What Am I Here For?

 

My husband says it was to save our daughter. I have saved my child. At least twice she was within days of dying. But is this all I am here for? I can’t keep her alive if she doesn’t want to be. Hell, I couldn’t even keep her alive if she asked me too. In the end, the work necessary for survival is hers. I can’t do it for her. And saving your own child isn’t magnanimous. It is what most of us would do. And, more importantly, it is what we should do.

Doing what you should do can not be a life’s purpose.
And we are all bound to fail if the purpose is following some sort of moral script.

Sometimes I wish we could all be avengers and superheroes; performing spectacular feats of a magnitude that we never predicted on our little home radars. Why can’t the tiny ripples caused by good deeds be more like tsunamis?

There is an urgent need for a lot of saving to be done.
And sometimes I just feel plain powerless as I sit here eating my lunch.

What “War” on Drugs?

“We lost more people last year than the entire Vietnam War and Korean War combined.”

I received this text on a frosty Sunday morning from a friend who is a cardiologist. He can not ignore the obvious. Every emergency room bed is filled up and down the East coast. Patients line the corridors in gurney traffic jams.

So how are we addressing this home grown war of epic proportions?

JP Clark, West Point professor and author of “Emergence of the New Modern Army,” explains that the US military prepares for war by planning during peace time. Makes sense.

The US has spent a lot of money, and time, attempting to stem the flow of drugs and incarcerate dealers. I am not opposed to either effort – but it has been a one-pronged enforcement driven approach. Notably; the drugs have not been contained. They continue to cross the Mexican border, and be flown in from China and Afghanistan. But before preaching isolationism consider the role of American pharmaceutical companies and script writing doctors…

According the to the Nat’l Institute on Drug Abuse, 80% of all heroin users began their addiction with access to a legal opiate prescription. Let me say that again. 8 out of 10 American youth are shooting up, stealing, selling themselves and dying because they had access to a legal prescription. Prescription opioids such as OxyContin and Percocet ARE Heroin in pill form. The molecular structure of these opiates is nearly identical and are all derived from the poppy plant. All are extremely dangerous and highly addictive forms of pain relief.

Purdue Pharmaceutical, the maker of OxyContin, knew this. But profits were just too good to share that information. (Purdue has since paid $635 million in fines after pleading guilty to false marketing charges.)

Insurance companies happily complied. Pills provide an immediate short term solution for pain, and are more cost effective than lengthier physical and holistic therapies. Insurers then began to base doctor compensation on pain management. (If you are envisioning a noose around patient necks… you are seeing correctly.)

Recently the AMA, after a judicial wrangle, reluctantly agreed to limit first time prescriptions. But the war has not been won….victory does not include leaving the troops behind.

We need immediate investment in rehabilitating our sick youth and adults.

Medicine is a big, big business, right? According to B. Lee in Forbes Magazine, “seven of the top ten profitable hospitals in the US were non-profits.” (Your eyebrows should most definitely be raised.) He quotes, “the system is broken when nonprofit hospitals are raking in such high profits. The most profitable hospitals should either lower their prices or put those profits into other services within the community.” Well why not push for a large percentage of those profits to be spent on improving addiction services?

Being a foot soldier, I have suggestions.

1. Outpatient service; often the first line of treatment, is notoriously ineffective. Heroin is classified as the most addictive drug on the planet with 1/4 becoming instantly addicted. (It also creates real physical and physiological changes to the brain.) Outpatient might be a form of acceptable treatment for marijuana abusers or sex addicts… but certainly not for heroin addicts. Why do we accept this as a permissible form of care?

2. If you are lucky enough to advocate for inpatient care, two weeks is the average stay. Two weeks only reduces tolerance and increases risk of fatal overdose. 90 days is the minimum amount of time needed for treatment to “catch.” (A full year is required for normal brain functioning to return.)

3. Removing an addict from their environs is important for success. Addiction is a brain disease. Removing quick access to destructive behaviors and people makes rehabilitative sense. There should be a demand for quid pro quo arrangements with out of state insurers to benefit those with HMOs and medicaid plans. We must find a way to do this or else only the rich or those with premium insurance plans will benefit.

