A life unraveling
January 11, 2016 7:14 PM   Subscribe

Over the past year, the [Boston] Globe spent time with an East Boston heroin addict as she struggled through recovery and the prospect of losing her children to the state. Nearly every key moment was witnessed by a Globe reporter or photographer. Brave, broken, loving, at a loss, this is Raquel and her story.
Warning: Does not end terribly, but does not end well.
posted by Etrigan (47 comments total) 12 users marked this as a favorite
 
At first, Raquel continues to use, gradually weaning herself off heroin as her daily dose of methadone rises. Her routine remains largely the same. She spends mornings drinking shakes at McDonald’s, surrounded by other people from the clinic. The idea of getting a job never seems to come up.

This sentence is weirdly out of place in the article, and surely can't be implying the shitty sentiment I think it's saying, right?
posted by EmGeeJay at 8:32 PM on January 11, 2016 [36 favorites]


Heartbreaking all around.
posted by salvia at 8:57 PM on January 11, 2016


The idea of getting a job never seems to come up.

This sentence is weirdly out of place in the article, and surely can't be implying the shitty sentiment I think it's saying, right?


Even if it was unintentional, and it's clearly not, it's incredibly shitty. They established she's on disability 8 paragraphs earlier. 12 days after that statement, she's in the hospital and discharged on home oxygen and a walker. The state believes she can't work, but the Boston Globe apparently disagrees.
posted by T.D. Strange at 9:13 PM on January 11, 2016 [41 favorites]


I... don't know if I can read this. I have certain challenges as more or less a constant in my life... but I am sooo super lucky that I've always been able to hold down a full time, responsible job, I have my health (more or less) and a very stable home arrangement. It's always... enlightening seeing stories of folk who fell further down the path- and There But For The Grace of Dog Go I.

One of the main things that's saved me from being in a much deeper hole is Suboxone. People sneer at it, as if it's a worse thing somehow- but I can tell you that for me, it's maybe literally saved my life. Just getting in a few paragraphs where she says she's losing her memory, her ability to even catch buses- once she's started on the methadone- well, Suboxone certainly hasn't had any effect like that on me.

Argh, maybe I should read it. I could probably do with the perspective right now, as my thoughts at the end of the working day shift to... well, ya know. Or maybe you don't. I'd recommend you keep it that way.
posted by Philby at 9:44 PM on January 11, 2016 [30 favorites]


There was an article in New York magazine recently that pointed out that life after heroin addiction can be pretty "....eh":
Addiction is the stuff of movies: self-destruction; brushes with death; villains; the chance of rescue, redemption, salvation. But for those who make it out, the rest of the narrative, the long, hard work of putting together a life — it’s much less compelling stuff. It’s what the rest of us do every day in one way or another. And it is mostly boring and exhausting and not so much fun, or else the fun is at the margins of the tedious, the brief moments between work and bills and child care and doctors’ appointments and grocery shopping and cooking and laundry.
I guess what I'm wondering is, what sort of support and programs are there for the "what comes after rehab" steps. This woman was thrust back into a demonstrably challenging environment without any sort of proactive goal, just the "Don't get back on the smack." Where was her "Do [fill in the blank]?" Why is there no emphasis on potential, merely on the lurking weakness?

And I am reminded of Darcy Padilla's The Julie Project (mefi post here), which also chronicled a woman from a deeply troubled background who had no social safety net to speak of and whose addiction led to her losing parental rights to five of her six children.

The opiates epidemic is devastating. Raquel's oldest daughter is already demonstrating how the effects reverberate across generations; I hope her younger children are able to break out somehow.
posted by sobell at 9:44 PM on January 11, 2016 [12 favorites]


It's a haunting story. There is clearly so much affection between Raquel and her daughters, but so much dysfunction, too. What a terrible calculus to have to make to determine what's over the line when it comes to the kids' well-being. That the proud day when both daughter and mom graduate can't cancel out a day when mom was maybe too strung out to get them dressed right. I can't get over the sweetness of the two graduation balloons...or the sight of that squalid, terrible bed.

