#couldn’t even get rehab when I had to get off of fentanyl and had to wait FOUR MONTHS to even see a therapist.

[angelnumber27]

It sucks so much not being able to get the medical care I need because it’s too expensive. I never ask for help even when I’m having really bad symptoms or a horrible mental crisis and know I need to see a professional because when I attempted suicide and was in the ER convulsing from taking so many pills, my dad stood in the doorway and said “this is going to be so fucking expensive.” and then left :-)

[sabrinariverdalefan]

I’ve got my eye on you

Xavier Thorp / Original Character

“I’m Xavier by the way.” The tall lanky boy released her arm and took a step back. He didn’t want to seem to intimidating to the girl, but she seemed anything but.

“Elizabeth…but you already knew that.” She said with an arch of an eyebrow “Let me guess you overheard me.”

Xavier looked down at the ground “I didn’t mean to I was just…” What was he even wanting to say to her? “You weren’t joking about that being an addicts anonymous meeting were you?”

Crossing her arms over her chest, she looked up at Xavier with what he thought was pity perhaps? “No. I’m an addict. Just got back from rehab after overdosing a while back…”

For some reason the only drugs that he thought she was doing was pot, but who overdoses from weed? “What…erm…did you overdose on?” He asked feeling immediately that this was a lot more serious than he had expected.

“Fuck…what don’t i take. I was on oxy, xany bars, hydros…Adderall.” Just speaking about it gave her the urge to reach into her pocket to grab her stash, afraid that it would suddenly disappear. “…Fentanyl…”

“Jesus…” Xavier said as he ran his hand through his drenched locks. She looked so lost to him and it tugged at something in his heart - what kind of life was she living to feel the need to get that high.

“Yeah…I kind of was in a coma for six days.” The blonde answered awkwardly as she played with the baggy of pills in her pocket.

The urge to just grab her and wrap his arms around her was so overwhelming; he didn’t want to ruin this moment with her by being affectionate. They’d have plenty of time to do all of that in the future. “Look…” Xavier began after taking a moment to let her words sink in “I know you don’t know me, but if you need someone to talk to…”

Elizabeth gave the lanky boy a sad smile. “Thanks Xavier…I’ll keep that in mind.” She replied feeling slightly awkward when she handed her phone over for him to put his number in.

Xavier loved hearing his name coming from her lips. It sent this spark through him that he couldn’t explain. He typed in his number and saved the contact as ‘Xavi’, a nickname those close to him used. Elizabeth in turn put her number in his phone with a nickname not too many people were allowed to use - Lilabet.

Elizabeth looked at the time on her phone before she returned it to her pocket. “I gotta get going. It was nice seeing you again and learning your name?”

He watched as she disappeared from sight unable to take his eyes off her until he could no longer see her. “Don’t worry Lilabet I’m here to save YOU.”

The next time he saw her was no accident.

Unknown to Elizabeth he turned on her location sharing when he added his number to her phone. Not to be weird but to be aware of where she was. There was nothing wrong with that certainly. It was only natural that he wanted to be worried; she had said so herself that she was an addict. She would see how much she could rely on him. How he could truly care for her. Elizabeth was everything he wanted. ‘My eyes are only on you.’

Xavier often checked the location in the days that followed and it was typical. From school, to the Weathervane and a couple houses that he decided had to be hers and her dealers, she didn’t go about much. This night however, he tracked her to a new house and immediately he found himself sitting up in his bed. Earlier when he was volunteering at the cafe he had heard the townie kids talking about a big party happening that night - of course she would be there.

Before he could control his urges he was dressed and waking up Ajax who even though annoyed at first was completely fine going to a party. It had started out with just the two of them but then they ran into Wednesday who for some reason his friend invited her to tag along. Even though the Addams girl initially seemed uninterested, she followed the two boys into town.

Following the girls shared location they ended up at a party unlike what they have at Nevermore. The place was crawling with drunken normie teens. Ajax didn’t hesitate when they walked through the door. Wednesday upon entering the house looked around in distaste. definitely not amused by what she considered idiotic behavior. Xavier couldn’t care less as they made their way through the crowd - no one seemed to notice that they didn’t belong. The only exception was his female counterpart who stuck out like a sore thumb with her black clothing and death stare. His mind was elsewhere as he searched the room for Elizabeth.

There sitting on the floor in between the couch and the coffee table was the object of his obsession. A powder substance lined in near little rows on a small mirror as the blonde held a rolled up dollar bill in her hand. Eyes heavily lidded and a dazed look upon her face, Xavier could immediately tell that the girl was doped behind comprehension and there she was snorting line after like of whatever the powder was in front of her.

Leaning back against the couch after the last line was gone, Elizabeth could feel her heartbeat get slower and slower. shit - she hated it when that happened. Is she having a heart attack? Is this it? With eyes closed and a look of peace on her face, she waited for a moment and before she took that same rolled up dollar to snort an upper to keep herself out of the ground. Once she came back to herself she let out a laugh as she grabbed her bottle of Bud Lite and chugged it down not even noticing the door lanky boy watching her from across the room. Unsteadily she gets up to take herself to the bathroom.

‘Perfect’ Xavier thought as he separated from Ajax and Wednesday, following the girl down the hall to see where she goes.

[eligalilei]

More Extensive Redditversations on Psychtogenesis:

Person A:

Truthfully, APs are really only effective in treating hallucinations. They don’t treat much else. No pill is going to stop you from holding a fixed false belief in the face of all contrary evidence.

My psychiatrist won’t even prescribe APs if you don’t hallucinate. Maybe a low dose of seroquel Person B:

Idk about that, maybe to some degree but I was out here thinking skin walkers were real, in an alternate reality, while they showed up as anything here, there they looked like shadow creatures that took control of people’s bodies. I was the prophet of that reality who couldn’t be touched by them, while I could telepathically speak with anyone and any living organism. Including god, zeus, animals, etc.

It wasn’t until I was on my way to my PO’s office, I was talking to all of them, but specifically one, he was the devil, I was Jesus, came to an agreement to work together, only for me to betray him by speaking with the others and discovering we were just schizophrenics that need meds, and as the realization came, all the people in my head left, leaving just me and “the devil”, who turned out to be my brother. Then it was a matter of getting him help, him being a long term user of fentanyl and others, was in rehab. He didn’t want to get help, we were in a shared psychosis. Only to finally discover after several weeks of investigating when it was only him and I in my head, that it was actually me who was the voice in my head, and it had begun to just say what I was already thinking but before I would. Eventually getting to the point where it just makes comments about what’s going on, sometimes it’s nice other times it’s an asshole, all depends.

Without the meds though I don’t think my beliefs would have changed, or that any of the revelations would have come. I easily could have been the guy sitting on a corner talking to myself for days, but thanks to the meds, I’m back to pretty much how I was. No more delusions, and I’m back in this reality. Able to decipher what’s real and what’s not, it’s nice.

If I stop taking them though, would I create another alternate reality for myself? Fixed beliefs, that I can’t change on my own? Me: That's a delusional complex with hallucinatory elements. They're talking about delusion by itself, which maybe APs will help somewhat, but basically only at the point where thought has been eliminated. Person B:

I like that explanation. I don’t understand the last sentence in the sense of, do you mean all thoughts are eliminated, or certain thoughts in particular.

I have thoughts that are almost impulsively thought that are delusional, but am able to blow the thought off as quickly as it came. When I was delusional, all those thoughts were put on the table as a possibility.

Would it be the meds that are helping me block the delusions, or is it me just becoming better at differentiating? Genuine question btw, you seem nice and knowledgeable.

extra banter I’ve only been back to “normal” for a few months and don’t know anything about SZA other than there’s delusions, hallucinations are involved (sometimes?), and my psychiatrist thinks I have it (although hasn’t diagnosed). I guess there’s a sort of test or something that they perform to determine if you have it or not? Idk.

extra extra banter Never really talked to anyone about it, was just forced to take meds(if I didn’t take them they brought a needle out and it was either I was going to take them or I was getting it injected forcibly lol)

Any insight would be nice when you’ve got the time and if you’d like to give some, I’d like to learn more about it rather than just the the things I mentioned above. I’d really like to stop meds because of side effects, but am worried I’d slip back into a psychosis. Me:

I was being cynical, tbh, and suggesting that, and experiences tend to bear this out, neuroleptics work by reducing thoughts... which is kind of true, but it's both the same and different as another way in which AP action is explained: via the dampening of one's experience of, and procedure for assigning, valence. What this means, basically, is that they make things seem less significant or urgent. This fits with your experience of having odd thoughts, but being able to dismiss them.

One way to fit these two ideas together, is to consider how 'valence', or significance ('salience' is another word that's often used), operates on conscious and unconscious levels. The suppression of conscious valence is experienced as having a, possibly 'psychotic', thought, and just not investigating it or investing in it to produce a series of spinoffs and sequels, as might happen in psychosis.

But valence/significance/importance/energy/salience is a property of, or at least is a concept which can be expanded upon and used to describe by analogy, all manner of mental phenomena. There's presumably a constant murmur of unconscious 'maybe' thoughts clamoring for the ear of the conscious mind, which is itself not fully situated in it (Freud call this domain the 'preconscious', and others have called it 'subconscious' in contrast with the 'unconscious.' In other contexts it is referred to as or related to the function of the 'censor', which selects and edits information on its way to the conscious/ego). The greater the volume of any of these unconscious voices, and/or the more 'interested' the conscious mind is, the more likely it becomes that it produces, or is encoded in, a thought that is experienced.

Of course, what occurs in the domain of consciousness is fed back into the unconscious, and is amplified and split into more more murmurs, which may or may not make their way into awareness. We could think about psychosis as a runaway feedback loop rapidly accelerating and expanding in content due to the volume and quantity of unconscious murmurs-become-shouts, the relaxed indiscretion of the preconscious censor (that usually rejects or suppresses potentially problematic tangents), to whom everything suddenly feels important, and the excitation of the conscious ego under the sway of this rapidly proceeding tempest of exciting mental happenings.

On some level, at least in some kinds of psychosis, what we're experiencing is a very unstable and disordered excitement due to everything seeming just so damn important or significant. And if something feels significant (though actually for no good reason besides brain stuff), other parts of the brain will run off and figure out 'why' it is significant, based on nothing but the all-too-enthusiastic assumption that it is.

Instead of evaluating phenomena, and the assignation of importance being largely under the power of the conscious or processes with which consciousness and society are largely comfortable, it's like importance sneaks in at an odd intermediary step, and things, due to one's being complacently accustomed to shit making sense, start to run backwards in an attempt to maintain a feeling of coherence.

Seen thusly, the delusions, or rather the rejection of, or failure to attain, 'insight', are, in fact, a way to maintain sanity: the fundamental delusion underpinning all particular delusions is the idea that the mind (or in traumagenic psychoses, the world) is still working correctly. This is why the 'insight criterion' (of delusion, or, for some people, psychosis itself, though I see that as being a bit heavy handed) developed: it's only a delusion if you believe it. That is, in fact, only part of the picture, the entirety of which you might be able to guess from here, and that I won't begin to render, since this is already getting a bit long, and I may still have to add more without even going on that tangent.

There are tons of more biochemically oriented theories of antipsychotic action, though none of them are really very totally confirmed. Most of them, though, relate to a reduction of some kind of activity, and comport pretty well with the ideas in the above sketch. While this is kind of my own spin, the general idea is referred to in psychology as the 'aberrant salience' theory of psychosis.

As far as what's happening in your mind goes, I think we can look at it both ways and a sort of third halfway one based on the above (we can call one the 'unconscious' understanding of cause, one the 'conscious learning' model, and the third a kind of 'cybernetic' or 'pseduo-psychoanalytic one):

Salience is being suppressed on multiple levels, which leads to fewer and less intense thoughts,

and now, knowing that you've been through psychosis, you no longer uncautiously receive the phenomena issuing from your unconscious mind with open arms and a set of keys to your car.

In a sort of hybrid of the two, we might say that decreased salience allows you to re-establish a 'normal' relationship between conscious and unconscious mind by reinstalling brakes on the feed-forward process of salience-driven, backwardsly-working, enthusiasm which uncritically meets the demands for extraordinary causes made by your extraordinary feelings. As salience ceases to be injected in large doses at an 'unnatural' stage of thought production (or noögenesis; isn't that a cool word?), though the thoughts you once thunk remain, they become compared with those constructed under 'normal' conditions, and may eventually be seen as the grotesqueries they may be.

That said, once a thought has been established as true, a drug is not going to make you not believe it, especially if it's one that has become especially important to you. They aren't going to just make you think different things. I am of the unpopular conviction that another person can often stand in for one's own ego in the journey back to sanity. ....but if you're seeing fucking dragons all the fuck over and feel like your limbs are about to fall off? Well, uh, it's just kind of hard to argue with that. Probably maybe take a pill and see if you'll make better decisions when not besieged by a menagerie of mythical monsters.

So, I mean, I was being a little overcynical about APs not helping delusions. They can re-establish a neurological environment that can make it easier for you to soberly reflect on them, and they can prevent the production of new ones, but often at the cost of mostly just getting rid of everything interesting in your brain. Sometimes that's a cost worth paying, or it need only be a temporary sacrifice.

