Magic Eraser Juice

September 7, 2019 6:34 PM

Some days everyone is just dying and coming back left and right like junkie whack-a-mole.
He stares at his hands for what seems like a long time. “No,” he says finally. “I don’t think there’s anything that would help. It’s a hell of an addiction.”
posted by bitmage (39 comments total)

geez the ending.
posted by Glinn at 7:42 PM on September 7, 2019 [12 favorites]

I will forever - forever - be grateful for the naloxone program in my community and the lives it has saved, often repeatedly. The team I am on has distributed thousands and thousands of kits and I hear the stories of their use whenever someone seeks me out for a refill kit. I wish, desperately, that the burden of keeping friends and family alive wasn't so often put on the shoulders of people who use drugs - many of whom have faced incredible loss and trauma already. They are the true first responders to overdose so often.. which often creates an escalation in their own drug use to cope.. putting them at risk of being the next death from a toxic, contaminated drug supply. I don't blame big pharma as much as people think I should - yes, they were intentional in creating so many dependent people, but I blame a truly sick society that stigmatizes those who most need connection to survive. I have so many feelings about the 'opioid crisis' and fentanyl (and its analogues) and most of them just come back to my own feelings of despair that we've already lost so many good people and there's no end in sight.
posted by VioletU at 7:51 PM on September 7, 2019 [46 favorites]

Elizabeth Rosen is a pretty fine writer, good at concept arrangement, and poetic description.

I took them seriously, the warnings about heroin addiction. I turned that stuff down both times someone offered it. So long ago. I was offered a 90 day lortab prescription by a worn out old ortho surgeon, who said I would love it, it was just like having a coctail, because he wasn't going to fix a bad shoulder, it apparently was going to be more cost effective to addict me to painkillers, after a work accident. Never filled it.
posted by Oyéah at 8:26 PM on September 7, 2019 [21 favorites]

geez the ending

I thought it was kind of cheap. How is this the fault of the imaginary rich person Other "sitting at a mahogany table on the thirty-fourth floor", and what it it that they are supposedly failing to do about it? Perhaps the author has good answers to those questions, but I did not see them here.
posted by thelonius at 8:32 PM on September 7, 2019 [7 favorites]

I guess I can forgive the author for getting a little resentful at some of the people treating the opioid crisis as an abstract something that happens to other people, when she and other people in the emergency medicine/crisis response professions have to deal with it literally every day, maybe even overgeneralizing a bit in her ending. As it happens, I live on the ground floor, not that far from a hospital; we've found needles in the lobby of my apartment building, and the ambulances are pretty busy. I comb through newspapers as part of my job, including the obituaries, and have noticed an uptick in deaths of younger people. My city has also gotten, AFAIK, its first Narcotics Anonymous club, on a well-lit street corner where, presumably, the dealers might hesitate to infiltrate the meetings.
posted by Halloween Jack at 8:48 PM on September 7, 2019 [9 favorites]

A couple of years ago somone ODed on our front steps — you can’t see the bottom of the steps from our front window, so luckily someone else spotted him and called 911 — the effect of the dose of Narcan was amazing. Magic eraser juice, indeed. He went from totally unconscious and non-responsive, to sitting up groggily, to standing up and answering questions all in the space of about a minute. Reading about it doesn’t really do justice to the surreality of seeing it work on someone who would otherwise soon be dead.

Incredible stuff, but it’s a pitty that it only takes care of the symptoms and is in no way a cure for the underlying addiction.
posted by Quinbus Flestrin at 8:50 PM on September 7, 2019 [10 favorites]

Yes, that is a fair point.
posted by thelonius at 8:50 PM on September 7, 2019 [1 favorite]

I worked with homeless youth in Portland in the late 90s - during a different explosion of heroin use - and I’m finding myself listing whose lives would have been saved if Narcan were out in the world then. A lot of people dealing with addiction are - permanently or otherwise - in my neighborhood, and I’ve been considering buying some to have on hand, just in case.
posted by centrifugal at 9:29 PM on September 7, 2019 [9 favorites]

I had to put effort into finishing this. Maybe as a former addict I'm hypersensitive to the depictions of addicts, and I get that saving addicts' lives is bound to make a person reach for gritty gallows humor, but the framing of the opening anecdotes came across as so unsympathetic and condescending that I was honestly bracing myself for the descent into a rant about "personal responsibility" or something. So I was completely unsurprised when the author admitted they'd never been a heroin user—adding that she doesn't judge these people, which I guess needed to be clarified, but that she "gets" addiction for reasons that are never stated. Then we get to the last few paragraphs: the history lesson, and how everyone wants to do something about the crisis but nobody really is, with zero indication that anything can be done, no ideas on that front. So I guess the point of the piece is "it's a powerful drug that ruins people".

