Opioid Odyssey: Discoveries of Recovery Through Medication Assisted Treatment

Opioid Odyssey Inc.

Discovery of Recovery Through Medication Assisted Treatment

Dr. Michael J. Murphy

Dr. Aafaque Akhter

ISBN (Print Edition): 978-1-54398-850-5

ISBN (eBook Edition): 978-1-54398-851-2

© 2019. All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.

This book is dedicated to my mother Asma

Dr. Aafaque Akhter

Table of Contents

Introduction

How to Read This Book

Acknowledgements

Foreword

Story 1: Krista

Brief Primer on Opioid Addiction

and Medication-assisted Treatment

What is Medication-assisted Treatment (MAT)?

Story 2: George

Story 3: Eric

The Birth of Norton Healthcare

Story 4: Ralph

Story 5: Patrick

Story 6: Kathleen

Identifying with the Eternal

Story 7: Alena

Story 8: Bill

Thoughts About Addiction

Story 9: Jim

Story 10: Peter

Story 11: Gustaf

Story 12: Rachel

The Story of Dr. M

Story 13: Dan

Capturing the 80%

Story 14: Rodovan

Story 15: Mick

The Problem with More

Story 16: Dillon

Identifying with the Eternal, Part 2:

A Different Kind of Emptiness

Story 17: Lance

Story 18: Brittany

Story 19: Homer

Portugal: Another (Better) Way?

Story 20: Colin

Story 21: Brenda

Story 22: Doug

Kissed by Two Saints: Dr. A

Epilogue

Introduction

In the United States, as well as around the world, a huge effort has been made to address and ameliorate the effects of the opioid crisis. Unfortunately, however, few people, including the readers and writers of this book, are more than two degrees separated from someone whose life has been devastated by opioid dependence and addiction. Each year, it seems that more and more people suffer and die from the opioid crisis.

Why has so much concern and effort generated such inadequate results?

More importantly, why is the reservoir of affection towards people identified as criminals or drug addicts so severely limited?

Truthfully, with the exception of a small population of medical professionals in the field of substance abuse research and treatment, few people really care about drug addicts. In fact, the media promulgates a one-dimensional stereotype of a substance-dependent person — one that identifies these individuals as dark, malevolent creatures afflicting our nation. But, in reality, rates of violence are at all-time lows. Many believe that drug addicts have created a problem for themselves and, as a result, should suffer the consequences of the mess they created. So be it.

But, in general, people care about people. In fact, most people care deeply about their families, neighbors, communities, and even strangers. More so, most people will give their time, attention, money, and even love to a person who enters their life and appears to genuinely need their help. We are wired that way — to care.

We are designed to care about and support one another, regardless of how many callous and heartless stories we hear in the media. Still, despite all the negative news, we have a deep reserve of compassion for those who are suffering. We understand that, however different we may appear in color or shape or history or cultural orientation, in some profound and fundamental way, we are all the same.

The shocking unspoken secret is that the opioid-dependent person, the drug addict, the criminal substance abuser, far from being some socially malevolent other is, in fact, us. They are not of some other tribe, no matter what tribe they may have been born into. No, these cast-outs are our sons and daughters, friends, parents, colleagues, and ourselves.

As this book will make clear, drug addicts, the apparent criminals of our time, are actually us. In each of these stories and in the supporting information, readers will recognize their close friends and neighbors, family members, the pillars of their communities, and themselves. Their stories are our stories.

Yes, the drug addicts are us. We, and they, need help, and above all, they need care. We can provide aid to the people who need us the most simply by understanding who they are and what has happened to them. The ultimate goal of this book is to bridge the gap between them and us and bring us all together into one human community, a community that seeks understanding and a better way to become more in sync and harmonious with each other.

Of course, these stories of courage and resilience may provide little comfort to those who have lost loved ones, or those who have watched loved ones lose significant parts of their lives to opioid use disorders. For these individuals, there may be no such thing as a happy opioid crisis book.

But it is important to understand that although true recovery is possible, it does not mean that it is certain or even probable. In other words, the complex elixir that constitutes effective treatment has and will create possibilities of freedom for many, perhaps most, who have found their lives ruled by opioid dependency. But the odyssey must be suffused with understanding and care.

The truth is, the United States and many other nations have been down this road before, and over time and with appropriate comprehensive interventions, the storm has always, after inflicting its damage, abated. With the right interventions, our current storm of opioid dependency will also eventually subside.

