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The Picture of Addiction: It Can Happen to Anyone
The Picture of Addiction: It Can Happen to Anyone
The Picture of Addiction: It Can Happen to Anyone
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The Picture of Addiction: It Can Happen to Anyone

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A physician mother shares her true story of learning about opioids in a rural community as she begins medical practice. This class of medications, highly desired for treatment of pain but resulting in addiction for many due to liberal prescribing, fuels an opioid epidemic. Following a reduction in legal opioid availability in her town, heroin arrives to fill the gap. The market for this illegal drug had already been created, leading to many more developing opioid use disorder.
Her own son makes a single bad decision and is exposed to heroin. As a result of her experiences doing everything a mother can to keep her son alive, she is shocked by the stigma and lack of effective and affordable care for people with this disease.
She discovers that the treatment with the best track record in helping people achieve recovery is a medication called buprenorphine. When emergency departments provide the first dose when a person with opioid use disorder is in withdrawal, then refer to out-patient clinics plus community programs to provide jobs and housing, people with this disease can recover. She initiated inductions with buprenorphine in her ER and demonstrates how easily this can be done in every hospital.
LanguageEnglish
Release dateAug 1, 2024
ISBN9798385217373
The Picture of Addiction: It Can Happen to Anyone
Author

Margaret J. Loewen MD

Dr. Margaret Loewen is the director of medical services for Maple City Health Care Center in Goshen, Indiana. She was previously the medical director of the Emergency Department for Prowers Medical Center in Lamar, Colorado. She and her family have started a company called So Long Overdue LLC to support and inform the public regarding the disease of opioid use disorder.

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    The Picture of Addiction - Margaret J. Loewen MD

    Part I

    A personal story of fighting back in small town America

    Chapter 1

    Before 2010—Blending career and family

    I was probably more than a little nuts when I decided to head down this career path later in life than anyone I knew. Reminded by a special friend while catching up over lunch that I had been unusually old when I started medical school, I was startled by the comment but nodded at her from across the table. Munching on my cold pork and olive sandwich, I bought myself some time to think by contemplating the antique pattern on the high ceiling of the picturesque Greek restaurant. Listening to the echoing chatter of patrons with the short-order cook behind the counter, I had to admit she was right. I remembered that many years earlier she had supported her husband through his years of training to become a pediatrician. It occurred to me that Jean understood better than anyone what this decision meant in its varied complexities for me and my family.

    She asked me a very simple question, Why?

    The soft features of her face were framed by shoulder length light brown hair and her blue eyes were expressing something akin to concern, demonstrated by a slight squint as she intently watched me.

    I tried but couldn’t define the reasons well enough in my mind to verbalize an honest reply. At that time, it was still early in my own understanding of the new opportunities and life I would have as a medical doctor after having worked for twenty years in the professional realm of human nutrition. Emotions and conflicting motivations made it impossible for me to distill these thoughts into a coherent answer. I couldn’t do any more than promise to tell her when I had it figured out.

    I will give you an update someday when I can answer this question, I said lamely. She appeared to be disappointed with my inability to articulate my reasoning but offered me her support as she always did. Her unconditional love was a constant.

    Years later, I began to realize that one of the factors contributing to the decision that she and I had been discussing was that I had a lot to prove. I had grown up at a time when higher education for women was encouraged but a demanding career was not. Chafing against the cultural norms, I had found my way out of a restricted space.

    I had pushed tradition aside already, marrying a man who held similar values as my own in many respects. But he lacked an appreciation for my closely held ideals of nonviolence which were non-negotiable. The strength of my feelings on this score were doubtless related to terrifying memories from childhood that I could never forget.

    When I was ten years old, my parents, siblings and I had experienced 111 days as hostages in Stanleyville. This was the largest city in the northern part of what had been the Belgian Congo. In 1964 this newly independent country was convulsed in a civil war. An uprising occurred after the fledgling democracy suffered political interference due to an effort by their former colonial master to control its alliances, purportedly in cooperation with the CIA. The Democratic Republic of Congo’s first prime minister, elected to lead this young nation, was Patrice Lumumba, a charismatic man revered by the Congolese to this day. His unexplained death during a routine flight across this mineral rich tropical country, for which all foreign governments denied responsibility, caused immense grief for this nation, justifiable anger, and a passionate distrust of the Belgians and Americans. That my father was a Canadian was fortunate. Neither American nor Belgian, he was an administrator for a Congolese university located in the center of this conflict. His job apparently conferred some protection for us during those months of occupation by the rebel soldiers who were also known as the Simbas. Our family was not harmed physically during our captivity. This was not the case for far too many Congolese, possibly as many as half a million, and hundreds of Belgians and Americans as well as expatriates of other nationalities who lost their lives during this civil war. No surprise, I detest guns and violence.

