Jonathan’s Journey to Recovery

Author: Joan Shepherd, Family Nurse Practitioner

Age 34, a carpenter with green-brown eyes and a long ponytail, he answered questions with “yes ma’am” and “no ma’am.” Jonathan had been buying oxycodone pills on the streets for about four years. They were getting pricey, and he was just ready to stop this hectic life and spending all this money.

Like many other guys his age, he has lost far too many friends to overdose. The fact that he was taking pills instead of using drugs intravenously kept him in denial for a long time. He didn’t consider it all that dangerous.

When we checked his urine, it shocked him that there was absolutely no oxycodone in his sample. Most pills people are buying on the streets these days are almost completely–if not wholly–comprised of fentanyl.

Fentanyl to Suboxone

He had managed to get an eight-milligram Suboxone strip the day before he came to the office. That was the last opioid he had taken, about 28 hours prior to this visit. His COWS (Clinical Opiate Withdrawal Scale) was getting higher as our intake appointment continued.

He was beginning to sweat, his knees were dancing a little and his nose was running. He was a bit agitated; despite all this, he remained pleasant and polite.

A couple of things stood out and surprised me a bit. One was the fact that Jonathan was unknowingly taking pure fentanyl and had not overdosed. Still, his dose had been increasing, especially over the last several months.

People can’t really know the actual milligrams of illicit fentanyl they are taking since it’s totally unregulated. It’s all just a guess.

Fentanyl is 50 to 100 times stronger than morphine. It is very easy to take too much.

A poster hanging in our office shows a grain of rice. It drills home the message that this amount of fentanyl, especially if taken intravenously, can quickly kill someone.

It’s especially deadly for someone who has a low tolerance to the drug. Fentanyl is much cheaper to manufacture than heroin or other pain medications, and it is readily available.

Another thing that surprised me was what didn’t happen when Jonathan took the 8mg strip of Suboxone 28 hours earlier.

“Did you experience precipitated withdrawal when you took the Suboxone?” I inquired.

“No, ma’am. It relieved my withdrawal symptoms pretty well, actually,” he replied.

“How long had it been between your last dose of fentanyl and the Suboxone strip?” I asked.

“About a day, I guess.”

Suboxone Treatment for Opioid Addiction

Fentanyl is a tricky rascal. As we attempt to induct people onto buprenorphine who have been regularly using fentanyl, I have seen some patterns. Many people experience significant withdrawal symptoms even after 48 hours.

The buprenorphine component of the Suboxone is ‘bumping off’ whatever other drug is there, and that’s called precipitated withdrawal. It can cause chills, sweats, vomiting, diarrhea, muscle cramps and restless legs. People who are switching from these short-acting opioids to Suboxone must start cautiously.

“I would say you’ve been pretty lucky, Jonathan; you must have an angel following you around.”

“Yes, ma’am,” he said, with downcast eyes and a small smile.

We continued with our intake appointment; I was trying to keep it efficient because I knew he was uncomfortable. When I got to the section asking about family, Jonathan told me substance misuse ran strongly on his father’s side. His father used to use cocaine heavily and his paternal grandfather died from liver complications due to alcohol use disorder.

“What about your mother?” I asked.

Jonathan was quiet for a moment and then answered, “She died in a car accident eight months ago.” He looked down at his hands in his lap.

I knew then who the angel was.

Opioid Epidemic Statistics

The opioid crisis has devastated countless lives and families.

A few facts from the U.S. Department of Health and Human Statistics include:

Nearly 108,000 persons in the U.S. died from drug-involved overdose in 2022, including from illicit or prescription drugs.
In 2016, the national rate of opioid-related hospitalizations was 297 per 100,000
Naloxone is a medication designed to reverse opioid overdose rapidly. The number of prescriptions for naloxone doubled from 2017 to 2018.
In 2019, an estimated 10.1 million people aged 12 or older misused opioids in the past year.
More than 321,000 U.S. children lost a parent to drug overdose from 2011 to 2021
Emergency department visits for opioid overdoses rose 30%in all parts of the U.S. from July 2016 through September 2017.

These statistics don’t even reflect the worsening picture that has evolved with the pandemic. We are expecting the official data for 2020 onward in the coming years.

Harm Reduction Tips for Your Recovery Journey

Not everyone who is using heroin, fentanyl or other opioids is ready to stop. Until that time, there are ways to practice harm reduction. These are strategies that aim to reduce the negative consequences of using drugs.

Use small amounts of the drug at a time.
As crazy as this might sound, tell a friend or family member when and where you will be using. Have them check on you at specific times.
Consider downloading an Overdose Prevention app on your smartphone. If the phone is in your pocket and you fail to answer prompts, the app will notify your friends.
You should provide naloxone to a friend or family member who will check on you. If this is possible, it will help in case you experience an overdose.
Most states allow pharmacists to dispense naloxone without a prescription.

Jonathan is an excellent candidate for finding a life of recovery with buprenorphine treatment. At some point, he may opt to switch his medication to naltrexone (a pure opioid blocker).

At that time, we can help him with that as we have helped hundreds before him. Between his motivation, our resources and perhaps some help from beyond, I think the odds are in his favor.

If you are trying to figure out the best solution to stop using opioids, please give Applegate a call. Our friendly staff will answer any questions you may have about our Suboxone treatment programs. Today is the perfect day to start your recovery journey; why wait?

In the meantime, stay safe – Joan Shepherd, FNP.

*Names have been changed for privacy.