In a sense, this is a book about everything and everyone.

You may have purchased this book, cracked it open for a peek in some old-fashioned bookstore, or downloaded a sample on your tablet, because you hoped it would present a different, and perhaps a fresher and more optimistic, perspective on our seemingly endless drug problem, our infamous opioid epidemic. And, it will. But, on this exploratory journey, we will travel paths that will cause us to reconsider many of our fundamental assumptions about substance dependence, and perhaps about life itself.

We will need open minds to fully understand the problem and a broad brush to depict it. Drug addiction is related to many things, all of which must be considered if we are to understand and address the problem adequately. If there is one thing we have learned through hundreds of thousands of drug-related deaths, it is that overly simple answers are even worse than useless ones. Not only do they not help, they provide a mistaken justification for destructive actions. After reading this book, our hope is that you will understand that the real answer to the opioid crisis is, in a sense, the simplest one of all — first and foremost, we need to understand and care.

Keep in mind that this book is not intended to be another wooly-headed manual of wannabe self-help philosophy. Instead, it lives at the forefront of our current drug crisis and enters the lives of real people struggling to rebalance their lives, lives that were destabilized by powerful drug addictions. Our aim is to demonstrate the ancient essence of the worldview-altering process that, when directed toward the problem of substance dependence, has been called recovery.

The heart and soul of this book centers on the real stories of those who have found themselves on the front lines of what is known as our drug war. It is about ordinary people, who woke up one morning feeling so repugnant that they decided they had to do something, anything, to get rid of that feeling. All of the people whose stories are included here are clients of a medication-assisted treatment program. They were perfectly normal until they found themselves suffering from the ravages of an opioid dependence. That’s when their real troubles began . . .

But these individuals have now learned what they needed to learn and what they had to learn to be able to change for the better, because if they didn’t, they saw they would continue on a path of pain and self-destruction. And, with change, many of them found their way out of that dense forest of pain, loss, and shame, and they have reconnected with what they have always valued most within themselves.

Once they acquired this knowledge, they have protected it with all of the energy they could muster. These survivors reclaimed their lives — lives they may have never even claimed in the first place. These fighters learned how to walk with a dignity that comes from living through deep suffering, surviving, and moving beyond it.

Consistent with the stories of redemption, this publication describes itself as a happy opioid crisis book, one that lends a dose of common sense and humanity to a medico-social phenomenon often described only in the most extreme and invariably negative language.

If there is one thing we have learned from these stories of hope, it is that, however much we crave them, there are no shortcuts to wisdom, no direct paths to perfect gratification and bliss. Life is a hard journey and always has been. Learning is usually accompanied by discomfort.

Keep in mind that at certain points during each of our personal odysseys, suffering may be an unavoidable side effect of learned wisdom. However, recovery, the discovery of a new, redeeming pattern of living is always possible. There are many worse things than sacrificing for what you believe is worthwhile. Our hope is that by the time you turn the last pages of this book, you will better understand that at the end, the real truth, the truth that can save us all, continues to reside where it has always been — inside each and every one of us.

How to Read This Book

This book is comprised of clinical and interpretive material, along with the exciting and dramatic stories of women and men who have bravely fought drug dependency and won. As mentioned above, it contrasts with the alarmist publications prone to using scare tactics to highlight our burgeoning drug problem. This book is what we like to call a happy opioid crisis book.

If so inclined, feel free to skip the interpretive and informative essays, and go straight to the stories of recovery. Our only request is that you allow yourself to be entertained for a time by stories of discovery, hope, recovery, and redemption. Then, after becoming more curious and motivated, return to the informative material to better understand the factual, and spiritual, underpinnings of the issues to which you have been exposed. The truth is every effort has been made to craft a book that clearly communicates a simple message of the inestimable power of hope and connection. Above all, we hope you enjoy the message of service that stands as a grateful acknowledgement to all those who made this book possible.

Acknowledgements

The authors are extremely grateful to the many dynamic contributors who participated in bringing this odyssey to its destination, the many colleagues, friends, and acquaintances who invested precious time into reading early versions of this book, and offering invaluable suggestions on how to present the most comprehensive and accurate literature to the public, as well as the countless parties, both in person and through secondary sources, who offered expertise and information that we hope will help inform and enlighten not only those who are troubled and confused by our infamous opioid crisis, but also those who are in recovery and who have openly and with great generosity shared the vivid details of their journeys. To you all, we say without hesitation that this journey, and all it means to you as well as others, could not have been completed without you. Thank you!