I don't know. This piece is certainly evocative and it skates close to a point, but it could have definitely used an editor to dial back the Addicts Say The Darnedest Things opener and arrive closer to a coherent point that goes a little deeper than "wow addiction fucks people up".
posted by Aya Hirano on the Astral Plane at 9:33 PM on September 7, 2019 [21 favorites]

I think that "Wow, addiction fucks people up." is apt. She's a citizen. She's never put the shit into her arm. Regardless she's right there at the ceremony always she's been an onlooker. An Innocent Bystander.

Addiction *does* fuck people up. My friend Josh, now nine years clean and sober, ODd so many times, so many times coming to in Brackenridge hospital and running out the door, and back into the life. He tells me that 30 days in county prison is a sentence in hell -- you're kicking, you're in with a hard crowd who don't give a shit about themselves, much less you, there is no sleep to be had, food you'd not give a dog you care about, you're dirty and gritty and 30 days is a long, long, long time. And so is 29 days. 28. Before his current nine years clean and sober, he had 20 years running and gunning -- I know the story, it's amazing that he is alive.

Lori. She's so beautiful but that matters not a whit. She was dead right on the overpass over I35, the street that runs past the Home Depot. Every time I go by there I think of her. They got her back, she's maybe fifteen years clean and sober now.

Ellie. She was in a movie theater parking lot. They shoved that shit into her and she came to, furious, outraged that her high was gone, and she had nothing more, and now back to the street to sell herself again to get the money for the next high. She is now fifteen years clean and sober.

I have stood around boxes with friends bodies in them. It sucks. I think so often of Eric, a great person, a good heart, he'd help you if you needed help. He couldn't help himself, not for long, and we couldn't help him either, he ODd, and we stood around that box, hurting.

By the end of my running all of my friends were trashy and most of them were junky. A junky wants to get that spike into your arm just same as a Jesus Jumper wants to shove a bible up your ass, they want to share the most beautiful thing they know of. I knew better than to let them get a needle into my arm, I knew how lost I already was behind drinking. I bet that they are all dead by now, HIV, this was early 80s, they passed around the same needle, offered it to my arm also. I've not spoken to but one of them since I set down drinking, our lives diverged. The one I spoke with, I told him I wasn't in it any more and he said "I am." and he drove off.

There really is nothing that can be done to help these people. It's a profound helplessness, it's heart-breaking as fuck. My nephew died two years ago, full on alcoholism, everything to live for. I tried and tried, we talked and talked, gave all the love I know of, he was my favorite family member. In the face of active alcoholism I was completely helpless and so was he. So he died. I cried like a kid, it hurt so goddamn bad. Another nephew, his wife died in their bed earlier this year, after he headed out to work. Opiates. Hard to come home and find your wife dead in your bed, or so it seemed.

Most alcoholics and/or junkies will die before they reach my current circle, or after they reach it they'll fall back. It is Grace, and I know that many here will nod their head and cluck their tongue at what a moron I am for believing in a sky god (or whatever it is they'll say), the fact is that any alcoholic or drug addict who is not using today, it is straight-up a gift. I don't deserve it, I don't understand why it was given to me and not the next person. I do all I can to protect this gift, to shield my small fire from wind or rain, and I do all I can to help anyone else who suffers this thing

I'm glad she wrote what she wrote. I think it's good writing. Maybe it seems smug but I didn't get that, just seemed matter of fact. She's on the front lines. I think that we are lucky that she is. I wish she was here in Austin, it would comfort me.
posted by dancestoblue at 11:12 PM on September 7, 2019 [141 favorites]

