The Invisible Casualties of the “Opioid Epidemic”

My wife Alison was one of the casualties of the tragedy described in the article just below. She took her life this past March by overdosing (I surmise) on the medications she’d been prescribed for chronic pain. She explicitly told me over the years that she kept a stash with her at all times in case things got bad enough for her to have to take her own life. “I have no intention of living past 70,” she’d often say. She was 57.

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Obey Your Master: A Visit with Narcotics Anonymous

About a year ago, I attended a meeting of Narcotics Anonymous (NA) as part of an assignment for a class on addictions counseling I’d been taking in the Master’s in Counseling Program at Felician University.[1] Struck by the philosophical richness of what I’d encountered at the meeting, I thought I’d reproduce a version of my report on it here in case readers found it of any interest. In the interests of preserving the confidentiality of the group’s members, I’ve omitted any identifying features of the meeting with respect to time, place, and the identity of those present, describing the event only in the most general way. My aim here is to reflect on matters of general principle, not to dwell on the particulars of anyone’s life. Continue reading

Six months a slave: my bout with Ambien addiction (Part 2 of “Psychiatric Medications: Promise or Peril?”)

I’d like to get back to summarizing the presentations at last week’s Felician symposium on psychiatric medications, but two things before I do:

First, I’m happy to report that all four presenters have agreed to write their presentations up for a symposium to appear in Reason Papers. The written version of the symposium will probably be published in the journal sometime in early 2016.

Second, an anecdote.

I’ve mentioned Robert Whitaker’s work here several times before. He’s the author of Mad in America and Anatomy of an Epidemic; he’s also a contributor to the website Mad in America. I happened to notice Marcia Angell’s review of Anatomy back in 2011 when it (the review) came out, but had no direct interest in the topic at the time, and more or less filed it away for future reference. I eventually managed to develop a direct and personal interest in the topic, and in the interests of disclosure—and the amusement of telling the story—I may as well explain how it came about.

The long and short of it is that in 2013, I became a psychotropic drug addict myself. The addiction came about through the good intentions but serious errors of my medical practitioners, and, as far as I’m concerned, it counts as a significant (though ultimately not medically serious) case of iatrogenic injury. The experience soured me for a while on the medical profession (including pharmacists), and especially on psychiatry and Big Pharma. I have a less bitter and less intense attitude now, but still have to confess to a residual resentment at all involved for what I went through. The benign residue of that resentment, however, is curiosity. I wonder what happened to me, and why. Hence the interest in the topic itself.

Anyway, here’s my story. After several straight months of insomnia and depression following a divorce, I asked my primary care physician for something to help me sleep. The something turned out to be Ambien. My doctor put me on a dose of 90 x 12.5 mg controlled release pills, which—in compliance with the directions on the bottle—I took “daily as needed” until I ran out (and then got some more).

Around day 25, the medication started to lose its original effect of knocking me out within about ten minutes of taking it.

Around day 40, I had regularly begun to lose my sense of how many pills I was taking on a given night, and started to double and even triple up on the 12.5 mg/day dosage. Having done that a few times, and having realized how insane it was, I then abruptly decided to stop taking the pills altogether, thereby inducing a relatively severe and totally unexpected withdrawal reaction (which I misinterpreted as the effects of extreme sleep deprivation). In the process, I almost crashed my car a few times, suffered two physical collapses on campus, and scared the hell out of a lot of people, including friends, family, students, colleagues, several nuns, a security guard, and an administrator or two. Colleagues had to call 911 for both of my collapses after finding me semi-conscious and on the ground. I found it scary, and judging from the looks on the faces of the first responders, and the way the cops encircled me and kept their hands on their weapons, they seemed pretty frightened, as well. (There’s no telling what harm a semi-conscious philosophy professor might do to a group of armed law enforcement officers. “I don’t really know where my hands are, but don’t shoot!”)

On the one occasion when I was taken to the ER (I refused treatment “against medical advice” on the other occasion–correctly, I still believe), no one seemed interested in hearing about my Ambien issues. They duly noted it in their chart, then promptly ignored the issue and moved on. The ER doctor diagnosed me as having “vertigo,” prescribed an anti-vertigo medication, gave me an IV with saline solution, and left it at that. In retaliation for his refusal to listen to what I had to say about Ambien, I lied to him and told him after a few hours in the ER that I was fit to drive home. I guess he believed me, and then cheerfully discharged me; I less cheerfully drove home (or at least in the direction of my home) and then nearly crashed my car into a diner. (Having missed the diner, I decided to stop and have a meal there: I mean, if you don’t wreck the diner while driving past it, you might as well stop and have the hot open-faced turkey sandwich to celebrate your good fortune. Insanity never tasted so good.)

I eventually got home, but still had to fill out the anti-vertigo prescription. I didn’t trust myself to drive to the pharmacy, but didn’t trust myself to walk there, either: vertigo is no respecter of modes of locomotion. I ended up staggering there somehow, only to discover that I had lost the anti-vertigo prescription somewhere between my apartment and the pharmacy. Out of options, I staggered back home, reframing the loss of the anti-vert prescription as a defiant refusal to comply with medical orders, and settling on the ground to have my vertigo in a safe place. That’ll show that ER doc.

I lay there awhile, let the vertigo wash over me a bit, then popped another 12.5 mg CR Ambien, settling soon enough into another four refreshing hours of non-REM sleep. By 2 am, I was wide awake, reading Jorge Luis Borges (on insomnia), and waiting for the sun to come back up so that I could start yet another vertiginous and sleep deprived day teaching ethics, critical thinking, and aesthetics to students who seemed not to notice that anything was amiss. (Conveniently, I had managed to collapse after class had ended. None of my students saw the collapse happen; I lay on the ground an hour before I was discovered by the instructor who needed to use the classroom after me.) At that hour, being “wide awake” for the forty-fifth night in a row didn’t feel anything like being in a Katy Perry video. It felt like being in a madhouse of my own making.