Where there is righteousness in the heart, there is beauty in the character. When there is beauty in the character, there is harmony in the home. When there is harmony in the home, there is order in the nation. When there is order in the nation, there is peace in the world.

~ A. P. J. Abdul Kalam

Foreword

Do not give your attention to what others do; give your attention to what you do or fail to do.

~ Buddha

Unlike the seriously mentally ill, the homeless, the desperately poor, and victims of sexual or physical abuse or violence, individuals struggling with substance dependence disorders, commonly referred to as drug addicts, do not elicit much sympathy from the general public. In fact, the mere mention of a drug addict evokes images of the legendary pusher man, destroying lives as his often-unwitting customers plunge into a pit of chemical slavery.

According to some, once individuals become infected with the disease of addiction, they begin to negatively affect the lives of others: spouses, partners, friends, employers, the government, taxpayers, etc. As a result, the lives of these others are also hijacked, and their freedom is sacrificed. According to the naysayers, the millions of drug-affected people in America today, both substance-dependent people as well as those who are in some way involved with them, are simply proof of the strange contagiousness of this disease.

Of course, there is a grain of truth to these stereotypes.

Thanks to our nation’s legal policies, drug abuse is, by general definition, illegal, so most drug-dependent individuals are, at least technically, criminals. In fact, a very significant portion of drug use is forced into a dark shadow market that moves billions in drugs and money in and out of our communities every single year. Sadly, our legal system assumes that, with rare exceptions of mental or emotional incompetence, people are responsible for their choices and behaviors. As we will see later, when applied to opioid use disorder, this assumption is clinically and factually incorrect.

More specifically, clinical experience and reliable research indicate that the majority of incarcerated or legally detained people are not criminogenic, sociopathic, or pathological; rather, they are simply substance-dependent individuals who, by virtue of medical malpractice, lack of opportunity, extreme poverty or pure chance, have found themselves in a very uncomfortable state called dope sickness, or drug withdrawal. As a result, these individuals have done what they felt was necessary to alleviate their extreme physical and emotional distress. In other words, as the reader shall see, most of these individuals established a pattern of regular illicit drug use to escape physical or emotional agony.

Therefore, one of the aims of this book is to reveal, very clearly and personally, just who the large majority of these drug abusers are, how their personal journeys have led them towards becoming ensnared in the drug trap, and how they found their way back from hell to regain their independence.

This book seeks to familiarize the general public with the actualities of drug dependency and to provide stories of successful recoveries and rehabilitation, as described by real people, who have experienced it all. After reading this book, our hope is that you will become honestly familiar with the reality of our opioid crisis, as experienced by substance abusers and their loved ones. We also hope you will be able to deeply understand how these warriors, with sensitively provided treatment, were able to return to productive and fulfilling lives.

What does this sensitively facilitated recovery entail? The discovery part of recovery is a holistic process that typically involves the medical, psychological, and spiritual aspects of the person being addressed, as well as the person doing the addressing. It has long been accepted that the quality of the connection between the helping person and each client, at least to a significant extent, determines success, regardless of how we choose to define it.

That is why the goal of this book is to share the reality of substance dependence and recovery, as revealed by generous survivors, who were brave enough to share their stories of getting lost, wandering, and then returning to a personal center filled with purpose and intention. Again, these stories come from clients who have participated in a medication-assisted treatment (MAT) program.

Note: Individual circumstances have been changed to protect the identities of the contributors.

Story 1: Krista

Leaning back, Krista pulled open the heavy drugstore doors. After entering she bounced between the shampoos, feminine hygiene products, sleep aids, and cereal aisles. Then, standing in front of her on a wire rack was her favorite cereal, Apple Crunch Cheerios. She took it as a good omen. She paused for a moment and allowed her eyes to pass over the various types of chocolate syrup, peanuts, candy.

She strived to look composed, but she was, to be sure, a bit preoccupied. To other eyes, she hoped, she appeared to be just another Saturday suburban shopper, enjoying the wide variety of useful products available at her local pharmacy.

As usual on such errands, she was clad in her old high school gymnastics uniform. She found that people loved it, and, now in her mid-twenties, it still made her look, at least to the unperceptive eye, like a teenager. People knew her as Tiny Krista, and she was famous, at least among the few people with whom she still spent time, for being able to pack prodigious amounts of opioids inside her diminutive frame.