I also feel really uncomfortable about the real names and images of the girls being used in the piece. They are already so vulnerable. On top of the trauma they've already undergone, having some of the most precarious moments of their lives open for public viewing with a hot spotlight could be damaging in all kinds of ways. Even commenting feels exploitative.

I was not thrilled about the remark about job searching not coming up, although since it's in reference to her being in a group of people from the clinic, and we don't know if any of them are also disabled, perhaps the implication was intended for the rest of them. If so, that was unclear at best - but either way it supports a theme of the piece which Sobell mentions, that of the blank spot of what comes next. Without a job, or later, her kids to care for, what is she going to do? I also noticed that when Raquel does start using, it's not in isolation - poverty contributes, as she takes in people (dealers/junkies) with apparently no where else to go and proximity encourages her to take up the habit again.

(I also thought the remark about her being obese was entirely unnecessary. She's a big woman. So?)
posted by prewar lemonade at 10:00 PM on January 11, 2016 [13 favorites]


Yeah I don't know, I think these are important stories to tell but I don't think the author of this article afforded much respect or compassion to Raquel in telling this one. In particular I think the emphasis on her body (how she dresses, how she eats) is pretty unnecessary and degrading-- e.g. when she is described as dressed in pajama bottoms at Dunkin’ Donuts, her hand wrapped around a large coffee with eight Sweet’N Lows or how she is wearing a tight T-shirt dress and leopard necklace to a graduation ceremony. I don't see what either of those sentences add to the story.

(The depictions of the physical aspects of addiction like bedwetting, hair loss, etc also bother me--but I guess one could make a case for their inclusion from a journalistic perspective.)
posted by bergamot and vetiver at 10:29 PM on January 11, 2016 [10 favorites]


Just getting in a few paragraphs where she says she's losing her memory, her ability to even catch buses- once she's started on the methadone- well, Suboxone certainly hasn't had any effect like that on me.

They mention she's taking Klonopin and I suspect it's that combo with the methadone that really does it. But yes buprenorphine/Suboxone is a wonder drug in a lot of ways.
posted by atoxyl at 10:54 PM on January 11, 2016 [2 favorites]


Totally agree that the cracks about her weight and the getting a job thing felt super judgy and unnecessary. This kind of journalism works a lot better when it manages to bridge the empathy gap between subject and intended audience, instead of reinforcing distance.
posted by terretu at 11:26 PM on January 11, 2016 [1 favorite]


These addiction stories inevitably remind me of Rat Park. They represent not so much a failure of the individual as a failure of society. "One death is a tragedy, a million is a statistic" should cut both ways. We blame the poverty-stricken, addicted, disabled individual for their plight--but if our society has a million of such individuals then we are getting a statistic about how we are to blame for them.
posted by schroedinger at 11:28 PM on January 11, 2016 [22 favorites]


Taking away the Kids is such a painful moment..
posted by amirimtiaz at 11:36 PM on January 11, 2016


> This sentence is weirdly out of place in the article, and surely can't be implying the shitty sentiment I think it's saying, right?

It seems particularly "buhh, so what?" in an economy where people at every imaginable level of education and experience are earnestly competing for jobs for which they're utterly overqualified. It trickles down. It's a tough time to get even an unskilled sub-minimum wage job if you've got a past that suggests you may be unreliable.
posted by desuetude at 11:56 PM on January 11, 2016 [5 favorites]


I'm the child of an addict, and painful as it might have been to read, the children being taken away was the best possible option.

Addicts are horrible parents. Where you see 'affection', I see essential narcissism, and the way the woman uses her own children as a drug -- to feed the tremendous black hole of need that she has. She doesn't love her children, as much as she loves the role they fill for her. Her primary relationship has been, and likely will always be, with heroin. She is incapable of putting anything else first.

Raquel is a disaster, and she has every right to continue to be a disaster. She does not have a right to drag children with her.
posted by gsh at 3:27 AM on January 12, 2016 [55 favorites]


I get the pushback about her physical description, but I want to offer this counter perspective:

When I was stoned to the gills on opiates--I had the fentanyl lollipops and everything--my self-care deteriorated and I made choices to appear in public clothed in a way I'm glad I only hazily remember. I haven't done anything like that (aside from the time I was chasing the cat, which had got outside) since I got off dope. I'd argue that the author isn't so much I don't know shaming the subject for her fashion choices as showing how devastating the addiction/withdrawal process is.

