Syringes to Sobriety

Stories and Advice from a Real Heroin Addict
MAT-Taking the Edge Off

Medication Assisted Treatment -Taking the Edge Off

Doctors overseeing medication-assisted treatment programs use prescription medication to help heroin and/or other opiate abusers break their physical dependencies.  Some of the prescribed medications available are Suboxone, Vivitrol, and Methadone. Medication-assisted therapy pairs prescription medications like these with behavioral therapy and counseling.  Many people are hesitant of medication-assisted treatment programs because they feel they are replacing one drug for another.

Medication Assisted Therapy

Health professionals use many other types of prescription medications to assist in withdrawal and recovery.   Drugs such as antidepressants, lithium, sleeping medications, and even medical marijuana are prescribed to ease the transition off of illegal substances.  Many users are finally able to receive a proper mental health diagnosis and a prescription for disorders like schizophrenia and bipolar disorder once they are clean.

Using a drug to treat heroin addiction does sound a bit counter-intuitive, so, on the surface, it is understandable that medication-assisted treatment is viewed as substituting one drug for another.  Some programs, like SMART Recovery, are very supportive of MAT and other programs that involve doctors prescribing medications.

My MAT Story

In my last year of law school, I had spent most of my savings on Percocets.  Low on funds, I had considered switching to heroin, which has a much lower street value.  Suboxone appealed to me because I did not have to miss any school to attend detox.  A Suboxone-certified doctor instructed me to stay clean for 48 hours (more or less) and then report to his office, three days in a row, to receive my Suboxone.  Within those three days, we determined my ideal Suboxone dose, which factored in my tolerance for opiates and pain threshold for withdrawal symptoms.  I stayed on the program, taking two pills a day for one year.  Unfortunately, I relapsed after a year and was taken off the program.

Pills on a scaleUltimately, this relapse was inevitable.  I had decided to start Suboxone for the wrong reasons.  If I am 100% honest with myself, I would not have quit if the money situation had not been so dire at the time.  Since then, I have witnessed Suboxone be a wonderful tool if the user is ready to recover.

A couple of years later, I was sent to an actual detox program for three days.  I was given a Suboxone taper to get the heroin out of my system.  After completing inpatient detox, I was prescribed Seroquel and Trazadone.  At low doses, Seroquel is prescribed for sleep; Trazadone for anxiety.  Most, if not all, long-term opiate users struggle relentlessly to sleep more than an hour at a time.  It is hard to relax your body and your mind never stops racing.  Seroquel allowed me to get at least 6 straight hours of sleep a night so I could stay focused on my recovery during the day.

Outpatient group therapy sessions, AA, NA and Smart Recovery meetings combined were not enough to keep my mood remotely even. Trazadone allowed me to maintain steady emotion so I could deal with tough issues confronted in recovery.  I credit most of my sanity in the first months off of heroin to these prescriptions.

During this period, I attended an Outpatient Recovery Program and lived in a sober living house.  Eventually, I was promoted to manage the sober living house.  As a result, I became familiar with the medical aspect of our client’s recovery programs.  For example, one client had a suboxone implant in her arm, which prevented her from having to take a pill every day.  Many people view popping a pill daily as addict behavior, so it is good to know they have innovated a way around this!

Overall, if the client was there to recover, medication-assisted treatment was not a hindrance.  In fact, I found it gave many clients an advantage.

Unfortunately, it is not realistic to live in a sober living house forever. (As much as I loved the girls, living in a house with that many women for long periods of time would be detrimental to anyone’s sobriety!)

After moving into my own place, I decided to start on the Methadone Program.  Currently, I take Methadone every.  Methadone has allowed me to stay clean, keep a job, pay my rent and be responsible.  I know I can taper off at any time, but for the first time in a long time, I can do things I love, like write this blog post! 🙂

I realize my story may not be enough to change traditional points of view on the subject:Substituting one drug for another

Many people still believe:

You will just be substituting one drug for another if you get on Methadone!

Outpatient, counseling, and meetings are enough for recovery!

You got yourself into this mess, so you need to deal with it! 

You are supposed to deal with your emotions by talking it out.

Am I right?

Thought so.

Well, I agree with you….to an extent, but I challenge you to the following thought exercise.

…In a Recovering Drug User’s Shoes

Instructions: As you read, imagine yourself in the situation.  How would you feel?  How intense would your emotions be?  Do not stop to think about coping with emotions as they arise.  Instead, feel each emotion pile onto the previous until you reach the end of the story. 

In a Drug User's Shoes

You walk into Dream Company Inc’s reception area.  You are there to interview for your dream job. You arrive early.  After all, you didn’t have to set an alarm to wake up this morning.

You check in with the receptionist, Anna, a beautifully thin blonde, ten years your junior.

You suck in your gut because the birth of your latest bundle of joy left your figure looking more pear than hourglass.  Anna says she will be right with you, without bothering to look up from her computer screen.

You find a seat in the upscale reception area on one of the benches outlining the walls.  It is obvious the interior designer was aiming for a hip, modern look, avoiding comfort at all costs.