4. Spiritually based programs work. Addiction is a disease that requires a form of “spiritual surrender.” That doesn’t sit well with some because it seems to imply an inherent moral failing or belief in God. Neither is true. What it fosters is recognition that self reliance is not an option when you suffer from a mental illness like addiction.

5. An increase in MAT (medication assisted therapy). Some addicts need it – and right now the number of physicians licensed to prescribe it is too low.

6. Increase the number of physicians going into adolescent psychiatric care. (One reason there are so few is because they are paid much less by insurers for their work.)

If we don’t do these things we will continue to watch our youth die.

My daughter has lost many acquaintances. Twenty-two to be exact. One male friend I recall frequently. He had a “thing” for her and had stumbled all over himself buying her shoes, groceries, and red roses. The relationship didn’t last, and he texted me, desperate, that he was “heartbroken and would never love again.”

It all seemed so overly dramatic. But he was right; he never would love again.
A week later he was dead from an overdose. He was just 22.

Stone Heart.

“Too Long a Sacrifice Makes a Stone of the Heart”  – William Butler Yeats

This week I had cause to worry about my child’s commitment to her sobriety. I had been led to believe that she had traveled by train to our hometown to spend time with a friend who is an active alcoholic and was, or still is, a crack cocaine abuser. This friend has a boyfriend who regularly beats her. She is a petite blonde with glassy eyes and bird like bones – but he throws her against walls and routinely blackens her blue eyes. My child was to spend the entire evening with them in a Boston hotel. She did not share this news.

Why would she choose to do these things? What good could come of this?

I felt fear – and anger.  I had a hard time sleeping that night. I took a melatonin, but it didn’t offer much relief. I also turned the phone off. I didn’t want to be woken by what I assumed would be a midnight phone call from an overcrowded emergency room. Or the police demanding I pick her up at 2 am. I imagined changing out of my warm pajamas, programming my gps, and driving into yet another cold, fraught ridden night. And then to be greeted by a kicking, screaming addict, a disgusted police officer, and the mind numbing question: how do you want to handle this?

I am still so tired and it’s been over a year.

I never got that imagined phone call. A few days later I drove up to Maine to see her myself – and she appeared healthy, happy and whole. Which made me ask myself, “why would I turn off the phone when I had a sneaking suspicion that she would get into trouble?” Why would I put limitations on coming to her aid when she had worked so hard for so long? People make mistakes. People relapse. Is it because I didn’t want to look at that fact? Or because I didn’t want to be inconvenienced?

In retrospect I should have made sure my phone was fully charged. I should have had a type written list of detoxes to call when the sun rose. And if her relapse had been fatal (as it often is after having significant clean time) I should have rushed to the emergency room to hold her.

I have a beautiful child. Despite it all she is caring, funny, hard working… and mine. Why had I allowed the past to make a stone of my heart?

Some Words Stick.

Two quotes have been bouncing around my head recently. I read them voluntarily but didn’t invite them to stick around. The fact that they have is disconcerting. A lot of the stuff I read, or hear, vanishes pretty quickly from the old memory bank. A story twice-told can still provide a surprise ending. Sometimes, half way through a movie, I ask myself, “have I seen this before?”

But Carrie Fisher’s description of addiction has parked itself inside my drive-through brain. She writes, “It was a kind of desire to abbreviate myself. To present the Cliff Notes of the emotional me, as opposed to the twelve-column read. I used to refer to my drug use as putting the monster in the box. I wanted to be less, so I took more – it’s as simple as that.”

Unlike Carrie; when I drink I want to become more. Her explanation is so contrary to my own that it gives me pause. When I drink each sip is like a loosening of some inner bind; a freeing of my emotional gatekeeper.

Why is our response to substances so dissimilar? Carrie speaks of a daily struggle to suppress the beast. She claims her substance misuse was an attempt to quiet a constant state of emotional overload. Does the non-addict control their inner monster by subconsciously cramming it down (and employing the weekend safety valve of a couple of “harmless drinks” to avoid explosion)? If so does this mean that the addict is more conscious of emotional dis-regulation? Or are they incapable of the “cramming” part? Are they incapable because they feel more? Or because they have less free space within which to cram the over wrought monster?