And a counter-argument to the not-looking-for-work thing: it's amazing how little time there is when one's on dope because there's that whole being on the nod thing. And being dope sick is completely devastating--it's like a terrible combination of deep depression and the flu. It's not that the subject of the article is lazy; it's that she's so consumed with her struggle with this substance and related dysfunction, there's just no time for it.

The thing that's unfortunate is that the details can be pernicious in that the details can inspire scorn and derision, and there's all sorts of class and race issue this touches upon, but the fact is that dope is evil shit.
posted by angrycat at 3:29 AM on January 12, 2016 [31 favorites]


These addiction stories inevitably remind me of Rat Park.

Worth noting that the rat park "findings" have proven curiously resistant to replication and are viewed with skepticism at best (well except in comics and pop-psych forums).
posted by Joseph Gurl at 3:56 AM on January 12, 2016 [3 favorites]


I agree with angrycat - the mention of a job not coming up seems to be more indicative of the hold that heroin has on her daily existence more than anything. Not sure why her weight is mentioned, but it might be to a counterpoint the assumption that heroin users are all rail-thin from singular focus on getting high.

The chains of poverty and the state's complete inability to help are so sharply defined here. There is no easy fix to the heroin epidemic from both an addict's and a policy perspective. It's devastating to see it in such personal detail.
posted by glaucon at 4:39 AM on January 12, 2016 [2 favorites]


Worth noting that the rat park "findings" have proven curiously resistant to replication and are viewed with skepticism at best (well except in comics and pop-psych forums).

This just isn't true. Some studies have failed to replicate, but others have. If I wasn't on my phone I'd dig up more, but it seems like in the failed experiments, it was the case that both rat populations were addiction resistant, so genetics nay also (imagine that!) be a crucial factor. In any case, there remains good reason to believe that environmental conditions greatly influence propensity to addiction.
posted by dis_integration at 4:46 AM on January 12, 2016 [5 favorites]


This ain't exactly the place for a lay metaanalysis of the literature, but here is one failure to reproduce, and three successes of various sorts: with cocaine, amphetamine and nicotine in addition to the morphine reproduction above.

Raquel's story is heartbreaking, and the reporter's implication that her addiction is a moral failure makes everything worse. Until we treat addiction as a social disease instead of a moral failing, a defect of personal responsibility, we're never going to even begin to overcome it.
posted by dis_integration at 5:03 AM on January 12, 2016 [5 favorites]


I might be having an overly charitable read of the piece but I really didn't find it judgemental about her looks or lack of searching for a job.

I read the job thing as how she has so much to deal with that a job is not even on her radar. I agree that when someone is wracked with addiction, their job is to get clean and it is unrealistic and unfair to judge them for not getting a "real" job. I thought the whole piece illustrated just how much stress, pain, and challenges Raquel faced every day and a "real" job is completely out of scope for her.

The points about her physical appearance (weight, clothing, general hygiene) brought some of the physical manifestations of drug addition to sharper focus. For me, these are everyday concerns. For Raquel, these fall completely to the wayside because of her disease.

It was most distressing to read about her young children. Thank you gsh for sharing your perspective, lots to think about.

bridge the empathy gap between subject and intended audience

Count me as a reader that was touched in this manner.
posted by like_neon at 5:43 AM on January 12, 2016 [7 favorites]


The job comment did stick out like a sore thumb to me. Like they were judging her on just the lack of puritanical intention to want a job.

I mean, even if she wanted a job, there's the barriers of finding and getting a job - what would she do? what are her skills, that privileged people like the journalist and readers have in spades and take for granted? And performing and keeping a job, in her physical condition. How was that going to happen?

It's just so condescending to still write, these lazy people, the subject of a job never even came up ...
posted by Dashy at 6:01 AM on January 12, 2016 [1 favorite]


It felt a little dystopic being back in my hometown in NH over break and seeing all the track marks heroin has made. I have a friend who had two acquaintances OD on heroin in the two weeks she was home. My brother went to a memorial for a high school friend who died earlier in 2015. My mom was telling me about the various car crashes where the drivers ODed on the highway. I was getting batteries at the Walgreen's down the street and ran into a friend's dad. He was telling me they had kicked her little brother out again, December 23, because, after being clean for 41 days after getting out of jail, they came home and found him shooting up while babysitting his toddler (who they have custody with while her mom is in jail for possession).