You become hyper-aware. You lick your teeth to remove any lipstick transfer you may have missed. You picked earth tone eye shadows to compliment your new suit and tan skin and you perfectly shaped your brows.  You are especially proud of your near-professional highlight and contouring job; slimming your nose and raising your cheekbones.

Makeup is on point, but as soon as you sit, your eyelids start to sting.  The tingling becomes uncomfortable and the weight of your eyelids becomes too heavy to bear.  If you don’t do something, your eyes will water, and your makeup job will have been for nothing.  So, you blink…

Blink

blink blink…

blink…

“Ms. Applicant?”

blink blink…..

Blink

Louder now, “Ms. Applicant? Ms. Dream Applicant?”

Your attention snaps to the receptionist, now standing three feet in front of you.

“Ms. Dream Applicant, they are ready to see you now.  Come right this way.”Interview Room

Walking down the long hallway, you glimpse a mirrored wall in the room at the end of the hall.  In the reflection, around a conference table, sits 8 of the company’s top board members. Heads bowed, reviewing personal copies of the cover sheet and resume you sent over two weeks prior.

A million thoughts race through your mind, but reality warps.  The hallway turns into a funhouse, miles long, mirrors reflecting distorted images replace the office doors.

Interview Hallway

 You quickly account for how you ended feeling the way you do.

14 days ago: First phone interview complete.  You are confident it went well.

10 days ago: You loaded up on Vitamin C when you started to feel sick.

7 days ago: Admitted to the hospital for pneumonia. Treated with IV meds

5 days ago: Sent home with antibiotics.  Not able to sleep more than a couple of hours at a time due to an awful cough.

Last night:  While finishing up your presentation, you felt the burning pain of a yeast infection.  At this point, sleep was not possible.  You used these extra hours awake to prepare your presentation for the interview.

Six hours of sleep in four days was going to have to be enough.

Your heart rate rises, gravity seems stronger, and you focus on avoiding an epic trip over your perfectly matched heels. Too scatter-brained to have switched your phone to silent, it rings as you walk through the interview room door.  You look down at your phone and read:

From: Husband <3

  I want a divorce…

Okay, Ashley, what the hell does any of this have to do with recovery and medications???

Let me explain:

Each event listed on the left produces an emotional response similar to the event listed on the right.

The third column lists how the events are alike, resulting in similar emotional responses

Interview Event: Recovery Program Event: Emotional Response:
Biggest Interview of your life Getting clean and starting a recovery program Life-changing events with the potential to start a positive new life chapter
Preparing your makeup, judging your appearance Starting from scratch with old tattered clothes, negative self-esteem Comparing ourselves to others is natural, but, in situations like these, we are overly critical of ourselves
Admitted to hospital for pneumonia Entering detox for a few days Both physically exhausting and painful, leaving you feeling weaker than you ever have before
Yeast infection Post-acute withdrawal syndrome (PAWS): After detox, the patient experiences PAWS symptoms that can be relentless for months More physically exhausting health issues, that just will not let up
Cough preventing sleep for more than 2 hours, seeing the funhouse illusion in the hallway Months of not being able to sleep after detox, becoming delusional Your mind starts to play tricks on you when you have not slept.  It becomes very hard to make good decisions and reasoning skills are severely affected.  Completely honest self-reflection is near impossible.
Text from the husband about divorce Issues dealt with in counseling or outpatient treatment Issues like divorce, rape, abuse, mental health disorders, making amends, and so on are enormously stressful for all of us.

So, truthfully, after feeling each emotion listed in the right column, how would you feel if you were Ms. Applicant?

Would you ace that interview?

No, NO ONE WOULD.

See what I mean? After examining the sheer number and weight of emotions experienced in recovery, it is a wonder ANYONE has done so successfully.  No wonder recovery rates are so low.

The average person would not succeed under the conditions laid out above

However, if a doctor is willing to responsibly prescribe medications to help with sleep, cravings, emotions, etc., real recovery work might be possible.  

A Closer Look

Medication Maintenance Prescriptions and Recovery

“You are just substituting one drug for another!”

Suboxone and methadone are opiates, so it is easy to classify them as substitutes for illegal opiate use.  However, with a little more research, it becomes clear that an opiate abuser does not get high taking Suboxone or Methadone.  The high after snorting Percocet or shooting heroin is in a different class completely.

I could say, trust me, I would know, but I’ll offer an analogy anyway:

Let’s say you are cutting onions when something startles you.  Your hand slips and you slice open your finger, blood gushing everywhere.  The high from Suboxone is equivalent to relief attained from bandaging the cut, avoiding infection and allowing natural healing.  The heroin high is equivalent to the relief attained from using your self-healing superpowers, immediately healing the wound and stopping all pain.

Most opiate users abused substances long enough to change our brain chemistry.  Like the bandage facilitates gradual healing of the skin, Suboxone allows for the gradual healing of the brain’s opiate receptors.  Like the bandage guards against infection, Suboxone guards against relapse by binding onto opiate receptors without producing a high.

