by Bette and Abe N. Jansen
July 10, 1995
We planned the crisis four weeks in advance. What supplies should we bring to deal with it? What was the best route to the hospital for things we couldn't deal with? Who would take the kids for the week of isolation? We collected up medicines for minor potential side effects. We packed clothing in various weights to handle chills, fevers, sweating, and vomiting. We saved up things from work that we could do to fill five days at home. We scheduled our friends' time to crisis-sit with us, to tend to the kids, and to forewarn them of our obligatory incapacitation.
The Percocet would run out on the ninth, if she could keep to the three-a-day schedule. We planned to leave on the morning of the tenth. The chills are supposed to set in after about 12 hours, and the physical pain after 24 hours. We wanted to be sure to get there before the intense craving began. She was scared to death. I was pretty scared, too.
Percocet. The godsend Percocet. The goddam Percocet. It was a godsend to her, an easy treatment for her back injury which didn't interfere with raising her three kids and teaching her courses. But it was a goddam curse, too, because after ten months on it, she was fully addicted. She had to get off of it, because the doctor wouldnt prescribe any more and he shouldn't, because he was well beyond the ethical limit anyway. We had to do the "detox" on our own because Bette's ex-husband would love an excuse to get custody of the kids. Bette's tenure board would also frown upon a detox center, or any mention at all of drug dependency. There's a Drug War on, after all, and loose lips sink careers.
She knew she was addicted when she began counting the pills in front of the kids. They offered to help count. The count was usually low the drug store would supply 88 when the prescription said 100. The pills sold on the street for $14-$20 per pill, so shorting her by twelve was worth about $200. The prescription price was $45 per bottle of 100.
"I've never been addicted to anything before," Bette said. "And I've had plenty of opportunities. I never even smoked as a teenager. I don't even know how I got addicted now." We took an hour or so every day the last week to discuss what her symptoms would be, and how to deal with them. I found a couple of books, all of which made withdrawal sound pretty nasty. But I figured that the more she knew, the less scared she would be, since at least she would know what to expect.
Three weeks earlier, I had to make a business trip to DC. The night before I came home, I got back from running around the city to a long collection of voice mail. "I really miss you," said the first, 4 PM. "I'm feeling awful," said the second, 6 PM. "The 'Don't Panic' sticker stopped working," 7 PM. "I don't know what to do," 8 PM. "Oh please, understand that all I want is peace of mind and complete darkness," 9 PM. Incoherent staccato, 10 PM. I called; no answer. I called the office; no answer. I imagined an illegibly scribbled note dropped in a pool of blood. I called again and left nervously pleasant messages despite the pervasive image. "Hi, just checking in I got a lot of messages, I'll see you tomorrow." I got up at 8 AM and tried again. No answer. The pool of blood grew larger in my mind, spreading across the room. 9 AM, from National Airport. No answer. The pool began to drip down the steps. I arrived at noon at Logan Airport in Boston. Should I call? No, more dramatic just to walk in and find the body. I took a cab.
Belle was on the steps and jumped up screaming when she saw it was me. "Abe's back! Abe's back!" I assumed that meant that the pool of blood was either cleaned up already, or that Belle hadn't seen the body. Bette came out, apparently whole. She said, "Didn't you get my message this morning? I said, 'Disregard all of last night's messages,'" she said. "I tried to detox myself. I thought you'd like that I was so tough and cool. It didn't work." She rolled up her sleeve to show me two bright red stripes. They were in the across direction, which means she didn't really mean it, but they sure were bright red. "I took two Percocet to make cutting myself hurt less. But they made me think straight again, instead. The last call to you was before the cuts. The pills were after, and now I feel normal again."
After that, she didn't try to go it alone. She didn't like being so dependent, but she didn't like being addicted, either. So we read books and asked details of friends who would know what to expect. My friend Scott, a nurse, said, "The first thing to do, if you're gonna detox yourself, is to remove all the sharp objects from the house." That was before I had told him about the slashed wrists. Bette felt relieved that at least she was acting normally, under the circumstances.
