Vote No on Laws That Prescribe

Regardless of why and how people develop substance use disorders, a.k.a.  addictions, 20 million Americans have them now, 1 in 7 is expected to get them, a person dies of a drug overdose every 19 minutes in the U.S., and only a fraction of those who need help are receiving it. Whether we approve of it or not, addiction is a national crisis. Not doing something effective about it strains our system and our people.

The two top treatments for opioid use disorder are the medications methadone and buprenorphine. Burpenorphine is dispensed primarily in two formulations, buprenorphine alone, brand name Subutex, and buprenorphine with naloxone, brand name Suboxone.

The purpose of adding naloxone to buprenorphine is political, not medical. Law makers have required pharmaceutical companies to include naloxone in the formulation of Suboxone in an attempt to prevent misuse of buprenorphine. Neither data about opioid use and misuse, nor the biochemistry of the metabolism of buprenorphine or naloxone, support including naloxone with buprenorphine as an effective method for preventing opioid misuse. Illogically, however, this requirement exists.

Each human’s physiology is unique and, therefore, each person’s response to medications is unique. Some people with opioid use disorder are able to tolerate Suboxone, i.e. buprenorphine with naloxone. Some people cannot. They have allergic reactions to naloxone, naloxone sensitivity, or pre-existing medical conditions for which the presence of naloxone creates complications. The expertise of medical professionals is required to determine what medications are suitable for each patient on an individual, case-by-case basis.

Virginia General Assembly House Bill 2163 entitled “Buprenorphine without naloxone; prescription limitation,” states “products containing buprenorphine without naloxone shall be issued only for a patient who is pregnant.” HB 2163 has passed the House of Delegates and is currently being discussed in the Senate Education and Health Committee. A similarly worded bill, Senate Bill 1178 has passed the Virginia Senate and is currently being discussed in the House Health, Welfare and Institutions Committee.

Virginia HB 2163 and SB 1178 mean that all men and non-pregnant women currently stable on Subutex must stop taking it and switch to taking Suboxone instead. HB 2163 and SB 1178 mean that all new cases of opioid use disorder in men and non-pregnant women in Virginia must be treated with Suboxone even if Subutex is the medically prudent, even medically imperative option.

Virginia HB 2163 and SB 1178 legislate medical malpractice.

In addition, the proposed bills mean that those taking Subutex who cannot take Suboxone will be forced to find another option. Access to the alternative top treatment, methadone, is virtually non-existent in our locale.* Treatment with naltrexone, while helpful to some, does not directly affect the areas of the brain most specific to opioid use (those treated by methadone and buprenorphine).

Those without buprenorphine in a form they can take, without access to methadone, and who find naltrexone ineffective, will have to do without treatment for opioid use disorder.

Of people with opioid use disorder who abstain from opioids without maintenance therapy, also termed medication-assisted treatment (MAT), 50-90% are likely to return to use. And, as reported by Maia Szalavitz, “[M]aintenance is the only treatment known to reduce drug-related mortality, which it cuts by more than 70 percent.”

Those desperate not to return to use do what people desperate for opioid use disorder treatment who languish on wait lists do as well: find friends or family members who are on buprenorphine and ask to share their doses. And those friends and family members risk and sacrifice to share their prescriptions in an attempt to save loved ones stricken by life-threatening opioid use disorder. Or, less often, they buy it from strangers, a.k.a. “dealers,” to self-treat opioid addiction.

Virginia HB 2163 and SB 1178 cruelly back its citizens into a corner, offering no healthful choices to benefit individuals with opioid use disorder or the Commonwealth as a whole.

I called my Virginia State Senator today. This is what I said:

“My name is Anne Giles and I am a constituent in Blacksburg, Virginia. I am calling to urge Senator Edwards to vote no on House Bill 2163. While I appreciate the attempt of public officials to address the opioid crisis in Virginia, HB 2163 would endanger those with opioid use disorder and further strain our systems providing them care. Health care professionals have determined that some people with opioid use disorder must take buprenorphine alone as Subutex and cannot take Suboxone for medical reasons. The law will require men and non-pregnant women on Subutex to switch to Suboxone, which may be medically contraindicated. HB 2163 legislates potential malpractice and must be opposed. I so hope Senator Edwards will take my views into consideration.”

State Senator: John S. Edwards (Democratic)
Capitol phone: (804) 698-7521
District phone: (540) 985-8690

. . . . .