Plus, therapy and hand-holding is financially and emotionally expensive. Pills and padded rooms are cheap low maintenance 'solutions' to the problem, though they only sometimes succeed in so being. Pills do have a place, plus, they may sometimes prevent the further propagation of actually toxic pathological perniciousness, though that hasn't been established to be universally true. In my (actually only somewhat) humble opinion, one of the best ways to establish whether this is true in any given case, is that of determining whether the pills seem to be necessary, and whether you actually feel better taking them. Some do, and some don't, find either or both true.

There's still more I could say on the last point, but I'm trying not to pontificate excessively, and this has already become rather an epistle. If you want more such nonsense, feel free to ask.

[chasing-classics]

Addicted to the Odds- Fezco x Reader

Pairing: Fezco x Reader

 Warning(s): Smut, mentions of drug addiction, angst, language

 Summary: You are an addict and it is indirectly Fez’s fault. Out of nowhere, your dealer refuses to sell to you anymore and you have a gut feeling Fez is the reason for it. You confront him and angst/smut ensues.

 ‘’What do you mean you don’t have any?’’ you all-but growled out from the screen door of your dealer’s run-down house.

 ‘’Like I said, ma. I don’t got any for you anymore,’’ he replied, taking a hit of his bong and refusing to look you in the eye.

 ‘’Nothing? OxyContin, fentanyl-‘’

 ‘’Nothing. Nada. Zip,’’ he cut you off.

 You huffed, narrowing your eyes as you shifted your weight to your right-hand side. You ran a hand through your hair, trying to keep a level head. For the past year-and-a-half you had been an addict. It all began when you attended a party with your best friend Cassie. She had just recently began seeing McKay and it was through one of his intense parties you met Fezco. The ginger-haired man caught your attention immediately. He was beautiful, in his own way. At the time, you had only dealt with weed and various fruity drinks. You were a good, kind-hearted girl. You did well in school and were well-liked by everyone. That was the thing about addiction; nobody ever strives to be an addict. It starts with one hit, then slowly crawls to another, then another, and another. You don’t realize you’re addicted until it’s too late, and by then the claws of addiction were already too deeply imbedded in your skin.

You wanted to let loose, have a good time. You wanted to fit into Fez’s world. ‘’Come on, Y/N get the stick out of your ass and live a little,’’ you remembered Nate Jacobs smirked down at you. That was the push you needed, you were embarrassed to admit. It sounded like a bad health class lecture, ‘’don’t give into peer pressure’’ and all that jazz. You remembered approaching Fez, his eyes trailing up and down your body with interest. That was the first night of the rest of your life as an addict. The moment you downed the OxyContin pill with a bottle of Hennessy, your life changed forever. All to get the attention of a boy who probably only saw you as another client. You ended up finding a different dealer because it became too difficult to continue going to Fez, who you had fallen for only to feel the sting of embarrassment when you realized he was never going to see you the same way you saw him. And that’s your story; became a fucking drug addict by the age of seventeen because you had a crush on a drug dealer who you had a handful of conversations with in the past nearly two years.

 ‘’Did Fez put you up to this?’’ you hissed. Your dealer’s silence was all the confirmation you needed.

 ‘’Fez! Open the door!’’ you yelled, banging on his front door.

 You knew Ashtray probably alerted his older brother of your arrival, but it didn’t stop you from marching to the front door. Every second that Fez took to answer the door felt like hours, sweat dripping down your body as the withdrawals were hitting you. Just when you were about to raise your fist to knock again, the door opened and the man in question was right in front of you. He towered over you, his green eyes taking you in and you could’ve kicked yourself for the butterflies you felt in your tummy.

 ‘’Y/n?’’ he questioned.

 ‘’Why did you do it? Cut off my supply?’’ you crossed your arms over your chest, your whole body fidgeting.

 ‘’I dunno what you’re talking about,’’ you could tell he was lying when he couldn’t look you in the eyes.

 ‘’Bullshit. You talked to my dealer, I know you did. Why?’’ you took a step towards him to the point if you puffed your chest up your breasts would brush against his chest.

 ‘’You need help, y/n,’’ he was about to head back inside when you forced your way in.

 ‘’You’re one to talk Fez! You sold me the drugs at McKay’s party! You got me into this life! God, I’m so fucking stupid,’’ you cried out, running your hands through your hair in frustration. You ceased and straightened yourself out, glaring at Fez.

‘’I wanted so badly to be in your life. For you to notice me,’’ you whimpered.

Fez stood in front of you, an unidentifiable expression on his face. He took a step towards you, reaching out for you only for you to take a step backwards. He nodded, taking in a shaky breath,

 ‘’I did notice you. Fuck, man. I noticed you the moment you walked into that party. You were full of life, but still shy. You brought this fucking light around you everywhere you went, ma. And when you came up to me to buy some pills, I wanted to say no. I should’ve said no. But I wanted an excuse to talk to you or see you again,’’ he confessed.

 You didn’t notice the tears until you felt them roll down your cheeks. You swiped them away, your heart beating furiously in your chest. You turned around and left, the sound of the screen door slamming ringing in your ears as you ran.

 Rehab took a lot out of you. You often questioned your decision to enter the facility, but the desire to retake control outweighed the desire to feel numb. 90 days felt like 90 years, but you were able to take the next step in your rehabilitation. Another three months passed and the light slowly but surely began to show in your eyes.

It had taken a lot of you, but when you were able to celebrate your twenty-first birthday with your old high school friends, it was all worth it.

 Cassie had convinced you to go out for one night. No drugs, only drinks if you were sure you could handle it. After two years sober, you were aware of your boundaries. You knew you could still go out and live a normal life, you just had to be careful in order to avoid a relapse. So here you were, celebrating your sobriety and your birthday. Maddy, Lexi, BB, and Kat were more than happy to come along and catch up. As you laughed and enjoyed your party, your face fell when your e/c hues locked with all-too familiar green ones. Fez was in the back of the club, talking to Rue and nursing his beer.

 You prayed you wouldn’t regret this, but you excused yourself from your friends and headed to the restroom. Thankfully, nobody else was in there as you leaned against the porcelain sink, staring deeply into your reflection. You sighed as your eyes analyzed every inch of you. You looked great, you felt great, so why did you feel so empty?

 The creak of the bathroom door didn’t cause you to look away, but the strong hands on your waist sure did. You jumped slightly until the smell of cologne and weed hit your nostrils.

 ‘’Fez,’’ you breathed quietly, suddenly becoming more self-conscious despite you looking like sex-in-high-heels.

 He didn’t respond, just pressed his face into the back of your neck. You felt the hardness that was his dick press into the small of your back. You sighed in content, his hands trailing up and down your exposed arms.

 ‘’I’m sorry,’’ he whispered. You blinked away the tears, shaking your head as he looked up so that your two reflections were looking at each other.

 ‘’Please,’’ you didn’t know what you were asking for, but Fezco did.

 He turned you around and slowly took in your face before capturing your lips in a long overdue kiss. It was Heaven and Hell, passion and sin, all together in that one kiss. The past four years replayed throughout your mental as you pulled him closer to you as your hands were on his chest and running through his shaved head. His hands gripped your waist as your tongues fought for dominance. You lost and moaned into his mouth when he nipped at your bottom lip before his tongue entered your mouth. The moan that erupted from his throat when you sucked on his tongue encouraged your hands to trail down and your hand to grip his hardened cock through his pants.

 That was all it took for him to pull away, shoving your lace panties down to your ankles and spread your legs as he pinned you against the bathroom wall. Anyone could have walked in and that thought alone caused you to become slick. Fez groaned when he pressed a calloused hand to cup your pussy.

 ‘’F-Fez,’’ you whined, hands going underneath his shirt to grip his shoulders and claw at his back.

 ‘’Fucking beautiful,’’ he breathed as he looked down at you.

 You didn’t even notice that he had taken his dick out of his pants until you felt the swollen head at your tight entrance. You looked up at Fez, engraving the look of pure desire and adoration on his face. He raised his eyebrows, as if asking one last time if this was ok. You nodded and couldn’t prevent the high-pitched whine that erupted from you as he entered you in one swift thrust. He grunted when he was fully sheathed in your tightness, hands gripping your thighs as you were pinned against the dingy walls of the restroom and impaled on his throbbing cock.

 ‘’Fez, please. Move I need to feel you,’’ you whimpered, fingernails clawing at his muscular back.

 ‘’Fuck baby,’’ he groaned as he slowly pulled back, only to snap his hips forward. Your cries fueled him, egging him on as he gained momentum. The sight of you, looking like something out of the cover of a magazine, taking his dick in this grimy bathroom in this shabby club. The fact that something so beautiful could want him, let alone cry out his name as he fucked into your tight pussy. The sight of his angry cock disappearing into your drenched folds. The revelation that you still loved him just as he still loved you. It was almost too good to be true.

 You moaned when one of his hands yanked down the front of your dress to release your tits so that he could watch them bounce from the force of his thrusts. You closed your eyes and threw your head against the wall when his mouth latched onto one of your breasts and began nipping and sucking at your bud. His thrusts were rough and unforgiving and you could hear the slaps of your skin echoing in the dimly lit room.

 ‘’You’re so tight for me, ma,’’ he groaned, his facial hair tickling the soft skin of your breasts.

 The tip of his thick manhood reached that special spot inside of you, causing you to cry out his name and clutch the back of his head. He focused on hitting that specific spot, succeeding over and over again. You could do nothing but moan out Fez’s name and hold onto him and take whatever he chose to give you. The feeling of being full of him and belonging to him was too much.

 ‘’I’m going to cum, Fez,’’ you panted, tears at the corner of your eyes as your walls began clamping around his thickness.

 ‘’Cum for me, mama. Milk my dick,’’ he grunted, hips pounding you into the wall. While one of his hands still held onto your thigh the other trailed to the side of your face and gently held your jaw, forcing you to look up into him as he took you, ravaged you. His dirty words and the strong grip on your face combined with the lust swirling in his beautiful green hues was too much. You came with a scream of his name, his thumb in your mouth muffling your cries only slightly as you felt your juices coat him and in between your thighs.

 ‘’I fucking love you,’’ he hissed, pressing his forehead against yours’ as he sloppily thrusted a few more times before you felt the warmth of his load crept up into the depths of your body.

 All you could do was hold each other; your legs wrapped around his waist. Your heels still on as his cum began dripping from your sore pussy. Eventually both of your breathing relaxed and you pressed a kiss to his lips. He kissed you back, looking down once more to watch his release drip out of you and his dick slowly slide out of you. He kissed you again before helping you down.

‘’I’m sorry,’’ he whispered.

You cupped his face with your hands, offering him a small smile.

 ‘’I know. Just hold me.’’

 You didn’t know what the future held for the two of you. You didn’t think a house with a white picket fence and two darling children was in your future with Fez, if you even had a future with him. The odds weren’t in your favor, but the same could’ve been said about the seventeen-year-old girl who was addicted to OxyContin and fentanyl. They said you wouldn’t make it to see your twenty-first birthday. The dusty clock that read 12:01 AM proved them all wrong. Maybe you and Fez could too.

[dnvrsmedia]

You’ll Get Better

Rue Bennett x reader

summary: you meet Rue at a party, and hit things off. Things slowly take a turn, but no matter what you’re always there for her.

warnings : under aged drinking, & substance abuse.

AN : if this fic offends anyone in anyway please let me know & i’ll gladly take it down! i have no ill intentions! i was trying to make it as close to the show was possible so i am sorry if it does hurt and or offend anyone. my request are still open!

Fez is more of a brother to you than a friend at this point. When you were 15, your parents kicked you out when you were outed at school. Since the town isn’t that big, news traveled pretty quickly. You were given an hour to take all of your belongings and move out of your childhood home.

You didn’t know who to turn to, since you originally didn’t have many friends. You ended up calling your sisters ex, Fez for help. You and Fez always have been cool even after their messy breakup. He was the first person you came out to and the person who taught you how to skate. Within the next ten minutes Fez shows up and helps you load your things in his car. You were so upset about it all you barley said anything about the cituation.

When you got to Fez’s house, he tells you that you could stay for however long that you needed. He even went to the lengths of almost giving up his bed to make sure that you were okay. After minutes of telling him that you’d take the blow up mattress instead, he finally agreed.

A year and a half later, you’re still living at Fez’s house. One day Fez finally convinces you to go to one of the parties he’s “working”. Parties weren’t truly your scene, but you’ve had a though past couple of months, so you give in. You follow Fez’s lead as the both of you walk around the party. You’ve told Fez before that you’d be willing to sell to help him out, since he’s done so much for you, but like the big brother he is he didn’t want you involving yourself in it.

After getting bored of standing around next to Fez as he “works”, you decide to head to the kitchen to get a drink. You pass a few of you peers and say hi back to who all acknowledged you. As you get into the kitchen and grab some shitty cheap beer, you notice one of the prettiest girls you’ve ever seen in your life. She had the most beautiful chestnut eyes and the most perfect clear skin you’ve ever seen . She was talking to some people around her who you noticed were the Howard sisters. You had a classes with the sisters, and you would say that they were the closest things that you had to friends. You took a swig of your disgusting beer, and walked your ass over there.

Lexi, who was visibly tipsy, saw you walking over & squealed. “Y/n! hi oh my god you came.”

