April 12, 2011

This guy knows...

My experience with withdrawal is limited to opiates, at least until Thursday morning. However, I will be undergoing a medical detox (primarily for alcohol) and should be pretty comfortable. In the case of opiate withdrawal, anyone who has any mileage on them with this class of drugs has experienced it. It is the devil incarnate. Most experienced junkies would choose an easy and quick death over withdrawal. The symptoms of withdrawal – insomnia, cold sweats, the shakes, muscle contractions, diarrhea, a penetrating chill that you feel in your bones, a feeling that you will never be happy again – sound bad enough. But withdrawal is more than the sum of its parts. Most people with the flu (to which withdrawal is often compared) would not tell you that they contemplated suicide. Most people who have experienced withdrawal have considered it. For me the worst part is the insomnia – this is also the key distinguishing feature from the flu. When you have the flu, your body puts you to sleep to heal. Withdrawal is accompanied with a miserable insomnia. It’s as if your body is saying, “oh no you don’t, you’re staying awake for this shit so you don’t do it to me again!”

Withdrawal is like labor pains in that you almost forget about it until it hits. Maybe I’m just speaking for myself, but one of the features of opiate use for me is a form of denial about what’s waiting for me at the end. Almost as if I’m surprised when I wake myself up with a jerk with one of the by-now all-too-familiar muscle spasms in my legs. For me that first day is accompanied by a metallic taste in my mouth too. So there I am, 6 a.m.: wide awake with the realization that today is really going to suck. Then the questions begin: how did I do this again? Why did I do this again? Self-loathing by the bucketful (punctuated by the commentary of a less-than-sympathetic wife). What little energy I have is reserved for texting my drugodex of opiates users and pushers to find just enough to feel somewhere above death. Usually I don’t have to say more than “In a bind; can you help?” One of the interesting things about the vast majority of opiate users is that if someone can help you out, they usually will, especially if they can relate. Honor amongst junkies, I suppose. There are friends of mine to whom I am truly grateful, who have bailed me out in a pinch: for job interviews, important work or family functions. I feel this way even though they were technically enabling me. It was the only way they knew how to help out, but they did, and there are some days that truly would have been disastrous for me if they hadn’t.  

Once withdrawal hits, it gets worse for about 48 hours before it gets better. The peak symptoms for me are right around the 48-hour mark. For a while I had the discipline not to buy any dope if I couldn’t get a Suboxone chaser. But as these things usually work, I eventually stopped caring. My worst days on this earth have been when I am on a three or four-week trip and run out of dope and money. My fellow junkies can relate: I can be damn resourceful when I’m in that state. I have never stolen anything, but I have manipulated the hell out of people. without revealing too much about me, I am an independent contractor (read: unemployed) in a profession that pays by the hour. And I can think of all kinds of people who owe me money when I’m in a bind. You can’t even imagine how daunting it is to wake up in full withdrawal with no money, and have to get your shit together enough to find someone who will pay you money, and then find a fix. Daunting, but not impossible. In that state, once I find the pills, I don’t even swallow them: I chew them into paste. My mom would be so proud.

The spectre of withdrawal drives everything in a junkie’s life. As I said in an earlier post, physical addiction is primary: it must be dealt with first. And my two good friends alcohol and cocaine don’t do shit for me when I’m in withdrawal from opiates. Assholes. Suboxone has put a swift and merciful end to the cycle for me. Drugs are a wonderful thing when you take them as prescribed. Suboxone is made up of two drugs: buprenorphine and naloxone. Buprenorphine is a slow-acting opiate with a high-binding affinity. Naloxone is an opiate antagonist that blocks other opiates. Between the high-binding affinity of buprenorphine and the opiate antagonist properties of naloxone, other opiates don’t work.  When Suboxone is in my system – which it is for a while, due to a 24-hour half-life – a handful of tabs avails me nothing, save for some acetaminophen damage to my liver. (Hooray Tylenol!). And drug cravings for me work like this: CRAVING —-> phone call —–> in car on way to drug dealer’s house, all within the span of thirty seconds. It’s not the kind of thing where I say, man I’d like some drugs, I think I’ll wait 48 hours for the Suboxone to stop working and go get some. So for me, Suboxone has dealt a crippling blow to my dance with opiates (cue ominous music and black-and-white stills of chopped cocaine on a mirror and alcohol a la Behind the Music, lest we think I’m all better).

Withdrawal is hell. That is the bottom line. It’s not sexy or romantic. Part of the appeal of drugs is the feeling of insight: “I know something you don’t know, because you’re too scared to try, or because your mommy told you not to do it, or because Nancy Reagan told you not to do it, or because your God told you not to do it, or because you’re too much of a conformer or too stupid or too uncreative or too mainstream to know any better. ” When you’re in withdrawal, you see these things for the ridiculous vanities they are. And worse: they are the height of banality too. You don’t feel too clever when you’re in withdrawal. Mommy was right.

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