Which leads me to the other quote that has taken up residence in my brain.  In The Folded Clock Heidi Julavitz confesses to carrying around a small water tap handle which she found between the studs of her newly demo-ed wall. She imagined the prior owner put it there because they didn’t want to throw it away, yet they didn’t want to keep it laying around because its daily usefulness was long gone. She contemplates what is stored between the “studs of the walls of herself…. who knows what I have hidden in there because I could make no sense of it at the time, and found nowhere else to put it.”

Which makes me wonder: what have I placed inside my interior walls? Are things taking up unnecessary space because I refuse to look at them? Or am sentimentally attached to their expired value? Should I create a little larger space inside for my inner beast to slumber or should I wake my monster and face the consequences? (Hey – is this what meditation is for? Will it both clear the mind debris and shrink my emotional beast?)

Do we have to look at all this stuff? Isn’t it annoying to have to look behind every wall? In some respects our “tap handles” are a record of a life lived. And our inner beast a barometer of our capacity to feel. The tap handle and inner beast may also represent the sum total of all of those emotional traumas we have absorbed but failed to assimilate. Funny, but when my daughter first started on her 12 step program she suggested that my husband and I pursue it as well – not because we are addicts but because it would allow a peek at our own hidden spaces.

For most of us, a certain point surely comes when the walls become overstuffed and the well over flows. Those conditions don’t just magically resolve themselves nor are they swept away by some outside force. Intimately seeing the path of a recovering addict has taught me the hard lesson that change can only come through painstaking self-analysis. Time for exploring this old house. Time to wake the monster.

Here I come 2017.

The Boy Outside of the Gym.

Today I saw a boy outside of my gym. He had his grey hood up and appeared to be waiting for a ride. It was 22 degrees outside. He was smoking a cigarette. Funny that; a cigarette outside of a gym. And then it occurred to me that he was in recovery. I have no proof of this random rush to judgement – just a hunch. I gave him a big smile and, contradictory to his rather unapproachable affect, he smiled back.

I felt like we had bridged, in some small way, a rather momentous divide. This may have been another rush to judgement on my part – but clearly we had plenty that separated us. Age, sex, income level and life experience for one. Most likely also politics, education, hobbies, and the content of our daydreams.

Once inside I focused on maintaining my speed on the treadmill. This is more challenging then it sounds because the desire to slow down is surprisingly strong with me – and it only takes the push of one sweaty button. Sometimes I bait myself with my daughter’s struggles… if she had the inner strength to quit drugs then you can certainly run for fifteen more minutes. (Maybe you could even, God forbid, kick up the speed.) It was then that I noticed the boy. I guess, unable to get that ride, he had returned to the warmth of the gym. He had removed his hoodie – and he was covered in tattoos. Not a tribal bracelet, soft green shamrock or the name of a lost family member. No, these were the scary kind. They traveled up his arms, his neck, his brow. They were dark and fresh and it would be hard to accept the challenge to look directly at them. I wondered if he had been a dealer. I wondered what kind of trouble he had gotten into in his brief life.

And then I saw him grab free weights – and he used them like a ballerina. Slow beautiful, deliberate arcs. Others grunted and watched themselves in the mirror. Some walked around more than they lifted. But he was lost in an interior world. At one point he looked like a Christ child; his arms impossibly spread, his posture shamelessly on display. I couldn’t help but imagine what he had suffered for his addiction. What avenues had he gone down to feed his fix? How could ones desire for something be so strong that they would risk destroying the beautiful body that they had been given?

Making yet another mad rush to judgement I decided that this is what we shared in common. A desire to both understand and to forget. And shouldn’t our interior worlds bind us more than our exterior ones?  It is unfortunate that they aren’t as obvious as race or culture.   Our interior worlds are often fiercely private and often lonely.  If only they glowed like some sort of mood ring – I am green I am working on liking myself, I am blue I am working on liking others, I am red I am working on controlling my moods, I am purple I am working on forgiving.  How cool would that be?  Then we could help each other, guide each other, or at least recognize a commonality:  I am not alone.

