In Rehab, a Nurse Denied Me Buprenorphine
A little vignette from my 2012 rehab stint in Minnesota. Musings on Maia Szalavitz's new NYT on AA and "the strange marriage of faith and medicine in addiction care."
I remember a conversation I had with a nurse. This was back when I was in treatment at Hazelden for Kids in Plymouth, Minnesota (they didn’t actually call it Hazelden for Kids; but that’s what it was). The nurse was tall and thin and he wore silver wire-framed glasses and had a long gray ponytail. At this facility, nurses dispensed our night meds after dinner and then they’d stay overnight at the med station in case anybody in the detox wing had an emergency.
The first week or so I was there I couldn’t sleep a wink because I was in withdrawal. Not even the trazadone sufficently knocked me out. I’d fall asleep for a bit, then wake up in a sweaty fit. Rather than lie in bed listening to four other kids snoring the night away, I’d go sit up at the nurse station. Sometimes I’d read whatever books or magazines were lying around. I remember one time reading Dr. Drew’s memoir. Even back then he was so up his own ass and self-important. You never want the doctor to have a worse case of narcissism than the patient.
Other late nights at the nurses station, I’d stay up and talk to this old nurse with the ponytail who kinda looked like a hippie. He was nice enough; subdued and disarming. He’d nod along listening to my desperate rants.
The old hippie nurse was in recovery himself. He told me about his addiction from decades ago. How before getting sober he was a young nurse stealing “pharmaceutical dope” from the hospital he worked at. You know, Dilaudid and stuff. I’d ask him how he got through it; how he handled the withdrawal. Questions that were so pressing for me in the moment seemed like a distant and fuzzy memory for him. Which, in a way, was helpful. The guy recovered and he didn’t seem to think much about that old painful stuff.
I was incessantly asking about withdrawal, in part, because I was angry. I was mad at the medical staff for sticking to their 3-day rapid buprenorphine taper. Ouch. Just writing that sentence hurts. They would only allow for three measly days of vastly under-dosed buprenorphine: 4mg, 2mg, 2mg, then you fall off a cliff to zero.
See, I was at Hazelden for Kids just before the 2012 policy change regarding opioid maintenance treatment. Like, I missed it by a few months! Funny enough, one of the first articles I ever read by Maia Szalavitz was her reporting for TIME about Hazelden allowing for longer-term buprenorphine prescribing. Hazelden was forced to change their rule around maintanence after acknowledging a grim reality: “Within days of leaving the residential treatment facility, most were relapsing,” Szalavitz wrote. “And at least half a dozen have died from overdoses in recent years.”
In other words, the type of short-term rapid taper they gave me was associated with people relapsing and dying shortly after leaving treatment. Hazelden pioneered the Minnesota Model rooted in abstinence and the 12-Steps of Alcoholics Anonymous. The institution’s rigidity around what was back then called “medication-assisted tratment” was part and parcel with their commitment to a 12-Step approach. But you also dont want your treatment to be highly associated with premature death. Not a good look.
Late one night, dopesick at the nurse station, I asked the old hippie nurse why not give people like me buprenorphine for more than three days? I had already asked the doctor and psychiatrist a million times. But maybe I could get a real answer out of this nurse. It was just him and me. Plus, he had a cart full of medicine, with plenty of orange flavored hectagonally shaped Suboxone tablets in there. Maybe I was only up there late at night out of some sort of delusion that I could convince him to give me buprenorphine on the sly. No would needs to know.
That never happened, of course. He was a true believer. And I’ll never forget his response to that question.
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