Our Children’s First Opioid Exposure: The Dentist

Dentists are the leading prescribers of opioids for U.S. teens and the largest increase in dental prescriptions from 2010 to 2015 occurred in 11- to 18-year-olds, according to a study published in the Journal of the American Dental Association…For many young patients, this is going to be their first experience with opioids. “The fact that we’re still prescribing opioids when we’ve demonstrated that non steroidal’s are as affective most of the time is a little disturbing,” said Dr. Paul Moore, co-author of the study. (03-27-18, Az Daily Star)

If these statistics are delivering a disturbing jolt to you, as they did to me, read on. The American Dental Association recently published an analysis of five studies in their Journal evidencing that non steroidal anti-inflammatory (NSAID) drugs work just as well – or better – for most dental pain (such as tooth extractions, root canals, implants) as opioids. The ADA announced a new policy that essentially tells dentists to eliminate opioids from their arsenal, if at all possible, while it is also pushing for mandatory education for dentists that encourages using other painkillers. Finally.

Many of us remember having teeth extracted before braces as young teens and also our wisdom teeth when we were young adults. We were sent home with a few pain pills that contained codeine. When I had a root canal a few years ago, the dentist sent me home with a prescription for a huge supply of Vicodin. What on earth was he doing? This same oral surgeon gave our son a 10-day supply of Percocet until his appointment to get his wisdom teeth extracted – and then another 10-day supply (with a refill) after the surgery. Over twenty days of Percocet? Our son then returned to heroin and within two weeks died of an overdose. JL had been clean and sober for 6 months until that first Percocet….

What role did we, as parents, play in this tragedy? JL didn’t want to tell the dentist that he was a recovering opioid addict and we, reluctantly, agreed. He knew, and we should have known, that this was drug-seeking behavior. He was 25 so we had no authority to deny him medication. But we did have leverage – we were paying for the surgery – we could have very easily stood our ground and insisted that he not have opiates before or after. But we would have had to be willing to let our son experience pain, which we had been trying to help our children avoid since birth. (see my blog Pain, Feb 19, 2018)

Parents of children and young adults do play an important role in the prevention of exposure to opioids – and all addictive substances. We are not powerless and regardless of angering our kids, our love for them and our commitment as their parents and guardians needs to be embraced and encouraged. I hope these insights into one of the earliest and easiest avenues of a negative life-altering experience will help others avoid the mistakes so many of us made over a decade ago.

Note shared by a friend:

Thanks to Opiate Nation for not only bringing to our attention the issue of addiction in this country but also for providing an understanding approach to those of us who suffer from addiction or from its disastrous spin-off. I have to live, as they say, a day at a time dealing with the history of addiction in my family of and of the irretrievable loss of my beloved son as a result of it.

While my son abjured the use of pain killers following oral surgery when he was in his teens, a subsequent year-long hospitalization as the result of an accident in a mine of necessity introduced him to the world of opiates. He left the hospital addicted to prescription medications. an addiction from which he never recovered. He ultimately took his own life. Parents are often accused of being the culprit in this vicious cycle. If indeed we were, it was from our own ignorance that we did not intercede. We simply didn’t see the danger. Bless the writers of this incredibly informative blog for understanding the pain that each of us with addiction in our family suffers daily. We still enjoy life, but not as much, and we still laugh, but not as robustly.  Our lives have been irrevocably  diminished. Having a sympathetic ear through this blog brings surcease from our ongoing anguish.

 

 

 

H.A.L.T.

What does the acronym HALT mean? And why is it an important part of a recovery plan? Hungry, Angry, Lonely, Tired: these are warning signs, red flags. HALT is a tool to remind us to stop – halt – and take a moment to listen to what our emotions and body are telling us.

