Notes from Michael's Interview on Substance Use Disorder

Michael's story about substance use disorder

Early Life and Introduction to Drugs

• Michael describes his childhood as normal, excelling in sports and academics through middle school. He started using drugs in high school.
• He recalls not judging those who used drugs or alcohol, even in middle school, which normalized substance use for him.
• His progression started with alcohol in late middle school or early high school, initially intending it to be a one-time thing.
• Marijuana followed, and he convinced himself it wouldn't be an everyday occurrence, but it became frequent.
• By sophomore year, he was using cocaine and ecstasy, viewing it as experimentation and drawing a line at injecting drugs.
• His focus shifted from schoolwork, leading to graduation but also an arrest for marijuana possession.
• Weekend cocaine and ecstasy use became regular, witnessing friends' dangerous experiences, which he began to see as normal.

Transition to Opiates

• After high school, Michael secured a good job and bought a house at 19 but later sustained work-related injuries.
• At a party, he was offered a Percocet for his pain, which he justified as a legitimate medication for his injuries.
• Despite knowing people who had transitioned from such pills to heroin and having witnessed overdose deaths, he believed it wouldn't happen to him.
• Percocet became his drug of choice; he never injected drugs but eventually consumed 25-30 milligrams daily for about four years.
• He needed the drug to function, even waking up in the middle of the night to take it. Excuses were made to miss work if he could not obtain the substance.
• To support his habit, Michael sold drugs and engaged in other activities he now deems unacceptable.
• His addiction strained relationships and put his life goals on hold. He regrets wasting years due to his dependence.

Legal Trouble and Turning Point

• Michael was apprehended by the DEA and faced federal criminal charges, resulting in a felony record.
• Despite friends going to rehab, he resisted, experimenting with Suboxone only to stave off withdrawal when Percocet was unavailable.
• His arrest led to an opportunity to participate in a federal drug court program, of which there was allegedly only 1 for the entire country, which he attributes to divine intervention.
• Initially upon being arrested his immediate thought was about how to get out on bail so that he could use drugs. His attorney needed to ensure that Michael did not have to do drug testing so that he could continue to use drugs. He admits that this was a rock bottom moment.
• He acknowledges that things could have been worse.
• He was offered a place in a federal drug court (apparently, there was only one at the time).
• Even while in the program, he still had an underlying motive to just pass the drug tests and get back to how he used to live.
• Over the year-long program, he began to realize that his previous lifestyle was unsustainable.
• He developed closer relationships with his family and had support available from his grandfather, who had been in AA for 35 years, and a sister who had experienced similar issues.

Narcan and Overdose Experiences

• Michael recounts that he never personally overdosed but knows friends who have.
• He shares stories of Narcan being used repeatedly in quick succession, highlighting its availability.
• While he believes Narcan is effective when used correctly, its ready availability can lead to a false sense of security and potential abuse.
• He questions whether it should be so readily available, suggesting it be dispensed to responsible individuals rather than users.

Advice for Healthcare Professionals

• Michael advises exhausting all non-opiate options before prescribing opiates for pain management.
• He suggests encouraging patients to try alternative treatments and non-narcotic drugs due to the addictive nature of opiates.
• Close monitoring of patients on opiates is crucial, with consideration of their symptom progression.
• He suggests having patient sit through meetings / listen to testimonials of people who have become addicted to opiates.
• He suggests providing patients with comprehensive information about the potential consequences of opiate use, including the risk of transitioning to heroin or fentanyl.
• Simply cutting off the drug supply is ineffective; patients will find ways to obtain it.

The Power of Addiction

• Michael emphasizes the power of addiction and how it took only one pill to trigger his dependence.
• The sense of security associated with prescription drugs can be misleading, as they are as addictive as illicit substances.
• He suggests that prescriptions should come with a disclaimer about their addictive potential.