Seeing the bizarre path of destruction in the affluent, mostly white part of town I grew up in makes the way previous drug epidemics and disastrous anti-drug policy devastated already marginalized, poor, and underserved black communities in big cities really apparent. The relatively well-off big cities and small towns can't get a handle on this, and they're starting off with a totally different relationship with police, with history, with the benefit of the doubt from law makers, and with political and economic capital. This isn't going to be solved by a War on Drugs - this is going to be solved by drug courts and treatment and a less punitive approach to addiction. But man, it's awful that it's not until a bunch of white people from New England start having drug problems that society at large starts thinking about different ways to approach drug addiction.
posted by ChuraChura at 6:35 AM on January 12, 2016 [11 favorites]


She buys the antianxiety drug Klonopin and other prescription drugs for $1 or $2 a pill on the street.

Terribly dangerous combination of methadone + benzos = very much the same high as heroin, or almost as much, from what I've read and heard from addicts. Methadone clinics tend to have people selling their Klonopin or Valium or Xanax to take along with the daily dose, and it gives a similar nod, and benzos are even worse than opiates for withdrawal. It's just a terrible cycle.
posted by xingcat at 6:35 AM on January 12, 2016


There's something inside of me that really, really blocks the consumption of stories like this, not unlike the way I (as the child of one) handle stories about hoarders, except in a very detached and stoic way.

Otherwise, I mean what can you do besides crumple beside your chair in sadness for these two (three? more?) generations of humans that have grown up treated worse, in some many ways, than most house pets.

My wife is finishing up a post-doc that focuses on treatment of fetal alcohol syndrome and, from the few things she relates to me about work, the stories can be are always heartbreaking. I don't know how she does it. I need to remember to be nicer to her, every day, because fuck....

In other news, what a crazy job for the writers/researches writing this article amirite?
posted by RolandOfEld at 7:14 AM on January 12, 2016 [2 favorites]


So many stories we read these days of those who got pain killers from doctors and then, addicted, turned to heroin for ease and price of getting that drug. And yet, the Congress was in fact trying to do something about these pain killers but
Makers of OxyContin Bankroll Efforts to Undermine Prescription Painkiller Reform
posted by Postroad at 7:18 AM on January 12, 2016


It's pretty jarring and disappointing to see the journalist refer to people as "addicts" and particularly "junkies" over and over.
posted by threeants at 7:50 AM on January 12, 2016


It felt a little dystopic being back in my hometown in NH over break and seeing all the track marks heroin has made. I have a friend who had two acquaintances OD on heroin in the two weeks she was home.

A couple of months ago I hired a couple of nice young guys off Craigslist to paint my living room. One day they apologized for getting a lot of texts and phone calls; they and some other friends had finally convinced a friend to go into rehab the day before, and they were now all dealing with anxiety and stress because the friend had been released during the night. The rehab place had determined that his addiction was serious or life-impacting enough to give a bed to, so they had kicked him out, without calling anyone to come get him. This was making the addicted friend feel like there was no point in trying to get clean, and their group of friends were trying to keep tabs on him, but had lost track of him, and all the texts and phone calls were about who had checked where and what they were going to try next.

Not long before, they'd had a friend OD shortly after finishing a stint in rehab—that typical post-rehab OD where the addict doesn't take into account his loss of tolerance and dies from the dose he'd been regularly using before. "Fucking heroin," one of my painters said. "Sorry! But--fucking heroin!"

The other one said, "Yeah, it's like all of sudden it's everywhere." They'd lost some number of high school classmates that seemed unlikely to me, but that was exactly their point. I hadn't had any idea it was so bad locally, but it makes sense. We live in the environs of a dying auto-company city in Michigan, and options are pretty bleak for a lot of young people here.
posted by not that girl at 8:03 AM on January 12, 2016 [11 favorites]


Missed the edit window, of course. I left out an important "not" in "NOT serious or life-threatening enough." Though I figure most of you got that from context.
posted by not that girl at 8:38 AM on January 12, 2016 [3 favorites]


So happy to see a thoughtful, balanced discussion on Metafilter about the drug problem!!