I am not an alcoholic or addict – you may not be either. So why did I use ‘us’ as I wrote this blog? Because all of us are subject to these basic needs – human needs – and if they are not met, we will instinctively search until we find a way to have them fulfilled. Our responses may not be as self-destructive as an addict or alcoholic, but they will affect our relationships in one way or another. Let’s be careful to not make such a wide differentiation between addicts / alcoholics and us: the ‘us vs them’ mentality that makes ‘us’ superior and ‘them’ inferior.

Hungry. This can be physical, emotional, or spiritual hunger. Physical hunger is fairly easy to satisfy, but for many addicts, getting nutritional meals can be a struggle. Yet it is still easier than getting the affection and understanding that is even more vital to our well-being. This is why a strong support system is so important – and must already be in place before a time of need. Attending meetings is good, but being part of a small group is even more critical.

Angry. This is a normal human emotion. The key is to self-assess and decide why we are angry and what we can do about it. If the issue is out of our control or we aren’t ready to confront it, we look for other ways to release the anger. Exercising, meditation and prayer, and creative outlets can help, as is having a trusted friend or counselor to discuss our feelings with. Whatever we do, denying or repressing anger will not be healthy for us long term.

Lonely: We can be lonely in a crowd or in our room. It is a sense of being isolated, not understood, not appreciated, fearful. Withdrawing feels safe when we are overwhelmed or anxious, but for many addicts it can lead to relapse. I will never forget a conversation with our son when he said “I hate being alone”. I was shocked because he had always been more of an introvert than our daughter. But once he was addicted to opioids, I think the isolation that occurs while using became like prison to him. Perhaps it made him feel less ‘normal’, which he wanted so badly to be. A healthy relationship where we feel safe reaching out to in times of need will make all the difference.

Tired: We all get out of sorts when we are tired. When our lives are filled with activities such as work, school, family, meetings, our need for rest gets pushed to the side. But it is not healthy for us physically, spiritually, or emotionally and it affects our ability to reason and cope with difficulties. Relapse is just around the corner unless our body and mind are restored. It may be hard and uncomfortable to say we need a break to get some sleep, but it will benefit us and it is critical to maintaining sobriety.

Self-awareness and self-care are not self-ish, as many of us were taught when we were growing up. They are vital steps to help maintain a life on the path of recovery and will not only benefit us, but all our relationships.

 

Spring: New Life?

Spring is the season of regeneration, new life, hope. The time of year when the whole earth seems excited to be alive after being dormant all winter. For those who celebrate Easter, the season begins with introspection through prayer and repentance. As we reflect on our life and behaviors that are destructive to ourselves and our relationships, we hope to shed them like the husk of a seed when it is buried in the ground. We expectantly wait for the transformation that happens deep inside that will spring up as new life, like the sprout from a seed. Yet, as it pushes up through the crusty ground, the process of transformation is not without struggle.
This is what those who are living with addiction hope for when they go to AA meetings and enter recovery programs: as they surrender control, they’re hoping for a total change from agony and depression into a new life.

People, Places, Things is a play about addiction and wearing masks by British playwright Duncan MacMillan and director Jeremy Harren. It opened to rave reviews. In an interview with NPR the creators share that at the center of the play is the 12-step process. It shows that for those who have trouble with AA and surrendering to God perhaps it is easier to understand it as acknowledging that you can’t have control over life. We are all powerless over People, Places, Things. It is literally one day at a time. They visited a recovery center in London to get insights for the play. And as one of the actors said after witnessing the daily life-and-death struggle that addicts fight:

“One day at a time. And Life has to win every single day.
Death has to only win once.”

In Tracey Mitchell’s blog (http://traceyh415.blogspot.com/2018/03/) she shares about a young person she has been corresponding with since 2013 and the cycles of opioid addiction and attempted recovery he went through repeatedly. He voiced his utter frustration: “It’s so insane how this drug has taken hold over me.” Tracey heard from him a few more times and then nothing: “I don’t know all the details. I just know I could have written this story. This was my story. Except I did not die at 25. I didn’t need to worry about fentanyl (in the late 1990’s). I got off everything at 27. I consider myself lucky…No one should ever have to die alone like this.”

