(Translation into most languages at tab to the right)
“We were trying, all of us, so hard, and he just wanted to live.” (1)
Ursula Rauh said this about her brother, Tommy, after his death from a fentanyl overdose and a dozen stints in rehab in ten years. He became addicted to Oxy’s at 23 after being prescribed an unlimited amount for tendinitis and a year later, another prescription for wisdom teeth extraction. Sam Quinones retells the family story in The Least of Us: True Tales of America and Hope in the Times of Fentanyl and Meth. “The tragedy wasn’t just the death of her brother; it was all the time, effort, love, and pain that the family traversed, the hoping and living for the smallest encouragement.” (1)
When my husband, John, and I returned from Australia in May, we decided that we needed to address the decades of files we had saved and ‘stuff’ we had accumulated and ‘stuffed’ away in closets. We have shredded and recycled dozens of boxes of documents, cleared out half the books in our library, and now I have moved on to scanning and sorting thousands of photos. While I was pulling bins of photos and albums out of closets, I came upon a few more file bins. I sighed out loud to John, “Oh boy…more of JL’s file’s I’d forgotten about.”
(Translation into most languages at tab to the right)
Mental Health and Addiction
Individuals who struggle with mental health issues and those with any addiction co-exist in almost half of both those populations, as the data shows after decades of research by the National Institutes of Health (NIH). Not surprisingly, individuals who frequently abuse drugs or alcohol are likely to develop a co-occurring behavioral or mental health disorder. There is evidence, for example, that abusers of marijuana have an increased risk of psychosis while those who abuse opioid painkillers are at greater risk for depression. Regular methamphetamine use causes psychosis, anxiety and panic attacks, memory loss and depression. Cocaine users have increased anxiety, paranoia, delusions and depression.
Self-medicating to minimize our inner conflicts is not new, but it has reached new heights in the 21st century – perhaps due to the ease of availability. In Woman of Substances, Jenny Valentish discusses self-medicating at length. She says “In the initial pursuit of partying, people are likely to find themselves drawn to certain families of substances, and they will discover that these additionally offer relief to symptoms of mental illness, distress, or emotional pain.” Why do stimulants calm most people who have ADHD while they have the opposite effect on the rest of us? Why do some antihistamines sedate most people but for some others, cause stimulation? Clearly, their brain chemistry needs something different than the ‘average’ person. It is for the same reason that for many, their drug of choice is a sedative. Their brains need something to turn off the rapid-fire stimulation that can be almost constant.
Informative and concerning statistics on mental health in the US:
Translation into most languages at tab to the right.
One of the things I have come to appreciate about the Australian way is their straightforward approach to life. They are easy-going yet they say what they mean and you know where you stand. A lack of pretense – with a large dose of slightly off-color humor added in.
I think that is why they are more advanced in their drug policies and treatments than America – they are more honest and have less taboos. They benefit from having had comprehensive public health for decades which has facilitated progressive drug policies such as clean needle exchanges, safe-injecting sites, and medication assisted treatment.
John and I had an interesting conversation a few weeks ago here in Australia with Jack Nagel. Jack does the “Real Drug Talk” podcast from Melbourne and also runs the Connection Based Living Recovery Programs. We were preparing to record a podcast with Jack – see links below – and were asking about his experiences and what the current trends are here with drugs of abuse.
In discussing opioids, I wondered why methamphetamines seems to be the main drug of choice and why heroin is not as common here as it is in the States. Jack said that in the 1990’s there was a big problem with heroin coming in from the Golden Triangle of SE Asia and lots of overdose deaths. And the heroin use was IV, not smoking. So, there is a collective memory of street people using heroin and dying which created a lot of stigma and fear associated with IV use.
After that trend slowed, people began using meth – young people like Jack –because smoking or snorting meth seems more innocuous and a less intrusive way to take a powerful drug than IV. Jack said that there is a huge cohort of people who don’t live on the streets and who smoke meth for years. Sadly, they don’t seek help because the public messaging that portrays meth addicts as homeless people with sores and missing teeth doesn’t apply to them. But meth addiction will eventually burst that bubble and ruin their lives too.
There is also a growing problem with cocaine. While once considered the drug of the wealthy city dweller with some high-flying users in Australia spending $10-$20K per week, statistics reveal cocaine usage has now spread much further. Consumption has grown in other areas and demographics where prosperity has increased such as middle-class teachers, tradesmen, etc. Australia is now the highest per capita user of the drug in the world. And the rise in use is being driven by men aged in their 20’s, with Sydney leading the country in use. The most recent stats reveal that there are nearly 1 million weekly cocaine users in Australia out of a population of 26 million. (1,2,3)
We also talked with Jack about what the entry drugs are for kids here in Australia. After alcohol and pot, they usually begin with hard “party” drugs used at house parties and concerts like ecstasy/MDMA, benzodiazepines, GHB/GBL. All mood-altering drugs that create different types of euphoria, but which are dangerous because many times they are mixed with alcohol and other drugs, sometimes without the user’s knowledge.
