It warms my heart when friends or strangers or people in-between email that they enjoyed reading, and wish me peace. THAT has been the best part of writing over the last 6 weeks. If you go back to the start of this blog in 2008 or so, you will likely see a lot of anger. I hope I don’t read like that now. I’m not as angry, but I do want to write about peace, buprenorphine, and Prince’s overdose — and what ties them all together.
Back then I didn’t feel angry, but I did feel driven. I had just started a new career in psychiatry after 3 years of being back at the bottom. Some professors treated me like someone who had worked as an anesthesiologist for ten years, where even after residency I worked twice as hard as psychiatry residency required. But a couple memorable professors and residents treated me as if I didn’t even attend med school. That stung, and made me determined to make some sort of name for myself.
Being a proponent of buprenorphine treatment was a gift, fallen from the Heavens. Nobody seemed to know how important that medication would become. I was there in the 90’s when the Joint Commission on Hospital Accreditation told us to INCREASE use of opioids, post those smiley faces all over, and get pain under control. And I saw use of opioids increase, as well as overdose deaths. They thought 20K per year was a crisis, and now it is over 100K. Back then it was a white suburban problem, but now it is an equal opportunity killer of young people everywhere.
Along comes buprenorphine AKA Suboxone, released in 2003 in the US, just as I began residency. Nobody used it! It was the perfect med at the perfect time. No detox required. No harmful side effects, so patients could take it indefinitely as with hypertension medication. It virtually eliminates cravings and risk of overdose. People taking it are NORMAL.
Do many people know this? Prince was addicted to opioids, and called an addiction doc in California for help. Prince’s jet had recently made an emergency landing — I think in Rockford Illinois? — when he overdosed en route to his home. Prince was given narcan and survived, and soon called the doc in California for help.
That doc (Dr. Kornfeld) couldn’t get to Minneapolis for a couple days, so he sent his son, a med student, to meet with Prince at Paisley Park in Minnesota. The student was CARRYING BUPRENORPHINE. Had Prince received it, it would have relieved his withdrawal, removed his cravings, and prevented overdose. A couple doses would have done those things for at least a few days.
The med student arrived at Prince’s home and knocked. Prince’s security searched for him, and found him in the elevator, dead from overdose. He was minutes from living a life without risk from opioids. There were discussions with the Feds about whether to charge the person carrying buprenorphine for deliverinig a controlled substance, but in my opinion cooler heads prevailed, and I believe those charges were never filed.
Of course I did my treatment the old fashioned way in 2001, before buprenorphine was available. Over three months away from the family, and released the day after the 9/11 attacks. I don’t joke a lot about that because (as I’ve written), my best friend from college who stood up at my wedding, Dan Shanower, was killed at the Pentagon on 9/11. But I do truly think that I’d still be in treatment if the attacks hadn’t happened. That was what I thought at the time, anyway.
I often tell people that traditional rehab doesnt work for most people. It does for about half of the affected doctors. Why? Because I was drug-tested by the Board for six years and required to spend that time in group and individual counseling. Try to convince someone to go through THAT electively!
Those were tough days, finishing a day as a resident, getting ‘the call’, and finding a lab. Tests had to be witnessed because the ‘wizzinator’ had been developed. The worst part was that many labs had no men on staff to witness at 6 PM, so I had to sit at the lab, in Milwaukee, and wait for a male employee to come in from home. I asked: “please, you’ve seen this before. I’ll give you $20! Please?” Never a taker. Another problem… after those six years, I can’t pee WITHOUT someone watching!
The Prince story is so tragic, and there are so many more. When I wrote I WAS angry. Bush and Obama didn’t mention opioids until the end of Obama’s second term. And now, all of the states are increasing regulations to prevent diversion, and monitoring the number of opioids each doctor prescribes. Now, in 2022 – when there isn’t a single tab of oxycodone on the street, or so I’m told. New patients now always say they are only using ‘H’, but almost none of them test positive for that drug. Instead they are surprised to hear that the only illicit substances in their urine are THC and fentanyl.
Search my blog (the box on the right) for fentanyl, and learn why it is so dangerous. It is not about potency.
I’m still angry, but I am trying to hold onto peace. I need to avoid politics and politicians but they seem to be involved in almost everything these days. Please– reconsider joining a ‘team’. Both sides encourage it, and it is not helpful for the world we will leave to our children. Be curious – even about the things your team says and does. Challenge narratives. You will find that a challenge is most useful when you challenge your own team members, because the other team’s members will immediately write you off.
Your emails help me, so feel free to keep them coming when it is convenient. This recent experience will hopefull change my life. I already see it as a gift from the Heavens, just like every beautiful Autumn day, and every good dog.
Still need a new name for this blog though.