    In addition to this personal history, the pacifist culture of my ancestors did not blend seamlessly with the pugilistic culture of my husband who had grown up in the mountains of Appalachia. Given our differences, perhaps the eventual demise of our marriage was predictable. However, for me, marrying Henry had been a liberating choice because this was a relationship filled with freedom that allowed me to learn and grow.

    When my husband and I discovered our infertility after seven years of marriage we were thrilled beyond words to adopt a newborn baby boy. As our first baby grew into childhood, like other adoptive parents we discovered that the natural talents of this lovely child were in some ways strikingly different from our own. I always remarked to myself with amazement that even as a preschooler little Frankie would never forget a face or a name, a trait that stands out among his natural abilities to this day. This was a gift he had received from his genetic inheritance, not a result of any training he had gotten from us. Quite honestly, neither Henry nor I were talented socially.

    When we were able to adopt a second time, we were absolutely in heaven. There was an eight-year age gap between our sons who both joined our family when they were newborns. They were beautiful beyond words in all the ways that children should be in the hearts and minds of their parents. For me, these precious children brought fulfillment and so much joy. In addition, Frankie was grateful to have a little brother when he finally arrived! Despite the years between them, these boys were close, they were bonded. Little Bezzy completed our family in such a perfect way.

    However, within our nuclear family dark clouds were forming on the horizon. The wind was whipping up and some shrill tones were unmistakable when I listened carefully for meaning. In an effort to make things better for my family, it seemed like a change of some kind was needed. I was apparently the only one in our marital partnership perceiving the threat. Cracks in our union were beginning to appear. As a result, one fateful day I had an epiphany at work and when I returned home that evening, I proposed starting a career in medicine. I received only encouragement from Henry. He thought it was a wonderful idea and he cheered me on. This was why I started medical school at the age of forty-seven.

    Unconventional life choices for a Mennonite girl might lead to countless challenges in personal relationships and I can confirm that many interesting situations did precede the events described in this book. Although I had loved the man that I married at least in part because of a different perspective that he offered me, there were dramatic differences between our two learned cultures. These differences could be accommodated before our children arrived but afterward, they simply couldn’t be ignored. We worked with several family therapists, in succession. We tried very hard to be parents together with years of supreme effort given to compromise. We talked through differences in our views of what we each considered appropriate child rearing, but in the end we could not succeed. To be brief and much to my surprise since I never thought I was a quitter, our marriage had to come to an end for the physical and emotional safety of our children. I hated that this was the ultimate result of twenty-five years of living in a veritable two-culture household. I felt like a failure.

    I am not going to minimize the effect of the divorce on my family in the telling of this story. It was complicated and difficult to share the truth with worried family members and friends when I left Henry with the children in tow. The problem was that I literally had to get my children out of that home environment before someone got killed. When I hear about family violence and murder-suicides I can relate to that unthinkable level of conflict within a family that often is so well concealed that even close friends and relatives are unaware. I considered leaving medical school briefly but decided that my need to focus on an intense educational program was not the source of the conflict. I kept going down this path because it would ultimately provide a level of financial security that I would not have if I left before completing the program. This seemed best for the future of my children and myself to continue pursuing the medical degree. When I was prepared for what I had to do we literally drove away one day. Sitting in the car together with my boys in the back seat, headed to my brother’s house, I told the children we were leaving and not going back. They both cheered.

    Our oldest son Frank was graduating from high school when we separated but our second son Bezzy continued to live with me. Although Bez and I had moved from a small northern Midwestern town to a different city during the last years of my medical education, we were fortunate to find neighbors there whose loving ways as a family made it possible for him to enjoy their love and attention while I was almost endlessly studying and working in hospitals to gain my clinical experience. With the start of my residency program, Bez and I moved again to a city not far from our town of origin, and in this neighborhood, we made new friends again who also bonded wonderfully with us. In our condo neighborhood an older woman and her adult daughter provided friendship, companionship, and eyes while others I hired to be present in our home were making sure Bez had appropriate supervision in my absence. Bezzy and these wonderful neighborhood friends worked on decorating projects and crafts that taught him much about creating beauty. In addition, he was also happy to have access to a swimming pool where he perfected his swimming skills while being watched by his nanny.

