Archives for March, 2011


Gratitude Deficiency

Since I don’t have much on my mind tonight, I’ll respond to a cleaned up comment from a reader:

I have been on opiates for about 15 years now. I’m 43 and I have been through hell and back again. I’m doing the Suboxone thing now.  It’s a little better than the methadone clinic; that place just wanted your money and they still treated you like a junkie with no hope ....hope...... I’m starting to wonder if there is a way out with Suboxone.

You have the same withdrawal problems trying to wean from it just like anything else.  Your body has to adjust to being sober and being on Suboxone is not being sober.  I hope someday the people at the clinics quit turning their heads and look at opioid users as real people needing real help. I would love to just stop taking the Suboxone. I am done (with taking it) but I have children and a wife to take care of and a demanding job that I have to keep so when am i suppose to find the time to go through the withdrawals?

It’s a messed up way of life with the appointments, with drug counseling during the middle of the day, and getting the script from the doctor, taking a pee test every time you go… oh well, this is what you have to do if you want a halfway normal life as an addict.  It becomes a part of your life.  It will be over someday, just not today.

Wow—so much for the joy of recovery!  To the writer, I feel for you—you are clearly miserable.  I will try to throw out a few suggestions, and I hope they are useful.  I realize, of course, that some people are simply not as ‘happy’ as others;  I’m probably more on the unhappy side myself, and there is only so much ‘cheering up’ that can be done for me—and I imagine the same is the case for you.
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Better Is The Enemy Of Good

When I worked as an anesthesiologist, I noted that the more experienced surgeons worked by the principle that "better is the enemy of good." This principle became important during surgical cases involving critically ill patients undergoing long procedures, such as emergency surgery for bowel obstruction due to adhesions—a tedious surgery necessary when scar tissue entraps and blocks a loop of intestine.

At some point during that type of surgery, the work is good enough. The patient has been on the table for several hours and the source of obstruction has been located and removed. Other significant adhesions-- areas where the small bowel has become fused together instead of sliding freely as it is supposed to-- have been removed to reduce the chance of recurrent obstruction. It is 3 AM, everyone is tired, and it is time to deliver the patient to the recovery room and call it a night.

A surgeon with less perspective for the big picture might decide to pick away at every little adhesion for several more hours. During that time, the patient’s body temperature decreases, causing clotting function to deteriorate. Anesthetic agents accumulate in the brain, increasing the chance of postoperative delirium. As inflammatory products from the surgery accumulate, cardiac and renal functions are affected. And by 6 AM, everyone in the operating room is more likely to make a critical error. In medicine as much as in any area of life, one must keep the big picture in mind.
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A Completely Different System

I’ve presented my case that addiction should be considered a disease, according to the definition of that term. I suggested that reservations some people hold against considering addiction a disease have to do with expectations of will power.  I suggested that such reservations are not fair, since the lack of will power is one of the core symptoms of addiction.

I described an example of how the medical community treats those with the disease of addiction.  Finally, I asked a question: Where is the outrage by organized medicine over the large number of deaths from the current epidemic of opioid dependence?

By ‘organized medicine’ I am referring to the many professional societies that claim to speak for doctors in regard to public policy-- the people who weigh in on health-care expenditures, health access, health insurance, and funding for medical research. I am also referring to doctors themselves, because the silence of policymakers largely reflects the lack of outrage among physicians.  Doesn’t anyone care?!
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