Diacetyl-M
Bluelighter
So I gave a reporter for a major newspaper an interview. I have been free of non prescribed opioids for years, and have completed my diploma in addiction studies and I’m working on my undergraduate degree in anthropology. I wrote the reporter this email a week before the story was published. It’s an example of how the media misrepresents people. Note she never mentions that I have been free of "addictive drug use" or drug seeking behavior for a long time. I do psychedelics but that’s about it currently. Well I drink very moderate amounts of alcohol. The story as it appeared in the globe and mail is just below my rather lengthy email. I was surprised that out of everything I communicated to her, she choose to mention that I had taken a few syringes from my diabetic grandma, which I only did one time, before I knew you could just walk in to a pharmacy and buy one OTC.
Hi Anna,
I enjoyed speaking with you the other day, I just felt that after we spoke that I should have given you a few key points that I feel are important for the public to hear if you are able to fit them into your story, as my interest in speaking about this is to raise awareness about the complex issues of trying to live with and deal with opioid addiction. If the article were to have me as giving one message about addiction to these drugs, I would like it to be the need for change regarding how people view and respond to those struggling with addiction. The governments "new" drug strategy that was announced a while back was disheartening to say the least, and it was frustrating to see mandatory minimums actually being put on the agenda after the disastrous results the U.S.A. had with their approach to "fighting addiction." Anyhow the folly of archaic ideas the government totes as "innovative" is not what I feel needs to be said most (though it IS important lol).
What people really need to understand about addiction, and what ANYONE who works with those struggling with addiction have discovered, (as well as those who study addiction, live with addiction, or live with an addicted person), is that no amount of consequences, punishment, or "tough love," will help the addicted person to recover. Education and compassion; a good doctor and case manager who take the time to get to know me as another human being; the availability of enlightened, tolerant, and most importantly evidence based treatment programs which acknowledge the overwhelming research indicating the ineffectiveness of cold-turkey/abstinence based approaches to opioid addiction; the freedom to choose how and when I am ready to recover. Most importantly, a supportive family who took the time to understand my addiction and the associated treatments. Who understand that I did not choose to become addicted, and that it is not a moral failing or a sign of weakness .... these are the factors which lead to my recovery. These are the reasons I went from a $200-$300 a day I.V. drug problem, facing the constant risk of going to jail from growing pot, or dying from an overdose.... to being a university student a few months from graduating who can hold a job, has a good relationship with his family, and tries to give back to the community by helping others who face the same problems.
Addiction to prescription opioids is something that can happen to anyone, from all walks of life, and all socioeconomic classes. Everyone is affected by addiction in some way, either through a friend, family, coworker, or themselves. Which makes it so puzzling why so many of us are willing to meet our family members and fellow members of the community, with rejection, stigma, indifference, hatred, fear, or even jail time. I have had the opportunity to meet many people struggling with this problem, some of whom have spent time in jail for no crime other than possession of drugs for their own use. Not one of them were helped or reformed by the experience. And no person with addictions will be able to recover or even want to recover if they are met with fear and rejection. As Dr. Gabor Mate explains in his book, In the realm of Hungry Ghosts, if there is any hope of the most severe addicts recovering, they must have a reason to want to in the first place. Those who use drugs as an escape from trauma, pain and abuse, are getting a very real need met through their drug use... the temporary relief of pain. How will threats, legal consequences, or total rejection by the community help someone who has been rejected and abused all their life... who now seeks solace in the temporary relief of their pain? Not all people who become addicted were traumatized or abused, but a disproportionately large percentage were. And the few who were not, often have underlying mental health issues that cause a predisposition to addiction.
I believe that a society is only as compassionate and enlightened as how it treats it's most marginalized populations, and I believe that a person's integrity is directly proportional to their kindnesses and ability to tolerate and suspend judgment of those they may not understand. I was very lucky to have come from a good family who helped me through my struggles, and to have had the support of some really good doctors and institutions like CAMH, who use evidence based approaches to addiction. Opioid addiction is VERY hard treat, and the more traditional approaches and schools of thought which view addiction as a moral weakness that must be met with disciplinary action, or insist upon "beating" the addiction via total withdrawal from all opioids, are very ineffective. Over 80% of people who try to quit opioids without replacement therapy like methadone or Suboxone relapse. Less than 15% of those addicted to opioids are able to abstain completely. On the other hand, opioid replacement therapy like MMT has an 80% success rate, and even if the person does not achieve total abstinence from all drugs, they are often able to live productive lives, going back to school, working and having healthy relationships. At the very least, methadone helps to stabilize a person so they do not commit crimes to pay for their drugs.
