A Drug Memoir That Isn't Anti-Drug 

[FREE] David Poses on practicing harm reduction, allowing people to take opioids, and being skeptical of rehab.

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Most drug memoirs follow a predictable narrative: the author loses their innocence after being introduced to drugs, they eventually hit a rock bottom, then they have a moment of clarity, often after going to rehab, and become 100 percent sober. The problem with these memoirs is that they paint a very inaccurate picture of how addiction and recovery often work. People have a much better chance of surviving opioid dependence if they’re given a drug called buprenorphine, an opioid that allows people to function without making them as high as more powerful opioids like heroin. Rehab has an abysmal success rate.

David Poses wanted to write a drug memoir that provided a corrective to mainstream, moralistic recovery narratives, using his own experience as a heroin user, and now as a buprenorphine user, to highlight a hopeful, and more scientifically proven way out of addiction.

His new book is The Weight of Air.

[This interview has been edited and condensed]

The struggle for me was that I didn’t want to be a “junkie”, but I couldn't live without heroin. It was the most effective antidepressant I could find, and it stopped me from killing myself. I began a successful career, I got promoted, I made a ton of money when I was on heroin. 

After rehab at 18 I kept all of this secret. I led everyone in my life to believe I got sober when I was 18, and was happy, and never looked back. As far as my wife and everyone knew, that was the last time I used drugs.

When my daughter was born, I swore that I had to stop doing heroin, but that caused me to fall into a black hole of depression, and then relapse. Years later, I found out about buprenorphine. I was just overwhelmed with guilt and shame for lying to everyone I knew. The opioid crisis was on every front page, and everyone was asking, “why is this happening?” When it was obvious to me: depression rates are skyrocketing, everybody’s anxious and traumatized. We’re an instant gratification society. And painkillers kill pain, and antidepressants don’t work well. 

That all made me decide to come clean to my wife and everyone, and I was prepared for the consequences of that—that she might throw me out. So I wrote this book, and shared it with my wife. And she was so gracious and understanding. I felt like I had to get out there and spread the truth. At a certain point I felt like my silence was contributing to this harmful narrative about drugs. 

I was ashamed and hid it for so long because we have this idea that abstinence is the only way to recover. If I’m a 40 year old man yelling about this stuff and I felt shamed, then what is it like for an 18 year old who is struggling and can’t freely talk about his drug use, or who can’t get on buprenorphine because everyone is telling him that it’s just as bad as heroin?

When I started speaking about this, tweeting about it, writing articles, I’d get at least one email a week from a parent who lost a kid to an overdose in the last couple of days, often with some very tragic story of being shamed out of buprenorphine. 

Buprenorphine is proven to cut the risk of overdose, relapse, death, by like 80 percent. And abstinence is proven to increase all those risks. And yet it’s often impossible to find buprenorphine treatment. 

Poses believes there’s a huge misunderstanding of what opioids actually are, and why people take them. 

Opioid is a category, and people who haven’t done heroin think that it’s somehow special. But if you’ve taken Percocet, or Codeine, or Tramadol, then you kind of know. It’s like saying you’ve drank beer but never drank whiskey. It’s just potency. Buprenorphine is a partial opioid agonist. Most other opioids are full agonists. So the mechanics are the same, but it’s not as intense. It doesn’t give you the same warm, gooey feeling when all your receptors are saturated. It’s basically a warm blanket that says “everything’s cool.” For a depressed person, when you have that blanket around your receptors, that raises the basement level of your emotional and physical pain. 

I’ve been depressed my whole life. I’ve been in the “basement” without being on anything. The heroin makes everything cool. It’s overkill. It’s a Lamborghini on a golf course. The buprenorphine is a golf cart on a golf course. 

Opioids have been around longer than the existence of written language. People have figured out that they help with pain, emotional and physical. And yet we still act like it’s crazy to use these drugs to treat depression and emotional distress.

There’s no question that Big Pharma’s business practices are reprehensible, but the base reason people use opioids is because people are in emotional pain. If you had a knee injury, and were prescribed OxyContin, then yes probably the reason you were prescribed it has something to do with the influence of Purdue Pharma. But if after weeks you’re still taking it, after the pain is gone in your knee, it’s because it’s providing you with relief in some other way. We have a hard time admitting that part of the opioid crisis right now.  If you live in coal country, and there’s no jobs, and no support, and no mental health services, but there’s opioids, why wouldn’t people look to that for pain relief? We have to understand that’s why people are using these drugs, which is why legalization is the only way to make them safer. 

Even if there are risks associated with opioids, we already accept those risks with, say, alcohol. Thousands of people die every year from drunk driving. People become violent on alcohol. But there’s no reason we can’t treat opioids the same, and mitigate the risks through legalizing it. 

The war on drugs is costing us billions, we’re lighting $51 billion a year on fucking fire. We’re spending 12 times more on enforcement than treatment. If we legalize drugs, tax them like alcohol, that’s hundreds of billions that could be used to mitigate any risks. That’s plenty of money to solve whatever problems might arise, plus it’ll put the cartels out of business, and it’ll save lives. 

People say, “oh well opioids are too dangerous,” but with them illegal right now, they're the leading cause of death in America. There’s nothing worse than death! That’s the worst thing that can happen, and we’re currently experiencing it. So how could legalization be worse?

Legalization doesn’t lead to widespread use. Most people don’t buy beer every time they go to the gas station. Most people aren’t driving drunk. If legalization led to use, we’d all be drunk all the time. 

We need to stop treating addiction with magical thinking. We need to address the base of the problem. It’s like if you watch the show Hoarders, they can take all the shit out of your house and clear the pizza boxes from your closet, but there’s always some big reveal as to why—like his wife died in a tragic parasailing accident 16 years ago and he hasn’t grieved properly. So that’s the base problem. With addiction right now, we’re sometimes clearing the stuff out of the house—getting people to be abstinent for a period of time (before they often relapse)—but not actually addressing why they’re using drugs. ……….

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