"This isn't gonna be easy," I told Bette, "but we can get through it together. Love conquers all."
"I don't believe in love," Bette reminded me.
"Yeah, but I do. And I'll make a believer out of you, because I love you. Especially your freckles," as I caressed her heavily freckled shoulders.
"I don't believe in freckles, either," she concluded glumly.
We asked Scott if we could detox at his house. His wife, Miriam, is a dentist, so she could prescribe stuff if we really needed something. They both recommended a detox center, but said okay.
We planned to leave for their place in New Jersey on Monday morning. Belle would stay at her grandma's house. Berke would spend the week with his godfather, and Benje would stay at daddy's place while mommy was "on vacation." Daddy couldn't know the truth, of course, since daddy was the reason we had to do it secretly.
On Scott's block was a sign saying "Drug Free School Zone." "How appropriate," Bette noted. "I'm glad his house was on this side of the sign or we would have been in the Drug Infested Illiteracy Zone and that would be a bad omen."
Bette fell asleep in my lap as I chatted with Scott and Miriam. Scott's plan was to go to work on Tuesday, since the first day wouldn't be so hard, and then stay home with us on Wednesday and Thursday, the bad days. By 8 PM, the time that Bette would normally take the next pill, she was out for the night. Scott said, "the best thing you can do is sleep a lot." With the kids, Bette never had the opportunity to sleep through the night, so this would be her first time in years. As it turned out, she didn't sleep too well.
She woke up in the middle of the night, feeling lousy, and concocted a plan. I can't do this detox shit, Bette thought. Scott and Miriam will leave for work at 8 AM. Abe won't wake up until 9 or 10. I can sneak out, go to the hospital, and explain that I was in town visiting friends. I'll clean up, to look respectable, and tell them that I had just thrown my back out. I just called my doctor, I'll say, and he says he can't prescribe out of state. This had happened before, so my doctor knew what it was, spinal stignosis and discal prolapse between T8 and T9, partially herniated with no sciatica, I'll say, to throw some terms around which would impress them. This happens every couple of years, and it's been a year or so. My doctor gives me a relaxant like Valium, and an anti-inflammatory like Narprosyn, and a pain killer, I'll say, to sound knowledgable. I can't take Perco-something-the-other-Perco-one, because it has aspirin in it and makes me throw up, but the other Perco-something, with Tylenol in it instead of aspirin, is just fine. The last bit is to sound innocent, so they won't think I'm an addict looking for a fix. I'll go in the morning, because going in the middle of the night looks too desperate. I just flew in to NYC, I'll say, and we're here for a week, so I need enough to keep me for six more days. I was in the city working yesterday, and came out to Jersey to visit friends, and I don't know what happened, I just walked down the stairs wrong, and now the pain is incapacitating me." She figured she had a very good shot of being believed. She went back to sleep and I never suspected.
"Anything that doesn't kill you makes you stronger," I quoted Nietzsche.
"Well, I'm gonna end up real strong!" Her other strength-inducing symptoms included dry mouth, freezing cold, a persistently and annoyingly running nose, immense bags under her eyes, and of course craving. "Craving is too mild a word," she said. "I want some fucking Percocets, and I want them now!"
Immediate gratification, just like Berke and Belle and Benje always want. What does she tell them? I echoed her favorite retort, singing the Rolling Stones, "You can't always get what you want."
"Yeah, I'll try to keep that in mind," she said, refusing to sing along. Practice what you preach, you weak charactered bitch, she thought to herself. This is only the first day. How about the beginning of the song, "I saw her today at the reception, glass of wine in her hand, she was there to meet her connection...." How ironic. My connection is an upstanding doctor, in a wealthy suburb with affiliations at the best hospitals.