There are so many myths about methadone, and so many stigmas surrounding its use, and almost all of it comes from a lack of information and education. The belief that methadone clinics attract crime to an area is one of the biggest myths, and one of the least logical. The people suffering from addictions already live in the neighborhood. Some of them require large sums of money to pay for their addiction. Why would offering them an almost free replacement so that they don't require money to prevent sickness and withdrawal, increase crime? There is a visible minority of people on methadone programs that are often associated with MMT in the public eye. But there is what many call the invisible majority who quietly go to and from the clinic, who hold full time jobs or go to school, that hide the fact they are on methadone due to fear of being stigmatized. Some were addicted to illicit drugs, but many became addicted to prescription opioids, many of whom had them prescribed to them legitimately for pain. These are the people who the public never really hears about, who also benefit from these treatments being available.
Though I didn't have a prescription for opioids (except when I had my wisdom teeth out), I was very much a functional addict that most people were not aware was addicted to opioids. I never stole from others to pay for my habit, I have no criminal record, and I've never been involved in any kind of violence, except when I was mugged and beaten for $10 in a mall parking lot. The invisible majority of opioid addicted persons (In Ontario, which has one of the highest per capita consumption rates of prescription opioids in the world)) range from someone like me, to a pregnant mother who has never tried an illegal drug, who was prescribed pain killers for and injury, to a senior who got hooked on opioids while fighting cancer. The stories you read about in the paper, are the heroin addicts who commit a violent crime (which there seem to be few of), or the community who is in an uproar over a "meth" clinic opening in their area. Perhaps if more of this invisible majority speaks about addiction, people will begin to realize that a "war on drugs," and the rejection or indifference of addicted persons is the rejection of our families, community members, and fellow human beings.
Anyhow, I just realized that spent most of our interview talking about what it was like to be addicted, and it was important for me to let you know how I feel about addiction as a whole. There are a variety of bio-psycho-social-spiritual reasons opioid addiction is on the rise in our society, as people use drugs for different reasons. A part of me feels very strongly that addiction in general is caused by a sense of being displaced or "not belonging" to something meaningful, whether it be employment which brings you satisfaction, or if you have a strong cultural or artistic identity. People get addicted for many reasons, but they all seem to stem from some kind of void which the person is trying to fill. With prescribed opioids however, it is possible for a person to become physically dependent yet not be addicted. These medications need to be available to those who need them for pain, and doctors must not be afraid to prescribe them for fear of legal/professional consequences... yet those who prescribe them should also be liable for treating someone who becomes dependent on a medication which they prescribe. Ultimately, I don't think the answer is to eliminate the supply... more carefully regulate it perhaps, or introduce better safety nets addressing diversion. I believe what we need to address is the demand. Even if oxycontin were completely banned (which would hurt far more people in need than it would help), addiction rates would most likely continue to rise. There are people who are predisposed to addiction that need compassionate help and healing, and if it's not prescription opioids it would probably be alcohol or something else. Prohibition didn't reduce the rate of alcoholism, so while we need to come up with a system to help reduce diversion of oxycontin, we need to continue to develop programs addressing addiction, as unfortunately I don't think it's going anywhere.
I'll get back to you tomorrow about the other people I mentioned, and sorry for the long winded email lol, but I'd rather be quoted as saying something useful or half intelligent, than just saying, "ya I was on drugs and it sucked." And this gave me time to think about what I had to say. Thanks, and kind regards, Diacetyl-M
HERE IS HER ARTICLE: From the Toronto Star
Canadians use prescription pills at a higher rate than almost any other nation. Patients are becoming addicts and pills are taking over from heroin as the street drug of choice. So why are voluntary 'guidelines' for doctors the best the experts can offer?
Janey Nagle wasn't looking for kicks when she began courting a drug habit. The Percocets her doctor prescribed were the only thing that could take away the excruciating pain that lingered a decade after a car accident threw her into a windshield with such force that her face left an imprint in the glass.
For the first two years, the painkillers did the trick. The Perth, Ontario, mother of four was able to work and look after her family. But after a while she couldn't get through the day without the pills' euphoric effect, and that demanded higher and higher doses.
Fearful her doctor would cut her off, Ms. Nagle looked elsewhere. She spent hundreds of dollars a day on prescription drugs bought off the street, primarily from friends and acquaintances. She photocopied her prescriptions and filled each one repeatedly at pharmacies around Perth, Kingston and Smiths Falls.
"It was a horrible, panicked feeling every morning when I woke up," says Ms. Nagle, now 43. She remembers the daily dilemma: "How am I going to get them? Where am I going to get the money?"
This went on for years before she was caught at a drugstore and charged with forgery.
