Category Archives: Addiction

Addiction Diaries: Lucky Boy

Addiction is an irresistible craving for a drug, leading to out of control use, and continued use despite consequences. 

As a physician practicing in acute care I’ve seen many terrible things. But what has surprised, shocked and saddened me the most is when I’ve dealt with cases of addiction. The consequences can be severe, even fatal. It’s important to talk about it and acknowledge that it exists. Because addiction is a long term problem and social/family support is perhaps the most important factor for recovery. The aim of this series is to inform and raise awareness, not to sensationalize. Whatever I write is based on facts and facts alone.

The following is based on true events:

RM is only 21. “Don’t be surprised doc. He’s tiny!” His nurse informed me before I stepped into the room. So he was. Tiny (barely over 5 ft, under a hundred lbs) and young. His innocent face belied the colorful life he’d led so far. RM had been admitted because he had popped a couple of fentanyl tablets he’d bought on the street  (the same drug that was found in Prince’s and Tom Petty’s system). When I inquired why, he said he’d been taking the drug for the past 6 months or so; 2 to 3 a day “to get high that’s all” he informed me as if talking about the weather. “No, I don’t want to kill myself but I get depressed sometimes;” was his response when I asked if he’d had any intention to cause harm to himself. I tried to maintain a straight professional face but I was flabbergasted. I was shocked he was still alive. The lethal dose of fentanyl is very small– a quarter of a milligram, and this young man had consumed several times that. He was one hell of a lucky boy. 

Fentanyl is the most powerful opioid/narcotic drug—100 times more potent than morphine (the usual drug used to treat pain) and 50 times more potent than heroin (the common street drug). All opioids bind to the opioid receptors in the brain and block pain signals (hence are used to treat pain), at the same time they produce sedation and euphoria by increasing the levels of the neurotransmitter dopamine producing the ‘High’ or ‘Feel good’ sensation we commonly hear about and what people get addicted to. Opioids also depress the breathing center in the brain thereby causing respiratory arrest which is the usual cause of death. Fentanyl is a highly controlled opioid and is usually prescribed to treat severe chronic pain in the form of slow release patches and as lozenges, lollipops and tablets for breakthrough cancer pain. In the hospital it is administered intravenously under closely monitored state. It is vital to know that Fentanyl should not be used to treat acute/short term pain and in someone who is opioid naive (has never been prescribed/taken opioids). 

The details about my patient poured in gradually. I learned the young man was on parole. He’d gotten into trouble for an alcohol related problem– and had been ordered by the court to attend rehabilitation classes. So, as he could no longer drink, he switched to another source (not an uncommon occurrence under such circumstances). And no, this young man was not a derelict or an orphan. He had a very caring mother who told me how terrified she was as she didn’t know when she was going to lose him. She was at the end of her wits. In fact, it was she who’d saved his life. She was his chaperone who was driving him home from the class when he passed out in the back seat then went ‘blue’ and started convulsing. She drove him to the ER which luckily happened to be just around the block. He was immediately administered a fast acting antidote called Naloxone, and revived. His life was saved, following which he was admitted for observation. What had happened is that Fentanyl, had suppressed the breathing center in RM’s brain, causing him to stop breathing. He’d have been dead if the effects hadn’t been reversed in a timely fashion. 

His mother was a brave soul. I guess she’d been through similar circumstances before hence had acted quickly. Many victims aren’t so lucky. Though her son had overcome death for the time being, there was no guarantee this wouldn’t happen in the future. She begged me to send him to rehab. She was tired and exhausted. At the end of her wits. I didn’t want to be in her shoes. I too have a teen daughter. I can’t imagine how I’d have reacted in a similar situation.  Even though RM appeared motivated to quit (or so he told me) the likelihood for relapse was very high, despite rehab, family support and so on. I know since I’ve seen it because these drugs bring about long lasting changes in the brain.Therefore, it’s important to avoid triggers and not give up hope even if relapse occurs. 