I have a strong feeling that me and this very different boy had lived through something regrettable and were working hard to reinvent it. A personal resurrection or rebirth of sorts. And it made sense to me, it was Christmas week after all.

I See You Mr. Double Standard.

I know many people believe that healthcare dollars should not be spent on those who choose to use street drugs. I get it. It’s about personal responsibility. Healthcare dollars are stretched enough caring for those who aren’t the agents of their own destruction.

However, I ask you to consider the following:

We cure cancer in those who continue to smoke cigarettes.
We staple the stomachs of those who ignore the food pyramid.
We perform heart surgery on those who have never seen the inside of a gym.
We given insulin to those who knowingly eat donuts.
We fix the broken limbs of those who practice extreme sports.
We pay for the delivery  of babies conceived by high risk mothers.
We stitch back the bodies of those who crash speeding cars.
We treat melanoma in those who refuse to stop sun worshipping.
We treat venereal diseases in sexually promiscuous people.

The costs incurred for treating these examples of “irresponsible behavior” are staggering: According to the Centers for Disease Control and Prevention, smoking is the number one preventable cause of disease in the United States and it costs $170 billion dollars a year in direct medical costs. According to the American Diabetes Association one in three medicare dollars are spent on treating diabetes at a cost of $322 billion dollars a year. And, “American use of tanning beds may lead to upwards of 400,000 cases of skin cancer annually.” (American Academy of Dermatology).

But you know what?  Those individuals receive treatment with care, efficiency, and efficacy. The same can not be said for those with substance use disorder. This time a year ago my nineteen-year old was turned away from a detox center because there were no beds. She then walked to Boston City Hospital’s emergency room, sweating and trembling, for help. They too turned her away. Desperate, she spent that evening trolling Mass Ave looking for the drug she needed to tide her over for one more day. The next morning she returned to both the detox center and the emergency room. And once again she was refused admittance. She called crying; “could I please, please help?”

Help should have been as simple as a request.

I spoke with the ER doctor. He explained, “we don’t treat drug addicts here.” He then explained that he would also not admit her for mental health reasons because he didn’t believe she “would kill herself.”

I felt weak at the knees. How does one mount a spirited defense when powerless?

“My daughter is only nineteen years of age. She is not yet a hardened street addict. She is high on a drug that is killing people at an unprecedented rate. She is asking for help. You are that help.”

Silence.

“We are not asking for charity. She is insured by two separate policies.”

His reply: “Hospital rules do not permit admittance.”

“Surely,” I argued, “it is time for hospital rules to change. This is an epidemic. Turn her away and there is a strong possibility that she will die tonight.”

Silence.

“Why wait for the hospital to change it’s policies in response to a dead child and a lawsuit?”

Silence

“You took the Hippocratic Oath.”

Silence.

“You could lie about the reason for her admission…”

Do you know how it feels to beg when you shouldn’t have too? Begging when the stakes are so ridiculously high?  It feels like swimming against the tide while trying to reach your drowning child. Swimming and swimming…and then the dorsal fin appears.  But hope is not lost: a lobster boat comes into view!  You yell for a rope. But they don’t throw one.   No, they don’t.  Instead, they sit back and watch.  Because, you know, she shouldn’t have been swimming in those waters.

I know I sound angry. That’s because I am.  I spend $1500 a month out of pocket for health insurance – and I have had to beg for life saving services.  Addiction is classified as an illness by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).   But the double standard most assuredly remains.

Don’t Categorize This.

We categorize and sort things:
Linen closet. Junk drawer. Shoe rack.
We differentiate and label people as well:
Type A. Neurotic. Extroverted.

Classification by the human brain is typically helpful. It is meant to move us quickly and efficiently through an increasingly busy and varied world.