Lexi slung her body on you and gave you a hug as you stood there awkwardly. You saw both the beautiful girl and Cassie try not to laugh loudly as Lexi separates from the hug. You smile and say hey to Cassie.

“Yeah i’m here with Fez tonight he’s working if you know what I mean. If y’all need anything just let me know.” You smirk and turn to Rue.”

“Wait, I don’t think we’ve met before, I’m Y/n.” You say as you stick your hand out to dap her up.

“Y/n... hmm i’ve heard of you, but we’ve never met. You’re Fez’s sis right? I’m Rue.” She lazily smiles.

The two of you hit it off that night and ended up spending all of your free time together. Sleepovers almost everyday, riding bikes for hours together, or even just being in the same room together. One day you finally had the balls to ask her out, and you both have been together ever since.

You didnt notice that Rue was using a little bit more than the frequent having fun at a party until she showed up at the doorstep of your home at 3am. You had no idea how she even got to your house since she was so cross faded, but you knew that she couldn’t go home like this. You took her phone and shot her mom a quick text telling her that she’s with you and forgot to text her before falling asleep.

You tried not to wake up Fez, but since Rue wasn’t in the right state of mind, she ended up being pretty loud. Fez walks out to see you trying to get Rue on the couch and gives you a hand.

“Y/n man, I know it sounds dumb as hell coming from me, but I think this shit got serious now. You gotta talk to her in the morning.” Fez hugs you.

“I know, and I can’t help but feel guilty. Maybe I’m not good for her.” you separate from the hug trying your best not to cry.

“Listen, when you to met, she already was using at parties and shit you know that. It couldn’t possibly be your fault. All you gotta do is stay by her side. I know what this shit is like and it’s not the best. She’s gonna need your support. Now, get some rest kid.” Fez responds and walks back to your shared room.

You sit on the couch and watch Rue sleep. You know that she’s hurting, and you wish you could fix it all. You couldn’t help but notice how innocent and at peace she looked while she was sleeping. You cuddle up the best you could next to her and drift off to sleep.

The next couple of months have been extra rough. After Rue came back from rehab things felt like they were starting to get normal. From what you knew, she went to her NA meetings and was staying sober. You couldn’t have been more proud of her, so you took her out on a surprise date. Things were looking up until that day.

You were out getting groceries for the house when Fez called you in a panic. When you heard that Rue was tripping on fentanyl you booked it the fastest you could to the Bennett’s. Lucky, Rue’s mom was at work, and Gia was over at a friends when you brought Rue into her room. You didn’t talk much to her. The only words you shared were telling her to lift her arms up and down or to sit down so that you could change her out of her dirty clothes.

When you finish, you lay her down on her bed. You go out to her kitchen to get her a glass of water. As you reach up to get the glass, you break down in tears. Not wanting Rue to start to wonder where you went, you wipe you tears and head back to her room with the glass in hand. You set it down on her night stand and cuddle your girlfriend.

“Baby...” Rue says and you look at her. “I’m so sorry.” she broke the silence and cuddled into you more. You knew that this journey wasn’t going to be easy, but she’s the love of your life.

“I know baby, I know.” you coo. “I’m here with you no matter what. I just wished you came to me before you felt like this. I’m always gonna be here for you. You’ll get better I promise, I love you, Rue Rue..” You kiss her head and caress her arm.

“I love you, y/n.” She says as she drifts off to sleep.

[justanotherone16]

He pressed send. And then he waited. The extreme tedium of simply waiting was not something that Mycroft Holmes could tolerate. His brother’s erratic behaviour and inability to accept the normalities of every day life was well known, and indeed Mycroft’s unwillingness to play along with the inane and mundane of ‘normality’ could well be inferred. Few people, however, successfully inferred or recognised that Mycroft’s consequent impatience manifested as restlessness too.

Dr Watson would surely come. He always does. Mycroft drummed his fingers rhythmically on the black folder that rested upon his lap. In times gone by Sherlock didn’t have a Dr Watson that Mycroft could go to with sensitive information, or emotional conundrums. No, in times gone by, he just had to take it straight to his brother. All things considered the widening of the tiny pocket of trust around Sherlock was a good thing; there was considerably less chaos.

A thick film of fog choked London, almost Dickensian in its persistence to blanket the city. November was in full swing and the days were drawing in rapidly. Today, the fog and the biting, piercing cold only served to cheer on the early darkness, that was knocking at the door in spite of it being just 15:42.

Mycroft was so lost in his pondering that he was somewhat startled when the car door opened suddenly and the familiar figure of John Watson ducked into the car and settled next to him.

The scent of winter air clung to John’s coat and his cheeks were rosy with cold. He rubbed his hands together in a feeble attempt to warm them.

“I hope you’ve planned at a stop at a coffee shop, I’m freezing my bollocks off” John joked as leaned back into his seat and blew hot air in between his hands.

Mycroft pushed the small red button near his window which rang through to the driver. “The closest Nero please.”

The car pulled away slowly and joined the chaos of the London afternoon traffic. “I didn’t expect you to agree, should I be worried?” John asked lightly.

Mycroft didn’t speak, he just opened the folder in his lap, which had been fulfilling a singularly percussive purpose while he had been awaiting John’s arrival. Mycroft took 3 separate pieces of paper and passed them wordlessly to John.

John’s brow furrowed as he scrutinised the contents, trying to understand the context. “Okay so three dead men... yeah I don’t get it. Why are you showing me these?”

Mycroft took a deep breath, placed the folder on the seat beside him. “Jonathan Callaghan, Zachary Noble and Jack Sharpe. Long-term heroin addicts that Sherlock has had previous associations with. All overdosed on Tuesday evening.”

“Shit... how?” John shook his head as he perused the documents, wincing inwardly at the photographs.

“Their heroin was laced with a fatally high level of fentanyl. It would seem that the quality of heroin circulating the streets of London is categorically unsafe.” Mycroft gave John a knowing look.

“I don’t think he’s using”.

“No, he isn’t. I would know”. Mycroft assured John.

John put the paper down and turned to face the elder Holmes. He was balding quickly now; ageing fast.

“Right so, why are you telling me?” John asked.

Mycroft rubbed his face with his left hand and when he spoke, there was more than a hint of resignation. “Because Sherlock will hear of these deaths soon, and more I should imagine. Many of his homeless network will fall victim to this. And... Jonathan in particular, was quite close to Sherlock, well about as close as anyone could get to him during this time of his life. Jonathan saved his life three times. Once he personally provided mouth to mouth and administered adrenaline that I had provided him with. The other two occasions he called me, even on pain of death from Sherlock. I... well I will always be grateful that Jonathan was with Sherlock in those... instances.”

John was sat dumb struck. That was a lot to take in; a great deal to unpack, with a man who rarely paused long enough to unpack anything.

“So, Sherlock will be upset? I’ve never heard him mention any of them, or Jonathan?” John tried.

“I should think so... He rarely discusses his past with drugs, I think because the regret, shame and fear of the power it had over him is too much. But, I do fear when he finds out he will be somewhat aggrieved. I don’t believe he will seek out drugs to cope with that, given what he will know about the chemical composition. But I can never be sure with Sherlock. And when I saw, saw these photos of these men. Men I have interacted with, men who have saved my brother’s life on more than one occasion- dead... I can’t help but picture, in my worst nightmare, Sherlock in the same state. This news will come to him. Not from me, probably not from you. But he will hear. And once again Doctor Watson I must ask you to look after him. Please.” Mycroft’s voice was uncharacteristically small. The pain of the past and anxiety for the future swam in his eyes.

“Of course I will look after him. Always. Although, for all of Sherlock’s complaining it doesn’t sound like you’ve done such a bad job yourself. In these kinds of conversations, I am increasingly surprised that Sherlock was alive to meet me.” John lowered his voice too. He didn’t see eye to eye with Mycroft and he never would. And there were half a million things that John wanted to tear into Mycroft for. But the care he had for his brother was clear and unrivalled.

“Thank you, John.” Mycroft smiled weakly.

John smiled grimly in return. “So alongside being there for Sherlock and keeping an eye out. You know he will pursue this. Try to find the source and stamp it out?”

Mycroft nodded and took a long sharp breath. “Yes I know. And I’m sure he will be successful. I’m primarilh concerned at how he will take the passing of Jonathan, Zachary, and Jack. You know... He went back to find them once he had gotten clean himself, for his longest period of sobriety, not long before he met you. He offered to fund their own rehabs. All three men declined of course. For various personal reasons.”

John was consistently surprised at what he did not know about Sherlock. While the pair of them virtually ignored the swathes of Sherlock’s life that were taken up by being high and shooting up, the effects and associated risks seemed to lurk everywhere.

“Perhaps I should tell him? Tell him what you’ve told me so that we have some control of the situation?” John asked.

“No. Sherlock won’t appreciate the idea that I am soundboarding you. If you must bring it up. Tell him only that I had made you aware of the lethality of heroin currently for sale in London and nothing else.” Mycroft firmly answered.

The car stopped outside a cafe Nero and the driver got out of the car, locked it, and strode into the shop to order coffee.

“When Henry returns with your coffee, walk back to Baker Street. Sherlock will assume you got the Metropolitan line at 4pm.” Mycroft said conspiratorially.

John nodded and defaulted to silently waiting for the driver to return with his coffee. “Are you okay Mycroft?” John asked seriously.

“Me? Yes of course. Why wouldn’t I be?”

John just eyeballed Mycroft, trying to the best of his ability to convey a ‘don’t be dense, I’m not fucking stupid’ sentiment in response.

Mycroft stood down his defences and sighed. “Yes, I am okay. Just, let me know how Sherlock is. And... I’ll, well I’ll thank our lucky stars that Sherlock did live past 30. And have a quiet toast to Jonathan Callaghan, who saved my brother 3 times and deserved far more than he got in life. That’s your coffee John. Don’t worry, it’s decaf, soya milk, one vanilla syrup shot. Text me if you need anything.”

A steaming cup of coffee was passed back to John. He couldn’t help but notice the Christmas theme on the cup- that time already?!

“Right, yes, yeah. Thanks for the coffee and, um take care. I’ll be in touch.” John said climbing out of the car, the chill in the air swiping at him as he did so.

[lafiametta]

(for Day 8 of the 12 Days of Carnivale: “a time of miracles”)

[Jopson/Little, set in my modern office AU]

Tom couldn’t sleep.

Part of that, of course, could be explained by the man sound asleep next to him in his bed, curled onto his side with an arm flung halfway across Tom’s chest. 

Edward seemed comfortable, at least, his face freed from that furrowed, serious expression he wore so often in the waking hours. He looked softer now, more relaxed, those long boyish lashes fanning towards his cheeks. The bedroom lights were off, but his features were partially illuminated by the glow of lights from the Christmas tree spilling from the living room, even though the holiday had been over for nearly a week at this point.

Tom was a light sleeper, he always had been, and having someone else in bed with him tended to make things even trickier. But that was something he was definitely willing to deal with if it meant Edward staying over. It hadn’t been every night – they weren’t quite at that stage yet – but in the two weeks since the office holiday party, Edward had slept over at Tom’s more often than not, with the exception of the three days Tom had gone home to spend Christmas with his family. 

It had all happened so fast, after the Secret Santa thing. As the party had worn down, someone had come up with the idea of a bunch of them going for drinks at the bar around the corner, and Tom could tell that if he said yes Edward would come too. (Thankfully, Irving declined, citing a family engagement.) So they both went, and in between Hartnell buying everyone a second round of Jäger shots and Morfin’s drunken serenade to the long-suffering bartender, they found themselves outside on the sidewalk, ostensibly to get some air, even though it was freezing cold and Tom had started to lose some of the feeling in his fingers.

They had huddled near each other, theoretically for warmth, eventually inching closer than they had any real need to be. Until, of course, the moment when Edward had leaned over and kissed him. Tom’s face was nearly frozen solid, but Edward’s lips were warm (with just the slightest aftertaste of Jäger), and he smiled and pulled his hands from his coat pockets so he could curl them around the back of Edward’s neck. 

It hadn’t taken much to convince Edward to share a cab back to his place. And once they were finally alone, in the privacy of Tom’s apartment, they had been able to get up to all sorts of things in direct violation of HR’s non-fraternization policy. 

The thing was, Tom had had his eye on Edward for a while now, nodding hello to him in the morning when he came in, listening to him in meetings through Crozier’s half-open office door – and while he was pretty convinced the attraction was mutual, it was kind of hard to tell. Edward was fairly quiet and reserved, not given to the usual office small talk, which was why it had been nice to finally draw him into a conversation, even if it had only been about 70s music. And if Tom had suspected – and secretly fantasized – about what it would be like once Edward Little let go of just a bit of that stringent self-control, the reality of it was even hotter. 

He had almost become a fixture now in Tom’s apartment, and in his bed, that dark head of hair mussed into glorious disarray as it fell across the pillowcase.

So maybe losing a bit of sleep wasn’t that much of a sacrifice. 

He stared up at the ceiling, letting his thoughts wander as he tried to coax them back into drowsy quiet. Aside from the thing with Edward (and Tom was fine with letting it stay undefined for now, and simply enjoying it for what it was), there wasn’t much else on his mind, aside for his quick visit home for Christmas. It had been really good to see his mom and his brother – with the hours Crozier had him working, he didn’t always have time to visit that often – and get to celebrate the holiday, just the three of them. 