Like Ms. Nagle, Canada has fallen quietly into the grip of a pill problem in the past decade. Medications designed to treat pain and anxiety are creating legions of accidental addicts from coast to coast. In Regina, it's morphine; in Toronto, OxyContin and Percocet; in Edmonton, OxyContin, various benzodiazepines and the whole Tylenol gamut.
At a rate of more than 466,000 doses a day, Canadians pop more painkillers per capita than almost any other country (topped only by the United States and Belgium). Spending on prescription opioids more than doubled from 1998 to 2007, and prescription-opiate abuse grew an estimated 24.3 per cent from 2002 to 2005, according to a study published this year in the Canadian Journal of Public Health - while heroin consumption fell 6.5 per cent.
The federal government's national anti-drug strategy has spent tens of millions of dollars on prevention and enforcement initiatives, targeting the country's most hard-core heroin, methamphetamine and crack addicts.
But the fastest-growing group of addicts doesn't fit that mold: They're getting drugs from pharmaceutical shelves or buying pills on the street in transactions police have difficulty preventing because the drugs themselves are legal.
In 2000, less than 4 per cent of the opiate addicts in withdrawal treatment at Toronto's Centre for Addiction and Mental Health (CAMH) were addicted to oxycodone, the primary ingredient in such prescription drugs as OxyContin, Percocet and Percodan. By 2004, that figure had climbed to 55.4 per cent.
The problem is complicated by what CAMH doctor Curtis Handford calls an "epidemic of chronic pain" in a stressed and aging population, and doctors "whose options to treat that condition are limited. They have an inundation of marketing and guidelines telling them that opioids are a legitimate treatment choice."
Under those conditions, he says, doctors can be too indiscriminate in their prescriptions and not careful enough about monitoring patients at risk of addiction.
Across Canada, this crisis is prompting medical authorities to study changing the way these drugs are controlled and policed. But some observers question whether these steps will be enough to get the prescription-drug monkey off the nation's back.
What begins with pain-suffering adults often gets picked up by thrill-seeking youth. A 2007 survey of Ontario students found that more than one in five had taken painkillers that weren't prescribed to them at least once in the past year. This could mean something as innocent as sneaking a pill from a friend's medicine cabinet, notes Jurgen Rehm, a senior scientist at CAMH. But it's indicative of how prevalent and acceptable prescription-drug abuse has become.
"We know that prescription-opioid abuse is the main mode of drug abuse among street kids and street drug users in general," Dr. Rehm says. "We know from the U.S. that there's a parallel between the abuse and the availability of prescription opioids." He adds: "We had been concentrating so much on heroin. ... We always thought that [pills are] just the lesser evil."
But that view is out of date. In preparation for a groundbreaking study on heroin treatment in 2004, doctors in Toronto ran into a bizarre problem - there weren't enough heroin addicts.
"We did a feasibility study ... and within several months we couldn't find any patients," Dr. Rehm says. "We do not have people who are predominantly, or mainly, or even with a regular frequency injecting heroin as their main drug. ... They don't exist."
The picture is similar across the country: A 2006 study found that the only two places in Canada where heroin abuse outpaces that of prescription opiates are Vancouver and Montreal - port cities that are hubs of the global drug trade.
Everywhere else, pill popping (or grinding pills into a waxy powder, to inject for a better high) is the order of the day. An estimated 30 to 40 per cent of the 1,000 to 2,000 overdose deaths in Canada each year may be related to prescription opioids.
"How common is it?" says recovering addict Diacetyl-M, 29. "Really common. I was driving to the store the other day and there was a group of five kids. ... I could hear, 'Oh, those aren't Oxys.' 'Well, what is it? How much do you take?' They don't know what they're taking."
Diacetyl-M got his first taste of prescription drugs at the age of 17, when he got his wisdom teeth out and was prescribed Percodan for the pain. The Kitchener, Ontario, resident has been chasing that same high ever since: "My depression went away, it gave me energy, it made me sociable."
A little while later, when his employer at a landscaping company was hard up for cash, she offered to pay him in the OxyContin pills she had been prescribed for chronic pain. "Was it responsible to pay an 18-year-old kid with OxyContin? Probably not," Mr. Diacetyl says, but he was only too happy to oblige.
When his employer's pills weren't enough, it was easy for Mr. Diacetyl to find friends, or friends of friends, selling their own. As his craving grew, he looked up instructions online and filched needles from his diabetic grandmother to inject.
"Everybody starts swallowing and snorting ... but it's just a matter of economy by then: You get so much higher with injecting that I couldn't afford to snort."