Unlike heroin and pain pills, Suboxone can bind to opiate receptors and simultaneously allow them to heal.  Over time, our brain chemistry can work toward equilibrium while on Suboxone.

Trust me, if I wanted to substitute my heroin use for something, it would not be Suboxone.  Heroin users looking to substitute will settle for nothing less than a drug-producing an equivalent high.

Prescriptions for Underlying Psychological Conditions and Recovery

Many people abuse substances to self-medicate for serious underlying mental disorders. After detox, a healthcare professional is more capable of making a true diagnosis. Receiving a diagnosis is a relief. Suddenly, there is no reason to continue dangerously self-medicating. A schizophrenic will be prescribed a medication to quiet the voices instead of continuing to shoot meth.  A bipolar will finally get a lithium prescription, balancing his emotions, instead of shooting heroin to make the pain go away.

Taking the Edge Off

Lastly, and this will not be a popular point of view to some, but I promised honesty.

Sometimes, it is okay to just ‘take the edge off’.  Once you experience an opiate high repeatedly, there are not manyTaking the Edge Off things that sound appealing anymore.  Let’s support doctors who are responsibly writing prescriptions to ‘take the edge off.’

Medical Marijuana is a great example of a drug that can take the edge off.  Legal in most states, tremendous work has been done in using marijuana to treat pain disorders and PTSD. I am hoping to see an increase in the use of medical marijuana for opiate treatment.

Sometimes saying “at least it is not heroin” is okay.  Accepting that we need to let people in recovery take the edge off somehow, changes everything.  Once the edge is gone, the focus shifts 180 degrees.  Instead of feeling crappy and scheming for the next easiest way to get high, the focus is on getting better and forgiving ourselves.

Don’t forget to read the Warning Label!

Warning Label

It is no secret that many substance abusers received their first opiate from a doctor.  There are some shady, money-hungry doctors out there. Common sense needs to be used when prescriptions are used in recovery.

If Xanax is the drug of choice, a good doctor will not prescribe Xanax or other benzos, trusting the patient to take it as prescribed.   The same goes for any mind- or mood-altering drugs. A legit doctor will examine each situation on a case by case basis.

Ideally, a patient’s counselor, psychiatrist, and doctor form a recovery team to discuss the best path forward.  The more communication the more comfortable the patient becomes. If a patient is comfortable, he gains confidence in his ability to recover.  Confident patients are more likely to stick a program, stay out of jail, off the streets, and most importantly, OUT OF THE MORGUE.

Remember, no two people become dependent on drugs in the same exact manner.  Therefore, no two treatments will be alike.  We must conform treatment to the individual, not the individual to the treatment.

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6 comments on “Medication Assisted Treatment -Taking the Edge Off

  1. Thanks for sharing your experience. You show strength for coming through the treatment but we could never fully comprehend what you have gone through, even with this glimpse into the treatments, detox, emotions etc. I found it hard enough to give up smoking which is nothing compared to what you have gone through. Stay Strong

    1. Recovering from the abuse of any substance, especially nicotine, which is so readily available, is always a huge accomplishment! A therapist used to tell me, “never let anyone take your big.” You go girl!!

  2. This is a great article. I had a brother that was a heroin addict that got on the methodone prescription it did wonders for his health and attitude. I also had a sister that was a schizophrenic and an opiate addict also found medical help but not quite as successful as my brother. However they both passed away last summer a month apart. Which is a little ( I don’t know ) because they were born on the same day one year apart And were both younger than me.
    Robert

    1. I am so sorry to hear about your brother and sister. Unfortunately, we have not discovered a fool proof recovery method. In fact, more than 50% of people, who complete recovery programs, relapse, and many lose their lives. My goal is to get people talking about it. Especially, recovering users. Who better to understand how to help than those of us who have been there?

      Know that your brother and sister loved you dearly and will always be with you. Thanks for sharing Robert.

  3. Wow – this is a very interesting article. I haven’t really thought about it from the addicts perspective in the way you described it before. It’s hard for a non-addict to truly see things from the addicts eyes but you described it in a way I never thought of before. I have been one to think that you are just substituting one drug for another and wondered if it’s really the right way to do things. I do like that you point out this only works if the person is truly ready to recover. My perspective has been tainted due to someone that has never really been ready. After reading this I have a new perspective on it.

    1. So glad you took the time to read this article Trish. Unfortunately, i is more common to hear stories of drug users failing with methadone than it is to hear stories about the thousands who succeed in recovery on methadone. Most of the articles I have read about methadone are biased, which is weird because the authors usually have no personal experience with substance abuse or recovery. As a result, those of us who use the program to make a positive change in our lives, face judgment by critics on a frequent basis.
      I have spoken to many family members of drug users who are scared to death when their love one expresses interest in one of these programs. Hopefully, this article finds other families these same concerns. I also hope to encourage anyone interested in these programs as a recovery option, to check them out. It may save their lives.

      Hope you have a great day Trish and thank you for stopping by!

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