Nothing Like It!

Nothing like it! I’ve been nursing for five decades. I’ve been nursing in withdrawal management since 1989. I was asked last week what sort of changes I’ve seen since I started working in detox facilities.

And there has been nothing like it. From Saskatchewan to Texas to British Columbia there has always been alcohol abuse at the top of the list. The list of the substances that kill has grown longer and more deadly. Cocaine, crystal meth, heroin in all their many forms. Smoking, snorting, IV drug use and just plain pills. Pills. Pills like oxycodone, hydromorphone and now fentanyl. Did I forget to mention all the benzodiazipines?

Everyone of these drugs, and in whatever form, have a certain withdrawal syndrome. When they’re mixed, the withdrawal syndrome is confusing and more dangerous. Some people actually survive. Some may have their lives saved, but their bodies and brains are damaged. Damage that is reversible or damage with long lasting consequences. And too many people of any age die. They just die.

Controlling drugs and alcohol has not stopped the use and development of more refined drugs and alcohols. In all of this mess, where are the studies, research and treatment for addiction and the medical effects of substance abuse? Short stay in a detox is barely a bandaid. Long stays to give the body, psyche and brain a chance to heal are what is really needed. My only satisfaction as a detox nurse is to help someone survive to live another day whether the services are out there or not. I depend on each individual to navigate our myriad of inadequate systems.

There has been nothing like it. Who do I blame? All of us. Our health care systems, our pharmaceutical companies, our families, our very cultures. Am I angry? I don’t have time to be angry when I am shepherding a youngster, a mom or a dad, or sometimes even a grandparent through a complex withdrawal. At some point, these dangerous, toxic substances trump survival.

“We’d stared into the face of Death, and Death blinked first. 

You’d think that would make us feel brave and invincible. It didn’t.”

~ Rick Yancey, The 5th Wave

Crisis of Care

In 1966, I stood in a linen closet crying because I was just too scared to do a bed bath…..on a man….kind of old - probably about 40. That was the crisis I had to deal with. 

Telling my dad that I was quitting nursing was the alternative. Just over twenty years later, there was another critical point in my nursing career. Yes, I continued in nursing. That crisis was on a medical unit in Regina. I wanted to know how, with nursing process, to care for patients in alcohol withdrawal. So I moved to Texas. There was no nursing education specific to alcoholism, however I did get experience in a treatment center. Nurses were in treatment centers, not hospitals. And yet, alcoholics and those with drug addiction frequently require medical care for the medical effects of alcoholism and/or drug addiction.

Today, there is another crisis in the world of nursing. In the world of health care workers at any level.  On the streets, in the ambulances, in emergency rooms. Fentanyl, prescription opiate and illicit opiate abuse. I’m not sensationalizing when I say the people are dying out there. Withdrawal management, better known as detox, is alive and well whether in hospitals or detox facilities. I have told many patients over these last many years that I will take care of them as many times as is needed. I have told them that relapse is not a shame but part of the process of addiction. This brings me to the next crisis in the world of active addiction. It has become so much bigger than that first bed bath. And it really is not my crisis.

We, within health care, have the knowledge, tools and abilities to treat the medical effects of this dreadful condition that spirals into so many other medical conditions. We are saving lives…..over and over again. For those that still have loving families, employment and community support systems there is some hope. Hope that a new life, a good life, is a possibility. And then there are those whose bridges have all been burned or are at least severely damaged. Those that are homeless, jobless, with no family. And yet we save lives.

I am reminded of Ebenezer Scrooge when he relegates them to ‘work houses and prisons’ and ‘if they would rather die then let them’. Is that where we are now? And yet we still ‘save lives’. And where do these lives go? The ones that are homeless, jobless, and with no family. Has society even thought about the personal addiction treatment that is needed alongside valuable medical management? In five decades, my limited view of how we have progressed past the stigma, to identify the chronicity of this condition, is that we are still blinded by the brilliance of controlling substances. We seem to have completely forgotten the individuals, the families that have been devastated by the conditions of alcoholism and addiction. 

To begin to mend this crisis, treatment centers, outpatient clinics and more importantly affordable homes are required. Housing and funding. For those that have housing, their ability to maintain clean and sober time increases, the quality of recovery is improved. Is this an easy task? No. It will require a complete restructuring of our attitudes and our ways of thinking in our increasingly complex system of health care.

“Sometimes you need a little crisis to get your adrenaline 

flowing and help you realize your potential.”

~ Jeannette Walls, The Glass Castle

Harm Reduction in Canada

My posts have been poetic, story, musings and my opinions. My opinion pieces have been about epilepsy, addictions and the state of affairs in the world. I have offered book reviews, movie reviews and an occassional play review. My life is pretty full and interesting.

Today’s post is inspired by an hour long seminar about Suboxone maintenance and Opiate addiction. Both topics can fill much longer than an hour, but for today a small group of health care professionals gathered to listen to a presentation about Suboxone, the medication we use for opiate withdrawal at the Detox where I work.