My only reaction when I read this was "Well, yeah? I've heard and read this story a million times. Until people are actually going to do something about it (ChuraChura's excellent suggestions of drug courts, etc.), then stop blowing smoke. You're just making it worse."
posted by Melismata at 9:16 AM on January 12, 2016


Everyone should be aware of naloxone (Narcan) for opioid overdose. CVS, Walgreens, and Duane Reade sell it without a prescription in a number of US states, and many states have programs and laws now under which lay people can obtain and administer it. Other countries have similar programs. Insurance, including Medicare and Medicaid may reimburse for naloxone or it may be available at no cost from certain awareness training programs. Many states also have overdose 911 good samaritan laws, under which witnesses to an overdose can call 911 or seek medical attention for the overdosing individual without fear of arrest or prosecution for minor drug and alcohol violations.
posted by melissasaurus at 9:21 AM on January 12, 2016 [5 favorites]


I had a really hard time with the addict/junkie language as well - coming from a harm reduction place, it's jarring to me now to hear those terms. Also could have used people-first language re: bipolar disorder. Basically, I'd like to read this story, as written by someone with some empathy and some understanding of these issues and complex intersections.
posted by Stacey at 9:21 AM on January 12, 2016 [1 favorite]


The rehab place had determined that his addiction was [not] serious or life-impacting enough to give a bed to, so they had kicked him out, without calling anyone to come get him.

Also, no offense, not that girl, but I've had addicts tell that very lie to me, when in fact they just didn't want to be at the rehab. God, what a bitch addiction is.
posted by Melismata at 9:22 AM on January 12, 2016 [1 favorite]


My only reaction when I read this was "Well, yeah? I've heard and read this story a million times....

Melismata, that's my impression, too. There's a new HBO documentary called Heroin: Cape Cod, USA, and I just cannot bear to sit through it. Same old story. It's reprehensible that drug companies are continuing to lobby to keep such strong and addiction-prone opiates readily available. We would not be having this upsurge in heroin addiction without Oxycontin, and it's not going away without prescription drug reform.
posted by something something at 9:24 AM on January 12, 2016 [1 favorite]


The problem with shutting down pill mills and clamping down on opiate prescriptions generally is that it completely fucks people who are already dependent on opiates, whether because they need them for chronic pain or because they are just abusers. It drives up the price of the relatively safe pharmaceuticals, which are of a known strength and purity, thus forcing people who can no longer feed their addiction onto heroin, which is almost always cut, but not always, and often with fentanyl, thus leading to even more overdoses. But that's OK because at least it isn't the big bad pharma companies feeding the addiction, amirite?

Moreover, the restrictions on bupenorphine maintenance therapy are just insane. Because doctors can only have a certain number of maintenance patients (30! in their first year and around 100 thereafter), it becomes impossible for many people to get a legit prescription. That creates a big black market for bupenorphine, making it worthwhile for those who are in treatment to sell, which often leads them right back to abusing other opiates thanks to the extra money the diversion brings in. And again, as even the maintenance meds become more and more restricted, people who would like to use it to get clean without having a permanent record of their addiction can't get it, thus forcing them to continue destroying their lives to come up with the money to maintain their sanity. And yes, force is the correct adjective, which you would know if you had ever seen someone in the throes of opiate withdrawals, much less been there yourself.

The sad thing is that even heroin addicts can be reasonably well maintained, to the point of holding down good jobs and being generally normal for 23 hours a day on their drug of choice if they have a legit supply. It is relatively easy to convert addiction into dependence (definitely a lot easier than getting someone totally clean), but we treat simple dependence as if it were the same as a full blown addiction when they are completely different issues.