*We were unable to find verifiable sources for the number of methadone clinics in the Commonwealth of Virginia. This source lists 3 methadone clinics in Western Virginia and this source lists 5 in Southwest Virginia. We verified that a clinic is operational in Pulaski, Virginia and is listed in the second source but not the first. Many people, particularly in rural areas, will be unable to make daily commutes to a distant methadone clinic, whether due to conflicting responsibilities (i.e., dependent care, work) or due to a lack of or limited transportation.

A version of this post first appeared in The Roanoke Times.

Disclosure and disclaimer: The opinions expressed here are mine alone and do not necessarily reflect the positions of my employers, co-workers, family members or friends.  This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Last updated 4/13/17

How Might We Work Together on This?

If I want to feel close to people, I’ve learned to listen for the essence of what they’re trying to express, which may or may not be directly conveyed by their words, the topic under discussion, or the position taken.

Since the 2016 election, and more acutely since the January 20, 2017 inauguration of President Donald Trump, I have been listening through the news, social media, and personal interactions, trying to hear what Trump’s supporters are expressing. I listened to several supporters on February 1, 2017, when NPR reporter Susan Davis interviewed Republicans on their views about Trump’s executive orders on immigration policies.

Seeking understanding

When I’m listening to adults, I assume they have reasons for what they’re saying that make sense to them. I assume they’ve learned through bitter experience to protect their feelings and to state reasons for feelings rather than the feelings themselves. I assume humanity, i.e. people will feel better or worse on some days, express themselves more or less clearly at some times, and simply make mistakes. I assume thinking fluctuates, evolves and regresses. I assume good intentions.

What I think I’m hearing is that Trump’s supporters want to feel safe geographically (immigration), financially (jobs), and morally (religion, abortion). They don’t feel safe – in fact, they feel threatened – they’ve tried individually and collectively to do something about it (Republicans vs. Democrats), that hasn’t worked, so now they want someone in power to make it happen. Regrettable means may be necessary, but they’re justified by the end in mind, i.e. safety and security.

I’ve learned that, if I want to have a working or close relationship with someone else – and I’ve discerned that the person is capable of it – after I listen, I need to try to understand. Internally, I discover and acknowledge my own position which may differ significantly from the other’s – in this case, until the election, I felt geographically, financially and morally safe in America – but I try to use my mind and heart to think and feel as the other person might. So, wanting and needing safety makes sense to me. Feeling threatened triggers my own survival instinct, the fight-flight-freeze response, an acute and destabilizing state of stress. I understand how alarm leaves no room for nuance and negotiation and any-means-necessary can kick in as an imperative.

Then I ask the person, Have I understood what you’re thinking? Is that what you’re feeling? I listen to the answers and refine until I receive confirmation that I do understand.

Then I seek common ground.

In her report for NPR, Susan Davis states, “[W]hen it comes to Trump, Democrats and Republicans are often living in parallel universes.”

In his article on how Chavez came to power in Venezuela, Andrés Miguel Rondón writes, “Don’t feed polarization, disarm it.”

In seeking common ground with adults, I assume at 58 something I could not fathom at 28: Opposing sides may both be true. Or truth may exist on a continuum. Or we may be in the wrong universe not even talking about what’s really the problem. And I, individually, never know enough or understand enough to make a perfect choice. I am limited to making the best choice I can with what I know at the time. Similarly limited are my paradoxically tough and fragile fellow human beings.

Fear may be the mind-killer. But judgment is the killer of connection.

To seek common ground, here is the question I ask:

How might we work together on this?

Asking the question requires vulnerability. Asking the question requires risk because the response may evoke shaming, rejecting, belittling. Asking the question asks all parties to suspend connection-killing judgment, at least for a moment. The answer may not be one we want to hear. The answer may alarm us, triggering a fight-flight-freeze reaction, or the more weighty, strategic decision to go to battle.

But not asking the question keeps us polarized, separated, disconnected.

What we want, we don’t have. We are not safe when we are not together.

How might we work together on this?

. . . . .

Photo by Zane Queijo

What Am I Worried About?

In response to a question about what Americans should do, Senator Tim Kaine asked a crowd of supporters gathered in Blacksburg, Virginia – of which I was a member – to pause for a moment and ask themselves a question.

“What are you worried about?”

Illustration by AnneThis was on the Sunday after the Friday President Trump signed what’s now termed the Muslim ban. Senator Kaine asked us to specifically, truly and personally answer the question for ourselves.