He would get out of bed and mix his usual - one-and-a-half 80-milligram pills of OxyContin, ground up and injected into his left arm - and "that would be like my wake-up."
In the five years Mr. Diacetyl spent hooked on OxyContin, he held down a full-time job. He had a long-term girlfriend and a supportive extended family. He took classes at the University of Toronto. "I was a functional addict."
But by the time he checked himself into a methadone clinic at the age of 23, Mr. Diacetyl weighed 145 pounds, had collapsed a vein and added vomiting to his morning routine. He had broken up with his girlfriend, moved in with his grandmother and "was trying to decide if I had enough Oxy, if I injected it all, if it would be enough to kill me."
In many ways, prescription drugs are less dangerous than other addictive substances: They're legal and their manufacture is regulated, so if you know what pills you're taking, you know what's in them. But because of their easy availability and that very lack of stigma, they are a far more insidious cause of addiction.
Such woes may be most common in smaller communities that are less likely to have the resources to cope. A University of British Columbia study has found that people in B.C.'s smaller towns are disproportionately dependent on prescription drugs.
Steve Morgan, one of the report's principal researchers, says painkiller use also seems to be higher in places - the B.C. Interior, Alberta's oil-sands region and Ontario's manufacturing heartland - with a higher number of workplace-related hazards.
"Could it be the case that occupational hazards lead to opiate addiction? ... This is something we need to be studying."
Approaches used with drugs such as heroin can be ineffective. Right now, methadone clinics are full of prescription-drug addicts who in many cases are not getting proper treatment.
When powerful painkillers first came onto the scene in the late 1990s, addiction was not even discussed, says Clement Sun, a doctor at a methadone clinic in Toronto's east end. "They simply said, 'Here's a pill, it's good for pain.' ... We didn't even know how addictive it was." When a patient got hooked, "the doctor would just say, 'No more' and they were cut off. Now, what does a patient do when they withdraw? ... They go out on the street." The challenge is to motivate doctors to retrain
There are, at last, some major initiatives under way in Canada to tackle prescription-drug abuse.
Ontario's College of Physicians and Surgeons and the Ontario provincial government each have convened panels of doctors, police, pharmacists and coroners.
At the same time, the National Opioid Guidelines Group, with more than 100 physicians, researchers and practitioners from across Canada, has been working out the country's first-ever parameters for doctors on when to prescribe opiates, which drugs to choose and how to tell if a patient is at particular risk for addiction.
Although the guidelines will not be binding, they are certainly a step forward, says the group's co-chair, Clarence Weppler, manager of physician prescribing practices for the Alberta College of Physicians and Surgeons.
But other jurisdictions have moved far more aggressively. California, for example, obliges doctors to get regular opioid-prescribing training or risk losing their license.
A few provinces, such as British Columbia, record the medications their physicians prescribe and can track patterns of which doctors are giving out what, which patients are shopping around for multiple prescriptions and which patient deaths can be linked to prescription opioids.
But that is more a service for doctors than a policing mechanism, says W. Robbert Vroom, deputy registrar of B.C.'s College of Physicians and Surgeons. "If a patient goes to five physicians in a one-month period for large amounts of opiates, we send letters to these physicians," he says. "We're not pointing fingers, saying, 'Your patient has an addiction problem.' "
But Doug Gourlay, a pain and addiction specialist at CAMH and Toronto's Wasser Centre for Pain Management, argues that mere directives do not go far enough. "Guidelines can be helpful, but, again, they are just that - guidelines," he says.
Many physicians say a California-style approach would not fly in Canada's public-health system. Forcing doctors to take time to attend prescribed classes would be deeply unpopular.
But Dr. Gourlay says that "in medical school and in our training, most of us aren't given much education around the challenges of discontinuing the opioid class of drugs."
For that reason, providing training to practitioners may be crucial. "The challenge," Dr. Gourlay says, "is in making it worth a clinician's while to do this."
Ultimately, Dr. Vroom says, physicians need to be part of the solution. "We can't enable addiction."
'I should have been supervised more'
Ms. Nagle's husband knew nothing about her problem until he was called to the pharmacy when she was arrested in 2007. "When he found out how bad it was, it was like being hit over the head."
She was given 18 months' probation and eventually enrolled in a methadone and counseling program. She has been off the other drugs for nearly a year, and her two youngest kids (10 and 13; her oldest is now 23) are still largely in the dark about the whole thing.
But she wonders why her doctor, who knew she had a history of alcohol problems, did not ask more questions before putting her on Percocet long-term. And she asks why he kept giving prescriptions to friends who did not need them - as she knows, because they were selling her their pills.