His brother had been in a good mood – he had just turned in the last of his college applications and now he was on a two week break from school – and his mom was in even better spirits, clearly proud of her youngest about to head off to school and thrilled to have both her sons with her for Christmas. At her insistence, they baked cookies and watched old movies, and on Christmas morning they opened presents in their pajamas, although Tom had stipulated that he needed at least a full cup of coffee before they started unwrapping anything. 

It was pretty amazing to see her like that, so excited and happy, and to know how far she had come in just two years. 

There were moments he had believed that she wouldn’t make it this far. 

Everything had started with the accident, of course. The other driver had been distracted (probably busy checking their phone or some other bullshit) and ran the red, immediately plowing right into them. His brother had been next to her, in the passenger seat, but all the airbags deployed and they both walked away from the crash, seemingly fine. But after a few weeks, her back started bothering her and there were doctor’s visits for pills, and then more and more pills: Vicodin and Percocet, eventually OxyContin. Tom hadn’t really been aware of how much she had been taking – she had been good about hiding it, and he had been so busy with work that he hadn’t been able to visit that much – and it was only later he found out how bad it had gotten, how she had moved on to occasional hits of fentanyl, somehow maintaining her habit while holding down two jobs and raising a teenage son. 

The absolute worst of it came – as it had to, eventually – one weekend in December, when had come home as a surprise and found her laying on the couch, unresponsive. His brother had been out with friends and there was no one else in the house, no one to wait with Tom as he counted the minutes for the paramedics to arrive, no one to sit with him on the vinyl upholstered bench seat in the back of the ambulance, no one to hold his hand as he begged and pleaded with whoever might possibly be listening to not let her die. 

Maybe someone was listening, maybe not. He wanted to think someone was. 

There was denial at first – as if the reality of what he had seen could possibly be denied – and then anger and tears and finally acceptance. She agreed to rehab, letting Tom’s aunt and uncle take temporary custody of his brother until she was ready, and it had taken almost a year, two treatment facilities, a halfway house, and a NA sponsor Tom wanted to nominate for sainthood to finally get her to where she was now. 

But there was always that question, that dread, lurking in the back of his mind – as he assumed it lurked in hers – was that really the end of it? Would the need ever get so strong again that she wouldn’t be able to resist? 

There wasn’t anyone he could tell, really, no one he could share these private fears with, certainly not with her and certainly not with his brother, who had already had to deal with far too much. And so Tom tried not to think about it too much, putting on his most cheerful face for when he saw them, doing his best to take each day as it came. 

“Can’t sleep?” 

Tom turned his head in the direction of the low voice and saw that Edward was awake, his dark eyes glinting in the low light of the room. 

“Just stuff on my mind, I guess,” Tom replied, as he stretched his legs out under the covers. 

The answer was vague and noncommittal, he knew, but it wasn’t as if he was expecting Edward to do much else beyond nod and go back to sleep.  

“Do you want to talk about it?”

Tom’s first instinct was to say no – perhaps not quite that directly, but to smile and find some way to gently decline the offer. Nobody needed to listen to him talk about things like that, especially not someone like Edward, who hadn’t signed up for hearing about all of Tom’s family issues when he decided to stay over. But there was something in Edward’s eyes, in the open, unguarded expression on his face that made Tom pause, because he realized, right at that moment, how much he really did want to talk about it.

And so he did. 

He told Edward everything: about his mother and his brother and his life growing up, about the accident and the pills and the couch and the disinfectant smell of her hospital room where he had waited for her to wake up. He told him about visit back home, and how proud he was of her, even as he was afraid, and guilty too, for allowing himself to doubt her when he considered the possibility of her relapsing.  

“It’s just hard sometimes, you know,” he said, “being alone with all of it.”

Edward was quiet – he hadn’t said much as Tom was talking, but had laid there next to him, listening patiently – and then reached up, letting his fingers graze along the line of Tom’s jaw. 

“You don’t have to be alone with it.” Edward swallowed roughly, pressing his lips together. “Not if you don’t want to be. Not anymore.”

Everything went still for a moment, even Tom’s heart, which he could feel in the deepest, most tender recess of his chest, although what it was trying to tell him, he wasn’t even sure. He watched as the Christmas tree lights from the living room glowed soft pink, blue, yellow, green across Edward’s bare skin, and then Tom turned and gently rolled over him, their lips meeting in a tiny miracle of light and breath and heat.

[pixiemunsons]

It's Hard To Love An Addict Like Ariana Did. I Know Because I Do.

I know this isn't my regular post type, but I'd really appreciate if you gave it a read. Thank you.

Rapper and singer Mac Miller died on Friday the 7th of September of a suspected drug overdose in his Los Angeles home. He was 26 years old. Since his death, both the music and fan community have been rocked, with tributes from the likes of Drake, Liam Gallagher and Elton. Self-proclaimed “mumble rapper” Lil Xan has gone as far to get a face tattoo in memorial of his fellow musician. However, Miller’s death has also opened up discussions on social media about the circumstances surrounding what would appear to be a sudden, tragic downfall, with his previous drug habits and recent break up with pop singer Ariana Grande in particular being suspected by fans as causes for his untimely demise.

Miller stated in multiple interviews that he was addicted to a variety of drugs, in particular a drink consisting of promethazine and codeine usually made with cough syrup and prescription drugs. The drink has been linked to a number of other deaths in the rap community; DJ Screw, who died of a codeine overdose in 2000; Pimp C who was found dead in 2007 after ingesting the mixture in a hotel room; Fredo Santana, whose death was only eight months before Miller’s, is believed to have been as a result of kidney failure induced by lean; and Lil Peep, who in 2017 died of a fentanyl overdose but was found with codeine in his system after years of abusing the drink. Miller is another in a long line of drug addicted rappers – so why are we blaming Ariana?

Miller and Grande met when recording song “The Way” in March 2013, during the video of which they kissed. Whilst at the time both were in long-term relationships, in July of the same year Miller referred to Grande as being “like an angel, she’s very nice, she’s a sweet girl.” In August 2016, Miller became involved in producing a remix of Grande’s hit song “Into You,” and later in the same month the two were spotted cuddling and kissing at the MTV VMA Award after party. This was to be the start of an almost two-year relationship, which whilst seemingly perfect on social media has been slammed by Ariana as “toxic”. Within two months of her and Mac splitting, Grande was engaged to SNL star Pete Davidson, which many of Miller’s fans believe led to his May 2018 collision with a lamppost whilst driving under the influence of alcohol and drugs. Grande fiercely denied the accusations on Twitter, calling their relationship “toxic” and stating that she is “not a babysitter or a mother and no woman should feel that they need to be.” She also described Mac as having an “inability to keep his shit together,” believed by many to be a reference to his drug addictions and sobriety issues. Of course, Mac was dead four months later, and the comments on Grande’s Instagram page show that many attribute this to their break-up; Grande has been described as “lowkey evil” and has been told by fans that she “killed” Miller with her actions. Grande’s Instagram comments have been disabled since Miller’s death.

I, for one, understand exactly how Ariana feels. The addict in my life is neither addicted to hard drugs, nor is he my significant other. He is my father, and he has been a drunk since before I was born. My struggles with my father have, on many occasions, forced me to withdraw contact. Once, when I was 16, I returned from an eight-hour shift at midnight to find him almost unconscious under his tipped-over sofa, three empty bottles of wine surrounding him and what appeared to be spilt drinks and cigarette ash ground into the carpet despite smoking indoors being both against his rent agreement and the rules I had set into place if I was to continue sleeping at his house. I slept at my uncle’s that night, and when I went back to my father’s house to confront him with his brother, he was asleep at 3pm and couldn’t remember the events of the night before, during which I had screamed bloody murder at him and he had called me a dozen times in a drunken attempt to win favour. My sister, two years younger than me and yet, even at 14, disturbingly aware of my father’s alcoholism, had stayed at my uncle’s house the night before when he came to drop her off after a day out and, despite it being only 4pm, discovered an empty bottle of wine at my father’s feet.

Like Ariana, I made multiple attempts over the years to discourage my father’s drinking in many ways. I begged, cried, pleaded and, eventually, screamed at him in order to pt across my feelings; that he, like he always had, was putting drinking above my feelings and my sister’s. His drinking was one of the main reasons my mother had left him when I was ten years old, and I was determined that even if my relationship with him broke down the same way his marriage had, his relationship with my sister was going to be resolved, attempts of mine that have failed as she has grown to resent him as I do. Despite my best efforts, my father’s addiction appears to be unsolvable. I have pleaded with him to enter rehab, yet his own mother, my grandmother, is so protective of her youngest son that she refuses to acknowledge his addiction, creating a route for my father to live in denial of his problems and to blame me for the issues in our relationship. Miller’s friends, since his death, have stated that no one attempted to help Mac as much as she did, with friend Shane Powers stating that “there couldn’t have been anybody more supportive of him being sober than Ariana.” I can only hope that my father’s family, and my family, understand my reasons for cutting off fatherly contact.

My father’s addiction is set to a backdrop of familial secrets and issues, hidden by the primary and central members of his extended family; first his father’s mother, then his aunt, and now his own mother. My family is riddled with disease and addiction, a taboo in the eyes of the elders, yet pressing issues for us in the next generation who are forced to deal with the after effects of these secrets. Huntington’s disease, a terminal genetic disorder which effects the nervous system and kills its’ victims young, is rife in my family; out of my grandfather’s nine siblings, five – including him – have or had the illness. It kills young, and my own grandfather died at 65. My father is now 47, and yet his own disease is progressing faster than usual; his cousins of the same age are just now starting to exhibit symptoms, whilst my father is coming to the end of his ability to walk. I now realise that this is likely a result of his drinking yet, in a sad twist of fate, my father began drinking to deal with the pain of his own father’s diagnosis. This sad fact affects many I know; just last year, my father’s cousin died at 52 from a heroin overdose following years of substance abuse. Just like the rap community, my regular, suburban family is followed by a crisis that no one dares speak out about, no matter how many deaths take place. There are many Mac Millers’, and almost as many Arianas’, cousins of mine in my exact situation. We are all aged from 14 up to 30, and our parents and uncles and aunts refuse to discuss with us the issues we face, so we talk in secret. Weddings, christenings and, more and more often, funerals, have become places for hushed whispers in corners, each of us telling stories; drugs, drinking, illness and affairs created by the unusual backdrop of our upbringings. My boyfriend frequently comments on how unusual it is that no discussion takes place regarding negative subjects in my family; that life appears to be perfect, when in reality it is a dream world created by my older relatives to save face.

I know exactly how Ariana feels because I have tried for many years to get my father sober, and have never been able to succeed. I also know that, even as I have cut my father off just as Ariana finished her relationship with Miller, I will be as devastated by his death as she was by his, and will likely receive the same backlash from my own family as she did from her own fans. I’ll likely be young, as she was – I am only 18 now, yet my father is more and more ill by the day. And yet, despite all of this, I can relate to Ariana for one reason more than any other; we have both loved addicts, and it was the hardest thing either of us has ever done.

[imrantingnow]

Fentanyl.

I’ve seen a lot of post about how it’s took peoples family members, how to stop it, what it looks like, who to call, the statistics.

But I’m here to tell you the story of my brother. He was an all star football player and wrestler in high school, scored a 32 on his act and fell asleep during half of it, he was smart. He had a full ride to wherever he wanted to go, he didn’t go though. My brother didn’t want that life for some reason, I was about six when he graduated high school. My older brother was my best friend. I spent so much of my childhood playing with him, cheering for him in the bleachers, wrestling and him letting me win even though he was 30x bigger than me, looking up to him. I don’t know exactly when the switch from weed to pills to heroin and meth and whatever else he could find happened, but I do know it was a slow switch, to me anyways. I didn’t know much about my brothers addiction until it was too late, 2018 that’s when I finally noticed. My brother moved in with me and my dad, he was always annoyed with me, he’d nod in and out of consciousness and just wasn’t him. It was weird though it was him, just like if he had just got his wisdom teeth removed and the laughy gas was still in effect. 2019, I went to pick up my order sister, she was going to buy me chick fil a. My older brother got in the car, I rolled my eyes becuase I couldn’t stand to be around him. We pull into the drive thru and I looked in the back seat, he was purple. “Hi! Can I take your order please?” I ignored the woman and reached to check his pulse, 80…70….60 “I need help getting out of the drive thru, my brother his over dosing” I don’t know how I remained calm but I did. She guided me to a parking spot as my sister slapped my brother and poured cold water on him, employees gathering around ready to help drag him out of the car. I could call 911 my phone had lost service, I head him gasp back to life. I took my sisters phone to call and he slapped it out of my hand, he didn’t want to go to the hospital. My sister ordered food they gave it to us for free, I didn’t eat. Matter of fact I didn’t go to work for a week, I was numb and in shock. Two weeks later my mom received a call, “your son has over dosed and has been receiving cpr for 10 minutes, we administered 3 rounds of narcan, he is asking to leave” my mom called the police. I was at a hair appointment that day, I didn’t cry but I answered on speaker so the whole salon heard. My brother had enough fentanyl in him to kill at least 5 people. My brother has a son he’s 4, and in foster care. He had court mandated rehab, left, went back, left, went back, and so on, My mom started putting money away for his funeral. Months went on and I came to acceptance that I’d loose my brother, until he called. “Hey gray bae, could you take me in the morning to visit your nephew? You can come too, you can talk to my councilor, I have 163 days clean!” I was happy. So for the next month every Wednesday I’d get up at 7 am and take him and hour away, we’d have fun, get food and then I’d drop him off, until the text. His girlfriend texted my mom, he relapsed and was on a bender. I was pissed, hurt, and mourning honestly. The rehab cycle continued for a year, I chose to not talk to him, I couldn’t. He made it to a halfway house and relapsed. That was a month ago, he’s living with relatives in another state. Moral of this story is, well. I don’t know yet, I guess I’ll let you know when I see an outcome.