Fantastic writing. Thank you.
posted by mwhybark at 11:44 PM on September 7, 2019 [1 favorite]

I would have titled it "Mostly Dead"
posted by analogue at 3:14 AM on September 8, 2019

any alcoholic or drug addict who is not using today, it is straight-up a gift. I don't deserve it, I don't understand why it was given to me and not the next person. I do all I can to protect this gift, to shield my small fire from wind or rain, and I do all I can to help anyone else who suffers this thing

Yes. This. Thank you for that, dancestoblue.
posted by I_Love_Bananas at 3:34 AM on September 8, 2019 [9 favorites]

if this was legal and people were able to get predictable doses of what they're taking, much of this wouldn't be happening

i'm not saying this would be a good thing - but it's better than people dying
posted by pyramid termite at 5:21 AM on September 8, 2019 [14 favorites]

Elizabeth Rosen has written a fresh piece on a journalistically stale topic. She jabs the subject back to life in each paragraph, just like she jabs these overdoses back to life.

In the end, however, her conclusion is more or less what dancestoblue says: "There really is nothing that can be done to help these people. It's a profound helplessness, it's heart-breaking as fuck. "
posted by Modest House at 6:28 AM on September 8, 2019 [6 favorites]

In the SF street art gallery of Clarion Alley there's a fantastic comic-book style piece that's been up a few years: Narcania vs Death. It's by Erin Ruch and Mike Reger and depicts a superhero angel punching the Grim Reaper and wielding a syringe of Narcan. I'd like to think it's educated people and saved some lives. It's sort of hilarious and also sad and weird. It's good art.
posted by Nelson at 7:00 AM on September 8, 2019 [6 favorites]

if this was legal and people were able to get predictable doses of what they're taking, much of this wouldn't be happening

Maybe not.

It's just anecdata, but my observation is that users who get far gone into dependence on intoxicants will often keep upping the dose after it ceases to get them any higher. If they're pot smokers it not such a big deal, but most other things get deadly after the point of diminishing returns.
posted by Aardvark Cheeselog at 9:34 AM on September 8, 2019 [4 favorites]

Yeah, unfortunately your body gets used to dosages and you end up needing higher and higher dosages to get the same feeling. Goes the other way, too. Frequently ODs come after a period of sobriety--the person takes the dose they were on before they stopped using, but it's way too high and their bodies can't handle it any more.
posted by Anonymous at 10:21 AM on September 8, 2019

33 years clean and sober. Or, 33 years clean, or sober. I don't really make meetings anymore, but I can tell you, like a lot of addicts, and alcoholics, I needed the safety of a room full people, not like me at all, but absolutely like me, to get where I am today. I know some folk who didn't make it, everybody in the rooms do. I love that this is available. Hopefully it'll give some folks a start down the road.
posted by evilDoug at 10:33 AM on September 8, 2019 [8 favorites]

Or, 33 years clean, or sober.

I guess people mean, no drugs or alcohol when they say "clean and sober". As opposed to people like me, who, when I stopped drinking, had no intention at all of also stopping smoking pot. Which, whatever you may think of it, really isn't about being sober. I mean if your weed man sold you some weed that got you really sober, you'd probably not be thrilled by that. Anyway, I came to see that as a mistake, and out it went. If I could do it once in a while and then not think about it or want it for long periods of time, that would be nice, but that's evidently not me.
posted by thelonius at 10:39 AM on September 8, 2019 [4 favorites]

if this was legal and people were able to get predictable doses of what they're taking, much of this wouldn't be happening

I knew someone--frankly a pioneer of illicit substances, he was chewing Duragesic (fentanyl) patches bought from old ladies back in the late 90s, before anyone had heard of the stuff--who was a white, college-educated man. A pharmacist, in fact. Lower-middle-class, at best (he couldn't hold a job past early middle age, due to the aforementioned Duragesic), but because of the other status markers, able to manipulate an SSDI payment out of the system and to bamboozle a few women into taking care of (and putting their own money into) him, thus able to maintain a lifestyle that looked like the outside to still be lower-middle-class, at least. As far as I know, he never ever got clean. But because of his other status markers and his connections that allowed him to avoid street versions of his drugs (and, I would assume, his pharmacological knowledge), he never ended up having to be paid a visit by the Narcan fairy.