We performed a ceremony to dispose of the empty Percocet bottle. "May you rot in a stinking pile on Staten Island forever, like the the rotten stink that you cause in people's lives," I said as we threw it into the trash together, one hand each. She was happy to to get rid of it because it made her crave more pills every time she saw it.
By evening, her runny nose demanded pills of its own. "I need some Dristan and painkillers," Bette said. She got the Dristan. I worried about this runny nose thing, since the textbooks didn't mention anything about it, and they had gotten all of the other symptoms right. She complained of excruciating back pain, which the textbooks said to expect, because she had been masking it for so long. I gave her a massage, which helped a little. "Oh, cool, I can see your back muscles spasming," I said, as they twitched and danced in my hands.
"I'm glad you're having fun," she responded. The pain is in every part of my body, she thought. I never knew I had so many muscles. I can't even take anything like aspirin or anti-inflammatory pills because they make me nauseous and with the omnipresent nausea, I'd puke for sure. Puking is not good for back problems. I feel like shit. Scott stuck a thermometer in her mouth and seemed disappointed that it was only 99. Everyone around me is complaning about the heat, but I'm freezing in a double sweat shirt plus three layers of blankets. Is that why they call it "the shakes?" What if I die tomorrow, or next week, then this'll be for nothing.
The massage made her feel good enough to make a case for some more pills. "What's wrong with being addicted to something," she argued with Scott, "if it becomes necessary for life? We're addicted to food! We need to eat every day, and we have to do it every day for all of our lives. So what's the problem with addiction? Isn't addiction healthy?"
Scott replied, "You're not thinking rationally, you're thinking like an addict."
"Isn't that rational, that something that nature makes you do is necessary and healthy?"
"We're bigger than you. You lose. No pills." When justice is gone, there's always force. Bette grumbled herself asleep.
"Orgasm indeed takes my mind off the pain and why we're in New Jersey," she said afterwards. "It's good for about a half hour. Shall we do it again every 30 minutes?" I was pleased at the idea, even if the actuality seemed unlikely.
When Scott and Miriam got home later, Scott must have noticed a smell and asked me, "Did you guys have sex in this room?"
"Yeah," I promptly answered, not being one to hide stuff from Scott.
"How embarrasing," Bette said to Miriam, "Abe thought it would be therapeutic."
Miriam asked, "For you or for him?"
We read the paper and hung around chatting. Bette drifted out of the conversation after a while, concocting her Plan of the Day. She asked, "Can I go for a walk?"
"No," said Scott and me simultaneously.
"What am I gonna do, I just want to take a walk."
"I'm not sure what you're thinking, but I'm sure there's some plan," I said.
In fact, I do have a plan, she thought to herself. I'll take a rock and break Abe's car window, and take the Tylenol #3 pills, which Abe had left over from some dental thing last month. I saw them "hidden" in his glove compartment on the drive down, and recognized what they were right away, but looked scornfully at such a mild drug. It didn't even have a real name, even if it was perscription. I couldn't be bothered, then. Now, even a lowly anonymous narcotic would do. Hey, they had some miniscule amount of codeine.
"If you want to take a walk, I'll go with you," I said.
OK, it's just the two of us, so I can persuade Abe to give me some pills, she began planning again. If Scott had said he was going to come, I'd have said I didn't want a walk after all, because he's a hard-liner, and I wouldn't get the pills. With Abe alone, I might get them. As soon as the door closed and we were outside, she said, "Do you have the car keys?"
"No," I responded, "you're not getting the pills."
I quickly realized that Scott had brainwashed Abe. Walking around the block, I looked for a place where I could seduce Abe, a nice spot in the woods, where I could promise him anything, pledging eternal love, if he would conspire to get me the pills. Or maybe, we'd have sex and I'd say "I can't continue because it hurts too much. Let me take some pills so we can finish," because I knew that all men's weak point was their dick.
"Nice try," I told her. My brainwashing was sufficiently thorough that we made it back without retrieving the codeine pills.