"He should have known not to give me anything addictive when I already had an addiction problem," she says. "When I got it, I needed it. But then I should have been supervised more, or questioned about it more.
"If that had happened, maybe I wouldn't have gotten so bad."
About the author
Anna Mehler Paperny is a reporter for The Globe and Mail.
Link: http://www.theglobeandmail.com/news/national/hooked-canadas-painkiller-problem/article1362848/
Hi Anna,
I enjoyed speaking with you the other day, I just felt that after we spoke that I should have given you a few key points that I feel are important for the public to hear if you are able to fit them into your story, as my interest in speaking about this is to raise awareness about the complex issues of trying to live with and deal with opioid addiction. If the article were to have me as giving one message about addiction to these drugs, I would like it to be the need for change regarding how people view and respond to those struggling with addiction. The governments "new" drug strategy that was announced a while back was disheartening to say the least, and it was frustrating to see mandatory minimums actually being put on the agenda after the disastrous results the U.S.A. had with their approach to "fighting addiction." Anyhow the folly of archaic ideas the government totes as "innovative" is not what I feel needs to be said most (though it IS important lol).
What people really need to understand about addiction, and what ANYONE who works with those struggling with addiction have discovered, (as well as those who study addiction, live with addiction, or live with an addicted person), is that no amount of consequences, punishment, or "tough love," will help the addicted person to recover. Education and compassion; a good doctor and case manager who take the time to get to know me as another human being; the availability of enlightened, tolerant, and most importantly evidence based treatment programs which acknowledge the overwhelming research indicating the ineffectiveness of cold-turkey/abstinence based approaches to opioid addiction; the freedom to choose how and when I am ready to recover. Most importantly, a supportive family who took the time to understand my addiction and the associated treatments. Who understand that I did not choose to become addicted, and that it is not a moral failing or a sign of weakness .... these are the factors which lead to my recovery. These are the reasons I went from a $200-$300 a day I.V. drug problem, facing the constant risk of going to jail from growing pot, or dying from an overdose.... to being a university student a few months from graduating who can hold a job, has a good relationship with his family, and tries to give back to the community by helping others who face the same problems.
Addiction to prescription opioids is something that can happen to anyone, from all walks of life, and all socioeconomic classes. Everyone is affected by addiction in some way, either through a friend, family, coworker, or themselves. Which makes it so puzzling why so many of us are willing to meet our family members and fellow members of the community, with rejection, stigma, indifference, hatred, fear, or even jail time. I have had the opportunity to meet many people struggling with this problem, some of whom have spent time in jail for no crime other than possession of drugs for their own use. Not one of them were helped or reformed by the experience. And no person with addictions will be able to recover or even want to recover if they are met with fear and rejection. As Dr. Gabor Mate explains in his book, In the realm of Hungry Ghosts, if there is any hope of the most severe addicts recovering, they must have a reason to want to in the first place. Those who use drugs as an escape from trauma, pain and abuse, are getting a very real need met through their drug use... the temporary relief of pain. How will threats, legal consequences, or total rejection by the community help someone who has been rejected and abused all their life... who now seeks solace in the temporary relief of their pain? Not all people who become addicted were traumatized or abused, but a disproportionately large percentage were. And the few who were not, often have underlying mental health issues that cause a predisposition to addiction.
I believe that a society is only as compassionate and enlightened as how it treats it's most marginalized populations, and I believe that a person's integrity is directly proportional to their kindnesses and ability to tolerate and suspend judgment of those they may not understand. I was very lucky to have come from a good family who helped me through my struggles, and to have had the support of some really good doctors and institutions like CAMH, who use evidence based approaches to addiction. Opioid addiction is VERY hard treat, and the more traditional approaches and schools of thought which view addiction as a moral weakness that must be met with disciplinary action, or insist upon "beating" the addiction via total withdrawal from all opioids, are very ineffective. Over 80% of people who try to quit opioids without replacement therapy like methadone or Suboxone relapse. Less than 15% of those addicted to opioids are able to abstain completely. On the other hand, opioid replacement therapy like MMT has an 80% success rate, and even if the person does not achieve total abstinence from all drugs, they are often able to live productive lives, going back to school, working and having healthy relationships. At the very least, methadone helps to stabilize a person so they do not commit crimes to pay for their drugs.