At that moment, Tiny Krista felt good, really good and optimistic. She was still riding the high of her last dose. Unfortunately, however, those were the last pills she and her boyfriend Patrick had. As the moments passed, she sensed the clouds appearing in the distant sky; the peak was behind her, and her high was just beginning to wear off. She knew what was happening. She sensed the deep rumblings, the subtle tremors, and the slight changes in her body temperature, changes that normally came before the terrible reality of dope sickness hit.

Of course, she’d been here before. Done this many, many times. This was not her first or second or even one-hundredth rodeo. She had with her perfect reproductions of physician narcotic scripts, the expert work of Patrick and herself. She made her way over to the pharmacy counter and presented the script, smiling innocently at the busy pharmacist, who reached out a hand as she stood, still staring at her computer screen.

Then, back over by the Cheerios, Krista waited. It was important not to give any indication of strangeness. The goal was not to give the pharmacist any reason to question why cute little Krista needed another refill of sixty pills of oxycodone. Of course, why wouldn’t she need these narcotics? She was a pretty, amiable, tragically injured gymnast, right?

Krista took a quick peak over at the pharmacy counter, and immediately her mood plunged. She just happened to catch the gaze of the hard-faced pharmacist, who at that very moment had the phone pressed between her shoulder and ear. She was peering at the green square of paper as she talked intensely on the phone. The green square of paper looked just like Krista’s forged prescription.

Of course, she and Patrick had tried to make the script look like all of the others they had made throughout the years. But still, she became nervous. She prayed that her sudden anxiety, like so many other times, was just another false alarm. However, even from across the store, she could practically read the pharmacist’s lips and sense the terrible message associated with her grimace. Yes, Krista imagined her saying to her faraway colleague, here’s another one trying to con me.

Then the pharmacist laughed, a small, cynical burst of laughter. She shook her head and made a final quiet comment and quietly returned the phone to its cradle. As Krista watched, nervously flickering her eyes from one anonymous object to another on the shelves, the pharmacist placed the green piece of paper in a special basket far away from all of the others.

Then, remarkably, the pharmacist raised her eyes and her gaze connected directly with Krista’s.

For a few brief, intense seconds their eyes were locked together. The visual blow felt to Krista as if she had been struck by an air hammer. The pharmacist, unsmiling, appeared for a moment to be peering deep into Krista’s very soul. Krista’s blood pressure rose as the color drained from her face and her pulse increased. Slowly, almost robotically, she turned and put the bag of candy she was clutching in her damp hand on a counter. Unsure what to do, she began smoothing the fabric of her sweats, the uniform that she had worn so long ago, seemingly a lifetime ago, when she would bounce and fly so carefully and yet so effortlessly across the mat. She looked down at the sterile linoleum floor. Then, decisively, Krista turned and with quick steps strode out the glass doors to the street.

Her mind was as empty as the inside of a balloon but filled with a silent throbbing as she walked the half a mile back to her mother’s house. She had been living with her mom for the past year, because she had no money to live on her own. The empty space in her brain seemed to echo. Now, at last, it seemed, there was nothing to be thought, nothing to be said, nothing to be done.

Over all of the past year Krista hadn’t even told her mom that she was on probation or, for that matter, that she had violated probation twice already. But she sensed that her mother already knew, as mothers do. Nowadays, with the arrival of social media, communication moved at a lightning speed. As usual, Krista realized, the only person she was conning was herself. So, with an addict’s wisdom and a suffering person’s capacity to face hard realities, Krista knew in her gut that she was done. Not wanting to prolong the inevitable, she picked up her pace even more.

By the time she got to the house, she was a little sweaty and her stomach was beginning to churn with that sickly rumbling that signaled the nausea to come. She didn’t even bother to go inside; she just sat down on the steps and waited. She did not know what it was, but something, she knew, was about to happen. Strangely, somewhere beneath the familiar tinge of nausea and the tremors, there was a sense of relief. Krista was, in truth, tired of the game, tired of the pursuit of the drug and sick and tired of being sick and tired all of the time. Really, she just wanted to go to sleep and wake up when it was all over.

