Mental Health

An insider’s perspective

John Charles Hilderley

Reprinted from "Opioids" issue of Visions Journal, 2018, 13 (3), p. 11

In 2000, when I was 18, I was prescribed OxyContin for two painful kidney problems. The drug was relatively new then. The first three and a half years, I took up to 240 mg a day (considered a high dose) plus Percocet, a drug that contains smaller doses of oxycodone, for what my doctor called “breakthrough pain.”

I hadn’t used “oxy” before. I had taken morphine pills, recreationally, as a teenager, but was never addicted. (A friend had lifted them from his grandparents’ medicine cabinet.) I also drank alcohol off and on, but I stopped when I had the kidney issues. Drinking made the kidney pain worse.

I had also been diagnosed with bipolar disorder. In the depression phase, I would lose my appetite and have little or no energy. I would fantasize about suicide. In the manic phase, I would feel like I could see and absorb hundreds of streams of ideas at once. I would hear voices. I felt I could do anything and everything, without needing to sleep or eat. At some point, of course, I would crash; existing on ideas and air can only sustain one for so long...

But I didn’t want to admit I was bipolar because many people in my family had the illness and I saw what that meant. In my family, it meant extended stays at the psych ward and, in the worst cases, suicide.

Under the oxy—and off the oxy

To say that OxyContin helped with the kidney pain is an understatement. I don’t think I could have functioned without it. I went from being curled up in a fetal position on the bathroom floor on some days, just waiting to pass a kidney stone, to being mobile and not debilitated by pain—in other words, normal.

In the beginning, oxy made me feel euphoric; later, it provided a calming, stabilizing high. In hindsight, I think I gravitated towards oxy because it regulated the way I felt. Rather than dealing with the rollercoaster of emotions that is bipolar, I felt a relieving flatness.

Eventually, surgery fixed the problem that had caused my kidney pain. But by that time, I was dependent, and my physician explained that I would have to be tapered off OxyContin slowly. That’s how I got off the oxy: slowly and grudgingly. It took six or seven months.

A crash—literally

Less than a year later, I fell 12 metres off a roof, cracking my lumbar vertebrae. I was unable to walk for six months—and I was back on the oxy for another year and a half.

When my hospital prescription ran out, I followed up with my GP, who was not happy about prescribing me oxy again, but it was also clear that I was in regular, daily pain. At this point, I discussed going back on oxy with my mother, who had bipolar. My mother was familiar with addiction to pills (in her case, Ativan and clonazepam), even though she refused to admit that she was ever an addict.

At the end of a year and a half, I was blasting through my monthly prescription in the first week of each month; I had to buy opioids illegally for the rest of the month just to float my boat. Most of the time, I bought oxy, along with morphine and hydromorphone. But somewhere along the line, I started smoking heroin regularly, too.

At the end of my legal prescription period, I was warned by my physician (as well as fellow oxy addicts) that the original-formulation oxy was no longer available, and a new formulation was being introduced. OxyNEOs were supposedly resistant to tampering (with the time-release part of the drug).

But Purdue Pharmaceuticals (the company that promoted and sold OxyContin) had created a demand, and that demand was not going away. As a result, places in Ontario that had never had much heroin before were now inundated with the stuff. I personally watched waves of people switching to black-market hydromorphone (Dilly 8s) or to heroin.

Vancouver—West side

In 2006, I moved to Vancouver to do an undergraduate degree at UBC. Throughout my academic life, I straddled the line between being a nerdy high achiever (having the top grades in many classes) and being a total ne’er-do-well. I won spelling bees in Grade 6, and sold contraband cigarettes behind the baseball diamond. In Grade 9, I hung out with the matheletes—and sold acid.

I financed my undergraduate degree with bursaries, grants and scholarships. One can be addicted to opioids and still be entrepreneurial and proactive, particularly if one is in a state of maintenance. Maintenance is about regulating and staving off withdrawals: it is not about getting high; it is just about feeling not sick.

While I was at UBC, I found an addictions doctor nearby in Kitsilano, and he prescribed me both methadone and Suboxone (separately, of course). I vacillated from use to sobriety to methadone to Suboxone. Eventually, I managed to stay away from using for a number of years.