There are so many myths about methadone, and so many stigmas surrounding its use, and almost all of it comes from a lack of information and education. The belief that methadone clinics attract crime to an area is one of the biggest myths, and one of the least logical. The people suffering from addictions already live in the neighborhood. Some of them require large sums of money to pay for their addiction. Why would offering them an almost free replacement so that they don't require money to prevent sickness and withdrawal, increase crime? There is a visible minority of people on methadone programs that are often associated with MMT in the public eye. But there is what many call the invisible majority who quietly go to and from the clinic, who hold full time jobs or go to school, that hide the fact they are on methadone due to fear of being stigmatized. Some were addicted to illicit drugs, but many became addicted to prescription opioids, many of whom had them prescribed to them legitimately for pain. These are the people who the public never really hears about, who also benefit from these treatments being available.
Though I didn't have a prescription for opioids (except when I had my wisdom teeth out), I was very much a functional addict that most people were not aware was addicted to opioids. I never stole from others to pay for my habit, I have no criminal record, and I've never been involved in any kind of violence, except when I was mugged and beaten for $10 in a mall parking lot. The invisible majority of opioid addicted persons (In Ontario, which has one of the highest per capita consumption rates of prescription opioids in the world)) range from someone like me, to a pregnant mother who has never tried an illegal drug, who was prescribed pain killers for and injury, to a senior who got hooked on opioids while fighting cancer. The stories you read about in the paper, are the heroin addicts who commit a violent crime (which there seem to be few of), or the community who is in an uproar over a "meth" clinic opening in their area. Perhaps if more of this invisible majority speaks about addiction, people will begin to realize that a "war on drugs," and the rejection or indifference of addicted persons is the rejection of our families, community members, and fellow human beings.
Anyhow, I just realized that spent most of our interview talking about what it was like to be addicted, and it was important for me to let you know how I feel about addiction as a whole. There are a variety of bio-psycho-social-spiritual reasons opioid addiction is on the rise in our society, as people use drugs for different reasons. A part of me feels very strongly that addiction in general is caused by a sense of being displaced or "not belonging" to something meaningful, whether it be employment which brings you satisfaction, or if you have a strong cultural or artistic identity. People get addicted for many reasons, but they all seem to stem from some kind of void which the person is trying to fill. With prescribed opioids however, it is possible for a person to become physically dependent yet not be addicted. These medications need to be available to those who need them for pain, and doctors must not be afraid to prescribe them for fear of legal/professional consequences... yet those who prescribe them should also be liable for treating someone who becomes dependent on a medication which they prescribe. Ultimately, I don't think the answer is to eliminate the supply... more carefully regulate it perhaps, or introduce better safety nets addressing diversion. I believe what we need to address is the demand. Even if oxycontin were completely banned (which would hurt far more people in need than it would help), addiction rates would most likely continue to rise. There are people who are predisposed to addiction that need compassionate help and healing, and if it's not prescription opioids it would probably be alcohol or something else. Prohibition didn't reduce the rate of alcoholism, so while we need to come up with a system to help reduce diversion of oxycontin, we need to continue to develop programs addressing addiction, as unfortunately I don't think it's going anywhere.
I'll get back to you tomorrow about the other people I mentioned, and sorry for the long winded email lol, but I'd rather be quoted as saying something useful or half intelligent, than just saying, "ya I was on drugs and it sucked." And this gave me time to think about what I had to say. Thanks, and kind regards, Diacetyl-M
HERE IS HER ARTICLE: From the Toronto Star
Canadians use prescription pills at a higher rate than almost any other nation. Patients are becoming addicts and pills are taking over from heroin as the street drug of choice. So why are voluntary 'guidelines' for doctors the best the experts can offer?
Janey Nagle wasn't looking for kicks when she began courting a drug habit. The Percocets her doctor prescribed were the only thing that could take away the excruciating pain that lingered a decade after a car accident threw her into a windshield with such force that her face left an imprint in the glass.
For the first two years, the painkillers did the trick. The Perth, Ontario, mother of four was able to work and look after her family. But after a while she couldn't get through the day without the pills' euphoric effect, and that demanded higher and higher doses.
Fearful her doctor would cut her off, Ms. Nagle looked elsewhere. She spent hundreds of dollars a day on prescription drugs bought off the street, primarily from friends and acquaintances. She photocopied her prescriptions and filled each one repeatedly at pharmacies around Perth, Kingston and Smiths Falls.
"It was a horrible, panicked feeling every morning when I woke up," says Ms. Nagle, now 43. She remembers the daily dilemma: "How am I going to get them? Where am I going to get the money?"
This went on for years before she was caught at a drugstore and charged with forgery.
Like Ms. Nagle, Canada has fallen quietly into the grip of a pill problem in the past decade. Medications designed to treat pain and anxiety are creating legions of accidental addicts from coast to coast. In Regina, it's morphine; in Toronto, OxyContin and Percocet; in Edmonton, OxyContin, various benzodiazepines and the whole Tylenol gamut.
