we have been misperceived, stereotyped, underrepresented
and grotesquely vilifi ed, often by ourselves. This, then, is
my minority report. I earnestly hope it makes a difference.
Because this is a matter of life and death.
COMFORTABLY NUMB
Hello, Eugene, is there anybody in there? Just nod
if you can hear me: Is there anyone home? The reason I
ask is, well, I’m worried about you, Eugene — and that
concern extends to Oregon, the Pacifi c Northwest and this
glorious country of ours in general. Have you seen the
latest statistics on how many Americans are feeding the
monkey these days? It’s scary.
A recent survey by the U.S. Substance Abuse and
Mental Health Services Administration found that Oregon
now has more people per capita abusing unprescribed pain
killers — that is, pills purchased on the street or fi lched
from grandma’s medicine cabinet — than any other state in
the U.S. As a nation, 4.6 percent of us above the age of 12
are self-medicating with pain pills, which is a frightening
enough number.
But get this: Most of the Northwest pegs in at well
above the national average. Oregon tops the list with an
estimated 6.37 percent of its peeps popping pain pills on
the down low, followed closely by our northern neighbor
Washington (third on the list, at 5.75 percent) and Idaho
(fourth, at 5.73 percent). Colorado — which, in places,
looks a lot like the Northwest — stumbles in at second in
the country, with a straight-up 6 percent.
Then, of course, there’s always heroin. This year’s
Threat Assessment and Counter-Drug Strategy released by
the Oregon Department of Justice, and currently posted on
the Lane County Sheriff’s website, fi nds that fi rst-time use
of smack by people 12 and older rose 54 percent from 2002
to 2010. The assessment also fi gures that heroin use and
availability “appear to have increased in Oregon,” a state
where “illicit drug use ... continues to exceed the national
per capita average.”
Hello? Eugene? Oregon? Are you needing an
intervention? And if you’re “only” popping, don’t think for
a second that shunning the needle stops the damage done.
Whether it’s in the form of Mexican cartel brown-brick tar
passing up and down the I-5 corridor, or illicitly procured
prescription drugs like OxyContin or Vicodin, junk is junk.
And, just like Burroughs said, it doesn’t matter “if you
sniff it smoke it eat it or shove it up your ass the result is
the same: addiction.”
That’s right, Oregon: You’ve become comfortably numb.
CURE AND DISEASE,
DIS-EASE AND CURE
One of the more recent innovations in the pharmaceutical
treatment-and-recovery phase of dope addiction was the
creation and marketing in the 1980s of buprenorphine, an
opioid agonist that can be administered in its pure form as
Subutex or — combined, typically one-to-four parts, with
Naloxone, an anti-opioid agonist that is meant to prevent
overdoses — as Suboxone. When it seemed I had nowhere
left to turn, and I was sick of being sick, my doctor turned me
toward Suboxone treatment. (Even when I had insurance, this
was an expensive way to go; a month’s scrip for Suboxone,
with coverage and a $25 coupon, ran me $50. Minus insurance,
my prescription cost upwards of $300 a month.)
Eugene-based physician Douglas Bovee, a board-
certifi ed specialist in internal medicine, is one of only
three doctors in Lane County now certifi ed to prescribe
Suboxone as a pharmaceutical aid in opioid-addiction
treatment. Federal and state oversight of physicians
prescribing Suboxone is incredibly strict: Bovee is legally
limited to maintaining no more than 100 patients on
Suboxone, and when he fi rst started with the drug his list
was capped at a mere 30 patients.
As someone who’s long been concerned with
understanding and treating addiction, Bovee says that one
of the toughest issues now facing the medical community
is “how hard it is to be a doctor and walk that balance”
between relieving pain, on the one hand, and opening the
Pandora’s Box of addiction on the other.
Bovee agrees that, physiologically speaking, a large
share of the diffi culty in treating opioid addiction can be
chalked up to opium itself, which remains the king of all
pain-relieving remedies. “There’s nothing remotely close,”
he says of opioid-derived painkillers.
Beyond that, however, the tangle of concerns and
complications that confronts anyone treating addiction
is epic. Often it’s less a tangle than a mess of tentacles
reaching out in every direction and grabbing hold of issues
that run the gamut from patient confi dentiality to public
policy, from access to medical care to the reluctance — on
the part of addicts, doctors and the general public — to
care enough, or at all.