There probably was a day when rapid generalization of objects and people wasn’t required. Possibly we had less things to sort and each thing had intrinsic value. That spoon was a spoon. (Not a silver spoon or a plastic spoon or a baby spoon.) Possibly at some point in time we all lived in small insular villages. Each inhabitant couldn’t be categorized by a singular adjective because they were too intimately known.

Addict = Junky.

Unfortunately, this characterization exists. And, to be honest, by the time an addict’s addiction has fully consumed them there is very little left by which to define them. Jobs, families, homes, hygiene, self respect, love….. all gone. The addict becomes the equivalent of an item in the proverbial “junk drawer”…..something that used to function, but is no longer useful.

But, just like those that know the value of that random fob or tube in their small kitchen junk drawer, those of us who parent children with substance abuse disorder know their inherent worth. They are valued and loved. And worthy of repair.

-The most stand out characteristic thing I can say about my son is when he enters a room and smiles the whole room lights up.

– My son is well read, a wicked movie buff, likable, handsome, has common sense, is a great athlete, loves fishing, boarding, and biking. (He has) so many amazing qualities which makes it so difficult to understand this disease.

– My son is so smart! He was offered the Abigail Adams award for 4 years of free tuition at any MA state university or college. If only he had accepted it. He’s also so generous and thoughtful. There were so many days that he would just show up at my work with a bouquet of flowers for no reason. And he has got the greatest personality. Of my 4 adult children, he’s the only one I can carry on a full, engaging, adult conversation with.

– My son ends every conversation or exit with love you.

– My daughter has a quick trigger – but also uses it for good. She is quick to call someone out when they have hurt another. Or to notice the injustice in situations she encounters. She is a defender, with a capital D. And twice on her birthday she had friends donate money to a local animal shelter instead of giving her a gift.

– (Even) when I visit my son in jail, he can tell a funny story and make me laugh…which is a good thing!

– My son is extremely sensitive. He is a hard worker, a talented musician, and a kind person. He loves to make people laugh even at his own expense. He is so sweet with his elderly grandmother who adores him.

– My son is an extremely hard worker and his staff always would say how much they loved working for him.

– My son loves animals and is very compassionate. He is passionate about his music and loves to read. Even when he was at his worst I always felt that he loved his dad and I. He is a vegan and always concerned about what happens to animals and to our planet. He tends to take care of people he meets that he feels are struggling like him.

– My daughter has a beautiful singing voice.

– My daughter gave away her winter jacket at a detox. “She needed it more,” is what she told me.

– My son is funny, charming and charismatic. He is a fighter and so tenacious for beating the odds and overcoming so many learning disabilities, stuttering, and of course heroin addiction…at least for now.

– One day my son came bustling into the kitchen looking for something to eat. He began making pbj sandwiches and putting them into a bag with gatorade bottles and chips. A little time went by and I looked out of the picture window and saw the top of two heads.  When I looked closer, it was my son and a stranger sitting on the porch step. The stranger was eating the food!  When my son came in a little later, I asked him about it.  The man was someone my son had met days before. He was homeless and hungry. My son told him if he was in need to come round and he would help. He also sent the man off with extra food, a comb, soap, bottled water, tooth paste, Tylenol, his old sleeping bag and rain poncho. That’s my son. I have NEVER loved another human being as much as I love my beautiful son.

– My addicted daughter used to tell me when she was little that she could see into the future, I always thought that it was a strange thing for a little kid to say.

I realize it is hard for many to see the humanity in those who have lost the ability to reflect their own human potential. And most likely the world will never be a perfect place. But fully seeing the marginalized amongst us….that helps bring the village back.

 

Trap Houses vs. Safe Houses

Those of you familiar with the language of addiction will know that I am not comparing domiciles that fail building codes with those that do not.

A trap house refers to a drug den. An abandoned property where addicts go to buy and use drugs for days on end. Think squalor. Think bug infested mattresses. Think quiet desperation. Think death.

“There is one way into a trap house, and one way out.”

A safe house is also a place for drug use. However you can not buy or visibly take drugs within. But you are expected to be actively high when you visit. Inside you are given the opportunity to swap out dirty needles for clean. And you may ride out your high in an upright chair instead of slumped on a dirty street curb. But most importantly: in a safe house you will not die. Nurses are present to monitor breathing, administer narcan, and call ambulances.