Words and images came to my mind in a rush – my former employee from Iran whisked away in the night, my father losing his retirement account through a stock market crash, my sister blocked by airport closings from seeing her newborn grandson. But I kept going deeper and deeper, lifting layer after layer, trying to get to the essence of my fear.

And I got there.

I am afraid that I will be found unacceptable. And then they will come for me.

I lived half a century on this planet as an acceptable-enough person. I did well in school, became a teacher, and did my best to live a principled life. I paid my bills and taxes. I am very sorry my two marriages didn’t work out, but I had the very best of intentions and truly did my best with what I understood at the time.

At nearly 50, I developed alcoholism. I’ve been in remission for just over 4 years and disclosed it publicly with 16 months of abstinence. I had no idea of the resentment, bitterness, even rage that people have about “alcoholics” until I received that label.

To me, I was going along as an acceptable-enough person, got hit with more trauma than I could handle in a very short time, including the shootings at Virginia Tech – 10 years ago this year – alcohol did the mysterious, black box thing it does on some brains – and I could no longer stop myself from drinking more, and more often, than I intended. At the end of 2012, without consulting anyone, I threw myself off the cliff of abstinence, beginning a period of unexpected, appalling anguish from which I am only beginning to emerge after nearly a half decade of endurance.

We studied Ralph Waldo Emerson’s essay The Over-Soul in high school English and Mrs. Maybury showed us a drawing by a fellow classmate of the “Over-Soul” – the essence of being human – as an ocean from which a droplet fell into each person.

I did not choose to develop alcoholism. It happened to me. The bodily container for this little droplet from the great ocean of humanity that is mine for this lifetime just happened to develop alcoholism. It might have developed diabetes or asthma or another chronic illness. But I contracted alcoholism.

Contrary to the latest findings of science, alcoholism and other addictions are still believed to be moral problems, not medical problems.

Some people, therefore, believe that I am bad. Or that I am capable of more badness than most. I am believed to not believe right, think right, choose right, do right, or be right.

I have done my very best to reverse alcoholism within me. I believe if anyone could do it, I could. A perfect storm of opportunity for healing exists. I am smart, healthy, well-educated, professionally successful, psychologically-minded and self-disciplined. I have specialized training and experience in addictions treatment and the backing of my family, both personally and financially. I had nearly 50 years to achieve full brain development and establish healthy living norms.

I can’t make alcoholism budge. I drank non-alcoholic beverages at the political gathering but I whimpered every time a glass wine or beer passed near my face in the packed restaurant. Nothing I can humanly do changes what happened in my brain that makes me long for alcohol.

Some people with untreated alcoholism do inhumane things. Some people with untreated alcoholism do humane things. One cannot generalize about the many from the few.

“All alcoholics should be shot at dawn – and that goes for drug users as well.” Comments like this one abound on the Internet.

Alcoholics won’t be shot at dawn in America, right? We would never do what Philippine President Rodrigo Duterte is doingWould we?

We don’t punish people for who they are, right? It’s not the color of our skin – or any other condition that’s simply a result of happenstance, i.e. where we were born, or which chronic illness we might have developed – but content of character, right, on a case-by-case basis?

Except on Friday, January 27, 2017, our president chose to use laws against people who happen to be the way they are. The assumption was that, based on the way they are, i.e. where they happen to be from, they might do something we don’t want them to.

I have that same profile. Because of what has happened to me – the illness I have contracted, not, in this case, the country I am from – since some people with alcoholism do terrorize others, I could be grouped with that “some,” given a label, and become a member of a group to which things are done en masse.

What am I worried about, Senator Kaine? That America will do to the group of people who have what I have what they are doing to this group. And then I dread what group might be next and who might be considered a member. My elderly father because he writes about science? My sister because she had 3.0 children instead of 2.1?  Who knows what the arbitrary criterion will be? What will be the droplet of humanity that will mark each of us for persecution?

If a Narcissist Unexpectedly Appears in Your Life

What a person without narcissism needs to understand about a person with narcissism is one simple word: won’t. The person with narcissism won’t understand, won’t realize, won’t empathize, and won’t change.

No matter what one says or does, no matter how vulnerably one reveals or starkly one demonstrates, no matter how impeccable the facts one cites, the elegance of one’s logic, the passion of one’s outrage, or the eloquence of one’s appeals to humanity or rule of law, the person won’t say or do anything other than what the person is saying or doing right now, regardless of what the person might have said or done previously.