[serein-333]

This is one thing that pissed me off, and frankly hurt me yet again from the POTUS... if you have lived with addiction, whether alcohol or drugs, whether yourself or your family or loved one or friend...it takes a toll. It puts a pressure on you that NO ONE should ever have. It makes you into an enabler most of the time because you just want to help this person you love so much. I’ve been through this with my mom, my dad, my grandfather, my uncle, and last...my brother. It pulls families apart and lives are lost. My grandfather’s alcoholism contributed to his death from a heart attack. My mother STILL struggles with Xanax addiction. My father’s alcoholism and drug abuse contributed to his heart problems and he has almost died twice. My uncle quit drinking, but he is a bitter old man, what you would call...a dry drunk, with a quick temper. Last...my brother. My brother started drinking at about age 18. Alcohol quickly became pills (oxy, Xanax, etc), which led to smoking pot, doing cocaine, and trying every drug out there. You name it, he has done it. Crack, meth, every pain killer you could imagine. He did not set out to become an addict. No one does. Nobody EVER knows whether they will become addicted to a substance until they have tried it. I am lucky... I am one of the few in my family that does not have an addictive personality. I even quit smoking cold turkey and haven’t looked back. I was a social smoker mostly. 

  My point is... the POTUS stooping to the level he did, the level he does all the time as to humiliate and intimidate and come after your family, your child...your greatest weakness... it is evil. Joe Biden lost his wife and infant daughter in a car crash, he lost his son Beau to cancer not too long ago. His son Hunter HAD a drug problem. He got help. He was lucky, and he got help. 

  Let me tell you something... if it were me standing there, instead of Biden... I don’t believe I would have been able to contain myself. See... my brother overdosed not once, but twice. Do you know who found him the first time?? I did. He almost died...they had to use Narcan twice and he was placed in a medically induced coma for 2 days. He survived. This happened while I was staying at my father’s place, visiting my granny every day in hospice because she herself was dying....complications from Alzheimer’s. Aspiration pneumonia and she wouldn't recover... she herself in a medically sedated state so she wouldn’t feel anything. Twelve long days and nights, with 4 of those worrying about whether my brother was going to end up dying also, just 4 floors down.

 The 2nd time he OD’d... nobody was there to help him. He had roommates..sure, but they were not paying attention. What my brother took was laced with carfentanil. Carfentanil is 10,000 more times potent than fentanyl. He died within a couple of minutes and there was no coming back with Narcan. His roommates didn’t find him until about 30 minutes after he had gone to the bathroom. They had no idea what he was doing in there because he had just gotten out of rehab two days earlier. See how difficult it is staying sober? This was probably the 10th time he had been to rehab in his 35 years. He left behind a wife and 2 boys, and 2 step children. He left behind a mother who is now a shell. He left behind a father who won’t even talk about it. He left me behind... his sister and only sibling...who tried her hardest to help him, who saved him once, but couldn't save him again. Should I be ridiculed because of the fact that I have dealt with these things? Should anyone? ABSOLUTELY NOT!!!!

  Trump has zero empathy and doesn’t care about anything except money and anyone except himself. He went to a movie the night his brother died, and played golf the day his other brother died of Covid. Even after getting Covid himself... he hasn’t changed, in fact it has made him even worse. ..if thats possible. 

  So, if you know me, family and friends...and if you support this piece of shit POTUS... get the fuck out of my life. I don’t wanna know you. You may not share his views or his actions but they aren’t a deal breaker which makes YOU...COMPLICIT. 

[gordonwilliamsweb]

Bringing ‘Poogie’ Home: Hospice In The Time Of COVID-19

After she landed in the hospital with a broken hip, Parkinson’s disease and the coronavirus, 84-year-old Dorothy “Poogie” Wyatt Shields made a request of her children: “Bring me home.”

Her request came as hospital patients around the world were dying alone, separated from their loved ones whether or not they had COVID-19, because of visitation restrictions aimed at curbing the spread of the virus.

Bringing home a terminally ill patient with COVID-19 bears extra challenges: In addition to the already daunting responsibility of managing their loved one’s care, families must take painstaking precautions to keep themselves safe.

Julia Shields, 53, one of Poogie Shields’ four children, said she had reservations about the risk of infection and how it might affect her family’s health and ability to care for her mother. “I didn’t want to bring my mom here, and have it where we’re all of a sudden collapsed in bed ourselves and can’t give her pain medicine and can’t take care of her,” she said.

But she and her siblings were determined to honor their mother’s wishes. So they stocked up on personal protective gear and converted the mudroom of Julia’s Greenwood, Virginia, home west of Charlottesville into a solarium where her mother could be closer to family.

Julia said she wasn’t sure how long her mother would survive; it could have been a few days or even a few months at her home. “She’s such a fighter,” she said.

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Poogie Shields, a former guidance and addiction counselor, had an appetite for adventure, be it camping on the Appalachian Trail or moving her family to Paris for a year while writing a master’s thesis. After raising her children in Virginia, she set off to do volunteer work, helping homeless teenagers in Florida and pregnant women facing addiction in Washington, D.C.

But over the past 20 years, Parkinson’s disease gradually limited what she could do, and three years ago she moved into an assisted living community in Crozet, Virginia, about 5 miles from Julia’s home. At first, she walked all over the campus, taking yoga classes and playing trivia with friends. But in recent years, she could manage only short distances with a walker, and Parkinson’s, a progressive nervous system disorder, was affecting her voice, according to her daughter.

“She was the person who had the most interesting thing to say in the room,” Julia said. “It was sad. You just couldn’t hear what she had to say.”

In mid-March, as the pandemic spread, Shields spiked a fever and got tested for the coronavirus. On March 22, while self-isolating and awaiting her test results, she broke her hip and was taken to the UVA Health System University Hospital.

In the hospital, a rapid-results test came back positive for COVID-19.

The coronavirus wasn’t killing her: Her symptoms had largely subsided, and she wasn’t in respiratory distress, said Dr. Lily Hargrove, a private practice physician who had treated Shields for 15 years and advised her family.

The biggest problem was her hip. Surgery was an option, but Shields had already endured “an excruciating loss of independence” over the past two years, Hargrove said. Recovery from surgery — two to three months in a rehab center with no visitors because of efforts to slow the virus in most facilities — “would have been a nightmare,” Hargrove said, and would not have returned her to normal functioning. She said she and Shields had reached an understanding during the past year that her disease had progressed so far that “we were beyond the point of fixing things.”

Julia and her siblings consulted a palliative care specialist and decided to pursue hospice. The hospital and hospice staffs told the family “this was not to be taken lightly — not only her dying, her potential pain, and also us getting sick,” Julia said.

The family signed up with Hospice of the Piedmont, which is one of about 75 community-based, not-for-profit hospices in the National Partnership for Hospice Innovation (NPHI). Dr. Cameron Muir, NPHI’s chief innovation officer, said most hospices in the group have treated or prepared to treat COVID patients, despite the added risks for workers.

Many hospices are facing shortages in staffing and protective equipment due to the pandemic, prompting concern from some advocates that patients won’t get the care they need. Muir said hospices in his group have bulk-ordered protective equipment together.

With the pandemic, most NPHI hospices are seeing an increase in the number of people they’re caring for at home, Muir said, because hospitals are “eager to get people with advanced illness home if possible” to make room for COVID patients.

“Absolutely the safest place for frail elderly without COVID is in the home,” said Muir, who is also chief medical officer of Hospice of the Piedmont, and “if you’re COVID-positive, the best place to be quarantined is at home.”

Hospice of the Piedmont has shifted to telehealth when possible and has stocked up on protective gear so that staff and families can safely treat COVID patients, said CEO Ron Cottrell.

While the hospice gathered equipment, Julia and her family set to work creating a sterile-yet-welcoming solarium in her home. They cleared out the raincoats and lacrosse sticks from Julia’s mudroom. They rolled in a hospital bed next to a window overlooking the deck and hung a picture Julia’s daughter had painted.

They filled the windowsill with fresh daffodils. Julia’s husband and two children, 18 and 20, went to stay at a friend’s empty house, while one of her sisters moved in to help her care for their mother.

On March 25, Poogie Shields came home, sedated with pain medication. Out the window, she could see a redbud tree in bloom and, soon, the faces of her visiting grandchildren and other relatives.

Julia, a tax preparer, and her sister, an archaeologist, got into a rhythm of suiting up like hospital employees — in scrubs, gloves, shoe covers, masks and eye protection — every time they entered the room.

Their time together was peaceful, Julia said. Other family members hung out on the deck, 6 feet apart, just outside the window. Her sister brought an iPad to coordinate video calls and read aloud dozens of emails and cards.

“There was a fairly reasonable feeling of normalcy,” Julia said.

Over the course of several days, Poogie Shields became unable to eat, drink or swallow medication. With Hargrove’s advice, Julia and her sister managed her fentanyl patches and slipped morphine under her tongue.

As her mother began to lose awareness, Julia softly sang Episcopal hymns — “Abide With Me,” “Breathe on Me, Breath of God” — to comfort herself and her mother, just in case she could hear.

Poogie Shields’ last day “was very peaceful,” Julia said. “It was such a beautiful day.” Relatives had all come by to see her. There was “no anxiety about anything that we needed to figure out,” no last unburdening of unresolved feelings.

Julia said she and her sister were with their mother as she took her last breath at 8:30 p.m. on March 28. Hospice staff came to the house about three hours later. In the meantime, Julia said, “nothing needed to be done. It was just very calm.”

Hargrove said that in her 20 years of practice, “I’ve never had a patient die with such reported ease and grace.”

“The two daughters were extraordinarily brave,” she said. “They were committed to honoring their mom’s wishes.”

After their mother’s death, Julia and her sister disinfected the house before Julia’s family moved back in. No one in the family has become sick with COVID-19.

For other families, bringing COVID patients home might not be possible, especially if someone in the house is at a higher risk of serious complications from the virus, Hargrove noted.

“I would hate to have someone who was unable to bring someone home, who was dying of COVID-19, to think that they had somehow failed that person,” Hargrove said. “I would ask that people find grace and compassion for themselves if this is not available for them.”

Bringing ‘Poogie’ Home: Hospice In The Time Of COVID-19 published first on https://nootropicspowdersupplier.tumblr.com/

[stephenmccull]

Bringing ‘Poogie’ Home: Hospice In The Time Of COVID-19

After she landed in the hospital with a broken hip, Parkinson’s disease and the coronavirus, 84-year-old Dorothy “Poogie” Wyatt Shields made a request of her children: “Bring me home.”

Her request came as hospital patients around the world were dying alone, separated from their loved ones whether or not they had COVID-19, because of visitation restrictions aimed at curbing the spread of the virus.

Bringing home a terminally ill patient with COVID-19 bears extra challenges: In addition to the already daunting responsibility of managing their loved one’s care, families must take painstaking precautions to keep themselves safe.

Julia Shields, 53, one of Poogie Shields’ four children, said she had reservations about the risk of infection and how it might affect her family’s health and ability to care for her mother. “I didn’t want to bring my mom here, and have it where we’re all of a sudden collapsed in bed ourselves and can’t give her pain medicine and can’t take care of her,” she said.

But she and her siblings were determined to honor their mother’s wishes. So they stocked up on personal protective gear and converted the mudroom of Julia’s Greenwood, Virginia, home west of Charlottesville into a solarium where her mother could be closer to family.

Julia said she wasn’t sure how long her mother would survive; it could have been a few days or even a few months at her home. “She’s such a fighter,” she said.

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Poogie Shields, a former guidance and addiction counselor, had an appetite for adventure, be it camping on the Appalachian Trail or moving her family to Paris for a year while writing a master’s thesis. After raising her children in Virginia, she set off to do volunteer work, helping homeless teenagers in Florida and pregnant women facing addiction in Washington, D.C.

But over the past 20 years, Parkinson’s disease gradually limited what she could do, and three years ago she moved into an assisted living community in Crozet, Virginia, about 5 miles from Julia’s home. At first, she walked all over the campus, taking yoga classes and playing trivia with friends. But in recent years, she could manage only short distances with a walker, and Parkinson’s, a progressive nervous system disorder, was affecting her voice, according to her daughter.

“She was the person who had the most interesting thing to say in the room,” Julia said. “It was sad. You just couldn’t hear what she had to say.”

In mid-March, as the pandemic spread, Shields spiked a fever and got tested for the coronavirus. On March 22, while self-isolating and awaiting her test results, she broke her hip and was taken to the UVA Health System University Hospital.

In the hospital, a rapid-results test came back positive for COVID-19.