A Boston safe house opened in April after receiving support from the medical community, those who care for the homeless, Mayor Walsh and Governor Baker. Safe houses, or “safe injection facilities,” already operate in Australia, Canada, Germany, the Netherlands, Switzerland and Spain.

Still the idea of ‘state sanctioned drug use’ sounds shocking. The medical community refers to this approach as “harm reduction.” (Certainly a less charged descriptor!)

The immediate goal is to curb the alarming uptick in deaths; especially among the young.   On a recent trip to a town office building I found the bathrooms locked. The secretary explained it was to “keep the addicts out.” My daughter’s former boyfriend overdosed in a Dunkin Donuts bathroom. Afterwards he chose Burger King stalls. The reason? He had just scored in the parking lot. The newspapers are full of stories of addicts being apprehended inside their own cars in public parking lots, under trees in local parks or tucked down public city alleyways. It is hard to understand an addicts sense of urgency. It can not be compared to the Friday night joy of buying a bottle of wine, bringing it home, opening it up to breathe, and then swirling it in the glass. There is a sense of immediacy that most of us will never know.

Therein lies the problem. What will prompt an addict to walk to a safe house to ride out their high when they score blocks or miles away? If curbing the number of deaths from opiates is the goal, then heroin users will have to be allowed to use their drugs in the safe house – or right outside. Death from heroin, or fentanyl-laced heroin, occurs almost immediately. The drug is potent enough to shut down breathing within the first few minutes.

Of course we can’t allow safe houses to become “shooting galleries.” Or can we? Sometimes it seems like the most humane option… especially when you witness first hand the places where addicts live. Even more so when you find your own child in them. I ultimately feared finding my daughter expired on a street corner, behind a dumpster, or in a motel. I didn’t want her last moments to be spent cold, unloved, hungry, or abused. It wasn’t an irrational fear… it was only a matter of time. I considered bringing her home, knowing she was not ready for change, but wanting her to have the warmth of her bed and food in her belly. I was ready to wave the white flag even if she was not.

Could a safe house have been that sort of place for my daughter?

But safe houses do not allow you to sleep in them. And they do not feed you. They are not shelters without rules, or over indulgent mommys. In the end they could not have allayed my fears.

The only other North American safe house (a true safe injection facility) exists in Quebec. A medical study by The Lancet showed that thousands of lives have been saved: overdoses stopped, the spread of HIV/Aids minimized, counseling and detox services accepted. It is working, despite the usual NIMBY complaints.

Hopefully lives will be saved here in Boston. There is nothing more upsetting than stepping over an addict on the wintery streets of Albany and Mass Ave and “continuing on your way.” Now at least you can lead them to a warm, comfortable room where a counselor can ask them if they want help. Can offer them water. Can look them in the eye and take their blood pressure. A small amount of decency can be provided.

Time will tell. My only hope is that we have some hard science around the outcomes. No more moralizing on the one hand, or fear based preventive measures on the other. Since 1980 addiction has been classified as a disease. To a certain extent it angers me that we have come to this. Would we be considering safe houses if we had provided better, more efficient, longterm, quality care earlier to this population? I don’t know. But I guess we have to start where we are. And I can’t help but embrace a concept I would never have considered years ago.

“PTSD” – Post Traumatic Stress Disorder

This is when I am supposed to reference Webster’s dictionary. I can picture the bulleted item list that has been carefully compiled by doctors and psychiatrists, and craftily winnowed down by editors.

Yet words are bound to fail. PTSD creates a feeling that can not be contained by bullets or paragraphs. If forced to use words they would be: “sense of dread.”

A sense of dread accompanied by unwelcome imagery. Imagery that is not imaginary. Dread that is not unjustified.

The ring of the phone makes me ill. Physically ill.
A knock on the door? Visions of a police officer.
An envelope without a return address?  Bad news.
My daughter not texting for a few days? Relapse.
Sad song on the radio? Message of doom.
Bitter snow? Frostbitten child.
Cheap motels off the highway? Sadness, loneliness, death.