Combine that with our propensity to make drug use and abuse a criminal issue rather than the medical issue it really is and we are the ones responsible for turning people into junkies, not those who find themselves with a dependence on opiates. Hell, it is our society itself that pushes people into dependence as well. So many service jobs use people's bodies in a way that leaves them with chronic pain. That and the constant anxiety and stress drives people to use. Many opioids are, after all, very powerful anxiolytics and mood elevators, in addition to their pain relieving properties. Nobody should be surprised in the least by the epidemic of abuse. It isn't caused by pharmaceutical companies pushing them, it is caused by our completely fucked up society.
posted by wierdo at 10:24 AM on January 12, 2016 [14 favorites]


Sorry, wierdo, but in fact pharm companies do bear a lot of guilt in this, as well as doctors.

If our society is "fucked up," what need we do to "unfuck it?
posted by Postroad at 11:15 AM on January 12, 2016 [2 favorites]


And a counter-argument to the not-looking-for-work thing: it's amazing how little time there is when one's on dope because there's that whole being on the nod thing.

More like, acquiring drugs every day is at least a part-time job in itself (except you pay them). But YMMV.
posted by atoxyl at 11:19 AM on January 12, 2016 [1 favorite]


While I get why people didn't like the "jobs" line and some of the terminology, I thought this was a fantastic story that deserves a lot more praise than criticism.

As far as the "jobs" bit is concerned, I agree with like_neon above, who argued that the line was meant to highlight that the problems these people face leave them with no realistic prospect of steady employment in the near future. Assuming that it was meant to insult these people as lazy doesn't make sense to me, given the generally sympathetic tone of the piece. Using the terms "junkie" and "addict," in context, doesn't seem like a problem to me, either. It's an article aimed at humanizing people often dismissed under those labels - I don't have an issue making that explicit.

People like Stacey and threeants above are obviously speaking from places of expertise, and are almost certainly right about terms like "addict" and "junkie" being fundamentally unhelpful labels that we should move away from - but they're also the language the vast majority of people understand. I hate that this sounds like I'm belittling the language of therapists and counselors and other mental health pros - I genuinely don't mean to - but it's meant for the people that are in need of aid, not for the immediate and unambiguous understanding of a general audience. Not every article can both challenge the entire vocabulary around substance abuse AND provide an evocative, hard-hitting look at its effects on one family. Not every article should have to.

Maybe I'm way off base - I admit that I don't have any personal experience with serious substance abuse - but as a journalist, it bugs me a little to see incredible work getting (politely and moderately, it must be said) bagged on for being insufficiently correct by people who have specialized expertise in this field. This is a great story that's clearly sympathetic to people suffering from substance abuse and stands a decent chance of raising a substantial amount of awareness on the subject. I just think we could celebrate that a bit more instead of picking at what aren't gigantically serious flaws.

Side story - One day, during an interviewing class in college, the instructor brought in three people whose relatives were semi-high-profile murder victims, so that they could tell us about their experience with the media and ways in which we could be non-horrible when trying to talk to someone who's in extremis. All three ended by telling us various ways that we "could help." "Don't expect anyone to talk to you in X situation," "You can help by reporting this kind of information and not that kind of information," etc. Everyone was very polite and sensitive.

When they left, the instructor asked if there was anything we had wanted to ask but hadn't felt comfortable enough. I said, in essence, "they talked a lot about ways we could help. And, I mean, I'm as sympathetic as I can be, and if I could help in that kind of situation, I would want to - but, strictly speaking, that's not my job." The instructor said that I was entirely correct, but also that part of the exercise had been about speaking truth in the face of horror and pain, and that I hadn't done as well at that.

My point is that sympathy and decency are important for reporters, for sure, but the core of the job is to report what's actually there.
posted by ColdOfTheIsleOfMan at 12:25 PM on January 12, 2016 [9 favorites]


I worked for years at the safety net hospital in Boston where most of the city's heroin addicts came to deliver their babies. I saw some success stories--women who were able to transition from using heroin to methadone or buprenorphine maintenance, who were able to secure safe housing, who made good choices about their partners, who attended every prenatal appointment and had clean urine drug screens and kept custody of their babies once they were born and the babies themselves were slowly detoxed. These women had robust family support systems and no prior criminal history and their mental health problems responded to treatment and they were almost universally white and didn't have to struggle with deeply entrenched societal racism.