What did he end up dying of, at more or less the average life expectancy for a man born around his time?

Small-cell lung cancer.

Yep, he died of the legal drug he had in fact kicked many years previously.

Not a nice guy at all, at all, and drugs had very little to do with that, but a better outcome than these poor people's.
posted by praemunire at 11:02 AM on September 8, 2019 [3 favorites]

Thank you for sharing your story, dancestoblue. I'm sorry for your many losses and I'm glad you're with us. You're also a hell of a writer. <3
posted by pelvicsorcery at 11:08 AM on September 8, 2019 [3 favorites]

We keep Narcan close at hand at the library where I work, and run through it fairly quickly. One important thing to note about it, if you are ever in a position to need to use it: it wears off after about 30 minutes, according to the EMTs who trained us at work, and often the drug it's being used to counter does NOT wear off that quickly, so absolutely, ABSOLUTELY call 911 even of the person who has ODed is awake and talking and mad at you and yelling at you not to. Otherwise, the Narcan might wear off, and the OD will just start again.
posted by sarcasticah at 11:42 AM on September 8, 2019 [29 favorites]

An important point - thanks, sarcasticah
posted by thelonius at 11:48 AM on September 8, 2019 [1 favorite]

I’m listening to the radio, to politicians and talking heads discussing what to “do” about it, how to “fix” it, with policies and regulations and focus groups, addiction, trauma, law and order, enabling, decriminalization, buzzword after buzzword coming down like rain.

And just how did that Narcan get to her to use? It was some politicians who voted to fund it, and public health officials who worked to get the policies in place, and talking heads who helped publicize the problem and mobilize public opinion to push the politicians. The first responders are doing amazing work and policymakers need to listen to them, but there's a whole infrastructure that needs to be in place to provide them with the resources they need.
posted by Mr.Know-it-some at 12:55 PM on September 8, 2019 [4 favorites]

I really want to hear more about Leticia, with her scooter and her shoulder-bag full of Narcan.
posted by palmcorder_yajna at 1:23 PM on September 8, 2019 [10 favorites]

Apologies for being a naive innocent, but on the description, it sounds like a person ODing would look just like a person sleeping. How do the people calling 911 or administering the shot themselves identify the person ODing?
posted by If only I had a penguin... at 2:05 PM on September 8, 2019 [1 favorite]

Signs of respiratory depression: pale, limp, purple/blue lips/fingernails, impossible to awaken or keep awake.

If you find someone "sleeping" in a situation that strongly suggests they just shot up (paraphernalia nearby, in a bathroom or other unlikely place) and can't rouse them, assume OD. Narcan won't kill you if you're sleeping, but not receiving it if you're ODing probably will.
posted by praemunire at 2:48 PM on September 8, 2019 [9 favorites]

If only I had a penguin..., from reading this, it looks like skin coloration and breath noises are the key differences to look for.
posted by palmcorder_yajna at 3:21 PM on September 8, 2019 [1 favorite]

Can't recommend the podcast Crackdown enough.
posted by avocet at 3:52 PM on September 8, 2019 [1 favorite]

There are also no contraindications to Narcan, so if we push plenty of it and nothing happens...well then we know it’s not an opiate or opioid overdose and can start thinking about other injuries/sicknesses and the protocols for treating them.
posted by sara is disenchanted at 4:26 PM on September 8, 2019 [1 favorite]

If you're in a city with an opioid poisoning crisis, please just take Nalaxone training and have a kit. Training is often now free and can be as short as an hour or two. Nalaxone kits are often free. If you live in BC you can go the pharmacy counter at Shopper's Drug Mart or London Drugs and they will hand you one no-questions asked.

And because I think two points already mentioned bear repeating, I will repeat them:
* While it kicks the opioids off the receptors (for about 30 minutes) it does nothing to change how much of it is still in the bloodstream. People can OD again when Nalaxone wears off.
* There is NO DANGER in giving Nalaxone to somebody who is not ODing from opioids!