Bette walked past the shoes, just glancing to see the keys. Scott saw her and said, "Forget it, Bette, they're not in the car anymore." He meant the codeine pills.
He was right I was looking at the keys to plan when I could grab them to run out to the car to take the Tylenol #3, with its oh-so-precious codeine! I walked out of the room, keeping my cool, but felt my blood pressure going way up because my plan had been shattered. Where could the pills be? Abe can't have them because I can beat Abe at arm wrestling so he knows I can wrestle them from him. Mir can't have them because she was with me. So they're either on Scott's person, or in Scott's car, or hidden in the house. I can't overpower Scott, so I need a better plan. I could kill them all, and then search the place, but I'm not sure I could kill all three, and besides, that's crazy and immoral. Killing them would be ok if they were bad people, but they're good people, so that's immoral. I'll have to hold a knife to myself, holding myself hostage and demanding the pills. I'll hold the knife to the artery in my neck (it's not a gun, you can't hold it to your head, that would look silly and probably wouldn't work), and I'll have to be ready to kill myself if they didn't respond in the necessary period of time.
"OK, let's eat," Miriam said. The smell of the Chinese food broke Bette's spell and she gave up her plans for homicide.
Bette woke me up just to have someone to hold for a while.
Scott entered the room, asking "Are you in pain?"
Bette replied, "Yes."
Scott answered nonchalantly, "Just checking," and left the room.
"Hey, Scott," I called him back. "Is she still going to have multiple orgasms after she's off Percocet?"
Scott answered "Probably, since it doesn't affect sexual appetite."
"If you lose that, I want you to go back on it," I said to Bette.
"Of course, Abe, your sex life is much more important than my health," Bette responded. "Abe, I need some more Dristan. And I had diarrhea in the middle of the night. And my muscles all ache. And the pain is spreading down my legs."
"OK, I'll give you another massage," I said. "Hey, Scott, what about this runny nose stuff? It's not in the book."
"Yes it is, it says 'rhinorrhea' in the list of symptoms," Scott noted.
"Oh, I thought that was some kind of allergy." We re-read the official symptom list. Bette was indeed responding normally. A small consolation.
Putting massage cream on her lower back, and rubbing it in with a hard massager, looked just like what the Physical Therapist did. It seemed to help a little. It got her mind off of things, anyway. Dropping the cream from about six inches up made the drops look exactly like chocolate chips, you know, with the flattish bottom and a 'love-handle' bulge just above the flat part and that cute little curl on top. "Hey, look! I finally understand how they make chocolate chips in that exact shape every time," I exclaimed. Bette, as usual, was happy that I could find some amusement in her agony.
"No," Bette answered, "but I looked." In fact, I had only looked in one place, she thought, where Scott and Mir kept all of their other medicines. I didn't look elsewhere because that would be invading their private space. But I was planning to take whatever medicine they happened to have cold medicine, cough syrup, some allergy stuff, a few leftover prescriptions, whatever and maybe some of it would do something. I was arranging the menu and I knew I was really going nuts because I never take non-prescription medication.
Then things started to feel bad. I put my cowboy boots on, and got ready to go to Manhattan. To the Village, I figured. I had no idea which way it was to "the City" (as they called it on this turf), but I figured the people around here would all know. I also took a handful of valium, because of the spasms and the shaking. Then it was like my body was completely betraying me I wanted to walk out the door, but the pain went through my back, down my legs, and everywhere. I lay down on the couch, thinking, 'Fuckin' missed another fucking opportunity,' knowing that I couldn't make it down the stairs. I fell asleep with my boots on. Like an outlaw. Then Abe came back from cleaning the car. He gave me a massage, took off my boots, and let me go back to sleep. Then the bottom dropped out.
She woke up covered in sweat, but shaking from the cold. She was fully dressed and her skin felt hot and wet all over. She demanded pain killers. Those hidden codeine tablets. She demanded them with a forlorn look and obvious unfaked pain. I caved in, "Let's give her two codeines."