“We are charged, and we want to relieve pain, and
we don’t want to hurt people,” Bovee says, apropos the
Hippocratic Oath that is the centerpiece of medical ethics
(i.e., “to abstain from doing harm”). “If we give too much
pain medicine to somebody who’s not able to manage it
safely, all kinds of bad things happen.”
In part as a response to growing concern over the issue
of opioids and pain management, the Joint Commission
on the Accreditation of Healthcare Organizations — a
powerful Chicago-based nonprofi t created in 1951 with
enough political oomph to hold sway over the medical
licensing process and Medicare reimbursement to hospitals
— now demands that pain be measured on a patient-by-
patient basis. This accounts for the common “How much
does it hurt on a scale of one to 10?” question that patients
are asked in emergency rooms. (And which any addict
learns to answer, Spinal Tap-style, with “ELEVEN! IT’S
AN ELEVEN!”)
According to Bovee, general awareness about the
growing abuse of opioids would seem to suggest that
doctors become even more cautious and observant when
prescribing painkillers. Administering opioids should
include careful monitoring of patients, he says, along with
things like material-risk notices and informed consent
agreements for people receiving painkillers. Nonetheless
— with abuse, addiction and overdose on one side, and
insuffi ciently treated pain on the other — many doctors,
along with their patients, fi nd themselves in a real pinch
when it comes to treating pain.
“It’s hard,” Bovee admits, noting that along with
informed consent and management agreements there are
further steps doctors can take to ensure safety — like
requiring urine drug screens and maintaining “the free
fl ow of information” between patient and doctor as well as
among medical professionals and organizations, while at
the same time respecting issues of patient privacy and
confi dentiality.
Professionally, nearly all physicians — and
certainly those prescribing opioids or opioid agonists
like methadone or Suboxone — are required by law
to take a full day of pain-management education.
Bovee sums up this “tangle” of issues
surrounding the use and abuse of opiated
painkillers: “So there’s this very strong push
in multiple quarters to adequately treat pain
— all chronic pain, not just malignant. Then a
whole bunch of new drugs came on board, with
pharmaceutical companies pushing them very
hard. Those products, with rare exceptions, are
all opioids, which are addictive, and most of them
can cause overdose death.”
The vicious cycle of dope: Around and around it
goes. And there was an old lady who swallowed a cat
to catch the bird who swallowed the spider to catch the
fl y that wriggled and jiggled and tickled inside her — but
don’t ask why she swallowed the fl y. Do you think she’ll die?
a really bad case of the fl u, and I say: HA! I’ve had the fl u;
it made me sweat and ache and poop and barf. Brother, the
fl u ain’t nothin’.
The torment of dope withdrawal is truly indescribable,
but let me give it a go anyhow: Imagine the worst hangover
you’ve ever had, and then imagine being stuck in a dank
basement and slathered with Vaseline while your head
is ratcheted in a rubber vise and then, simultaneously,
you are being mildly electrocuted, pricked with needles,
alternatingly overheated and chilled while, still at the same
time, everything you’ve ever done wrong is screamed
repeatedly into your ears at ungodly volumes by a chorus
that includes Satan, your mother, Geddy Lee, Fran Drescher
and Gilbert Godfried.
I’d opt for being drawn and quartered any day — at least
death comes eventually. Don’t believe me? I’ve still got a
few very kind, very tolerant people in my life you could call.
Sure, I can almost hear all the dim-dick bootstrap
baggers and draconian Darwin types lining up in the
confederated raspberry mob to shoot back the stock mock-
lament: “Oh, poor crybaby junkie, look how sick you get
from STICKING A NEEDLE IN YOUR VEIN of your
own damn free will! Shut up! Loser!” Hey, a lot of the time
I feel the same way — because, honestly, show me a dope
addict who doesn’t carry a hefty rasher of self-loathing,
and I’ll plug every glory hole in the Republican wing of the
House. But here’s the deal:
As an addict speaking to all you professional healers,
counselors, policy wonks
and hard-ass rugged
individualists of the
world, I’d like to
say: Shit or get
off the pot. You
tell me I have
a disease, and
then you look
at me with the
eyes of a narc,
crooning over my
pupils and piss as
I prevaricate and
dodge just to get you
off my back. I’m a
human being.
Just a lit-
BETTER OFF THAN DEAD
There are fates worse than death, and kicking opioids
is one of them. I’ve heard people describe the withdrawals
one suffers while kicking a chronic dope habit as being like
DR. DOUGLAS BOVEE
PHOTO BY TODD COOPER
eugeneweekly.com • March 28, 2013
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