Over my 21 years of using opioids I’ve often joked to myself that I don’t have a drug problem, I have a running-out-of-money problem.
In the mid-aughts when I was buying Opana (oxymorphone) and Dilaudid (hydromorphone) off the street, my tolerance was under control in the sense that the pills were working fine for me. Because they’re a sure thing. As long as you’re dealing with legitimate pharmaceuticals, you know what you’re getting every time.
A regulated supply means you can have a tolerance plan. You can budget yourself something that keeps you in that balanced, happy medium between withdrawal and overdose. Not so little that you’re alternating between the toilet and the bed. Not so much that you forget to breathe.
Anyway, what was getting out of control was the expense. When 80 mg pills are going for $20 and you’re going through 10 or more 80s in a day, that’s your problem. Time to shuffle. Deal yourself a new opioid.
Going through one $10 bag of dope—I personally reserve the term for heroin, which is what we were still getting in those years before fenta-dope came along—in a day was a much more manageable habit than the pharmaceutical analgesics. And the potency didn’t wreck your tolerance so you could still mix in buprenorphine if you happened to have access, as long as you knew what you were doing.
It used to be easier to find the 8 mg Dilaudid tablets. Then just the 4 mg tablets. Then the 2 mg. Some people say the 2 mg is actually better, because physically it’s so small that there’s not a lot of binder—the adhesive powder that holds a tablet together—so it’s easier to inject. Personally I say it’s better to have the bigger pill and figure it out.
I used to be able to get Subutex (buprenorphine) prescribed without too much trouble, but only for six months or so. Any longer and docs start insisting on Suboxone (buprenorphine with naloxone), which is more likely to end in precipitated withdrawal when you’ve got short-acting opioids in the mix. For a while you could say the color additives that made the Suboxone tablets orange gave you a headache and they’d prescribe the white Subutex instead, but they figured that one out eventually.
Opana and Dilaudid seem scarce these days. And the street price of legitimate pharmaceuticals is such that when you do have access, it’s more economical to sell them and put the money toward fenta-dope anyway.
Availability. Price. Tolerance. Inevitably one of them changes. Whatever balance was achieved is now lost. Time to shuffle, deal yourself a new opioid. If it weren’t for the running-out-of-money problem, I wouldn’t be so vulnerable to the unregulated supply problem. Or the methadone clinic problem.
Used to be that if you were on buprenorphine and using dope on the side, the dope would let you linger in that tolerance range where under 24 mg of bupe did something for you. But past 24 mg, past 32 mg, time to shuffle and go from bupe to methadone.
Soon it’ll be time to shuffle again. Taper the methadone down until it’s low enough to jump back to bupe. Stabilize at 24 mg bupe. Try to maintain on bupe and fenta-dope. Jump to fenta-dope and methadone. Honeymoon periods, followed by the long straight shot down the highway—as long as possible, please—of functional usage, and eventually arriving in the familiar position of holding my head in my hands asking myself how I wound up here. Hopefully there were some pharmaceuticals along the way.
The running-out-of-money problem. It foretells the true battering of my psyche, the fear felt in my very soul when the first faint chill of withdrawal slides down my spine. A harbinger of what’s to come if I don’t fix the problem in time.
The dread of impending withdrawal is difficult to separate from withdrawal itself. I find that benzodiazepines ease passage through both. My collection of nicotine vapes also eases the omnipresent anxiety of that mental calculus: How much dope do I have left? So does coke, but the vapes do less to exacerbate the running-out-of-money problem.
Shuffling from one opioid to another is so often a gargantuan task that leaves little room for anything else, which may or may not be an issue depending on what kind of responsibilities you have in life. Some people tapering off methadone try to speed up the process with short-acting opioids, like the ones that got them on methadone in the first place. You can forget to take a step back and check in with yourself about what exactly is your goal here.
Sure, I want to get high. That cozy mellow buzz, like a warm blanket and a cup of hot chocolate milk—opioids have served me well with their ability to temporarily delete emotions, when those emotions are too much. The stages of grief after a loved one’s passing? Too much agony. Too much aching. Starting over after losing a job, perhaps due in large part to an opioid problem, or rather a running-out-of-money problem? Too much guilt. Too much shame. Do I have to feel those things? How much dope do I have left?
But my objective is always maintenance. A long time ago I came to terms with the idea that I will be on opioids, in one form or another, for the rest of my life. It surprised me at first to find relief in accepting this, even an affirmation of my conviction that opioids are helping me through life. Why leave behind something that smooths the sharp edges the world throws our way? Why not regulate the supply, and stop overregulating methadone, so that we can achieve this without gambling on respiratory failure? That shouldn’t be the only way to solve the running-out-of-money problem.
Top image (cropped) via Canadian Centre on Substance Use and Addiction. Inset images via Substance Abuse and Mental Health Services Administration.