Yes, no one, especially a young person, should have to die having failed to experience a new beginning – after so much effort at turning over control and hoping for a normal life. But, with the purity of heroin in America having risen sharply in the last 15 years, and fentanyl now mixed in unbeknownst to users, the physical addiction is beyond comprehension. For those who are overdosing and dying in record numbers, they had no intention that their next use would be their last. This was what happened to our 25-yr-old son. Whatever he bought and used was more potent than what he was expecting and accustomed to. He died alone, with the needle still in his vein. Death only had to win once.

Prevention is the best way to stop these needless deaths. But once addiction to opioids has taken control, harm reduction with a solid 12-Step program is the best way to help addicts emerge from the darkness and be able to have a truly new life.

 

The Well-Known Effects of Opioids

I was re-reading a book by George MacDonald, entitled The Curates Awakening. I had forgotten an aspect of one of the main characters plight: opioid addiction. What struck me as I read this paragraph was the age-old, well-known addictive qualities of opioids:

“From a tragic accident of his childhood, he had become acquainted with the influences of a certain baneful drug (opium), to which one of his Indian servants was addicted. Now…to escape from gnawing thoughts, he began to experiment with it. Experimentation called for repetition, and repetition first led to a longing after its effects, and next, to a mad appetite for the thing itself…on the verge of absolute slavery to its use.”

This was written in 1870. Laudanum – an opium tincture that contains almost all of the opium alkaloids, including morphine and codeine – was developed in the 16th century. By the 18th century, the medicinal properties of opium and laudanum were well known.

By the 19th century, laudanum was used in many patent medicines to relieve pain, to produce sleep, to allay irritation.The Romantic and Victorian eras were marked by the widespread use of laudanum in Europe and the United States. The early 20th century brought increased regulation of all narcotics as the addictive properties of opium became more widely understood. By mid 20th century, the use of opiates was generally limited to the treatment of pain, and were no longer medically accepted “cure-alls”. (Wikipedia)

How is it that the manufacturers of OxyContin (Purdue Pharma) and other prescription opioids claimed and advertised that they were not addictive? Their scheme was so persuasive that I have friends today that believe that if you are truly in pain, opioids are not addictive. This is absolutely false. And how did the FDA let this go on?

Yes, we can be thankful that new ways to deliver pain relief were developed for patients with extreme pain from cancer and terminal illnesses. I have seen the need for it when I cared for my sister who was dying of brain cancer and had a morphine drip. But the wholesale promoting – pushing – of these drugs for every ache and pain while knowing how absolutely addictive they were is unconscionable. Had we really understood the power of opioids when we first learned our son was addicted, we would have taken a much more pro-active approach to his initial recovery program.

On October 30, 2017, The New Yorker published a must-read multi-page exposé on Mortimer Sackler, Purdue Pharma, and the Sackler family, by Patrick Radden Keefe:
https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain

“The Sacker dynasty’s ruthless marketing of painkillers

has generated billions of dollars – and millions of addicts.”

The article links Raymond and Arthur Sackler’s business acumen with direct pharmaceutical marketing and the rise of addiction to OxyContin. The article implies that the Sackler’s bear moral responsibility for the Opioid epidemic. During the sixties, Arthur got rich marketing the tranquilizers Librium and Valium using techniques were sometimes blatantly deceptive. In 1974 Mortimer renounced his US Citizenship and lived a flamboyant life in his many residences in Europe.

OxyContin was introduced in 1996 and just since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids.Many addicts, finding prescription painkillers too expensive or too difficult to obtain, have turned to heroin. According to the American Society of Addiction Medicine, four out of five people who try heroin today started with prescription painkillers. Our son is one of those statistics – and fatalities.