Logical, rational, insightful, informed, well-meaning, moral people who have someone appear in their lives who has narcissism will end up in paralyzed, demoralized despair if they keep pulling the hope lever. Wishfully, wistfully thinking “If only they…” and making one more attempt, then one more, results only in exhaustion, sometimes in punishment. Nothing can be done. The person simply won’t.

If a narcissist unexpectedly appears in your life

How can this be? Psychologically-minded people might attempt to analyze what’s going on within the person with narcissism. They may gain expert insight into the origins, manifestations, and recommended treatments for this person’s particular form. Their smarts and efforts are for naught. The person won’t.

That means that no matter how keen probability models might be, no prediction about the words or actions of a person with narcissism is possible.

People who have a person with narcissism appear in their lives are plunged into a chaotic reality. What happens next is unpredictable and intermittently volatile, and they are powerless to influence any of it. The new reality operates in opposition to all natural laws of human connection. People logically begin to question themselves. “He/she is a person, I’m a person, and we should be able to understand each other. If we can’t, it must be my fault. I’m not trying hard enough, I’m not saying or doing things in the right way, I’m not good enough…” No matter what one tries, says or does, no matter how one attempts to transform and improve, the person won’t. Minds and hearts break under such circumstances.

In situations where interacting with a person with narcissism is optional, people usually opt out. However, if a person with narcissism appears in one’s life in a position of power from which one cannot extricate oneself, perhaps as a partner, parent to one’s child, neighbor, boss, even chief executive, only one priority can exist: safety.

Safety has to be the one and only goal because no other goals are possible. The person won’t hold to negotiated agreements no matter how contractually we obligate him or her. Deal-breaking can range from showing up late for our coffee date, to breaking our terms of engagement when discussing conflicts, to delayed paperwork. Protesting, “Yes, but you said!” is based on the fallacy in logic that a person with narcissism operates with a knowable code. Unless they’re keeping their word right now, in this moment, whether or not they will do so in the future is an unknown.

The only way to deal with someone with narcissism in a position of power is to accept powerlessness rather than to resist it. This requires initially overriding one’s survival instinct to do anything and everything to right wrongs and create life-nourishing stability. Paradoxically, accepting the reality of unchangeability and volatility creates a different kind of power: the power of strategy.

The only triumph over a person with narcissism in a position of power is to outlast them and, while doing time, outgrow them. People move on, lose favor, age or weaken, and so, too, eventually, will the person with narcissism in your life.

That means developing the ability to access to one’s full heart and full mind at all times, developing excruciatingly, on-going, meticulous control over one’s potential reactions, and using discernment, moment to moment, about what to say or do, or not say or not do, all with the intent to foster one’s ability to protect oneself and others and to grow. No more is one dissipated by attempting the impossible, i.e. to influence the other person by pleasing, appealing, arguing or explaining. One acknowledges that both too much and too little may escalate the interaction and provoke attack. One accepts that what one says and does has no discernible causal power over the other person’s reaction, only over how one builds one’s own inner power or weakens it. And to do that in the next moment. And the next one.

To use one’s energies on oneself and one’s purpose – safety for self and others – rather than on the impossibility of the other person, frees one to grow the power, strength, fitness and endurance of one’s own heart and mind to be able to handle whatever happens. Further, “strength in numbers” is a cliché because it’s true. One can examine which relationships one has that are strengthening, and work on deepening those and building new ones.

The corollary to this is to have as little private, unwitnessed contact as possible with the person with narcissism and to remove oneself from such situations as soon as possible. People with narcissism can be highly adept at engendering self-doubt about one’s own perception of reality and one’s own worth and competence as a person. Alone time can trigger the conditioned response of pulling the hope lever. Alone time drains energy rather than restores it.

In addition, attempting to understand and or empathize with a person with narcissism, or speculating whether or not the person is impaired and could be treated and healed, wastes precious resources that could be used for growth. No matter what, the person won’t. That is the state of things.

People who are imprisoned, whether physically, emotionally, relationally or politically, have choices about how they spend their time. The walls are what they are. If someone with narcissism has unexpectedly appeared in your life, this is my advice: Master yourself, grow yourself, take care of yourself and your fellow inmates, protect yourself and others the best you can, perform triage in aftermaths, and prepare to be able to access your full heart, full mind and wise strategy for the day when the person with narcissism is just about to harm the children.

