Dr. Junig writes about buprenorphine, a life-saving but underused treatment for opioid use disorder.
I wrote about my background 12 years ago, when I started the Suboxone Forum. Rather than get too involved here, I invite you to start browsing pages. You can see my CV (up to 2008 or so) at my business pages, either for Psychiatry or for Addiction. For those who really need to know where I came from before you start reading, I will copy that section from my forum and paste it below:
Some of you may have seen my interview in Men’s Health years and years ago regarding addicted physicians. But even after 6 years of acceptance, treatment, and reflection, the word ‘junkie’ still carries a sting. I don’t know how Men’s Health heard about me or why they decided to write about me; when they first contacted me, I had never seen Men’s Health magazine. I figured it was… a health magazine. I really thought that they wanted my opinions on why a person with so much going for him ‘picks up’. Don’t get too excited—I don’t know the answer. Or answers. Even after my experiences, it is hard to decide which parts of my actions were intentional, which parts were accidental, and which parts were medical.
I firmly believe that in order to maintain sobriety, a recovering addict should be more concerned with the ‘rules’ of recovery than with psychobabble mumbo-jumbo. That said, I have been in analysis for several years—one motivation is to understand the aspects of my behaviors and thoughts that have proven to be self-defeating. I recognize that analysis is very egocentric, and most addicts (myself included) are self-absorbed to begin with. I also remember my addictionologist telling me that most psychiatrists see addiction as a symptom of something else, whereas he believes that one does better to see addiction as a primary illness. I admit that if a patient of mine kept asking “why do I do these things?”, my answer would be “it doesn’t matter. Go to a meeting”. And so I tread very carefully on my path to possible self-discovery. If, in reading this, you detect an air of self-importance, that is ‘my bad’. I have had an interesting life so far, and I likely share it with dramatic flair, so I ask that if for some reason you keep reading, you will forgive my self indulgence. Would I read someone else’s rambling autobiography? Only after the end of football season, after reading all the newspapers, and after going through every New Yorker magazine laying around and looking at their cartoons.
Enough excuses. This is how I see things so far.
I felt alone growing up. I had plenty of people around me, but I never felt a part of them. I was socially anxious and shy. I felt guilty that our family had a 1300 sq ft house in a neighborhood of 1000 sq ft houses. I was ashamed of being skinny. Schoolwork was easy, and there I excelled, always fearing however that my talents would result in me getting beat up at recess. Over time I developed an ‘outside’, separate from my ‘inside’. The outside smiled; the inside worried about the meaning of life. I developed impressions of the world that solidified my ‘split’; I saw other people as different, and assumed that they looked down on me on some days, and imagined they were jealous of me on other days. I used fantasy to numb my inner loneliness and pain. Sometimes I had big muscles. Other times I was the secret guitarist for Pink Floyd, and I would make my debut at Prom in front of all the people that didn’t like me.
At age 15 I discovered pot and alcohol. The drinking age was 18 back then, making alcohol readily accessible to anyone with an older brother. During my last two years of high school I got straight A’s despite being stoned almost every day. The split deepened; now in addition to my smile, I was a scholar who was going places. Inside, though, I knew everybody was wrong. The pot allowed me to avoid thinking about how I really felt on the inside—that I was weak and alone. Imagine my Imagine my thrill when I had the opportunity to save a drowning woman one afternoon.
The next few weeks were magical—my fantasies had come true. Besides the ‘drowning woman’ story, something else happened. I saw the woman while I was working, and I was wearing my favorite T-shirt—on the front it said ‘Beloit’s Largest’, and on the back it said ‘Locally owned bank: First National Bank’. Like any good boy scout I took of my shoes and pants before jumping into the river, not concerned at the time about my bright red briefs. I got out of the river quite a ways downstream, allowing for a number of people to see me with my soaked T-shirt, clinging tightly to by body along with my only other article of clothing—the red briefs. For the rest of the summer I had it made, because for an adolescent ego, nothing beats entering a bar to a chorus of ‘HEY— IT’S BELOIT”S LARGEST!!’