Finally, there may be organizations in your area that will provide free on-site drug testing at events. Having on-site drug testing used to be incompatible with having legally licensed events, but that has been changing over the last few years as governments have reasoned those policies as unsupportable.
posted by WaylandSmith at 4:40 PM on September 8, 2019 [4 favorites]

if this was legal and people were able to get predictable doses of what they're taking, much of this wouldn't be happening

That's what the UK had for many years and my understanding is that it was helpful but not perfect.

Before you get that addicted though there is a time where providing meaningful economic opportunities to young people prevents most of them from becoming addicts. There is a huge amount of evidence showing that drug addiction rises with declining economiesa and declines as jobs become more available and equitable And most addicts do start young. The vast majority of people who supposedly became addicted due to a single prescription in their 30s have a prior history with addiction or drug and alcohol misuse

So what I'm saying is this is a symptom of a sick society and we can't fix it one addict at a time, much love to those trying to though.
posted by fshgrl at 4:44 PM on September 8, 2019 [4 favorites]

if this was legal and people were able to get predictable doses of what they're taking, much of this wouldn't be happening

It's just anecdata, but my observation is that users who get far gone into dependence on intoxicants will often keep upping the dose after it ceases to get them any higher. If they're pot smokers it not such a big deal, but most other things get deadly after the point of diminishing returns.

This is a complicated question. People manage to kill themselves with pills - with the dose stamped right on them! - all the time. But if you excluded concurrent use of alcohol, benzos, etc. I suspect the number of these deaths would look much smaller. And I think it's pretty indisputable that the sharp increase in opioid deaths recently is more than anything the result of the introduction of fentanyl analogs (and products adulterated with fentanyls) to the illicit market.

One often hears things said like "tolerance to the euphoric effects of opioids develops more quickly/completely than tolerance to the respiratory depressant effects" which may be true in some sense but I've seen conflicting claims about it and there doesn't seem to be a clear ceiling on either? I don't think the notion that opioid users will increase their dose chasing a high until they inevitably overdose is well supported. One tends to reach something of a plateau - constrained by cost if nothing else.

On the other hand there are a lot of weird variables that seem to go into tolerance. So I think a more trustworthy supply would do a lot to improve the safety of users, while not by any means making opioid use totally safe.
posted by atoxyl at 5:02 PM on September 8, 2019 [1 favorite]

What I have always heard is that opioid addiction becomes all about not getting withdrawal sickness, not about getting high
posted by thelonius at 5:12 PM on September 8, 2019 [3 favorites]

What I have always heard is that opioid addiction becomes all about not getting withdrawal sickness, not about getting high

For very practical reasons - at some point one can't afford enough dope to get more than transiently high - yes, absolutely. If one had unlimited access to drugs it would depend on one's personality - when I knew a lot of hard drug people I knew some who were constantly seeking oblivion, for sure, but contrary to certain stereotypes they were clearly in the minority.
posted by atoxyl at 5:22 PM on September 8, 2019 [3 favorites]

There's currently a request for Augmented Reality phone gamers (like Ingress or Pokemon Go) to carry Narcan while they're out gaming.

As someone who plays these kinds of phone games quite often, I'm planning on picking up a kit of my own to take with me gaming.
posted by spinifex23 at 9:35 PM on September 8, 2019 [4 favorites]

I watched two of my roommates slide down the long road from drinking and occasional cocaine to full blown heroin and meth injections. It was harrowing to watch, though they tried to hide it from me. I had a stash of Narcan on hand just in case. I'm thankful I never had to use it.

They have since moved out, and I just hope they can eventually find their way out of addiction before it is too late.
posted by ananci at 8:03 AM on September 9, 2019 [3 favorites]

And I think it's pretty indisputable that the sharp increase in opioid deaths recently is more than anything the result of the introduction of fentanyl analogs (and products adulterated with fentanyls) to the illicit market.

Can't find it now, but there was an article floating around that provided a visual illustration of the relative potency of different opioids, from plain old opium all the way up to carfentanil, which is kind of terrifying. ("For pain relief, a unit of carfentanil is 100 times as potent as the same amount of fentanyl, 5,000 times as potent as a unit of heroin and 10,000 times as potent as a unit of morphine.")
posted by Halloween Jack at 1:23 PM on September 9, 2019 [2 favorites]