Somewhere around day 85, it began to dawn on me that I was addicted to Ambien and had to find a way to get off. (What, you ask, did I do between day 45 and day 85? I followed the directions on the bottle, that’s what. I popped those pills “as necessary,” supplying my own personal criterion of “necessity.”)

No one—not my physician, not my pharmacist—had ever informed me that any of this was likely or possible. In fact, my pharmacist insisted that Ambien was harmless, that no one ever got addicted from it, that one could safely be on it for years, and that when the time came to get off years hence, I could safely make that decision at will.

Not really. Getting off the medication was a bit of a drag. I started the taper around my hundredth day on the medication. The taper protocol, which involved a 12.5 mg reduction of the medication per week–one abrupt drop per week from 12.5 mg a night to 0–gave me intense nightmares, paranoia, and hallucinations, among them a particularly wild psychotic episode in which I believed that my brain was being devoured by pink, L-shaped worms.* I also had unbelievably vivid, detailed, apparently true-to-life dreams of home invasions, of unknown intruders coming into my house and maliciously leaving all the lights on (while, in the dream, I was alone in my apartment tapering from Ambien), and (my favorite) of being asked by an ex-girlfriend to lead an eager and willing army of small children to overthrow the U.S. government. (I woke up before we did any harm.)**

A physician I eventually consulted to help supervise the taper described my taper protocol as “an act of self-punishment,” and put me on a more gradual one. Unfortunately, before it was all over, I had yet another episode that put me in the ER. This time, I had to call 911 myself, only to discover that the paramedics sent to rescue me had gotten lost on the way to my apartment. (In other words, my local EMS had failed to pull off what Papa John’s routinely accomplishes. Is it the tips?) As I saw them circling my apartment complex without ever quite finding their way to my building, I was forced to leave my apartment in the middle of what was supposed to be a medical emergency to guide them to their intended destination. When I did, one of them blamed their inability to find me on the complexity of my apartment complex. The other one blamed it on her addiction to Xanax. Et tu, Paramedic? Anyway, there’s nothing like honesty.

When I told her that I myself was suffering side-effects from Ambien withdrawal, Xanax Girl blurted out, “Ambien? Shit, I was going to switch to that tomorrow. They gave me the prescription for it, and I’m pretty sick of this Xanax–but you know, maybe I won’t now. You’re fucked up, honey. I don’t want end up like that.” I told her she had a point. She thanked me for the advice, then got me into the ambulance, and nearly managed to crash it into a barbershop before we got to the ER. (No, we didn’t stop for a haircut.) I’ll never forget the crazed, anxiety-ridden look on her face. I felt protective of her. She seemed worse off than me.

This time the ER doctor listened to my anti-Ambien rant, then nodded sagely and said, “Yeah, but Ambien is nothing. You should see Klonopin withdrawal. Now that’s some shit! I’ve seen people vomiting for hours from that. I mean, not to make light of what you’re going through right now.” Not at all.

Another saline drip. A few questions about my fitness to leave the ER. Some informative sheets of paper on the perils of Ambien dependency. Then, discharge. My friend Mike picked me up, and we decided to get pizza (pizza cures everything). Unfortunately, despite the pizza, the symptoms came back that night, but I couldn’t bear to call 911 again. I got through it somehow, mostly by forcing myself to stay awake.

All in all, the withdrawal lasted 71 miserable days. Once I got off Ambien, however, my sleep patterns returned to normal. The irony was that the Ambien had done almost nothing to help me sleep, which is what it had been prescribed to do. I suffered eight consecutive months of insomnia, six of them on Ambien–less than four hours of sleep a night for about 250 nights. Bad as the insomnia was, however, the experience as a whole convinced me that Ambien was a lot worse than the condition it had been prescribed to correct. It also gave renewed meaning to a line from Ozzy Osbourne’s “Flyin’ High Again”: I really should have kept my feet on the ground, and waited for the sun to appear. Better insomnia than addiction. And the experience primed me for Robert Whitaker’s anti-medication message.

Though it’s obviously not Whitaker’s fault, it was probably a mistake on my part to have read his book during withdrawal from a psychiatric medication: I learned a lot from the book, but the experience of reading it at the time almost certainly ramped up my sense of paranoia, and probably fed my nightmares and hallucinations. (On the other hand, I have to admit that the nightmares and hallucinations gave me new and distinctive insight into Descartes’ Meditations, so I guess I made epistemological lemonade of the psychotropic lemons I’d been served. Call it a contribution to positive psychology.) Even under the best of circumstances, it’s difficult to read and contemplate Whitaker’s thesis without suffering mental disturbance of some sort.

A year or so after my Ambien ordeal, I’d like to think that I’ve achieved some measure of objectivity.

*Postscript, December 14, 2014: I forgot to mention the episode where I hallucinated that demons had entered my brain via my eyes, roosting in my eyelids. I blame the lapse of memory on my Ambien use, but hey, according to the experts, Ambien improves memory, so don’t listen to me.

**Postscript, February 9, 2015: I just happened to discover a music video that’s a picture-perfect depiction of an Ambien withdrawal nightmare–“Big Bad Wolf” by In This Moment. Just fall asleep after hours (or days or weeks) of insomnia, draw out the wolf-piggie dialogue depicted here for a few hours, and repeat every night for a few months–and you’ll get the idea.