PAIN – Part 2

Not only did we, and many of our generation of parents, try to shield our children from as much physical pain as possible, we tried to spare them emotional pain too. But there is one source of pain that we will all experience and that parents and loved ones of an active addict experience on a daily basis: pain of loss. Lost hopes, lost dreams, lost potential, lost futures. When we  birth our children, we experience the joy of a new life and all the expectations of journeying through life together. We embark on a path with goals and plans and dreams fueled by hope and joy. But life rarely delivers what our dreams foresee.

“Awakening to joy awakens us to pain….Eventually, I am guaranteed to lose every earthly thing I have ever possessed. I will lose every single person I have ever loved. Either abruptly or eventually. All human relationships end in loss (death).” (Ann Voskamp, One Thousand Gifts)

The losses that people who are addicted (to anything) experience on a daily basis brings pain for them too. Sadly, addicts will lose most of their relationships while they are still alive. We watched this happen to our son as his addiction progressed. Initially, friends who were not involved in drugs slowly distanced themselves. Eventually, JL was spending more time on his relationship with heroin and had no energy left for friends. When he was sober, this was a source of pain – and shame – for him.

The sense of shame that hangs like low black clouds gathering over our lives any time we as humans engage in something we know is not good for us – or others – is the ultimate loss of self-worth. It erodes the very core of our being and I believe it is the hardest obstacle (aside from the physical addiction) for opiate addicts to surmount in seeking recovery. Shame paralyzes us.

“Shame is an overwhelming negative sense that who we are isn’t okay. It is a no-win situation. Authentic, legitimate guilt is the feeling or thought that what we did is not okay…Compulsive and addictive behaviors are shame-based. If we participate in them, we will feel ashamed. It is inevitable…When guilt is legitimate, it acts as a warning light, signaling that we are off course, and need to make a change…Learn to change shame into guilt, correct the behavior, and move forward.” (Melody Beattie, The Language of Letting Go)

Yet, it seems that for the rare few who have escaped their addiction and are in recovery, that very shame and sense of worthlessness somehow became the impetus for seeking change. Herb Stepherson is a young man who is in active recovery and helping others. His website/blog is: https://junkboxdiaries.com/.  It seems he had a similar story to our son, with one exception: he was not propped up by well-meaning parents and was allowed to experience the full degradation of his heroin addiction. While in prison and planning on suicide, he had an epiphany and God entered the story.

As we look back at the path of our son’s addiction, we feel that by our being overly involved probably prevented him from hitting whatever ‘bottom’ would have been the stimulus he needed to desperately seek help. Although we know he felt a lot of shame, our continual encouragement to him as a person of value and worth to us and God was constant. The conflict was how to communicate that to him without enabling his addiction? Did we short-circuit the role of shame fueling legitimate guilt and the desire to change? We were never sure. We always tried our best. May others learn from our story and do better.

PAIN

One time when our son was camping with friends and their families in the wilderness, a friend of ours asked him why he used heroin. JL said: “Because it takes away all the pain.” Our friend shared this with us and several hundred other friends at our son’s memorial – and said he always wondered if JL was referring to physical pain, emotional pain, or both.

From my earliest memories, my knees and legs ached at random times and varying intensity. Sometimes I thought it was from running or playing too hard. At other times, it seemed like it happened when it rained. But, being in a large family growing up in the late 1950’s and 60’s, there were not many options for relieving that pain. My parents would sometimes rub my legs with witch hazel, which made my legs feel good at the time. Sometimes they would wrap my knees in an Ace bandage to help while I was at school. Yet there was one thing that never happened: I was never given any medicine to relieve my pain.

I didn’t realize when I was young that most likely even if my parents had known of a drug that would have relieved my pain, they would not have given it to me because they were not worried about me having to suffer a little pain. They knew that pain was an inevitable and bearable part of life, and an important part of forging resilience. Sadly, John and I — and many of our contemporaries — did everything we could to help our kids avoid pain. Now we are  experiencing the result of those mistaken values. We found the same thoughts expressed by Sam Quinones, as he discusses this at length in Dreamland: The True Tale of America’s Opiate Epidemic. (www.samquinones.com/books/dreamland/) He believes this dynamic is in large part responsible for the opiate epidemic because it is intertwined with our American culture of comfort and prosperity.