    Thinking back to these years, this sweet youngster was doing well. He attended a public school in a district with a lot of resources providing him with many opportunities that enriched his life. He was especially digging learning to play the saxophone! What a gift that was for his development. He had started taking piano lessons when I was in medical school but, unfortunately, with my even more demanding schedule in residency I could not keep this up. Clearly, he had a talent for musical improvisation as well as artistry. I had chosen a safe and friendly neighborhood when we moved to this new urban environment. Aware of Bez’s need for a good support system in this location where we didn’t have any family or longtime friends, it was important to provide him with a great school district. That I had the means to provide this for him, I am still thankful.

    He made some good friends his own age whose parents liked him and recognized his need to connect socially. One of his closest friends was a boy whose mother was an administrator for the Girl Scouts national organization and Bez was invited to be their guest when they went to the Great Wolf Lodge for a short family vacation. It was quite a gift. Bez was well liked and seemed happy generally. We had joined a local congregation, and he went through the normal religious teaching for a young person of his age.

    But as with every child, there were difficulties too.

    One of the hardest things during this period in his life was when his special little dog came up missing. He had an adventurous pet who could squeeze through the tiniest opening in the sliding door of our walkout basement and given the slightest opportunity the dog would take off. One weekend Bez and I were out of town visiting family and upon our return we discovered that the furry creature had escaped and had not returned. Bez was devastated. This little dog was never found, and it was a significant loss for him as well as a cause for longstanding grief. I don’t know if he has completely resolved that sadness, even now. My priority of meeting ongoing medical residency requirements prevented me from taking time off to locate the lost animal.

    Another situation occurred when he was about thirteen. He and a friend from our neighborhood were caught stealing something from a local store. I had gotten an urgent call at work from a supervisor at that retail establishment telling me that the store’s security staff had called the police. Bez and the girl were charged with theft. I was stunned. I rushed to the store as soon as I could leave work and found that he and his friend were being held in a small dark, windowless room with cinderblock walls painted a depressing shade of blue. It was memorable to me in its ominous appearance. It was a stark room with a bare light bulb providing some dim light.

    Both were sitting quietly in metal chairs lined up against one wall. Bez was not very forthcoming with information; it seemed to me that he was attempting to appear nonchalant about the whole situation which was understandable since he was sitting next to his also accused friend. However, he did look pale and serious, staring off in another direction that did not connect with my eyes. He was almost wordless during the conversation we had with the police officer and the store manager. In the end, he and the girl were banned from that store forever and the juvenile authorities sentenced him to several months of weekly classes with his peers.

    My gorgeous youngest child with a heart of gold who wanted nothing more than to make the people that he loved happy, was becoming increasingly distressed with his father’s incessant raging against the world of his mother’s family and friends. On Christmas Eve, Bez ran into my parents’ house with tears coursing down his cheeks after being dropped off by his dad as my extended family was assembling for the annual celebration and gift exchange around the tree, beautifully decorated for this season.

    I asked, after pulling Bez into a private space, What’s wrong? What has happened?

    Dad’s gonna kill Lee! he shouted.

    Eyes puffy from crying, he was frantic. His youthful lanky arms were waving at me for emphasis as he shouted, Call the police!

    That was when it became completely clear to me that I needed to get help from the courts. Lee and I had been dating after my divorce and my ex was not accepting that our marriage was over. I didn’t have money to spare on my resident’s salary, but I also didn’t have a choice. My lawyer filed the complaint that allowed for a hearing. The judge ruled in my favor and my ex was required to attend court-ordered parenting training and anger management classes. Meanwhile, Henry was not allowed any unsupervised visits while his behavior was being closely monitored. When he demonstrated his improvement in conversations and activities with our son, the restrictions gradually lifted and they were allowed to be together again, unsupervised.

    I was a single mother, and I was doing my best for my dependent children. It was so over the top for me emotionally to be in court fighting for my son’s sanity and for my family’s safety during that time. Henry’s threats of violence were eye-opening for me even though I was

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