The coronavirus wasn’t killing her: Her symptoms had largely subsided, and she wasn’t in respiratory distress, said Dr. Lily Hargrove, a private practice physician who had treated Shields for 15 years and advised her family.

The biggest problem was her hip. Surgery was an option, but Shields had already endured “an excruciating loss of independence” over the past two years, Hargrove said. Recovery from surgery — two to three months in a rehab center with no visitors because of efforts to slow the virus in most facilities — “would have been a nightmare,” Hargrove said, and would not have returned her to normal functioning. She said she and Shields had reached an understanding during the past year that her disease had progressed so far that “we were beyond the point of fixing things.”

Julia and her siblings consulted a palliative care specialist and decided to pursue hospice. The hospital and hospice staffs told the family “this was not to be taken lightly — not only her dying, her potential pain, and also us getting sick,” Julia said.

The family signed up with Hospice of the Piedmont, which is one of about 75 community-based, not-for-profit hospices in the National Partnership for Hospice Innovation (NPHI). Dr. Cameron Muir, NPHI’s chief innovation officer, said most hospices in the group have treated or prepared to treat COVID patients, despite the added risks for workers.

Many hospices are facing shortages in staffing and protective equipment due to the pandemic, prompting concern from some advocates that patients won’t get the care they need. Muir said hospices in his group have bulk-ordered protective equipment together.

With the pandemic, most NPHI hospices are seeing an increase in the number of people they’re caring for at home, Muir said, because hospitals are “eager to get people with advanced illness home if possible” to make room for COVID patients.

“Absolutely the safest place for frail elderly without COVID is in the home,” said Muir, who is also chief medical officer of Hospice of the Piedmont, and “if you’re COVID-positive, the best place to be quarantined is at home.”

Hospice of the Piedmont has shifted to telehealth when possible and has stocked up on protective gear so that staff and families can safely treat COVID patients, said CEO Ron Cottrell.

While the hospice gathered equipment, Julia and her family set to work creating a sterile-yet-welcoming solarium in her home. They cleared out the raincoats and lacrosse sticks from Julia’s mudroom. They rolled in a hospital bed next to a window overlooking the deck and hung a picture Julia’s daughter had painted.

They filled the windowsill with fresh daffodils. Julia’s husband and two children, 18 and 20, went to stay at a friend’s empty house, while one of her sisters moved in to help her care for their mother.

On March 25, Poogie Shields came home, sedated with pain medication. Out the window, she could see a redbud tree in bloom and, soon, the faces of her visiting grandchildren and other relatives.

Julia, a tax preparer, and her sister, an archaeologist, got into a rhythm of suiting up like hospital employees — in scrubs, gloves, shoe covers, masks and eye protection — every time they entered the room.

Their time together was peaceful, Julia said. Other family members hung out on the deck, 6 feet apart, just outside the window. Her sister brought an iPad to coordinate video calls and read aloud dozens of emails and cards.

“There was a fairly reasonable feeling of normalcy,” Julia said.

Over the course of several days, Poogie Shields became unable to eat, drink or swallow medication. With Hargrove’s advice, Julia and her sister managed her fentanyl patches and slipped morphine under her tongue.

As her mother began to lose awareness, Julia softly sang Episcopal hymns — “Abide With Me,” “Breathe on Me, Breath of God” — to comfort herself and her mother, just in case she could hear.

Poogie Shields’ last day “was very peaceful,” Julia said. “It was such a beautiful day.” Relatives had all come by to see her. There was “no anxiety about anything that we needed to figure out,” no last unburdening of unresolved feelings.

Julia said she and her sister were with their mother as she took her last breath at 8:30 p.m. on March 28. Hospice staff came to the house about three hours later. In the meantime, Julia said, “nothing needed to be done. It was just very calm.”

Hargrove said that in her 20 years of practice, “I’ve never had a patient die with such reported ease and grace.”

“The two daughters were extraordinarily brave,” she said. “They were committed to honoring their mom’s wishes.”

After their mother’s death, Julia and her sister disinfected the house before Julia’s family moved back in. No one in the family has become sick with COVID-19.

For other families, bringing COVID patients home might not be possible, especially if someone in the house is at a higher risk of serious complications from the virus, Hargrove noted.

“I would hate to have someone who was unable to bring someone home, who was dying of COVID-19, to think that they had somehow failed that person,” Hargrove said. “I would ask that people find grace and compassion for themselves if this is not available for them.”

Bringing ‘Poogie’ Home: Hospice In The Time Of COVID-19 published first on https://smartdrinkingweb.weebly.com/

[dinafbrownil]

Bringing ‘Poogie’ Home: Hospice In The Time Of COVID-19

After she landed in the hospital with a broken hip, Parkinson’s disease and the coronavirus, 84-year-old Dorothy “Poogie” Wyatt Shields made a request of her children: “Bring me home.”

Her request came as hospital patients around the world were dying alone, separated from their loved ones whether or not they had COVID-19, because of visitation restrictions aimed at curbing the spread of the virus.

Bringing home a terminally ill patient with COVID-19 bears extra challenges: In addition to the already daunting responsibility of managing their loved one’s care, families must take painstaking precautions to keep themselves safe.

Julia Shields, 53, one of Poogie Shields’ four children, said she had reservations about the risk of infection and how it might affect her family’s health and ability to care for her mother. “I didn’t want to bring my mom here, and have it where we’re all of a sudden collapsed in bed ourselves and can’t give her pain medicine and can’t take care of her,” she said.

But she and her siblings were determined to honor their mother’s wishes. So they stocked up on personal protective gear and converted the mudroom of Julia’s Greenwood, Virginia, home west of Charlottesville into a solarium where her mother could be closer to family.

Julia said she wasn’t sure how long her mother would survive; it could have been a few days or even a few months at her home. “She’s such a fighter,” she said.

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Subscribe to KHN’s free Morning Briefing.

Sign Up

Please confirm your email address below:

Sign Up

Poogie Shields, a former guidance and addiction counselor, had an appetite for adventure, be it camping on the Appalachian Trail or moving her family to Paris for a year while writing a master’s thesis. After raising her children in Virginia, she set off to do volunteer work, helping homeless teenagers in Florida and pregnant women facing addiction in Washington, D.C.

But over the past 20 years, Parkinson’s disease gradually limited what she could do, and three years ago she moved into an assisted living community in Crozet, Virginia, about 5 miles from Julia’s home. At first, she walked all over the campus, taking yoga classes and playing trivia with friends. But in recent years, she could manage only short distances with a walker, and Parkinson’s, a progressive nervous system disorder, was affecting her voice, according to her daughter.

“She was the person who had the most interesting thing to say in the room,” Julia said. “It was sad. You just couldn’t hear what she had to say.”

In mid-March, as the pandemic spread, Shields spiked a fever and got tested for the coronavirus. On March 22, while self-isolating and awaiting her test results, she broke her hip and was taken to the UVA Health System University Hospital.

In the hospital, a rapid-results test came back positive for COVID-19.

The coronavirus wasn’t killing her: Her symptoms had largely subsided, and she wasn’t in respiratory distress, said Dr. Lily Hargrove, a private practice physician who had treated Shields for 15 years and advised her family.

The biggest problem was her hip. Surgery was an option, but Shields had already endured “an excruciating loss of independence” over the past two years, Hargrove said. Recovery from surgery — two to three months in a rehab center with no visitors because of efforts to slow the virus in most facilities — “would have been a nightmare,” Hargrove said, and would not have returned her to normal functioning. She said she and Shields had reached an understanding during the past year that her disease had progressed so far that “we were beyond the point of fixing things.”

Julia and her siblings consulted a palliative care specialist and decided to pursue hospice. The hospital and hospice staffs told the family “this was not to be taken lightly — not only her dying, her potential pain, and also us getting sick,” Julia said.

The family signed up with Hospice of the Piedmont, which is one of about 75 community-based, not-for-profit hospices in the National Partnership for Hospice Innovation (NPHI). Dr. Cameron Muir, NPHI’s chief innovation officer, said most hospices in the group have treated or prepared to treat COVID patients, despite the added risks for workers.

Many hospices are facing shortages in staffing and protective equipment due to the pandemic, prompting concern from some advocates that patients won’t get the care they need. Muir said hospices in his group have bulk-ordered protective equipment together.

With the pandemic, most NPHI hospices are seeing an increase in the number of people they’re caring for at home, Muir said, because hospitals are “eager to get people with advanced illness home if possible” to make room for COVID patients.

“Absolutely the safest place for frail elderly without COVID is in the home,” said Muir, who is also chief medical officer of Hospice of the Piedmont, and “if you’re COVID-positive, the best place to be quarantined is at home.”

Hospice of the Piedmont has shifted to telehealth when possible and has stocked up on protective gear so that staff and families can safely treat COVID patients, said CEO Ron Cottrell.

While the hospice gathered equipment, Julia and her family set to work creating a sterile-yet-welcoming solarium in her home. They cleared out the raincoats and lacrosse sticks from Julia’s mudroom. They rolled in a hospital bed next to a window overlooking the deck and hung a picture Julia’s daughter had painted.

They filled the windowsill with fresh daffodils. Julia’s husband and two children, 18 and 20, went to stay at a friend’s empty house, while one of her sisters moved in to help her care for their mother.

On March 25, Poogie Shields came home, sedated with pain medication. Out the window, she could see a redbud tree in bloom and, soon, the faces of her visiting grandchildren and other relatives.

Julia, a tax preparer, and her sister, an archaeologist, got into a rhythm of suiting up like hospital employees — in scrubs, gloves, shoe covers, masks and eye protection — every time they entered the room.

Their time together was peaceful, Julia said. Other family members hung out on the deck, 6 feet apart, just outside the window. Her sister brought an iPad to coordinate video calls and read aloud dozens of emails and cards.

“There was a fairly reasonable feeling of normalcy,” Julia said.

Over the course of several days, Poogie Shields became unable to eat, drink or swallow medication. With Hargrove’s advice, Julia and her sister managed her fentanyl patches and slipped morphine under her tongue.

As her mother began to lose awareness, Julia softly sang Episcopal hymns — “Abide With Me,” “Breathe on Me, Breath of God” — to comfort herself and her mother, just in case she could hear.

Poogie Shields’ last day “was very peaceful,” Julia said. “It was such a beautiful day.” Relatives had all come by to see her. There was “no anxiety about anything that we needed to figure out,” no last unburdening of unresolved feelings.

Julia said she and her sister were with their mother as she took her last breath at 8:30 p.m. on March 28. Hospice staff came to the house about three hours later. In the meantime, Julia said, “nothing needed to be done. It was just very calm.”

Hargrove said that in her 20 years of practice, “I’ve never had a patient die with such reported ease and grace.”

“The two daughters were extraordinarily brave,” she said. “They were committed to honoring their mom’s wishes.”

After their mother’s death, Julia and her sister disinfected the house before Julia’s family moved back in. No one in the family has become sick with COVID-19.

For other families, bringing COVID patients home might not be possible, especially if someone in the house is at a higher risk of serious complications from the virus, Hargrove noted.

“I would hate to have someone who was unable to bring someone home, who was dying of COVID-19, to think that they had somehow failed that person,” Hargrove said. “I would ask that people find grace and compassion for themselves if this is not available for them.”

from Updates By Dina https://khn.org/news/bringing-poogie-home-hospice-in-the-time-of-covid-19/

[anotherwriterinbrooklyn]

