Challenging Misguided Assumptions About Addiction

This past week, I had the opportunity to have a small part of my story relating to prescription opiate addiction appear in The Globe & Mail. As usual, the opinions and comments I've received in response to the article "Number of opioid drug prescriptions in Canada skyrocketing" have been all over the map; from amazingly supportive, to ignorant and misinformed.

This is certainly nothing new or unexpected for me, as it unfortunately still comes with the territory. Regardless, I wanted to take the time to touch on a few things that were not mentioned in The Globe & Mail article, as well as address some of the surrounding discussion.

You can view  the article here, and check out a couple photos of the print copy in my previous blog post.

The article itself was different than what I was expecting, although one never truly knows what to expect when it's another author doing the writing. It raises the important issue of prescription opioid abuse in Canada, and how it isn't simply an "Oxycodone" problem. The issue extends to all prescription opiates. Remove one, another simply moves in to take the top spot.

This article was first published by Studio L. You can read the original here.

In early 2012, the Canadian government moved to stop funding OxyContin through Provincial plans (except Alberta) and replace it with a new, "tamper-resistant" formulation known as OxyNeo. In June of 2015, they took it a step further, announcing that in the future, all Oxycodone products will be required to have the "tamper-resistant" features, like OxyNeo.

However, placing this type of restriction on OxyContin (and in the future, all Oxycodone products) has simply led many users to switch to another opioid. Here in Canada, that happened to be Hydromoph Contin, a different prescription opioid medication produced by the same drug company behind OxyContin; Purdue Pharma.

"Hydromorph Contin, also made by Purdue, is now the most popular long-acting opioid in Canada, with prescriptions reaching 1.6 million last year, up 60 per cent since 2011, according to a Globe and Mail analysis of figures provided by IMS Brogan, which tracks the drug industry." - The Globe & Mail

Take away access to the pharmaceuticals, and users will be forced to find yet another substitute. This can have the unintended side effect of pushing prescription opioid users on to heroin; which is unregulated, impure, and near impossible to know the dosage or potency.

I realize this article is focusing on the prescription opiate crisis, and the skyrocketing rates at which they are being prescribed, but some of the comments and discussion that ensued revealed plenty of ignorance regarding addiction in general. Regardless of a user's opioid of choice, what seems to be missed by so many is that there is FAR MORE involved in the journey into addiction than over prescribing, patient weakness, stupidity, lack of responsibility, and/or the decision to mistreat one's prescription medications. You might think that this is fairly common knowledge, but let me assure you, it is not.

The underlying issues and traumas that so many people struggling with addictions face, is what seems to be consistently missed by so many who are reporting on the subject. So ... let's make this clear, shall we?

We didn't just wake up one morning, turn to our bottle of opioid pills which we had been dutifully taking exactly as prescribed, and thought to ourselves, "today seems like as good a day as any to start banging these. Where are the rigs at?" Ignorance at its best (well, worst). It simply does not work like that. What so many fail to realize is that addiction is based on many factors, not just wanting to "get high."  Addiction is a far more complicated beast than that. To paint it as anything less negates the experiences, trauma and pain of those who have struggled endlessly with it.

The Trauma Factor

For many people who struggle with addiction, trauma is a huge underlying (and often ignored) factor. The cause and source of that trauma varies widely for each person, and no one particular experience is more valid than another.

"Larke Huang, director of the Office of Behavioral Healthcare Equity at the Substance Abuse and Mental Health Services Administration (SAMHSA), defines trauma broadly as a stress that 'causes physical or emotional harm from which you cannot remove yourself.' Trauma is subjective, meaning what matters most are the individual’s internal beliefs and their innate sensitivity to stress, not whether a family member, therapist or other outsider deems an experience traumatic."

It is these various different traumatic experiences, and the often times overwhelming feelings that perpetuate even long after the initial cause/source of the trauma is removed, that can lead to the dampening of emotional pain by altering consciousness through various different drugs.

This was the case in my situation. A previous relationship of mine had been emotionally, physically and sexually abusive. Needless to say, this left a massive impact on me. After it ended and I moved on to bigger and better things, I did my best to very neatly pack away all of the trauma that I had experienced. Ignoring it seemed like the most effective option at the time. Opening up to talk about it hurt like hell, and I wasn't ready. So, I proceeded to go about my life as usual and do my best to pretend it simply didn't exist. But all that pain was still there; raw and undealt with. It affected me on a daily basis, but I refused to acknowledge the true extent of it. This was a bit of a habit of mine. I tended to put away anything that was emotionally painful, and try "be okay."

In 2009, I suffered an injury to my knee, and as a result was prescribed Oxycodone by my family physician. I was absolutely in legitimate pain from my physical injury, and the Oxycodone undoubtedly helped obtain relief. A short time into my treatment, I began to notice that the medication my family physician had prescribed to me for relief of my physical pain was effective for far more than just that. Each time I took a pill to relieve the physical pain I was feeling in my knee, I found that I was also getting relief from other types of pain I had been struggling with. Opiates began to very effectively alleviate not only the physical pain I was feeling at the time, but also relieved the intense emotional pain and trauma I had been trying so hard to conceal. With my pain pills, I was able to escape it. That is, until the dose wore off.

As more time passed, naturally my tolerance to Oxycodone increased, and with it, the relief I felt from the emotional pain took a sharp drop. It required a higher dose to get the relief I once did, both physically and mentally. I had a taste of what it was like to be free from the all encompassing pain of that trauma for the first time, and I couldn't bear to go back. At this point I was already physically dependent on the pills, which terrified me. Yet the thought of having to go back to the way I felt before was far more frightening at the time.

At first, it was taking an additional pill or two along with my prescribed dose. When that no longer provided the same relief it once did, instead of swallowing my medication as prescribed, I began chewing it. Eventually, chewing my pills wasn't enough, and I progressed to crushing and snorting, which eventually led me to injecting. Over the course of just a few years, I had unwittingly gone from knee injury to intravenous drug user. All in a desperate attempt at relieving the pain I had inside of me at the time.

I see this all so much clearer now than I ever did at the time, though. They say hindsight is 20/20, right? I didn't full understand the extent to which I was relying on drugs for emotional pain at the beginning of this descent. I moreso saw it as something that just "made everything feel better," and not just my knee. For the period of time that the pills were at their height, everything bad that was weighing on me completely stopped. But not only that, I actually felt good. Really good, for a change. That's not to say I wasn't happy at times, but I sure as hell had some demons, and they were always waiting, ready on the back burner. But looking back now, I can easily see very specifically what issues and pains I was trying to escape from.

"Drug use may also serve other purposes for trauma survivors. For instance, it may allow them to disconnect from their feelings, dampen guilt or rage, increase feelings of relaxation or control, or reduce chronic anxiety or suicidal thinking. Depending on the drug of abuse, patients may seek to numb painful emotions or conversely to feel “alive.” Patients also report a feeling of camaraderie or unconditional acceptance among other drug users, in some ways replicating the family unit." - Emotional Trauma: An Often Overlooked Root of Addiction

So, next time you see or read about a person struggling with addiction, or choose to comment, know that chances are there is far more to their story than what many see as the seemingly simple and selfish desire to "get high."

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Studio L is a freelance writer living in Southwestern Ontario. She is a recovering IV drug user, methadone patient, and harm reduction advocate, and covers these issues in her blog.