But after a few weeks the contrast between my inner insecurities and my outer heroism became more and more painful. Even initially I continued my pot smoking to blunt the contrast (look at my eyes in the photo above). But the rest of the summer was lost in increasing efforts to avoid awareness. I had it all, for a teenage kid. But on some level, I couldn’t stand it.
Life went on. College meant bigger and better drugs. Quaaludes, cocaine, hash, opium, speed, shrooms, nitrous, acid—eventually I was using all of them. Pain pills never did it for me, for some reason. I continued to do well academically, but also continued to feel like a failure. Some people mistook my insecurity for cockiness. I didn’t mind—cockiness was better than the way that I thought of myself. I developed a way, though, to actually step into the persona of the scholar/nice guy/hero. I don’t know how I did it—perhaps I was motivated by… wait, who am I kidding? I did it to get laid. I became better and better at pretending; so much better that eventually even I was buying it. I started feeling like I was somebody—somebody special. So special that I was super-special—so special that I was different from the other losers out there, and I was playing by a totally different rule-book. Sure, I broke rules sometimes… but only because I had to. Rules didn’t apply to me because my intentions were honorable. I felt like saying, “don’t you know who I am?” (I never actually said it, because I realized that if someone said ‘who?’ I would have no answer). The split was complete. The dark side—the loser side—was still there. But I didn’t have to think about him. I could keep fooling myself, especially if I could find a drug or a date to keep me from thinking too much.
Eventually I tired of the drugs. I was doing well in school—so well that I felt special. I worked as hard as I used to party. I cruised through grad school and then med school. I lost track of the means that I had used to survive, or at least how it began. The split was not even a distant memory. And so I became confused. I was doing so well…Why was I unhappy? Why did I have to enter the back of the auditorium, afraid to stand in front of others? Why didn’t I have friends? I married during medical school, and for the sake of decency I will leave Nancy out of my story as best I can, as she is innocent and has been there for me whenever possible—for which I am grateful. But otherwise my life was all about performance, and I tried to keep my attention in that arena.
I was in med school when my son was born. And I was swept away by my love for him in ways that I had never experienced. His smiles, giggles, tears… his curiosity… I had never been so moved. Father of such a beautiful boy, top of my game, training to be a doctor—I had it all. And those unpleasant feelings in the background? I let them be.
Residency went fast, and I loved it. Motor vehicle accidents, gunshot wounds, major trauma, blood and guts in the big city… what’s not to like? My beautiful daughter Laura capped the end of three years in Philly. In the new Rocky movie I look at the steps of the Art Museum and remember how a person could get in free on Sunday mornings. Of course the person would have to miss church…but who needs church when everything is going so well? Besides, the last thing I wanted to do was think too deeply about life.
I’m going to have to compress things a bit. I moved to Wisconsin, and for the first time in my life made good money. We bought a house on a hill. In the middle of our first cold winter, I prescribed codeine cough syrup for my son. I don’t know if it was legal or not, but it didn’t matter—I have good intentions, after all. If it is illegal, then it is a stupid law. A few weeks later, with my own version of the virus, I used the remainder in the bottle. And that was…nice…nice…nice zzz…nice…zzz…nizzze..nzzze…zzzzzzzz. Another joyful time of love at first site. I slept like a baby, I was warm, I was calm…although eventually something happened. I wanted more, of course—who doesn’t want more of a good thing? But the more I used, the more the creature in the black shadows moved around. Looking back I blame it on my conscience, which to be honest I wasn’t sure I had. I didn’t think too deep, remember? But something wasn’t right about using a drug to feel better at this age, this level of responsibility, this amount of success. When I started to realize that I couldn’t stop using codeine, the creature in the corner jumped at the opportunity to return to life. Suddenly he was there… I was there… and I was more disgraceful than ever. I was weak… skinny…unpopular…deceitful…all of the things that I had pushed out of mind for years. The realization, the bursting of my bubble of pride—there was only one way to feel better.