At a rate of more than 466,000 doses a day, Canadians pop more painkillers per capita than almost any other country (topped only by the United States and Belgium). Spending on prescription opioids more than doubled from 1998 to 2007, and prescription-opiate abuse grew an estimated 24.3 per cent from 2002 to 2005, according to a study published this year in the Canadian Journal of Public Health - while heroin consumption fell 6.5 per cent.
The federal government's national anti-drug strategy has spent tens of millions of dollars on prevention and enforcement initiatives, targeting the country's most hard-core heroin, methamphetamine and crack addicts.
But the fastest-growing group of addicts doesn't fit that mold: They're getting drugs from pharmaceutical shelves or buying pills on the street in transactions police have difficulty preventing because the drugs themselves are legal.
In 2000, less than 4 per cent of the opiate addicts in withdrawal treatment at Toronto's Centre for Addiction and Mental Health (CAMH) were addicted to oxycodone, the primary ingredient in such prescription drugs as OxyContin, Percocet and Percodan. By 2004, that figure had climbed to 55.4 per cent.
The problem is complicated by what CAMH doctor Curtis Handford calls an "epidemic of chronic pain" in a stressed and aging population, and doctors "whose options to treat that condition are limited. They have an inundation of marketing and guidelines telling them that opioids are a legitimate treatment choice."
Under those conditions, he says, doctors can be too indiscriminate in their prescriptions and not careful enough about monitoring patients at risk of addiction.
Across Canada, this crisis is prompting medical authorities to study changing the way these drugs are controlled and policed. But some observers question whether these steps will be enough to get the prescription-drug monkey off the nation's back.
What begins with pain-suffering adults often gets picked up by thrill-seeking youth. A 2007 survey of Ontario students found that more than one in five had taken painkillers that weren't prescribed to them at least once in the past year. This could mean something as innocent as sneaking a pill from a friend's medicine cabinet, notes Jurgen Rehm, a senior scientist at CAMH. But it's indicative of how prevalent and acceptable prescription-drug abuse has become.
"We know that prescription-opioid abuse is the main mode of drug abuse among street kids and street drug users in general," Dr. Rehm says. "We know from the U.S. that there's a parallel between the abuse and the availability of prescription opioids." He adds: "We had been concentrating so much on heroin. ... We always thought that [pills are] just the lesser evil."
But that view is out of date. In preparation for a groundbreaking study on heroin treatment in 2004, doctors in Toronto ran into a bizarre problem - there weren't enough heroin addicts.
"We did a feasibility study ... and within several months we couldn't find any patients," Dr. Rehm says. "We do not have people who are predominantly, or mainly, or even with a regular frequency injecting heroin as their main drug. ... They don't exist."
The picture is similar across the country: A 2006 study found that the only two places in Canada where heroin abuse outpaces that of prescription opiates are Vancouver and Montreal - port cities that are hubs of the global drug trade.
Everywhere else, pill popping (or grinding pills into a waxy powder, to inject for a better high) is the order of the day. An estimated 30 to 40 per cent of the 1,000 to 2,000 overdose deaths in Canada each year may be related to prescription opioids.
"How common is it?" says recovering addict Diacetyl-M, 29. "Really common. I was driving to the store the other day and there was a group of five kids. ... I could hear, 'Oh, those aren't Oxys.' 'Well, what is it? How much do you take?' They don't know what they're taking."
Diacetyl-M got his first taste of prescription drugs at the age of 17, when he got his wisdom teeth out and was prescribed Percodan for the pain. The Kitchener, Ontario, resident has been chasing that same high ever since: "My depression went away, it gave me energy, it made me sociable."
A little while later, when his employer at a landscaping company was hard up for cash, she offered to pay him in the OxyContin pills she had been prescribed for chronic pain. "Was it responsible to pay an 18-year-old kid with OxyContin? Probably not," Mr. Diacetyl says, but he was only too happy to oblige.
When his employer's pills weren't enough, it was easy for Mr. Diacetyl to find friends, or friends of friends, selling their own. As his craving grew, he looked up instructions online and filched needles from his diabetic grandmother to inject.
"Everybody starts swallowing and snorting ... but it's just a matter of economy by then: You get so much higher with injecting that I couldn't afford to snort."
He would get out of bed and mix his usual - one-and-a-half 80-milligram pills of OxyContin, ground up and injected into his left arm - and "that would be like my wake-up."
In the five years Mr. Diacetyl spent hooked on OxyContin, he held down a full-time job. He had a long-term girlfriend and a supportive extended family. He took classes at the University of Toronto. "I was a functional addict."