"No way," said Scott, "Cold turkey is cold turkey."
"But the book says that milder narcotics are a good way to do withdrawal," I pleaded.
How endearing, thought Bette, except that it's obvious Abe is going to lose the debate.
"No way," said Scott, and left the room.
We lay down on the thick carpet in the living room. For the first time, she cried a few tears. I held her tight. "Hold me tight," I said, "squeeze me to bear it."
"I don't have the strength to hold you," she said faintly. She barely had the strength to speak, and I had trouble even hearing her.
"Take my strength," I said, "I have plenty to spare. I've been saving it up for right now. Take all you want." She managed to get her arms around me. My eyes welled up, too. "Here, take a teardrop onto your lips. That's how you can take my strength." I touched my eyes to her lips and she tasted the salt. It somehow did make her stronger, it seemed. We held each other for a long time, laying on the floor. "This is as hard as it gets," I said. "This is the worst; it only gets easier once you get through this."
He better be right, Bette thought, too weak to say it. I'm tough, or I used to pretend that. Only I don't feel tough at all now. I wonder if I'll ever be able to beat Abe arm-wrestling again.
Bette hid in the back, absolutely mortified. "Here, try this detox mixture," the clerk offered. It was an herbal cleansing mixture of some sort, for $15.95.
"What do you have for analgesic? You know, for general pain all over the body?" The clerk offered another bottle of herbal pills.
Bette came up to the counter. "What kind of pain is it?" the clerk asked her.
"Spasming back," Bette admitted despite her mortification.
"Oh, I thought you meant spiritual pain," the clerk said, pointing to his head. "These pills are for spiritual pain. I'll give you something else for back pain." He produced a tube of cream from behind the counter, ammonia-based heat massage or something. Another $12.50.
"Well, this is what credit cards are for," I thought to myself as the digits flew by on the cash register. I consoled himself by thinking that maybe, just maybe, if I bought enough pills, I might get laid tonight, if even one of them worked. "What the heck, $85 is still a cheap lay."
We got back to the apartment. Bette chug-a-lugged some ginseng. I opened up the B-vitamins and gave her the high end of the recommended daily dose, thinking, "She likes excessive pills, and these are better than codeine." It was 20,000% of the Recommended Daily Allowance for B1, B2, B6, and B12. Scott looked up the herbal concoction's chemical components in his medical handbook as Bette took the pills. I mixed up a spirulina milkshake, with a double dose of spirulina powder. The ammonia cream made wonderfully bright blue chocolate-chip shapes on her back.
Miriam said to Bette, "You look a little green. Do you feel up to going out?"
Green is not a good skin tone, Bette thought, but her addiction to bookstores and her desire to get out of the apartment (and potentially escape) overrode her pigmentation phobia.
We went to some mall, endemic in New Jersey, with a Barnes & Nobles. We picked out a new computer program for Berke, and found Belle and Benje some nice postcards. After an hour, Bette's greenness caught up with her. Where the hell is Abe?, she thought, feeling disoriented and imagining being lost in the bookstore and throwing up in the middle of the health aisle. "Here you are, in the obvious spot, reading porn while the honorable Scott reads History," she said. "I feel a little sick."
"There's a bathroom in the back," said Scott.
She couldn't find it in her disorientation, so I walked her to the five-foot-tall "RESTROOM" sign, alphabetically located between Reference and Science. She looked very green upon entering, as I turned her from the MEN'S sign to the other one. "I'll meet you at the cash register," I yelled after her, and then went back to the History section to find Scott and my unfinished pornography.