I've also seen terribly sad stories of women who couldn't do any of those things, largely because their pre-addiction mental health status was tenuous at best and they had no support system and they were women of color.

What's missing from this article is deeper insight into the root causes of addiction. Lack of access to treatment for pre-existing mental health issues (especially anxiety or schizoaffective disorder) leads people to self-medicate to control their symptoms. Racism and sexism prevent women of color from getting access to the healthcare they need.

We will never control the addiction crisis in this country without first solving our mental health treatment crisis.
posted by jesourie at 12:34 PM on January 12, 2016 [10 favorites]


I couldn't read this article due to a paywall, but wanted to respond to a few things here.

First:

Addicts are horrible parents. Where you see 'affection', I see essential narcissism, and the way the woman uses her own children as a drug -- to feed the tremendous black hole of need that she has. She doesn't love her children, as much as she loves the role they fill for her. Her primary relationship has been, and likely will always be, with heroin. She is incapable of putting anything else first.

Raquel is a disaster, and she has every right to continue to be a disaster. She does not have a right to drag children with her.


I understand that this person's experience of having addicted parents was awful and that is bad, but just as you can't say this is true of all depressed parents (who can harm their kids, too— search medline) or all bipolar parents or all parents in any group other than "bad parents," you can't say this of all addicted people.

Some are narcissistic monsters—such people are overrepresented in the addicted population— but they are not the majority and it is not a defining condition of being addicted that you will be a bad parent. All this does is reproduce stigma and create situations where people take kids away from people with addiction simply because they have a drug in their system, with no evidence of child abuse. What this does is clog the foster system with cases that don't need to be there while allowing it to miss cases where the kids really do urgently need to be taken.

Addiction is not a personality disorder; there are many with addiction who have personality disorders and other mental illnesses, but there is as much variety within people with addiction as there is between people who don't have it.

And we're not going to help people with addiction or their children by increasing stigma like this.
posted by Maias at 3:25 PM on January 12, 2016 [9 favorites]


All right, I've read it now and there are serious problems with that story. One, the bedwetting and all that— that is not a side effect of anything to do with methadone.

Second, the way she was dosed and the idea that relapse wasn't going to happen given that is completely absurd— they set her up to fail. There is clearly something more going on here, possibly to do with her mental illness.

It's hard to tell anything from this story other than that poverty, child sexual abuse, lack of education, and mental illness are bad and will often lead people to self medicate and that the systems we have set up to deal with this are completely inept at doing so.
posted by Maias at 3:33 PM on January 12, 2016 [3 favorites]


Oh and regarding the CDC's pain guidelines— it's not only the industry that is opposing them. They created the guidelines through a secretive and possibly illegal process that ignored pain patients and their doctors and that was filled with moral crusaders who basically believe that opioids should not be available to people outside the hospital long term unless they are dying. This group argues that it was only industry that said chronic pain could be treated with opioids and that anyone who makes that case is either an addict or a pharma shill.

In reality, there are many people who benefit, most of the people who get addicted were *never* pain patients, most of the "pain patients" who are addicted were pre-addicted and went to the doctors to get drugs, not because of pain.

But the media sides with the CDC because it has bought the line that the only reason for opposing a crackdown on chronic pain prescribing is because you are profiting from selling opioids.

The reason to oppose it is that it won't work, it will harm patients, it already is driving people to heroin and if we really want to fight addiction, we actually need to treat it and do real prevention, not focus on law enforcement against doctors and stigma against pain patients.
posted by Maias at 3:39 PM on January 12, 2016 [5 favorites]


Sorry, wierdo, but in fact pharm companies do bear a lot of guilt in this, as well as doctors.

Obviously doctors and big pharma have to take their share of the blame for her selling crack nearly thirty years ago.

She was probably prescribed that crack for a minor health problem. If only big pharma hadn't pushed it on the medical profession with their bribes and their advertising, there wouldn't have been any crackheads at all.

Oh wait...
posted by PeterMcDermott at 4:57 PM on January 12, 2016 [5 favorites]


If our society is "fucked up," what need we do to "unfuck it?