But as I neared the end of my undergrad, in 2010, my mother went missing. I flew back to Ontario to help look for her. She was supposed to be taking five different heavy-duty psych drugs a day, but she had quit cold turkey two weeks previously.

It turned out that she had taken her own life.

I’d been in bad shape when I had my kidney stones and then later when I injured my back, but this was nothing to how I felt when my mother killed herself.

I blamed myself. I got very angry with my father. Ach, it just tore my heart out. Even though I had been off illicit opioids for a few years by then, I relapsed in Ontario after my mother died. I used oxy and Ativan, which I found in my mother’s prescription stash. By the time I returned to Vancouver, I had also got my hands on a hundred methadone pills from an old friend of mine.

In 2011, I started using heroin. Thankfully, I never overdosed. I did, however, have to revive a roommate with naloxone when I came home one night. He wasn’t breathing, had no pulse and his lips were blue. This experience, along with the memory of my mother, pulled me out of the wasteland of heroin addiction and back into the land of the living.

Setting myself free

I got off opioids in 2013. I decided to go back to a daily dose of methadone. I also went to Narcotics Anonymous (NA) meetings.

For exercise, I dragged my sorry hide to the local pool and swam laps every day. I also started running and going to the gym. During this time, I began to play and record music with a friend of mine from UBC. On the advice of my physician, I have continued to stay on a low dose of methadone.

I also finally got prescribed the right psych meds for my bipolar disorder because my girlfriend—bless her heart—made me go to the local emergency department with her. I needed to go. I was constantly talking with people who were not there. I was paranoid. I had messianic delusions. At one point, I was so removed from reality that I felt I might never return, which was deeply frightening for me.

On the bipolar meds, I have a degree of stability. I sleep regularly and I feel more even-keeled. It’s ironic that while I was able to admit I was an addict many years ago, accepting my bipolar diagnosis took much longer.

Fear fed my addiction, and acceptance set me on a path of healing. I was afraid of the power of my addiction and the hold it had over me. But when I finally accepted that I was an addict and that I had bipolar 1, things starting getting better for me, slowly but surely. I realized I had been stuck in an ever-accelerating cycle, where I self-medicated to function in the world, which inevitably and reliably made things worse, again and again and again.

Thoughts on the overdose crisis

You have probably heard this old chestnut: No one ever dreams of being a junkie when they grow up.

I used opioids so that I wouldn’t have to face my mental health issues. Opioids provided me with a comfortable, impermeable blanket; they killed the pain, soothed the voices, calmed my racing mind. In the Western world, we have a sick relationship with pain. We think that we are entitled to live completely pain-free. We believe we deserve instant gratification and comfort. We unambiguously embrace pleasure and demonize pain.

I am not suggesting that we need to stop avoiding pain. But I do think that we need to re-imagine how we see and judge pain and physical discomfort. Is all pain so categorically harmful that we should imbibe everything from opiates to cough syrup to avoid it? Don’t we learn from pain?

When we stop demonizing our own pain, we can stop demonizing the pain of others—and we can stop ignoring the suffering we see around us. Vancouver prides itself on being healthy, green, ethical, free-trade, organic, spiritual, open-minded and aware—but we aren’t aware where it really counts: we don’t show concern for the people of the city. 

People who use substances are frequently systematically punished and discriminated against—or worse, forgotten. As a society we have become desensitized to suffering—we don’t want to see it—so we walk past the panhandler on our way to work, we ignore the howling of the ambulances. What can I do about it anyway? They do it to themselves. It’s their fault. They have a choice. They deserve it. These are all sentiments I have heard shared openly by fellow Vancouverites.

But we can save lives—if we can acknowledge and accept pain, and if we can challenge those who look at someone who uses drugs as anyone other than a brother, sister, daughter, son, parent, friend, colleague or peer. Those who use drugs are human, just like the rest of us. We all feel pain and we all feel fear. When we overcome our fear of pain, we can access great strength and grace. It is there, waiting for us.

And when we acknowledge that, we can begin to heal each other and ourselves.