I went into the bathroom and immediately threw up a wierd looking concoction of herbs and vitamins. I've had a lot of Johnny Walker in my day, and spicy greasy food, and it's never gotten to me, but this herbal stuff is fuckin' serious shit. Throwing up is supposed to make you feel better, but I feel worse because the throwing up itself makes my back pain worse, gives me worse stomach cramps, and I still feel nauseous after one round. I washed up and went out to find Abe perusing Penthouse. He looked at me as he signed the 3-digit sales slip for the books, and I knew his heart was sinking because his previous sales slip had gone to naught.
"There goes my investment," I thought to myself, noting how green she still looked. "Let's get home," I said.
I had cleverly gotten two plastic bags at the checkout counter, so I could give one to Bette in case of trouble on the way home. "Pain. Cramps." said Bette, reduced to monosyllabic sentences from her usual charmingly non-stop chatter. "Nausea. Pain." As soon as we got home, Bette retired to the bathroom to eject the remainder of the herbal goop. I read through the Playboy more properly, noting to myself to have Bette fill in the Mail-In Sex Survey at a more appropriate time.
I filled up the bath for Bette. I figured that a bathtub would get the weight off of her back. Bette got in and I got in behind her. Bette suddenly felt something other than pain in her back. She turned over in the water and took me into her mouth. "I love your freckles," I said, caressing her back, "and I love you." I pulled her up onto me, entering her under the water.
She came twice, quietly. I feel more completely high out of my mind, she thought, than I ever felt on any drugs, my own endorphins combining with Abe's endorphins make me higher than any artificial substances I've ingested or injected into my body. We held each other as the water drained out, feeling completely drained ourselves, and then got out of the tub.
I asked, "Do you feel better?"
"Yes."
"Does your back hurt?"
"No."
"Are you nauseous?"
"No."
"Do you have stomach cramps?"
"No."
I gave her a thumbs-up. "Therapeutic sex."
"Well, waking up is the hardest," I said. I held her and pulled the covers over her, because she was shivering and sweaty. I said, "Okay, this is the last bad time, all we have to do is get through this time and it's all over."
"Every part hurts, I don't want to be in any part of me."
"I want to be in part of you."
I laughed inside but hurt too much to smile outside. I began plotting about how to get the knife, and how to get Abe off of me. It's like a freight train running through my head, everything felt awful, nauseous, stomach cramps, back pain, every muscle aches, all of the symptoms simultaneously magnified, I just want to get out of this death trap, out of my body. I feel really weak too, so I can't do anything. Plotting to get the knife was tricky I have to make an excuse to get Abe off of me, and then I have to gather up the strength to get the knife. I tried to put myself into a trance. It didn't work too well. "Do you know where the codeine pills are?"
"Yes," I said, and nothing else. She would have to ask, and ask again, if she wanted them. I wasn't going to offer anything beyond acknowledging their existence.
The way he said Yes, his voice so pure and honest as he lay on top of me, made me suddenly believe in love and saving the world again, over death and addiction and medicating myself, and I knew I couldn't ask for the pain pills. It was a mental turning point. I didn't want to live the way I had been ever again, I sure didn't want to go through this again, I wanted to be just me again and I knew after all we had been through that Abe loved me just like that, and I suddenly realized I loved him totally and unconditionally. I believe in people that believe in freckles and I believe in the freckles themselves. The walls came crumbling down. So I didn't ask.
I pulled her closer. She was too weak to hold me. "I bet I could beat you arm wrestling now."
"Reason enough to kill myself." I can go into a trance, she thought as we lay together for a long time. I feel him breathing, I can try to get into him and out of me. I am aware of his breathing and nothing else. I will find a blank space in the middle of my head, and fill it with him. I am aware of every aspect of his body, his breathing, just him. I half-achieved my trance and filled myself with him. I don't remember how long it was, but it sort of worked.
I held her for a long time, just waiting for the worst to pass, and letting her get warm. I had five blankets on top of us, and I held my over-heated body against hers too. And I set the thermostat to 85ฐ so the room would warm up for when she got out from under the covers. When I couldn't take the heat any more, and she had stopped shivering, I got up to find something to distract her. The place was littered with pills and potions, and I figured if each one had a small placebo effect, that the cumulative effect would be fairly substantial. "Here, take these," I said, offering a complete set of ten pills or so: the 20,000% RDA B-vitamins, a set of the herbal "cleanser," shots of ginseng, the Dristan, and some chewable vitamin C.