Even though heroin is in the background in Australia, it is still available and becoming more dangerous due to fentanyl being mixed in to the supply of much of the heroin, and all opioids, along with other drugs of abuse. (4)
When our son, JL, began using Oxy’s he never thought he would even try heroin. Then, as Oxy’s became more expensive and heroin was cheaper, he started smoking heroin. He then swore he would never stick a needle in his vein – the danger and stigma to him was clear. Eventually, just like 95% of heroin users, he did just that. He was living under the delusion that smoking opioids – or any drug – would never lead him to become a “junkie”, an IV drug user.
My concern for the young people and families of Australia is that, as The Age reported in 2020, pain management with opioids has increased here too, although not to the degree it had in the States. Opioid-related deaths have increased in the past decade and today at least three people die from opioid harm each day and 150 are hospitalized. (5) Fentanyl is showing up in wastewater testing and drug overdoses of cocaine and meth, drugs where the users are not expecting a potent narcotic. Because it is synthetic and cheaper to produce in China and India, it brings its criminal networks a greater profit margin.
As I’ve said before and will continue to say: We will not treat our way out of the opioid/drug epidemic. Prevention is key. Let’s continue to stay aware and educated about what we all can do to keep our children and their future safe and healthy.
Translation into most languages at tab to the right.
The need has never been more urgent to alert us all to the risk of overdose facing millions of people worldwide. During the 18 months of the Covid-19 pandemic, overdose deaths have risen approximately 30% in many parts of the world due to isolation, unstable drug sources, and lack of reliable medical and recovery help. Even the normal inadequate support services have been seriously disrupted and diverted. And the hope of C19 disappearing sometime soon is now seen as wishful thinking – it is a new deadly virus we will have to learn how to live with.
So, what can we do to help prevent further loss of lives for those already struggling with addiction?
(Translation into most languages is available to the right.)
During a recent podcast on Straight from the Source (1), David Higham (founder of The Well, a peer-run alcohol and other drug service in the northwest of England) spoke about his life.
For more than 20 years, David was a habitual heroin user more accustomed to life in prison than the outside world. He joined a 12-step program during his final stint. Upon release, he found that sustained well-being and recovery was rare and he knew he had to help change that. What interested me most from his story was this insight:
“Drug treatment is trying to find a solution for my solution…But what’s the solution for my problem?”
(I am re-posting this from July 4th for those who were on holiday and missed it.)
Topical blogs taken from OPIATE NATION. Translation into most languages at tab on right.
I was listening to a young man who had been heavily addicted to crystal meth. As he told his story, one of his “ah-ha” moments was walking into a bathroom in his parents’ home and seeing himself in the mirror. As he looked at the vestige of his former self – an emaciated, festered, hollow-eyed man – he remembered who he once was: a happy and carefree young person with good friends, a star athlete, a kind and honest person, a loving son. That moment of realization caused him to reach out and ask for help which eventually led to the beginning of his recovery journey.
As I heard his story, a photo flashed before my eyes of my son, JL – one we found on his phone after he died from a heroin overdose. It was a selfie he had taken after he had relapsed, just days before he died, standing in front of a full-length mirror in a public bathroom. He was dressed for work in slacks and a dress shirt. No smile. I have always wondered why he took that photo. Was it to remind himself of who he really was? To be able to be honest with himself when he might look at it later when he was high? Was he attempting to make himself stop using? To ask someone for help?
Topical blogs taken from OPIATE NATION. Translation into most languages at tab on right.
I was listening to a young man who had been heavily addicted to crystal meth. As he told his story, one of his “ah-ha” moments was walking into a bathroom in his parents’ home and seeing himself in the mirror. As he looked at the vestige of his former self – an emaciated, festered, hollow-eyed man – he remembered who he once was: a happy and carefree young person with good friends, a star athlete, a kind and honest person, a loving son. That moment of realization caused him to reach out and ask for help which eventually led to the beginning of his recovery journey.
As I heard his story, a photo flashed before my eyes of my son, JL – one we found on his phone after he died from a heroin overdose. It was a selfie he had taken after he had relapsed, just days before he died, standing in front of a full-length mirror in a public bathroom. He was dressed for work in slacks and a dress shirt. No smile. I have always wondered why he took that photo. Was it to remind himself of who he really was? To be able to be honest with himself when he might look at it later when he was high? Was he attempting to make himself stop using? To ask someone for help?
I’ll never know.