Understand that this is only how things go after the fact, when one has time to put things together and try to make sense of things. At the time, I wasn’t using to feel better. I really don’t know why I was using. In fact, ‘why’ isn’t even applicable, because the word ‘why’ suggests that I had a choice in the matter. I had no choice. Non-addicts will not understand the concept, and will insist that everybody has choices. But addicts no very well what I am talking about. If you are like me, you know what it is like to promise yourself one thing, and then do the opposit
Seven years ago, when my addiction was peaking, suboxone was technically available (the law allowing maintenance treatment with suboxone passed in 2000), but nobody in the US was prescribing it. Opiate addicts had three options: long-term residential treatment and /or 12 step programs, methadone maintenance, or continued addiction. The third ‘option’ always ended badly; to borrow from AA, continued use led only to ‘jails, institutions, or death’. For a doctor, methadone maintenance is no option for a number of reasons ranging from restrictions by the licensing board to time commitments. The ‘good option’ of sobriety is the one that addicts need the most, but also avoid like the plague. And I was no different than anyone else. My addiction grew from codeine to stronger pills, and shortly after that to ‘waste drugs’, the drugs that are left over at the end of the day. The drugs could be taken orally, but when injected they have far greater potency. Because of tolerance, I was soon using doses of medication that were extremely dangerous— medications that I would never have given to a patient without continuous monitoring of breathing and oxygen levels. Opiate addiction in anesthesiologists very often presents when the anesthesiologist is found dead, needle hanging from the arm, in the hospital call room. I consider myself very lucky to have survived.
Within weeks of my first use, I knew the horror of my situation. I knew that I could not stop, as I had already promised myself every evening that starting the next day, I was done. But my addiction only grew. I cursed myself in the mirror, calling myself weak, loser, junkie, addict… I truly hated myself for what I was doing. At home, I lied to cover up irritability, or bruises, or slurred speech. At work I grew more and more angry and irritable. Eventually I made desperate attempts to ‘cure myself’ of my affliction— I took naltrexone, which causes instant, severe withdrawal, and stays in the body for a number of hours. I would lock myself away for weekends, hoping to go two full days without using so that I could start the week off ‘clean’. I knew the way to find help, but like other addicts, I had no interest in ‘interrupting my life’ with residential treatment. I wanted to fix myself. Like most addicts I would not accept treatment until I was desperate, at the so-called ‘rock bottom’ that some of us are lucky enough to find, before we find death. In the end I lost 30 pounds (a lot for a skinny guy like me), I lost my job, I lost my friends, and I almost lost my family.
I eventually was busted, and in a daze I accepted the ride to detox and treatment. I was extremely sick during withdrawal— I remember my goal on day 3 was to take a shower, as I was unable to support all of my weight by standing. After a week I could walk 40 feet or so without needing to stop to rest. I was in treatment for over three months in all at the Herrington Program, Rogers Memorial Hospital in Oconomowoc, Wisconsin. It was a great program, at least in retrospect— if you have seen the movie ‘28 days’, you get the idea. Sort of like the movie, multiplied times three.
Treatment had hours of individual therapy, group therapy, art therapy, experiential therapy, music therapy, guided imagery, ropes course, psychiatric visits, addictionologist visits… but in the end, treatment comes down to one simple thing… Do you ‘get it’? After years of sobriety and recovery work, I understand what one needs to stay clean. Like other people who treat addicts, I can often tell very quickly if a person is going to do well, or if they are going to fail. To stay clean a person has to do one basic thing— surrender. Self pride has to go. Will power has to go. The person that used? He/she has to go— gone. That person is no more. In his or her place is a new person— someone who embraces humility, striving for it always, even if it is sometimes out of reach. The new person knows with all his/her heart that opiates are poison, and they always will be poison. They know that they will never, never, hope to control their use. They are done. Over. No questions asked. Each relapse starts with one thought— maybe, just maybe, this time will be different… that little thought has killed thousands and thousands of opiate addicts over the years.