Writing Under the Influence

On Tuesdays I like to go to one of my favorite bars and partake in their writing club. The organizer comes with four prompts and we write in 20 minute chunks. Here's what I came up with last night. Enjoy! 1. Pretend you’re in a tree-house eating breakfast around a table with a number of other people. Someone enters the tree-house and gives you an important message. Describe the ensuing events. A psychic friend of mine invited me to a treehouse in the middle of a Pennsylvania mountain range with five strangers. I was getting sick of the New York City heat, the hot train tunnels and unbearable bike rides to coffee shops with cranked ACs, so it seemed like the perfect getaway when I responded to the email. We were sitting in the treehouse having breakfast when a crow flew the window with a message and dropped it on top of the pancakes. My friend, the organizer, fished it out of the syrup with her fingernails, unfolded it and said. “Find A or else B.” I chewed on a piece of sausage and washed it down with a swig of coffee and it scalded my whole throat. “Find A or else B, what does that mean?” A friend of a friend said. I didn’t know him, we had just met last night. There wasn’t a distinguishable quality about him and I doubted I would see him again after this trip, but I trusted my psychic friend that this man must have something going for him, maybe that he was so unrecognizable, almost translucently pale with milky blue eyes. “Find A or else B, that could be anything,” chirped another friend. She was a little more recognizable than the man, with blunt blonde bangs and a dime-sized birthmark on her cheek. She was a hairdresser, spunky and quick-witted. “So who dies first?” Said Raphael, my friend from college, tipsy from a few glasses of mostly champagne mimosas. “It’s very vague,” I said, agreeing with the hairdresser. My psychic friend inspected the piece of paper, folded it up and opened it again. It was on a notecard, written in pencil. “Well, it looks like the owner has a game for her guests. What starts with A, and ends in B.” “I don’t know, you’re the clairvoyant one,” Raphael chirped, raising his eyebrows and pouring himself a forth mimosa without the orange juice. “How much time do we have?” I said, “How are we supposed to play if we don’t know the window?” “I think we should wait,” said the hairdresser, wrestling a pancake onto her plate. “Nothing good comes out of acting in fear or panic. The white man looked even whiter. “This concerns me,” he said. “I knew this wasn’t a good idea, I knew I shouldn’t have come to this treehouse in the middle of Pennsylvania. This is so unlike me.” He started breathing very heavily, pressing his fingers into his temples. “Calm down,” said my psychic friend, “I hear something, there’s a voice whispering.” 2. Write an elliptical conversation. Maybe they’re speaking about a grave matter that they don’t mention, or maybe they’re just being elliptical for the hell of it. You decide. “There’s a snake in my bed and I keep trying to tell it to go to go away but it keeps coming back. It laid an egg in my ear and now I feel sick.” This is what his son said to him from his hospital bed at the psych ward. He had been there for two weeks and hadn’t stopped hallucinating. “Seriously, dad. I don’t have a problem, I just need to get away from this snake. I promise I won’t use again, I swear.” His son had overdosed on methanthetamine, xanax and fentanyl 17 days ago for the third time in two years. He had been admitted to rehab five times, clocking in at a grand total of 6 hours in rehab. He remembered when his son was younger and they’d buy trading cards at the grocery store when he was well-behaved, and how often that was. Then at the end of the trip, while he was in the check-out line, his son would pick through the packets of trading cards until he found the one he wanted, then placed it at the end of the line-up of food for the week. When his son was 12, two shiny packs fell out of his pocket when they were loading groceries into the van. Instead of reprimanding him, his father decided to ignore what he saw. Maybe he paid for them with his allowance money. He wanted to trust his son. His son was a good boy. He got his homework done and picked up around the house, said please and thank you. He didn’t want to accuse his son of stealing if he wasn’t stealing, and most of all, he wanted his son to like him more than his mother, especially in the middle of the custody battle. Even if he did steal two packs of cards, so what? They were just playing cards, and when he was younger, he had pocketed candy bars and cans of soda, too. It’s something that he grew out of when he realized that the cashiers and people who worked at the grocery store were the ones who got in trouble when things were stolen. He knew because he pushed carts at the grocery store down the block from his house in high school. His son would learn naturally. There was a certain order about the world that could be followed, but in the middle of a heated divorce, he didn’t seem to know why to tell his son to follow rules and what they would be good for anyway. He had followed all the rules growing up and look where he ended up, at a corporate office, the same one for ten years, continuing to ask for a raise but not getting one. “Dad, the snake, get it out of here or get me out of here. I am sad and I want to go home. I will never use again.” 3. Find a piece of artwork over 300 years old on the internet, and write a story about it. The men gathered the young king and shifted him onto a cot made of blue silk and golden tassels. This is where the man’s body would stay while his people prepared his burial site. Underneath his home, workers sifted through his belongings, finding a brass and onyx gong that was a gift from a neighboring kingdom, one that he restored peace with and created trade sanctions. He was a diplomat, a father of ten, but that’s not who he was now. In the afterlife his body would find sanction in a tomb built just for him, his family and his legacy. He would be buried right next to his father, buried right next to his father’s father. With turquoise, rubies, and statuettes of the gods to protect him as his soul was ushered into the spiritual realm. In his new form, he felt weightless yet saddened that he had to leave his family so soon. He was 50, and had passed of natural causes. He had prepared for old age, said his respects to his family, assigned his second born son as the heir to the thrown, since his first born son had died in battle, in an effort to make piece with the neighboring country who had gifted the gong. His guards carried the gong and the king’s body out into the air, and rang the gong to announce to the community that the king had passed away, that there would be a successor to the throne. The king’s soul was torn. He wanted to stay to watch his body be prepared for burial, he wanted to feel himself anointed with fine, aromatic oils, but knew that he would never feel his skin from inside. His bones were not his — now they were the earth’s, and they would stay wrapped together in place with a thick winding cloth, then placed in a sarcophagus that would defy time, dust, and war, discovered hundreds of years later by a rich civilization from another hemisphere hell-bent on a treasure hunt. But for now, he would find his son. 4. Write a story in a style you don’t normally use. It’s changing things are changing wooooooooo can you feel it things are changing. It’s fall and the bugs are still biting they are making little holes in legs and arms, necks and cheeks, fleshy smelly holes. Lick the sweet sweat from your lover’s side and know that you are exactly where you need to be right here right now. Nowhere is how it feels to be everywhere all at once without reason. Find a purpose and stick to it like a mosquito finding a fleshy crevice to drink out of. Pour yourself a Guinness and start tapping on the keypad anything that comes out of your fingers is magic. No disrespect to the mosquitos they’ll keep on doing what they came to do but how do you concentrate if you’re always itchy and irate. Grrrrr you bugs you bugs find your own earth. Let’s collect all the mosquitos and put them in the trunk of an old car then send it to space. Let’s smash all of those bodies into the trunk and send it off to space. Let them eat each other make them feel the weight of their blood, human blood, all of it. Don’t you feel itchy reading this it makes me woooooooo zyyyy. There’s no one but you and I and this fly that’s on the table, circling around the candle. That fly is telling the other flies where to find the light, don’t you see. We are doing that too, we find the lights and like flies, like mosquitoes my draw more people toward it. There’s something to it, something to the light. It’s California. Let’s pack all of the people you know in a city bus and send them out west where it’s warm and bright and see how they live there. Let’s evacuate the flood lines before Miami’s submerged. Don’t you love how it feels to live fearfully of the flies and the waves, doesn’t it feel nice. Don’t you want the heat. When you have these worries to distract you what can you really get done. It’s so easy to focus on the flies and mosquitos. If we just pack them up and put them somewhere couldn’t we get more done. Who do you think you are telling me how to focus my attention when there’s this fly buzzing around my head and mosquito bites all down my legs. I’m afraid for my attention span. Wooooooooooo one point for admitting what comes naturally it’s who I am. I suck the life out of writing prompts and pound the table to find my voice. I drum my fingers and mosquitoes fly out and they bite my face as I bike home and it’s all I can think about, how I’ll have more bites and do I really need bugspray in October? WINTER IS IMMINENT so why worry at all about the bites isn’t there something like Zika in the air or West Nile virus or sssssssssss who is this person typing these words I don’t recognize them I think I’m going crazy because I should be writing pop music not this and I should always be writing something that I’m not writing but it’s more fun to just write and not look back. Like the horse, the horse that runs away with the reigns and there’s nothing you can do except keeping riding because consciousness just keeps on coming and you have to find a step back from it and watch the process from a distance, what’s really going on. There’s a beauty in not controlling it, it cuts through the mosquitoes, it feels triumphant to let the horse go crazy and you’re just riding it hoping that it goes forever but even horses get tired, even mosquitoes get tired and have to sleep. The flies die in the winter and then they come back again. Once the horse rests it will keep going for awhile. It starts and stops so when there is this motion you might as well ride it wooooooooooooooooooo

[theconservativebrief]

When 27-year-old Debbie Honaker went to her doctor in Lebanon, Virginia, after a routine gallbladder surgery in the early 2000s, she was prescribed “Oxy tens” — 10 milligrams of OxyContin. At her next visit, it turned into 40s. Then she graduated to Percocet. Soon, she began stealing pills, then buying them from Medicaid patients for $1. “At the end of your journey, you’re not going after drugs to get high; you’re going to keep from being sick,” she says.

Honaker’s story is just one of many in author Beth Macy’s new book Dopesick: Dealers, Doctors, and the Drug Company that Addicted America, which chronicles the 20-year history of the opioid epidemic, starting with the dawn of OxyContin in 1996 and ending with grim statistics: 300,000 Americans dead from opioid overdoses over the past 15 years and predictions that 300,000 more will die in the next five.

Macy’s first book, 2014’s Factory Man, underscored the toll of offshoring business on America’s rural communities. In Dopesick, Macy, a Roanoke-based journalist, continues to follow American workers, investigating how those who have lost factory and mining jobs have been hit especially hard by the opioid epidemic.

The villains of Dopesick are the pharmaceutical companies — namely Purdue Pharma, the company that sold OxyContin — corruptible doctors, and a lax Food and Drug Administration. The victims? The rest of America, especially those in economically distressed parts of the country.

America is sick, Macy argues, and too many people have looked the other way during the worst drug epidemic in its history.

I spoke with Macy to better understand the history of the epidemic, its real-world impact, and what is missing from our national conversation on opioids.

Our conversation has been condensed and edited for clarity.

Hope Reese

You write about central Appalachia as “the birthplace of the modern opioid epidemic.” What are the characteristics that made a region like Lee County, Virginia — which began seeing teenagers overdose in the late ’90s — susceptible to the OxyContin epidemic?

Beth Macy

It’s the same thing if you look at the other initial hot spots. In Machias, Maine, a logging and fishing community, there were also many people already on painkillers from legitimate injuries due to these manual labor jobs. But in Appalachia, in particular, you had trade deals like NAFTA in ’94, and then China joined the WTO in ’01, and so you saw the furniture and the textile mills closing and the jobs going away — and at the same time, a huge rise in disability.

Now, 57 percent of the men of working age in Lee County are unemployed. As this is happening, this whole notion that we were horribly undertreating pain began being pushed by big pharma. Suddenly you couldn’t go and visit somebody in the hospital where there wasn’t a whiteboard where they would ask you to rate your pain on a scale of 1 to 10, or draw a smiley face or a frowny face.

All these things sort of converged: the joblessness, the rapacious behavior of big pharma, Purdue Pharma in particular. One of the first cops I interviewed said, “Oh, yeah, people were walking down the street with green and orange smudges on their shirt.” Orange was the color of an Oxy 40 mg and green for the Oxy 80 mg. They had held the pills in their mouths to soften up the time-release mechanism coating so they could get the euphoric rush of an entire pill all at once, then wiped the coating off on their shirtsleeves.

Hope Reese

I’m also interested in how doctors were incentivized. They were basically taking bribes — going on Caribbean vacations, for instance, hosted by pharma companies. Has there been a crackdown on doctors? What kind of gifts are they allowed to accept from sales reps?

Beth Macy

That’s changed in more recent years. In the first decade, it was kind of like a Wild West of pharmaceutical sales tactics. Pharmaceutical ads were starting to air on TV. A good friend of mine who is a pharma rep broke it down for me: They would find out what the doctor wanted and they would show up with whatever that was. He was waiting for the doctor, a chain-smoking doctor in Bland, Virginia, and another rep has already beaten him — they were there with a carton of cigarettes with a Celexa sticker on it.

Purdue used similar techniques. They paid doctors to be spokesmen for them, saying: Come to a seminar in Boca Raton or Arizona, and we’ll pay you to go out and give speeches about [OxyContin].

Hope Reese

Many people who become addicted to OxyContin eventually move on to heroin, which is cheaper. How are we doing with the pill problem? And even if we have tackled that issue, isn’t it a bigger problem once people start taking heroin?

Beth Macy

The updated CDC guidelines in 2016 were a great improvement. It was kind of what those parents who initially lost their kids to OxyContin overdose wanted. They wanted the guideline to be that opioids were used sparingly, that doctors try pain relievers like ibuprofen and aspirin before prescribing the highly addictive pills, and that they give most patients only a few days’ supply — that opioid therapy for short-term pain last three days, and very rarely longer than seven. Overall, that’s good, but as soon as the OxyContin and the other pills got harder to get, you saw the drug cartels bringing in heroin.

Marijuana laws started becoming legal in states, and the drug cartels needed to make up their profit [from lost marijuana sales]. The doctors are doing better about not prescribing opioids out the wazoo, but we now have 2.6 million Americans with opioid use disorder. What are we going to do about that? You just can’t flip off a switch and it stops.

What I see on the ground are serious holes in the tapestry of treatment. The Roanoke Times finally did a story on medication-assisted treatment, or MAT, which combines therapy with medications like methadone or Suboxone. In it, they quote Steve Ratliff, adult and family services director for Blue Ridge Behavioral Healthcare, and he doesn’t believe in it. He told the newspaper that they only use buprenorphine if counseling has been attempted first and doesn’t work — and then they give them the option. This is not consistent with state policy, and in my view, it is just wrong.

Now, in an age of Fentanyl — dealers started cutting heroin with fentanyl heavily in 2015, and it became much stronger and deadlier — the risk of dying is much higher. We’re going to let them fail first?

Hope Reese

In the book, you point to evidence that shows that abstinence-based centers, a model of treatment in which people are cut completely off of the drugs, have not proven to be the best route to recovery. So why do they dominate the treatment landscape?

Beth Macy

I think it’s because the recovery industry developed largely as treatment centers for alcoholism. So the abstinence-only models put forth by [Alcoholics Anonymous and Narcotics Anonymous] are historically what most of the recovery industry has been centered around.

Abstinence models may be better to treat alcoholism, but not opioids, since opioids, especially those laced with fentanyl, are deadly. [Many fewer people] OD on alcohol [compared to heroin]. What I see on the ground is families that can afford to send their children to rehabs — and most families can’t — end up spending thousands of dollars for treatment that is not what science says is the best way to treat opioid use disorder.

One family I know with two heroin-addicted sons spent $300,000 on an abstinence center. That wasn’t including the heroin-related legal fees that they had.