My list could be longer. But it hurts to write it. If I suffer from PTSD, how badly must my daughter suffer? I have seen the results of her use, but have not lived through the experience of it.

“Conquer your fears” is written everywhere nowadays – from business journals to self help magazines. But the kind of fear they often refer to is that of financial risk. (Or a lifestyle change: try that new vegan diet! get a new partner! make a career switch!) I am talking about a different kind of fear. A primal fear. The fear of losing your stormy green eyed child to something so unpredictable, so misunderstood, so maddeningly unacceptable. I have written my daughter’s obituary in my head. I have actually looked in my closet to see if I have an acceptable black dress. These were my attempts to conquer my fear. My attempts to claim and manage the unacceptable.

Nelson Mandela says that “courage is not the absence of fear, but the triumph over it.” That the “brave man is not he who does not feel afraid, but he who conquers that fear.”

I am not there yet. But my daughter is. She is putting one step in front of the other…. steady and straight. Even with those swirling thoughts that must exist in her head. If I had to provide a picture of bravery for Webster’s dictionary it would be of my stubborn green eyed child making her way across a tight rope.

And I am waiting on the other side.

Dunkin’ Donut Straws

Dunkin’ Donut straws are thick. You need a decent pair of scissors to cut them. Cut in four inch snippets they are perfect for snorting drugs. Crush a Suboxone pill into a perfect pile of orange dust and use your color coordinated straw. The high is similar to that of heroin, but lasts longer. My daughter used to explain it this way, “I can’t overdose you idiot. It has naloxone built in. You don’t know a fu*&ing thing.”

I know this much: finding sawed off, shotgun-style straws scattered around your child’s bedroom is not a good sign. Ditto with disemboweled tampons. (The thinner interior tube makes a pretty sturdy straw).

So what is Suboxone? It is an opioid agonist prescribed by specially licensed doctors to relieve addicts of their cravings and to prevent withdrawal symptoms. It is comprised of two ingredients: Buprenorphine (“Bupe”) and Naloxone. Bupe mimics heroin by attaching to the same receptors in the brain, but doing so “imperfectly.” Its partial attachment provides the same sense of euphoria and reduction in pain. According to its manufacturer, Reckitt Benckiser, it is safer than heroin because it doesn’t fully occupy the receptors, and it has a ceiling effect, thereby decreasing the possibility of full respiratory arrest.

Unlike heroin, Suboxone has Naloxone built in. Naloxone is an opiate antagonist because it prevents opiate receptor attachment. Its presence prevents patients from misusing the pill, which is supposed to be taken orally.  The FDA warns that if injected or snorted, the Naloxone will fill the receptors faster than the Bupe – thereby negating any intention by the addict to achieve a quicker, stronger high.  An unintended result could be precipitous withdrawal – something most heroin addicts would like to avoid at all costs.

I also know this: my daughter got high as a kite from abusing Suboxone. She did not suffer from its immediate use. She suffered from her love of it. At $20 a pill, she couldn’t afford it for long. At $5 a bag, heroin is cheaper. And when you are addicted, you are addicted.

And there are a whole lot of people addicted to Suboxone.

I will also tell you what I don’t know: the answers.  I know that the medical establishment doesn’t have them yet either. Medication assistance has its place in the pantheon of drug recovery. I sat across from a young mother at a Learn2Cope meeting who explained that she wouldn’t have made it without Methadone assistance. And I have heard many parents say Suboxone saved their children. I watched a doctor tear up because Suboxone helped his patient avoid constant relapses. But I also know that it can be abused. The pills crushed, or the sublingual film cooked down and injected. I don’t know if this was considered during its trial phase. I hope it was and that there wasn’t a pharmaceutically driven rush to profit from its marketability. But I suppose, like anything, the benefits were weighed against the risks. It’s just hard to reconcile the fact that with a single prescription you are handing a known drug addict the means to better health, or the means to further destruction. I wish the process to recovery was clearer, simpler, cleaner.  Unfortunately, I know that it is not.