years since I had used, although I had stopped attending meetings for a couple years, certain that I was ‘cured’ and even talking to some people now and then about the addiction I ‘used to have’. So I bought the codeine for my son, sure that I would be fine, but by the time I got back to our rental my mind was working like crazy on all the reasons why a bit of codeine would be a good idea– for me as well as my son. I practically had myself convinced of my own neck injury by the time I got back! And to my horror and excitement I took some codeine, then took it every day for the next week.

Codeine is converted to morphine, which then is responsible for the actions from taking the codeine. Different people have different amounts of the converting enzyme, but even in good metabolizers the buzz of codeine is nothing to ‘write home about’. I always got more stomach cramps than anything else. One thing is certain– the positive feelings I have had in my life from codeine are not anywhere near as significant as the pain codeine caused for me. Not even on the same page. And yet the codeine seemed pretty important at the time. Messed up, but that’s addiction.

I was scared to death on the flight back home, but I didn’t pick up in the OR until about six months later. I was stressed out over something– I had gotten pretty interested in, if not ‘addicted to’, the adrenaline rush by that time of my career– and the thought occurred to me that I had ‘quit’ the codeine when I got back from the Bahamas… so I must have control over it now! This led to the three or four months that ultimately ended my career as an anesthesiologist… I was the rat pushing the lever, using more and more narcotics without any control whatsoever. I am very lucky to have survived– many anesthesiologists don’t.

It took me awhile to realize that anesthesia had to go– for awhile I tried to tell myself that I would go back and be fine. But I knew that the odds are heavily tipped toward relapse, and this was before Suboxone– a relapse back then was something that was much more difficult to get out of. And I didn’t want to die in a call room; I have seen enough dead people over the years to know that there is nothing glamorous in dying in that way. I know how Jim Morrison must have looked, and it is not a pretty sight.

Men’s Health magazine did a story on me; it was fair enough I suppose, but a bit of a shocker to see myself described as a ‘junkie’ in such a widely-read magazine. I mean, does a guy run and tell his mother the exciting news about the article or not?

I left anesthesia because I have learned that I cannot control opiates. I can’t control them, and I can’t predict whether I will ever control them. My mind and personality change in ways that I cannot predict, in response to thoughts about using opiates.

I am going to start writing about what to do once a person is on Suboxone. There is not really anything at this point geared toward helping people at that stage of things. I think the appropriate thing is to adopt some of the tools and attitudes from AA and NA, with powerlessness at the top of the list

Being on Suboxone carries the risk that the person taking it will see it as ‘controlling opiates’, so that they eventually relapse. I encourage you to remember that buprenorphine is unique, and not like agonists in its actions. Make a clear line in your mind between buprenorphine, which has unique properties, and opiate agonists– which opiate addicts have no power over. Do your best to keep the memories of the misery of use, and always remember the times you looked in the mirror and cursed at yourself for breaking your promise… again.

JJ

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