So much has been learned about the brain and still there is more to learn. For this nurse, brain function and the brain changes that occur in any addiction is the most important part of any level of addiction care. From those that work in street clinics and community teams to those of us employed in withdrawal managment or hospitals to the counselors, social workers and nurses that work in treatment centers across this continent, we are all working with individuals with varying levels of brain dysfunction. Although neuroplasticity can rebuild some of the damage, that rebuild will take years to complete and only with long term life stability. 

Long term opiate abuse has increased in Canada by leaps and bounds with the development of a variety of narcotic pain killers. The advent of the drug Suboxone (buprenorphrine/naloxone), has allowed those addicted to the longer acting opiates, to complete a withdrawal process, because of how it works in the brain at the level of opioid receptors within the brain. Brain changes also occur in long term abuse of any of other drugs whether prescription, illicit drugs, or alcohol.

Possibilities for pharmaceutical assistance in aiding those with opiate addiction were expanded. Problems arise with matters of funding for continued therapy, availability of clinics and pharmacies that manage Suboxone and the stability of individual life styles. These problems occur far too frequently, barriers yet to be addressed effectively. I continue to hope that these barriers are recognized and addressed.

“The hard things in life, the things you really 

learn from, happen with a clear mind.”

~  Caroline Knapp, Drinking: A Love Story

Slender Preparations

‘You have to be ready.’
‘He’s not ready yet.’
‘Ready? She’s not there yet.’

Readiness takes preparation
A mind set - an intention.
Preparation becomes it’s own purpose without a label attached.

Preparation takes time, energy and commitment.
Time vanishes when addiction is active.
Energy drains away in active addiction.
Intention for breaking free of active addiction - flicked aside by internal cravings.

A slender opportunity presents in detox facilities and hospitals
Slender by the standards of time and space.
Opportunity to become prepared - nourishment, rest and renewal.
Intention supported - but only for the next step - outside of the slender space

Preparation for sobriety is building up of all strengths
Physically - the slender piece but sometimes the most difficult
Mentally - possibly a much longer piece starting in the moment and stretching back in time.
Emotionally - roller coaster of emotional responses threatens to invite substance cravings.
Spiritually - a development of personal core beliefs to develop and maintain mindfullness.

“There are no secrets to success. It is the result of 

preparation, hard work and learning from failure.”

~ Colin Powell

The History of Detox

Private homes seconded for detox

when it was time for a break from the drink

Hospital beds for the very sick.

Social Detoxes with three hots and a cot

when social transition was needed as bodies mounted.

Hospital beds for the very sick.

Treatment centers of thirty days or more

to teach ‘them’ what to do and when to do it.

Hospital beds for the very sick.

Medical detox facilities thinly spread

when all those programs were still not enough

Hospital beds for the very sick.

“You have to look at history as an evolution of society.”

~ Jean Chretien

It's Only a Play

Time: noon

Place: a detox centre in an unknown city

He asked:  Where do all these people come from?

She said:  For a disease that is never discussed there sure are a lot of people with this disease of addiction!

(cue laughter)

(fade to black)

“Theater is, of course, a reflection of life. Maybe we have to 

improve life before we can hope to improve theater.”

~ William Ralph Inge

Courage - Revised

        Courage - Revised

Jutting boney thin and pale, with long hair barely twisted into a dirty braid, she was so tired, afraid and hungry every day. Active addiction’s long, long time hunger ruled every waking minute.

She had forgotten how or when the balance had tipped and the demands of active addiction had started. How could something that had been fun with friends and with family destroy a life so completely and leave a body still walking and talking? Intrusive, warm, comforting cravings for drugs and alcohol had become incessant, demanding more - and there was never, ever enough.

Sitting, tightly rocking with a thin veil of politeness, in a doctor’s office, she desperately wanted to run away from the brightness and noise of the busy Monday morning. But she just had to get into Detox. Taking precious time from her constant, frantic search for the next score was almost more than she could manage. Many days, despite incredible tiredness and hunger for solid food, she had not been able to take time to save herself. She had become desperately afraid for her life.

Later, huddled on a hard cot, covers pulled over her head, she shivered uncontrollably. Each tiny muscle in her body vibrated with need for the bottle or needle that would deliver relief. She was drenched in foul smelling perspiration that oozed from every pore. And so cold! Even her bones ached. Her legs kicked and jerked, sleep so fragile that constant movement kept her awake and ready to bolt.

Nausea and hunger mingled in a bile coated, shrunken stomach. Every noise magnified, jolting sounds worked in concert with jerking muscles. And why were all the lights so bright? Head completely covered, tiny rays of light lasered through minute cracks in the thick blanket, jabbing through pinched eyelids.  

Every cell and nerve in her body screamed for the relief that she refused provide. It would be so, so easy. There were many only too willing to help her back into the chaos she was trying to escape. Her very life was at stake. The high and the fun had gone as surely as her job, her home and her family. Would any of them wait for her to come back? Many family and friends had already turned away - she knew they had been right.