Yes, the pharmaceutical companies and their executives who shamelessly promoted drugs that they knew were highly addictive are responsible for much of what we are living with — and dying from — in America today. But we are responsible for facilitating a culture of pursuing a pain-free existence. It can be obtained, but at what price? Is it one more way we humans think we can overcome the perils of nature and living in an imperfect world?

We are not sure when our son first started using opiates, but we think that it started with prescription pills that were not his or ours. And we know that after a serious accident, when the doctor would no longer give him prescriptions, he bought Oxy on the street, then switched to BT Heroin. He just couldn’t deal with the pain and he was not motivated to do physical therapy — it was too much work.

I feel certain that JL was referring to both physical and emotional pain. What may have started as looking for relief from some physical pain when he was a young teenager, turned into a monster that was causing him shame and ruining his life — and that is painful.

Triggers

A young friend visited our blog this week and had a very disturbing experience. She is a recovering IV drug user and someone I rely upon for  honest input and opinions on drug addiction and recovery. She is one of the few opioid addicts we know who has survived to have a second chance at life.

When she saw the image of a needle in a spoon she said: “I absolutely can’t handle that kind of trigger. For the families of users and people in recovery, that image is especially traumatic. It would make my parents panic, and it made me panic also.”

I felt so unwise – and sorry. I thought back to why I had used that photo. It was one we found on our son’s phone months after he died – I was stunned when I saw it and found that he had taken it two weeks before he died. The fact that he took that photo, documenting his using, was so distressing to us – I felt he did it to urge himself to get help but just couldn’t. 

I wanted the photo to convey the reality of what we, as families of addicts, face in our daily lives. But, as another young recovering addict friend said: “It’s like having a graphic image of someone on their death bed being injected with chemo – and trying to use that for an article about cancer. It adds shock value, but not too much else.”

So what are triggers? Are they the same for everyone? Our son said it was not hard for him to be around us when we were drinking alcohol – it was his decision to drink or not. But that was not what actually happened when he was around friends and alcohol – he ended up drinking – and then relapsed on drugs. We don’t know what the other triggers were for him with opioids, but when an addict sees things that they associate with drugs and their own using, it causes intense cravings, memory flashbacks, PTSD symptoms, racing heart, panic – and ultimately a step towards finding and using their drug of choice.

There are many good articles on internal and external triggers for addicts and alcoholics. I will summarize a few important points from this article, well worth reading: Understanding Triggers

by Sonia Tagliareni  https://www.drugrehab.com/recovery/triggers/

Long-term drug use creates an association in the brain between daily routines and drug experiences. Individuals may suffer from uncontrollable drug or alcohol cravings when exposed to certain cues. The cravings act as a reflex to external or internal triggers, and this response can even affect individuals who have abstained from drugs or alcohol for a long time.

External triggers: are people, places, activities and objects that elicit thoughts or cravings associated with substance use…A NIDA study maintains that exposure to drug-related objects may influence a former addict’s behavior. The brain registers these stimuli and processes them in the same areas involved in drug-seeking behavior.

Internal triggers: are more challenging to manage than external triggers. They involve feelings, thoughts or emotions formerly associated with substance abuse. 

Stress: stress rendered people in recovery more vulnerable to other relapse triggers.

Another good article:

https://www.thefix.com/content/triggers-addiction-dawn-roberts0318

I am grateful for the feedback from our young friends. Reviewing the role of triggers has been an important reminder that there are many friends and strangers who need me to be more thoughtful about what they are struggling with on a daily basis and to take the time to find out what I can do – or should not do – to support their recovery efforts.