Image: iStockphoto

It’s Just Hard

One month ago, on the eve of my 58th birthday, I fell down a short series of stairs in the dark and broke my foot. That morning, as I had nearly every morning for a decade, I exercised. I ran 3 miles on so many days a week for so many years that I didn’t break a sweat or breathe hard. On non-running days, I swam 30 minutes straight, again, without losing my breath. I lifted weights each week with a trainer and didn’t get sore. I concentrated on consistency and form and, at 57, except for belly fat, had solid fitness, a low pulse rate and good muscle tone.

Broken foot and elder catToday, I am deciding whether or not the trips around my house in a walking boot to gather my things, the trip to the car in the boot, taking off the boot, getting in the car and driving with a sore foot, arriving at the pool, putting on the boot, getting out of the car and walking to the locker room, taking off the boot, and limping to the pool to get in it, making my foot sore from swimming, and then going through the reverse is worth it. It will take about 2 hours to do a 20-minute swim. I’ve had chronic pain in my back and hamstring from old injuries that exercise manages. They’re aching away, along with my foot in its boot.

I feel like I’m decomposing, like a pile of leaves, little particles dropping off bit by bit from my structure.

People break bones all the time. Why am I having such trouble? I’ve known a long time that I’ve got some conditions in my life that aren’t helpful to handling the human condition, whether a stubbed toe or a broken foot. I’m partner-less, childless, motherless, and live alone. I work at part-time jobs primarily out of a home office. Most of my work involves process rather than results. I’ve had trouble finding groups and communities in which I feel a sense of belonging. In isolation, each experience can feel magnified.

Oh, yeah. And that other thing. Fucking alcoholism.

I have worked my ass off to not have this. For four solid years, I have longed to drink and not. I have tried every treatment I could access, tried every way of thinking and re-thinking and feeling and re-feeling and doing and doing differently and it just won’t let up. I am exhausted.

I didn’t know how much my daily freedom to exercise intensely to my heart’s content and my mind’s calming and my body’s relieving meant to me until I lost it.

I continue to marvel at how people who have this condition, and don’t have the resources I have, stay abstinent. I have employment, housing, transportation, health insurance. And a gym membership. Maybe they make it because they have someone who loves them? I have people who love me, of course, but at a distance. As it should be. They’re living their lives. I am to live mine, too.

How to live a solitary life with a chronic illness? Gee. It’s just not the question I expected to answer at 58. Barbie, Ken, Baby, Cinderella, Handsome Prince. That’s my paradigm!

Yesterday was hard, today is hard, and tomorrow will be hard.

That’s actually been mostly what it’s been like to be me during these four years of abstinence from alcohol.

For me, turning towards the truth, not away from it, is a relief. And the truth is that this is just hard as hell, harder than I ever could have anticipated, possibly harder than I have the capacity for. And way harder than anyone who’s tried to help me has found it to be. This just seems intractable. And it may be. I just might not triumph. Okay! That’s the deal!

I think it was my 8th grade math teacher, Mrs. Hooper, who first taught me how to do proofs: start with the givens. Given that 1) today will be a day of deprivation, i.e. no alcohol and no significant exercise, both of which would offer a blessed break, 2) today will be a day of above average physical pain, 3) nothing known today can make tomorrow better, 4) intimate, connected contact won’t happen, but general contact might, 5) the top recommendation for politics-induced anxiety is, wait for it, physical activity, how, Anne, would you like to spend the day?

I would like to write a blog post on my blog stating my truth, and I would like to say, yeah, I might relapse but it won’t mean much of anything, just a bout with a chronic illness after a pretty significant period of remission.

I would like to give swimming a go, I would like to try to use Uber to get to the Neuroscience of Addiction class I’ve been given permission to attend at noon, I would like to anticipate that my elder cat might sleep on my chest during a nap, I would love a post-nap Starbuck’s coffee but that requires the boot so I dunno, I would like to wait on my younger cat who has me on an intermittent but insistent schedule, I would like to (sigh, see, this is where the despair starts) eat a pleasant dinner at home, but everything makes me fatter and I have no groceries and wouldn’t know what to put on the list if someone wanted to shop for me, and I would like to try to just be there for myself today, moment to moment, truthfully. No demoralizingly simplistic slogans, no admonitions to serve others, no phony rah-rah. Just be there for myself and acknowledge to myself that, yes, this is really tough and it’s probably just going to be a moment-to-moment thing. And not push, or scold, or measure myself. Just keep myself company through a really hard time.