There was nothing she could do, so she was finally free to do nothing. She lowered her head towards her crossed arms on her lap and just caught in her peripheral vision a glimpse of the cruiser turning the corner and slowly advancing down the street. She sighed and felt the gentle breath on her forearms. She tried to relax for a moment, slowly inhaling and exhaling, over and over again. It was the same thing she had done before some of her best performances years ago. Then, like now, she had just waited for the next moment to arrive.

Krista had come by her persistent optimism naturally. The younger of two sisters raised in a loving home with warm, intelligent, and very creative parents, when we talked, she described her childhood as interesting and a lot of fun. Although her parents divorced when she was just six years old, her father, who was a combat jet pilot in Vietnam before becoming an airline captain, was always present. According to Krista, her father loved his kids and did a good job of protecting his family.

But, like many Vietnam veterans who at a very vulnerable age had seen and done much more than they could be expected to understand, her father drank too much after the war. He drank so much that Krista’s mother eventually divorced him. But, surprisingly, the divorce seemed to cause him to wake up, that and an unexpected late-night experience of psychically channeling a fifty-eight-year-old Vietnamese man, who, he understood, had been killed during one of the many fire bombings that Krista’s dad had inflicted on Vietnamese villages years before.

During the channeling, Krista’s father learned that the Vietnamese man forgave him from the depths of his heart and the essence of his soul, which was remarkable, and very inconsistent with Krista’s dad’s then-limited Western perspective. The man, it seemed, having negotiated the journey of death, understood why Krista’s dad had done what he had done. The Vietnamese man realized, through his elevated and now otherworldly perspective, that sometimes even very terrible things need to occur, especially if the vast and incomprehensibly intelligent turnings of the universe are to progress towards its inevitable destiny.

And there were others after that, others who had been forcibly escorted to another plane of existence by Krista’s now very spiritually attuned dad, others who let him know that his perception of good and bad, guilt and innocence, and shame, while in some ways noble, were also a sign of an unacceptably limited awareness. Sometimes things, even things that appear to be terrible, just need to be.

As Frederic Perls, a Gestalt psychologist, used to say, To die and to be reborn is not easy, nor should we expect it to be. In the vast incomprehensible cycle of tones and vibrations, suffering, the Vietnamese man said, is just another note; a note that is necessary for completion of the great symphony, and in that sense, as paradoxically great a gift as can be given.

Krista’s dad appreciated and respected these amazing gifts, and, over time, he shared them with Krista. For him, retirement meant becoming a reiki instructor and a kind of modern-age shaman. He understood that there is more in our universe than our ordinary language can communicate. If Krista called her dad from two thousand miles away and complained of a nasty headache, he would tell her to pull over, so her brain and spirit could receive vascular regularity as she reclined in the driver’s seat and received the soothing words of her father. It worked, Krista said, just well enough.

Because Krista knew that her dad cared for her, even from afar, she never really felt alone. She internalized the groundedness of her father, and she knew she was her mom’s favorite. It was her mom who diligently drove her to every gymnastics practice and sat watching, like a loving and devoted parent. The problem was, Krista’s mom just didn’t deal with things well, though, thankfully, she had a way of meeting men who did. So, all in all, according to Krista, she was a happy kid, who wasn’t too upset about her parents’ divorce.

At fourteen, Krista’s older sister decided to go and live with her pilot father in the Midwest. Krista, two years her sister’s junior, went along for the ride. But, after a year, she missed her mom’s lightness, her playfulness. She was also worried about her mom being alone with this-or-that boyfriend, and she knew that her mother needed her, too. Krista’s older sister, conversely, valued the peace, order, and ambition of her dad’s home, and she loved his new wife, who soon became a lifelong best friend.

After returning to her mother, Krista soon drifted back into her self-appointed job as her mom’s caretaker and running partner. She did just enough to get by in high school, although she certainly did not do as well as she could have. Looking back now, it was apparent that she was slowly adopting the mentality that the world she lived in was safe and benign, and that even when one made bad decisions, those decisions didn’t cause significant consequences.

As a child, Krista and a close friend persevered and earned all the major badges in the Girl Scouts. She tried marijuana twice and hated it. To fill her time, after graduating from high school, she enrolled in a local community college and got a degree in liberal arts, mainly because it was there and was easy to do.

Krista sometimes accompanied friends to raves, dance parties typically held at nightclubs, warehouses, abandoned buildings, festivals, and private venues. These events typically feature DJs who blast loud, pulsating techno, trance, and electronic music. During these raves Krista took ecstasy, the well-known therapy drug. She continued to do this at parties until,