It’s Goodbye! Mr. Pethadine

Mar 07, 2012 News

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By Practitioner

Let me start by apologizing in advance to any reader I might offend with the intensely personal nature of this article – my rationale is recounting what I’ve been through is the best way of communicating my thoughts on an issue that has wider public health ramifications.
By the time you would have read this article, I should be in hospital somewhere overseas.  Over the next couple of days, I will be struggling with a personal medical problem that has hounded me for too many years than I’d care to recount – chronic back pain.
I’ve written about this issue and – more importantly – the attendant dependence I’ve developed on the painkillers used for treatment about twice over the past two years.  The first article, I wrote generally on the issue of pain management and the second one had more to do with my reaction to the rife and completely inaccurate speculation of my hospitalisation last year.
This time, I wish to write more directly on the issue, not just the larger picture, but bringing as well some of the unique perspective that I possess.  Dependency, addiction, in the larger connotation of it, has almost many manifestations as there are things people can do.
Some people are addicted to gambling, others are addicted to sex.  I remember reading one news story a few years back, one I showed to my son as hint, where a young man was so addicted to a videogame that he played it several days non-stop before collapsing and dying in front of his computer.
Some people are addicted to shopping, although admittedly (and I expect some repercussions from my wife for saying this) it’s hard to tell if many women are actually addicted to shopping or if it’s just a regular weekend.
That said, chemical addictions, or substance dependency, constitute the most widespread and critical forms of addiction.  According to a recent report by Dr. Sanjay Gupta that I saw on CNN, there are some 23 million Americans currently addicted to one substance or the other – alcohol, marijuana, tobacco, illegal drugs, prescription medication and even glue.
The actual order of primacy of abuse, the top three addictive drugs are, in descending order, alcohol, marijuana and prescription painkillers.  The latter, accounts for 1.9 million of those addicts.
I’ve had two major back surgeries in my life – intended to relieve the chronic back pain I experience – and each necessitated the use of very strong prescription painkillers for my recovery.  And I, quite frankly, have struggled with a clear addiction to them. There is a serious and sad irony attached to the use of powerful painkillers: while they work well to relieve pain at the onset, very often, with the real pain gone, the body (or brain, rather) becomes so addicted to their effects that coming off them makes you feel much worse than the pain they helped to relieve in the first place.
Coming off a strong prescription painkiller is a living, walking nightmare of craving for the drug, body chills, insomnia, anxiety attacks, depression – one minute you’re delirious, the other you’re irritable and no one can talk to you.  All these are things I’ve experienced and it is no picnic for me.
The thing is, it isn’t a picnic for others either, as with any addiction, particularly chemical ones, the addict doesn’t suffer in isolation.  The drugs alter your personality so subtly but so significantly at the same time that although you most likely won’t notice the difference, the worst of it – the alienation, the irritability, the lack of communication – is felt by those closest to you.
I’ve spent a long time thinking hard on how this thing has impacted upon my life and I can tell you, that time has been personally enlightening for me with regard to my perspective on substance dependency.  For example, you see the typical drug addict, the typical junkie, walking on the street and your view of that person is somehow subhuman.
To satisfy his or her addiction, the cocaine or marijuana addict’s life is one of great personal compromise – humiliating and arduous manual labour for little compensation; being treated with indignity and scorn by almost everyone they come across.  I’ve been witness to one ‘junkie’ disparaging another – equally ragged, equally homeless – because the former would only smoke marijuana and drink rum, while the latter was a full blown cocaine addict.
At a fundamental level, prescription pain medication dependency is the same thing, the same sacrificing of personal standards, granted to a much lesser degree.  This sort of medication is difficult to come by, and while I’ve personally never checked, I am sure that it is far easier to get a joint of marijuana or a gram of cocaine than it is to procure, say, a couple Vicodin tablets, or a syringe of some other pain-relief drug.
If I’m to be honest with myself, at my worst point of dependency, I’d say I was nothing more than a sophisticated junkie and like any junkie, your addiction affects how you work.  I’ve been short with staff, and I’ve had to cancel meetings, and the only thing that has spared me really is that my other addiction; work itself, served as a sort of therapy for me.
Potentially addictive painkillers, or potentially addictive regimens of painkiller treatment, should really be the last resort in the treatment of any pain related condition or illness, and whenever the decision is taken, it should include comprehensive patient education about the pros and cons, in addition to extensive psychotherapy throughout the duration of the treatment.
This would save the patient a great deal of pain in the long term, whether actual pain or the psychic trauma that comes with dependency and the attendant stigma attached to it.
Which brings me to this: in an upcoming article, I want to deal frontally with a serious related issue that regards patient confidentiality, particularly within the private healthcare industry in Guyana.
While I am grateful to, and have tremendous respect for, the medical personnel that have attended to me at various times, I believe that there are gaps in the private health care system here which facilitate the leakage of an individual’s personal health information, the sort of gaps that would be prosecutable in other jurisdictions.
In closing, let me say that I am extremely grateful that I have the family that I have, and the staff that work close to me, people who’ve weathered the storm of my shift in moods, and stuck by and supported me throughout.
I remember going to former President Bharrat Jagdeo and Head of the Presidential Secretariat, Dr. Roger Luncheon, both of whom I had to communicate directly with regard to my professional responsibilities in various capacities, and being encouraged to take as much time as I want to deal with my medical problems adequately.
I remember the President saying clearly, and sincerely, “We want you to get better.”  I, of course, didn’t take their advice and went back to work as soon as I felt marginally better.
As for my anonymous detractors, particular those behind the letter writing campaign – questioning my health, my capacity for job performance – that prompted the article I wrote a year ago, ‘Coming Clean’, about my personal health problems, I will be off for a few weeks and while I’ve prepared some columns to be published, I apologise in advance that I will not be able to respond directly to feedback for obvious reasons.

This is the first in a series to focus on the abuse of prescriptive drugs. Many in the medical profession, among them doctors and nurses are drug addicts—addicted to prescriptive drugs, not least among them Pethadine.
Some conservative estimates place the number of addicted doctors at about 20 per cent.

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