First, stop expecting poor people to destroy their bodies for poorly paid employment. Second, make health care zero cost at the point of service so people who have mental or physical health issues that are pushing them towards drugs of whatever sort to get the support they need. Third, a basic national income would reduce the anxiety inherent in living paycheck to paycheck, wracked with constant worry.

For those who already have a dependence on opiates, allow them to legally obtain their needed medication, and make methadone or preferably bupenorphine maintenance more widely available for those who can/want to get off the drugs. We must also force employers to allow their employees the time away from work necessary to detox. It doesn't do much good to get clean if yoi are left in an equally precarious financial situation because you got fired for absenteeism because you were too busy puking your guts up and shitting yourself for a week or two straight to go to work. As I said earlier, there is nothing stopping the vast majority of people from maintaining a perfectly normal life if they can dose when they need to without having to spend all their money staving off the withdrawal, so keeping that from being an option causes significant harm with zero upside to anything but the asset forfeiture fund and private prison companies.

Those are just the obvious things, I'm sure there is much more (or better alternatives) that I have not thought of.
posted by wierdo at 6:52 PM on January 12, 2016 [3 favorites]


The points about her physical appearance (weight, clothing, general hygiene) brought some of the physical manifestations of drug addition to sharper focus. For me, these are everyday concerns. For Raquel, these fall completely to the wayside because of her disease.

Agree 100%. A person in her situation simply doesn't have the bandwidth to think "oh, I should build muscle mass and cut some fat", or "I'll quit eating fast food and eat lean meat and kale". Dealing with an all-encompassing addiction pushes out such "normal" lifestyle considerations to the fringes of consciousness.
posted by theorique at 3:13 AM on January 13, 2016


It's pretty jarring and disappointing to see the journalist refer to people as "addicts" and particularly "junkies" over and over.

I think someone addicted to an illegal drug could factually be referred to as an addict. Junkie, however, seems to be a little more value-judgy.

Sorry, wierdo, but in fact pharm companies do bear a lot of guilt in this, as well as doctors.

So true. Though I'm not even sure they even realize they're at fault. Studies have been done that show pockets of high heroin addiction are always preceded by pockets of high prescription drug addiction. I'm pretty sure doctors don't wake up in the morning going "
posted by prepmonkey at 7:53 AM on January 13, 2016


Yeah, because doctors have been forced by the DEA and idiotic prosecutors to cut off existing patients cold turkey rather than properly tapering them off the drugs or maintaining them on the drugs, for those who have a continued need for them. When the alternative is losing your license and possible jail time, who can blame them?

Which one of you is going to volunteer to have a week or two of hell and lose your job rather than switching to heroin when you get cut off arbitrarily? You can say "oh, they shouldn't have been prescribed opiates in the first place," but that does absolutely nothing for those who were and became dependent on them and completely ignores the fact that there are literally millions of people in this country who have a choice between opiate dependence and literally debilitating levels of chronic pain.

If you applied the puritanical attitude to Viagra or cholesterol meds instead, maybe you'd see how stupid it looks.
posted by wierdo at 8:03 AM on January 13, 2016 [5 favorites]


The Boston Globe also did a story back in 1989 about a heroin addict going through a pregnancy. It was a finalist for the Pulitzer. It remains one of the most affecting things I've ever read.
posted by reenum at 5:06 PM on January 13, 2016 [1 favorite]


Studies have been done that show pockets of high heroin addiction are always preceded by pockets of high prescription drug addiction.

Citation please? I cover this area and have *never* seen such a study. Certainly, they may *sometimes* be preceded by high levels of prescription drug issues, but they are absolutely not *always*— for one, given that pain meds are massively underprescribed for black people, you'd have a hard time explaining the heroin epidemic of the 70s that way.

Also, there were these wars in Vietnam and and Afghanistan that you may have heard of...

It is a very recent development that the typical sequence in opioid addiction goes from marijuana, alcohol, cigarettes coke to painkillers and then heroin. (And yes, about 80% of people with painkiller addictions started as heavy recreational alcohol and marijuana users, NOT pain patients).


Historically, the pathway skipped painkillers in 80% of heroin users, and you can see this if you look at this JAMA Psychiatry study.
posted by Maias at 10:24 AM on January 16, 2016 [3 favorites]


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