"I always feel better when I'm popping pills," she said, after the tenth one.
She was still too weak to get up, and the room still hadn't warmed up to its full 85ฐ, so I boiled three gallons on the stove to speed up the heating-up process. I brought a teapot under the covers and let out the steam, and she breathed it in and let it play over her face. I got the idea from some Sherlock Holmes movie, where they would breathe in steam under a hood. "That feels pretty good," she said. "Why did Sherlock Holmes do it?"
"He was addicted to cocaine," I said. "Haven't you read 'The 7% Solution'?" We breathed in the steam, and it seemed to help. I brought the pot of water under the sheets. She seemed a little nervous about having three gallons of boiling water in the bed with us, but I figured any feeling other than pain was positive. It only splattered once or twice.
As she breathed in the last of the steam, I went to Scott's medical book collection and brought back the "Textbook of Pain" (a real book!). I made Bette take an oath, with her left hand on the Textbook of Pain, and her right hand in the air: "I hereby unambivalently and unambiguously swear I will never kill myself as long as Berke and Belle and Benje and whatever future children I have are alive, or unless at least 50,000 human lives are at stake." We negotiated the last clause she would have settled for a dozen, but 50,000 people was enough even for me, egoistical and self-centered, to sacrifice myself for.
"No, of course not," I said. "He has to take the hard line because he knows I won't. He's doing this out of love. He doesn't know you very well, but he loves me, so he loves you through me, and he's doing this out of love."
"I'm not making a very good impression."
"Yeah, well then, let's dance." I put on "American Pie," and we sang along, changing the refrain to "And good all boys were drinking JD and coke, singing this will be the day that I croak," since Jack Daniels and Coke is Bette's drink and I never had actually drunk rye and I hated whiskey.
"It's OK for me to sing about croaking after having taken the oath this morning," Bette noted. We danced until we collapsed in a pile of sweat and exhaustion.
The official ending came at 4 PM, as stated in the Textbook of Pain, hour 72. "You've made it now," I told Bette. "Maybe some milder symptoms, for a few weeks, but this is it, we're done."
We were busy thinking of the proper ritual when Scott came in and provided a conclusionary pep talk. "You can never take pills again," he said. "Once an addict, always an addict. You'll have to use other methods now to deal with the pain: meditation, acupuncture, biofeedback, whatever, but you can't do pills. And if you don't take care of the underlying problem, you'll just end up taking something else," Scott proselytized. "Narcotics make you feel great, but they don't address the problem. They're worse than a band-aid, because they hide the pain entirely, so the source of the pain gets worse. A band-aid at least tries to fix the problem. There's a reason you were hooked on Percocet, and going off Percocet will still leave that reason to get hooked on something else. Heroin junkies are the same their underlying reason is that their lives suck, or something like that. Unless they make their lives not suck, going off heroin doesn't help, since their life sucking will cause them to go on to some other addiction next."
He looked me in the eye and I felt like a teenager who had been caught shoplifting or something, instead of someone a year older than him and much more experienced, and I sometimes couldn't look at him and tried to make stupid jokes to lighten up the solemnity. He told me to talk to psychotherapists, hire a new shrink just for this problem, how it would be worse going back to my lifestyle, how I had to make these changes. Scott said to do some teaching over the summer, which I want to but don't feel together enough to do with the kids at home, and maybe even a little scared. I knew deep down he was right about most of these things. Abe didn't even talk during Scott's speech which is most unusual.
"I agree with Scott," I said. I was just happy that someone else had said all that stuff, so that Bette would hear it. But I wondered, would Bette be addicted to something else next? So detox now is pointless? I certainly don't want to go through this regularly once is okay, but do I want to be in a relationship defined by addictions?