But after listening to this other young man, I’m guessing my son had similar thoughts going through his mind. Yet, what seems to have happened is that his addicted mind told himself that he could handle it on his own – that he could just cut down his use and not have to go through withdrawal one more time, not have to be embarrassed by telling us he had relapsed after 6 months of sobriety, not have to start all over again.
Perception refers to how we interpret things and it is the motivation behind our actions and reactions. His perception of his ability to use his willpower was skewed, because our self-perception is influenced by many factors including our perceived needs, our experiences, and our expectations.
Beneath self-perception is our self-concept, our view of our self, which influences our decisions, our feelings, and our judgement. It may include genuine self-knowledge or varying degrees of distortion.
Many times, we choose – albeit unconsciously – to be self-deceived because it is too painful to be honest with ourselves, to interpret what we see in the mirror with unbiased and accurate judgement. There is a saying written in the first century AD that sums this up:
“Those who hear (a clear direction) and don’t act are like those who glance in the mirror, walk away, and two minutes later have no idea who they are or what they look like.”
Because of this very human tendency, we all need a few close friends and a safe community who love us enough to honestly reflect back what we saw in the mirror – which we can so conveniently forget.
(Thirty-fourth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)
This week’s Story of Hope is from a young friend of ours, Anne (not her real name). Here are some excerpts from her story in Opiate Nation (5 min read):
I was eleven years old when I first experienced shooting heroin. Looking back, I can hardly believe it and I am so thankful to be alive, and to be sharing my story.
My boyfriend and I watched the movies Trainspotting and Requiem for a Dream and they really piqued our interest in drugs. The way it was portrayed in those movies made me think using heroin would be an amazing dream sequence, when in actuality, it made me violently ill. My boyfriend insisted we keep trying. He became obsessed with all drugs: ecstasy, LSD, cocaine, and various pills and so I tried them all.
(Twenty-ninth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)
I have never been one to accept something without question – anyone who knows me well, knows this – and they live with the frustration my incessant questions create. But it’s the way I need to process what is happening to or in or around me in order for me to honestly make the decision to accept or reject whatever the issue is at hand. I don’t think I could live with myself if I pretended I agreed or accepted something when I didn’t – the dishonesty would keep me in turmoil. And many times, it is ultimately for self-preservation that I accept something distasteful or painful when I finally understand there is no other option.
Death leaves us no other option – it is not negotiable. For most of us, our survival instinct brings us to the realization that in order to retain our sanity, we must eventually accept death – even of those we love the most in this world – whether we like it or not.
(Twenty-sixth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)
Nine months after our son, JL’s, sudden death, we were gradually unearthing our grief, as we gradually unearthed pieces of his life. We were miners searching for something precious, digging through the layers of years as if through layers of rock. Or perhaps we were more like survivors of an earthquake. Our entire earth, with everything we had built on it, was suddenly shaken to the point of collapse, and we were sifting through the remaining buildings and rubble to see what was left. Deciding what to keep and what to dispose of. “Dispose of” has new and unwelcome meanings now. Clothing, personal belongings, furniture, files, photos, childhood toys, keys, memorabilia.
John’s journal entry on May 12, 2015 expresses some of our feelings:
Dear JL,
It’s dad again. We are going through more of your things and I spent a half-day shredding your old papers and notes. It is so odd that much of our lives comes down to boxes of paper to shred. This is very, very hard for me. Shredding your life.
I love you – Dad
Grief is about what is going on inside us after a loss—how we feel. We have no more control over it than we have control over other feelings. Our choice involves how we deal with it.
Mourning is the action of dealing with our loss—what we do, the common rituals, the external part of the tragedy. Again, we choose how we mourn.
Some people put acts of mourning off indefinitely – leaving a deceased loved one’s belongings just as they were when they died until they die themselves. Others, urged on by society or their own distraught emotions, will almost immediately begin sorting and throwing. For us, there were some natural milestones when deep inside we seemed to know it was time to face the loss of another part of our son’s life. The grief-work we were engaged in – being aware of the various stages of grief and facing them as they surfaced – was our internal guide. We never let societal custom or any external pressure guide us, while we did read and listen to other’s experiences.
One thing became clear: this loss of our child was very, very different than the loss of our parents or siblings. Although each of those were difficult in their own distinct ways, the level of personal pain with our son’s death was unique. He was an intimate part of who we are – of course – he came from us. As he grew and became his own person, he yet remained a part of our life and more significantly, our future. All is engulfed in a thick fog. Which is why the quote in the photo is so poignant:
When you lose a parent, you lose the past. When you lose a child, you lose the future.
The Ohio Society of Addiction Medicine is a chapter of ASAM - A professional society actively seeking to define and expand the field of addiction medicine.
Opiate Nation 