She sobbed bitter, despairing tears - again. This was not the first time in Detox for her recovery to begin.

“If you are craving your wants, first ask your needs.”

~ Rodel Natividad Casio

Courage - Day Two

To continue from last evening

and to move forward out of the mess that I left you in.....

Courage - Day Two

With a fresher face and softer voice, she said urgently, 

‘I’m still feeling really sick this morning but would you tell me when breakfast is, please?

I’m going to try to eat. 

And will I be able to see a social worker today,

find out what I have to do next.

I can’t do this anymore, I miss my children and my family.

I 've screwed up again." Her voice caught in her throat but she continued "I know you’ve heard all this before from me,

but I really will do something different."

Who was this person?

Certainly not the angry, frightened person that

I left only 16 hours before?

There were still pale, dark circles under her eyes, 

under a tired looking and anxiously wrinkled forehead.

The identification band on her wrist said that it was her...

brown hair shiny and damp

hazel eyes clearer,

the same eyes that held me fiercely the day before.

Even the freckles that covered her skin seemed more defined.

What was different?

Clean, smelling of shampoo and soap?

Shaky confidence that she could try one more time?

Oh, it wasn’t the first and we never knew 

if it would be the last time that she, or anyone else, tried 

breaking the vicious cycle of active addiction

leaving behind people and friends she had known for years

learning to build new and healthy friendships

rebuilding frayed and damaged family relationships

finding finances for 

a roof over her family's head, 

food on the table for her children.

We were all only grateful that she had lived to try again,

and that she had made the call on her own.

I reminded her about the risks of

eating too much, too fast

exercising too much, too fast.

resting during the day to conserve this new buildup of energy

to move slowly as her mind raced....

"When the world says, "give up,"

Hope whispers, "Try it one more time."

~ Author Unknown

Courage

A missed opportunity yesterday, I am taking advantage of it today

Recovery has a path -
but it doesn't start out with clarity.

to add my commendation to all those women, men and teens that have attempted, 

and maybe even succeeded,

on this journey.

Yesterday was 

Recovery Day in Victoria

A celebration of Recovery from active addiction,

and of those brave and committed souls that

keep on, keepin’ on despite the many challenges

that they face, and burned bridges to mend.

My work in Detoxes across many miles 

is at the beginning of this often terrifying journey

that so very many take in an attempt

to restore joy and order from chaos and loss.

I am grateful to each and every patient and client, 

over the past twenty-seven years of my much longer nursing career,

for the fun, gratitude and caring you have given me,

and more importantly, given to each other.

That sounds so trite - but let me share with you 

a piece I wrote several years ago about 

this often stuttering beginning on the road to recovery in Detox.

It is not a pretty piece to read, so please do not continue if you

have difficulty with the details of sickness.

This story is a composite of many, and is true of any gender or age. 

Alcohol or drug withdrawal can be accompanied by minimal or severely acute medical crises.  A rather average story, it is simply called:

Courage.

She was so very tired; afraid and hungry every single day.  She sat huddled in a doctor’s office, desperately wanting to run.  Edgy and anxious, she was barely able to sit still. This waiting was taking precious time from her constant, frantic search to score and was almost more than she could do. If someone didn't help her soon she would be too sick to stay here.  Many days, despite her tiredness and weakness, she had not wanted, or even been able to take this time to find a way out.  She was desperate – and truly afraid for her life.

***

Now she was huddled in a hard cot at Detox, covers pulled over her head, shivering, feeling each tiny muscle in her body vibrating with dope sickness.  She was so cold.  Sweat drenched her in foul smelling sweat oozing from every pore, soaking thin cotton pyjamas.  Her bones were cold and ached miserably.  Her legs seemed unattached to her body and lay kicking and jerking, never allowing her to rest. 
Nausea and hunger mixed together in a bile coated and twisting stomach.  Every noise was magnified, sounds working in concert with jerking muscles.  And why were all the lights so bright?  Even with her head completely covered, tiny rays of light lasered through minute cracks in the thick flannel blanket, jabbing through tightly squeezed eyelids.  Every nerve in her body was screaming for relief.  

She refused to provide it.  It would be so easy.  Her dealer, or certain friends, would be only too willing to help her back into the chaos she was trying to get away from.  Now her very life was at stake.  The high and the fun had gone as surely as the job, home and family.  She missed her darling children so, so much.

She cried bitter tears when she remembered words spoken her kindly, only moments before:  "Withdrawal is the easy part of recovery."

She groaned, dragged herself out of bed and wiped her tears away. It was time for another hot shower.

"A fine glass vase goes from treasure to trash, the moment it is broken.  Fortunately, something else happens to you and me.  
Pick up the pieces. Then, help me gather mine."

~ Vera Nazarian

Courage...

...strolled Detox halls tonight disguised in ordinary clothing, accompanied by quiet conversation and laughter.

“The test we must set for ourselves is not to march alone

but to march in such a way that others will wish to join us.”

~ Hubert Humphrey