We packed, and I straightened up and tried to make Scott and Mir's apartment back into the neat conventional place it was before we arrived. We got on the road again, blasting hits of the 70's, singing along to "Seasons in the Sun" and "Billy Don't Be a Hero" through the highways of New York and Connecticut, burning up with the car heater when the shakes came, taking off the T-top to cool off when they were gone. "I feel free, just give me a shot of rock & roll," Bette said. We hit every traffic jam, and like the five days of withdrawal, it took a long time to get home. You can go home again, thought Bette as we turned onto their street.
We pulled into the driveway. Berke and Belle and Benje saw us through the window. The kids yelled and turned to run down the stairs. "I couldn't have done it without you," Bette said. I replied, "And I couldn't have done it without you, either."
[Harrison's Principles of Internal Medicine, 11th edition]
THE OPIATE ABUSER: The Medical Abuser: People with chronic pain syndromes (e.g., back, joint, and muscle disorders) may misuse their prescribed drugs at various times. If physical dependence is established, abstinence syndromes can then intensify the pain, promoting continued drug intake. A few precautions can help the physician to avoid contributing to physical dependence in chronic pain patients...: 1) the goal is to minimize the debilitating effects of the pain with the understanding that the discomfort may not be completely eliminated; 2) get the patient actively involved in improvement; 3) analgesic medication should be only one component of treatment; include behavior modification techniques (meditiation or relaxation).
PHYSICAL ADDICTION AND THE OPIATE ABSTINENCE SYNDROME: The symptoms of withdrawal:
The time to onset as well as the intensity and duration of the acute abstinence syndrome are influenced by a number of factors including the drug's half-life, its dose, and the chronicity of administration. The withdrawal symptoms tend to be the opposite of the acute effects of the drug and include nausea and diarrhea, coughing, lacrimation [teary eyes], rhinorrhea [runny nose], profuse sweating, twitching muscles, and piloerection [goose bumps]; and mild fever. In addition, sensations of diffuse body pain, insomnia, and yawning occur with intense drug craving. Drugs with a short half-life, such as morphine or heroin, cause symptoms typically within 8 to 16 hours of the last dose (thus, many addicts awake in mild withdrawal every morning); peak effects are apparent within 36 to 72 hours after discontinuation of the drug, and the acute syndrome disappears within 5 to 8 days. However, a protracted abstinence phase of mild symptoms (e.g., pupillary dilation, autonomic dysfunction, changes in sleep patttern) may persist for 6 or more months.
Treatment of the withdrawal syndrome: Proper nutrition and rest must be initiated. Effective treatment requires readministration of sufficient opiate medication on day one to decrease symptoms, followed by a more gradual withdrawal of the drug, usually over 5 to 10 days. Any opiate may be used for treatment, since all have some level of cross tolerance.
[Physicians Desk Reference, 47th edition, 1993:]
Percocetฎ contains:
5 mg of oxycodone hydrochloride (WARNING: May be habit forming)
and 325 mg of acetominophen
Oxycodone is derived from an opium alkaloid, thebaine.
CLINICAL PHARMACOLOGY:
The principal ingredient, oxycodone, is a semisynthetic narcotic analgesic with multiple actions qualitatively similar to those of morphine. Oxycodone is similar to codeine and methadone in that it retains at least one-half of its analgesic activity when administered orally.
INDICATIONS AND USAGE
Percocet is indicated for the relief of moderate to moderately severe pain.
WARNINGS: Drug dependence:
Oxycodone can produce drug dependence of the morphine type and, therefore, has the potential for being abused. Psychic dependence, physical dependence, and tolerance may develop upon repeated administration of Percocet, and it should be prescribed and administered with the same degree of caution appropriate to the use of other oral narcotic-containing medications. Like other narcotics, Percocet is subject to the Federal Controlled Substances Act.