Young people are curious. They want to conquer the world. They want to experiment. It’s in their nature to be impulsive. They are also defiant and would rather go against than heed good advice. The teenage years are the most crucial as seeds of addiction are most readily sown during this time. Not that adults are spared. It takes only a few days to get addicted to a certain drug– so next time your dentist prescribes something for a toothache think twice and if you do indeed have to take the drug do so for the shortest time.  

But as we are all aware addictive substances are available on the streets under various names and formulations causing various effects, but did you know they are also available OTC (over the counter) in your local medical store or pharmacy? Things like cough and allergy medicine, decongestants, motion sickness pills. Sometimes when one drug doesn’t produce the desired effect, people take a cocktail which can include pain pills, sleeping pills, antidepressants, muscle relaxants, cough medicine. 

My advice to everyone out there (young and old) is to say NO– to drugs, alcohol, tobacco etc. You never know when that one glass of wine becomes two, or three or more, or that one pill becomes a dozen. If they say it’s cool to do so, tell them it’s not cool to lose your life.  

Dear parents- Talk to your kids, learn about their likes and dislikes, encourage them to share their fears and anxieties. Inquire about their friends and peers. Keep the channels of conversation open all the time. Assure them of your support. 

And if you choose to smoke, drink or indulge in risky behavior avoid doing it before them– as young people tend to mimic their parents. 

PS: Please feel free to share your thoughts and experiences as well. Thanks for reading!

simi blog imageDr. Simi K. Rao, creator and founder of The MedBag is a board certified internist and hospitalist currently practising in the Denver area. She has special interest in preventive medicine. She is also a published author. You can learn more about her work at https://simikrao.com//

 

 

Holidays Past and Present

Holidays past and present.

Celebration has taken on a new definition since recovery:

In my using days I approached the holidays with a frenetic search for the wildest parties; where the flow of free booze was bountiful, the company raucous, and the music deafening.  Was I seeking fun and companionship?  Hell, no.  When I was sober, I was extremely uncomfortable in those surroundings, I didn’t particularly like the people, the boring conversations, or the atmosphere.  So why did I bust my ass to be part of that scenario?   Because during the holidays I deduced that I could drink twice as much as I usually did, and it would be socially acceptable.  That reasoning even spilled over into our family gatherings.  During the Holidays we all trekked to the liquor store to stock up on the fancier pleasures:  Attractively decorated bottles of Vermouth, Brandy, Creme DeMint, and good wines were, after all, a step up from the beer and bourbon which was our usual fare.  It mattered little that the irresponsible consumption by some of us would become the portal to heated arguments and the ruination of relationships.  The true meaning of the designated holiday was lost in the shuffle.

In early recovery, the Holidays can be extremely difficult.  A multitude of triggers are just lying in wait to coax the addict and alcoholic back out where their misery will be quickly refunded. Family functions rarely change because one member no longer imbibes. Christmas parties carry on.  Temptation stocks the shelves of drug stores and grocery stores.  Alluring advertisements of the bubbly stuff blare their invitations a few decibels louder from your T.V.  And tantalizing, large as life figures offer you a few sips from towering billboards. There seems to be nowhere to hide.  Below are a few proven tips that might alleviate the constant bombardment.

  1. Pick and choose which functions you are comfortable attending
  2. The same rule of thumb applies to both family gatherings and parties.  If you must go, take a recovering friend with you and make sure you are parked where you can make an early exit.
  3. Avoid the aisles that display the alcohol.
  4. Leave the room or mute the commercials.  Take that time to make yourself a cup of coffee with a favorite creamer or savor a cup of tea with spiced mullings.
  5. Keep your eyes on the road and avoid the temptation to fixate on the billboard splashing the booze from a crystal glass.
  6. Volunteer, and do something kind for someone less fortunate than you.
  7. And last but not least, think about the true meaning of the holiday, and send up a prayer for the opportunity to redefine your definition of the word Holiday.

Dallas H lives in a small city in the Northern Panhandle of West Virginia. In addition to being a recovering alcoholic, she is also a part-time employee at a local bank and a poet. Dallas considers herself to be just another run-of-the-mill alcoholic and refuses to allow that aspect of her makeup to define her. In 2018, Dallas celebrated 31 years of continuous sobriety.