But by the time he checked himself into a methadone clinic at the age of 23, Mr. Diacetyl weighed 145 pounds, had collapsed a vein and added vomiting to his morning routine. He had broken up with his girlfriend, moved in with his grandmother and "was trying to decide if I had enough Oxy, if I injected it all, if it would be enough to kill me."
In many ways, prescription drugs are less dangerous than other addictive substances: They're legal and their manufacture is regulated, so if you know what pills you're taking, you know what's in them. But because of their easy availability and that very lack of stigma, they are a far more insidious cause of addiction.
Such woes may be most common in smaller communities that are less likely to have the resources to cope. A University of British Columbia study has found that people in B.C.'s smaller towns are disproportionately dependent on prescription drugs.
Steve Morgan, one of the report's principal researchers, says painkiller use also seems to be higher in places - the B.C. Interior, Alberta's oil-sands region and Ontario's manufacturing heartland - with a higher number of workplace-related hazards.
"Could it be the case that occupational hazards lead to opiate addiction? ... This is something we need to be studying."
Approaches used with drugs such as heroin can be ineffective. Right now, methadone clinics are full of prescription-drug addicts who in many cases are not getting proper treatment.
When powerful painkillers first came onto the scene in the late 1990s, addiction was not even discussed, says Clement Sun, a doctor at a methadone clinic in Toronto's east end. "They simply said, 'Here's a pill, it's good for pain.' ... We didn't even know how addictive it was." When a patient got hooked, "the doctor would just say, 'No more' and they were cut off. Now, what does a patient do when they withdraw? ... They go out on the street." The challenge is to motivate doctors to retrain
There are, at last, some major initiatives under way in Canada to tackle prescription-drug abuse.
Ontario's College of Physicians and Surgeons and the Ontario provincial government each have convened panels of doctors, police, pharmacists and coroners.
At the same time, the National Opioid Guidelines Group, with more than 100 physicians, researchers and practitioners from across Canada, has been working out the country's first-ever parameters for doctors on when to prescribe opiates, which drugs to choose and how to tell if a patient is at particular risk for addiction.
Although the guidelines will not be binding, they are certainly a step forward, says the group's co-chair, Clarence Weppler, manager of physician prescribing practices for the Alberta College of Physicians and Surgeons.
But other jurisdictions have moved far more aggressively. California, for example, obliges doctors to get regular opioid-prescribing training or risk losing their license.
A few provinces, such as British Columbia, record the medications their physicians prescribe and can track patterns of which doctors are giving out what, which patients are shopping around for multiple prescriptions and which patient deaths can be linked to prescription opioids.
But that is more a service for doctors than a policing mechanism, says W. Robbert Vroom, deputy registrar of B.C.'s College of Physicians and Surgeons. "If a patient goes to five physicians in a one-month period for large amounts of opiates, we send letters to these physicians," he says. "We're not pointing fingers, saying, 'Your patient has an addiction problem.' "
But Doug Gourlay, a pain and addiction specialist at CAMH and Toronto's Wasser Centre for Pain Management, argues that mere directives do not go far enough. "Guidelines can be helpful, but, again, they are just that - guidelines," he says.
Many physicians say a California-style approach would not fly in Canada's public-health system. Forcing doctors to take time to attend prescribed classes would be deeply unpopular.
But Dr. Gourlay says that "in medical school and in our training, most of us aren't given much education around the challenges of discontinuing the opioid class of drugs."
For that reason, providing training to practitioners may be crucial. "The challenge," Dr. Gourlay says, "is in making it worth a clinician's while to do this."
Ultimately, Dr. Vroom says, physicians need to be part of the solution. "We can't enable addiction."
'I should have been supervised more'
Ms. Nagle's husband knew nothing about her problem until he was called to the pharmacy when she was arrested in 2007. "When he found out how bad it was, it was like being hit over the head."
She was given 18 months' probation and eventually enrolled in a methadone and counseling program. She has been off the other drugs for nearly a year, and her two youngest kids (10 and 13; her oldest is now 23) are still largely in the dark about the whole thing.
But she wonders why her doctor, who knew she had a history of alcohol problems, did not ask more questions before putting her on Percocet long-term. And she asks why he kept giving prescriptions to friends who did not need them - as she knows, because they were selling her their pills.
"He should have known not to give me anything addictive when I already had an addiction problem," she says. "When I got it, I needed it. But then I should have been supervised more, or questioned about it more.
"If that had happened, maybe I wouldn't have gotten so bad."
About the author
Anna Mehler Paperny is a reporter for The Globe and Mail.
Link: http://www.theglobeandmail.com/news/national/hooked-canadas-painkiller-problem/article1362848/
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