Hope Reese

More than 40,000 Americans died of overdoses from opioids such as fentanyl, heroin, and prescribed painkillers in 2016, and they are estimating even more in 2017. What about long-term consequences? If this has been going on for 20 years, what will the country look like in 20 more years?

Beth Macy

Think about the foster care system. In Lee County, one in three kids are raised in foster care now. And think about what are their kids going to be like? That’s really frightening.

Another long-term consequence that scares the dickens out of me is hepatitis C. There are centers, needle exchange programs, where you come and you turn in your dirty needles. There, you get clean needles and you get to know these people who want to help you and want to help you get you hooked up with social work and counseling and ultimately, when you’re ready, go on to treatment. That’s what’s missing in most of America right now.

I was visiting a needle exchange recovery program in Las Vegas recently that was only located on the outskirts of town. If you’re an addicted person and you’re homeless, you probably live near the downtown in these tunnels underneath the city, so the homeless people who are addicted have to save up their bus fare to go there. And it’s because they didn’t want the tourists to see the addicts.

The guy who runs it who has been in this world of prevention and harm reduction for a long time said that what keeps him up at night is in 15 to 20 years, we’re gonna have a tsunami of hepatitis C because so many people who are injecting are sharing needles.

I mean, it’s cultural. Our country’s way of thinking has been, “We gotta incarcerate our way out of this,” “We gotta be tough,” “We gotta just say no.” And that has not worked in other countries. Other countries that have adopted a treatment approach have done much better.

Hope Reese

This topic has finally become of part of a national conversation — but what’s still missing from the larger dialogue? What surprised you after spending all this time with addicts, dealers, and families?

Beth Macy

What surprised me is how this could happen to just anyone. It literally spares no one. And because it started out in these politically unimportant places, people didn’t pay attention to it. We’re basically leaving the institution of the family to deal with the worst drug crisis in the nation’s history.

You see these families in so much pain. They’re so weary; they’re so worn out. Many of them have these ideological divides within the family, because maybe they have somebody in AA or NA themselves — who maybe doesn’t see medication-assisted treatment as the best way for their addicted loved one to get better.

You see that colors a lot of family dynamics around medication-assisted treatment, and you see them worn out also because of bad behavior by the addicted people whose brains have been taken over by this drug, such as users who steal from their families to fund their next fix, for instance. Too often, the addicted person isn’t seen as someone worthy of evidence-based medical care until people are sitting in the pews at their funeral.

Hope Reese

I want to know how the book affected you, especially since a lot of the reporting was done in your own community. In particular, one of the women addicted to heroin who you spent a lot of time with ended up becoming a prostitute in Nevada, and was eventually found dead, in what appeared to be a violent murder.

Beth Macy

It was really hard to interview people who died before I had the chance to write up my book, but it was nothing compared to the pain that these families are going through.

I was constantly balancing that between anxiety and feeling hopeless about it.

I take things pretty personally sometimes. I have hundreds of text messages back and forth with many of the mothers in the book. But as a friend of mine said, “The only way I think you’re going to be able to protect yourself and write this book at the same time and survive it is to find the helpers.”

Hope Reese is a journalist in Louisville, Kentucky. Her writing has appeared in the Atlantic, the Boston Globe, the Chicago Tribune, Playboy, Vox, and other publications. Find her on Twitter @hope_reese.

Original Source -> The author of Dopesick on how we’re still failing opioid users

via The Conservative Brief

[newstfionline]

Inside a Killer Drug Epidemic: A Look at America’s Opioid Crisis

NY Times, Jan. 6, 2017

Opioid addiction is America’s 50-state epidemic. It courses along Interstate highways in the form of cheap smuggled heroin, and flows out of “pill mill” clinics where pain medicine is handed out like candy. It has ripped through New England towns, where people overdose in the aisles of dollar stores, and it has ravaged coal country, where addicts speed-dial the sole doctor in town licensed to prescribe a medication.

Public health officials have called the current opioid epidemic the worst drug crisis in American history, killing more than 33,000 people in 2015. Overdose deaths were nearly equal to the number of deaths from car crashes. In 2015, for the first time, deaths from heroin alone surpassed gun homicides.

And there’s no sign it’s letting up, a team of New York Times reporters found as they examined the epidemic on the ground in states across the country. Here are their stories.

MARBLEHEAD, MASS. In Suburbia, ‘Tired of Everything’ Katie Harvey walked out of the house where she lived with friends, shoved her duffel bag into her mother’s car and burst into tears.

“I need to go to detox,” she told her mother, Maureen Cavanagh. “I’m just tired of everything.”

Ms. Harvey, 24, had been shooting heroin for three years. She had been in and out of detox--eight times altogether. But it had always been someone else’s idea.

This time, Ms. Harvey made the arrangements herself. She had come to loathe her life. “I haven’t even been doing enough to get really high,” she said. “I’m just maintaining myself so I don’t get sick.”

Before she left for detox, Ms. Harvey curled up on the couch in her mother’s living room in this well-to-do suburb north of Boston and reflected on her life: her low self-esteem despite model-worthy good looks; her many lies to her family; how she had pawned her mother’s jewelry and had sex with strange men for money to pay for drugs.

As she spoke, tears spilled from her eyes. She wiped them with the cuff of her sweater, which covered track marks and a tattoo that said “freedom”--her goal, to be unshackled from the prison of addiction.

Ms. Harvey had been a popular honors student. But she developed anorexia. Alcohol was next. By 21, she was hooked on heroin.

In 2015, she was arrested on charges of prostitution. In an extraordinary act of contrition, she wrote a public apology online to her friends and family.

Still, she plunged in deeper. She estimated that at her worst, she was shooting up a staggering number of times a day, perhaps as many as 15--heroin, cocaine, fentanyl. She overdosed five times. In Massachusetts, almost five residents die every day from overdoses.

“I don’t know how I’m alive, honestly,” Ms. Harvey said.

That night in October, she went into detox. Four days later, she checked out. She went back to her friends and drugs, developing an abscess on her arm, probably from dirty needles.

Two weeks later, she was back in detox. This time, she stayed, then entered a 30-day treatment program.

The return trips to detox have been an emotional roller coaster for her mother. To cope, Ms. Cavanagh founded a group, Magnolia New Beginnings, to help drug users and their families.

Among her words of advice: Tell your children you love them, because “it might be the last thing you say to them.”--Katharine Q. Seelye

MARSHALLTOWN, IOWA Help May Be Thin on the Ground Andrea Steen is one of the fortunate ones. For people in this rural community of 28,000, getting medication to help overcome opioid addiction used to require long drives to treatment centers.

That changed about a year ago when two doctors here were licensed to prescribe Suboxone, a drug that eases withdrawal symptoms and helps keep opioid cravings at bay. Now Ms. Steen is one of their patients, coming once a month to check in and renew her prescription.

This epidemic is different from those of the past in significant ways. One is that it has spawned a growing demand for medications that can help modify addiction’s impact.

One of them is naloxone, known as Narcan, a powerful antidote that has jolted hundreds of overdosed users back to life. Another is buprenorphine, typically sold as Suboxone.

By keeping users from experiencing cravings and withdrawal, Suboxone can make it easier for addicts to stay off heroin and other opioids. The number of doctors certified to prescribe buprenorphine has more than doubled since 2011, to about 36,000 from about 16,000, according to the Substance Abuse and Mental Health Services Administration. Yet the drug remains out of reach for many rural Americans.

Ms. Steen, 46, is among 20 patients who get Suboxone from the two doctors authorized to prescribe it here. Until last summer, she said, she abused Vicodin and morphine relentlessly. She would steal them from her disabled husband, who would try in vain to hide them. But sometimes she couldn’t root out the pills fast enough, and she would experience what every addict dreads most: withdrawal.

She heard about Suboxone from a friend in Tennessee whom she met through Facebook.

“She could tell when I was high,” Ms. Steen said. “Her husband was on Suboxone. She was trying to help me.”

Ms. Steen started on Suboxone in July, initially making weekly visits to Dr. Nicole Gastala and Dr. Timothy Swinton, the family practitioners here who prescribe the drug. Then it was every other week.

Unlike methadone, which also helps treat opioid addiction but must be taken under supervision at special clinics, Suboxone can be taken at home. Some doctors fail to follow Suboxone patients closely, or to test their urine to make sure they are not abusing or selling the medication or using other drugs. But the protocol here is strict.

Besides her doctor visits, Ms. Steen must attend group therapy and have regular urine tests.

She has mostly stopped craving opioids, for now.--Abby Goodnough

LOS ANGELES Tough-Love Rehab They enter through an unmarked turquoise storefront, nestled between fashion boutiques on Melrose Avenue. They gather in a circle, ready for the tough-love approach they have come to expect from Howard C. Samuels, a clinical psychologist who runs the Hills, a drug rehabilitation center whose location is central to its marketing.

A spot in the room is hard to come by, as are most drug rehabilitation services, especially for the poor and anyone without the proper insurance. The Hills, which can cost around $50,000, serves a more privileged population, yet its mission is no less daunting.

In 2014, heroin became the most common reported drug of choice among those seeking treatment in Los Angeles County, surpassing marijuana and methamphetamine.

Dr. Samuels began with what he called a reality check. “How many of you have been to at least five treatment centers?” he asked. Nearly every one of the 19 clients in the room raised a hand.

“How about 10?” Still half of the clients raised their hands.

One of them, Jordan, who agreed to tell his story only if his last name was not disclosed, knows he is one of the lucky ones. This is only his third time in rehab, a relative rookie at 33 years old. This was his 118th day sober.

He had smoked pot, taken ecstasy and occasionally snorted cocaine. But heroin seemed off-limits to him, a college-educated son of two therapists, until a friend offered him some to smoke. Four years later, he blew through a $20,000 inheritance in a month to get what he called the best heroin in the city.

After his first days of detox were over at the Hills, Jordan began what would be months of therapy. He confronted what Dr. Samuels calls “character defects,” and rattles his off easily: lust, anger, lack of discipline.

On this day, he knows he will draw the wrath of Dr. Samuels: Subverting the rules, he recently went out for his seventh tattoo. “My addiction has been replaced with addiction to other things: going to the gym, smoking, girls, getting tattoos.”

“Don’t you owe me an apology?” Dr. Samuels said to him, almost shouting.

Jordan answered quietly: “Yeah, I guess I owe you and some people an apology.”

“I’m glad you’re apologizing to me. That’s good, but what’s bad is, it came so naturally,” Dr. Samuels said.

“All of us have some real impulse control problems,” he continued. “That’s why we’re drug addicts.”--Jennifer Medina

SEATTLE ‘For the Grace of God, There Go I’ The girl looked to be barely out of her teens, and was teetering on the brink of consciousness.

“She couldn’t even form a sentence,” said Dan Manus, a soft-spoken 61-year-old in a Seattle Seahawks cap. His jaw tightened as he recalled the night in October when he and his partner on the King County Emergency Service Patrol found the girl and, he thinks, saved her life.

A former addict, he knows the terrain too well. He’s been clean for 22 years now, and working for the county for the last nine.

“I can relate to everybody I work with down there, because for the grace of God, there go I,” Mr. Manus said, standing in the patrol parking lot between runs. “So, yeah, I feel like this kind of was my calling.”

The Emergency Service Patrol was established in the 1980s by a private charity (later taken over by King County) to rescue street alcoholics by bringing them to a safe “sobering center” to sleep it off.

In October, though, in an acknowledgment of heroin’s new ravages--treatment admissions for heroin in King County surpassed alcohol for the first time in 2015--Mr. Manus and other patrol crew members were trained and equipped with naloxone.

“Harm reduction” is an approach that was to some degree pioneered here. One of the nation’s first clean-needle exchanges started in nearby Tacoma in 1988.

King County is now considering opening what could be the country’s first safe-injection site. There, addicts could use drugs under supervision by a health worker who may, crucially, also open the door to recovery programs, all under one roof.

For Mr. Manus, the crisis is personal. In 1992, he was saved from death by someone who found him in mid-overdose and called paramedics.

Seattle was a different, harder-edged city back then. Grunge music, and the heroin that swirled like a slipstream through the lives and song lyrics of some of its stars, was spilling out of the clubs.

The mix of drugs was changing, too. Heroin’s impact in King County surged in the late 1990s in the number of times it was identified in connection with a drug death, before beginning a near decade-long slide--a period that coincided with an increase in the number of times prescription opioids were found in victims’ bodies, which peaked in 2009. In that same year, heroin’s role began rising again to hit its highest-ever, worst numbers in 2014 with a drop since then, according to county figures.

More people lately seem to be on complex combinations of drugs, Mr. Manus said--like the girl who, at his direction, was treated by paramedics.

“It just seems today that there’s so much more out there, so many more people,” Mr. Manus said quietly. “It feels nonstop.”--Kirk Johnson

NOGALES, ARIZ. Outwitting the Mules A tipster warned: Look out for a silver Nissan Sentra approaching the busy Dennis DeConcini Port of Entry in Nogales, Ariz., a crucial gateway for cheap heroin made in Mexico.

Early one morning, the Nissan rolled into passport control. A Customs and Border Protection officer caught the telltale signs of a driver who had something to hide: the darting eyes, the tight grip on the steering wheel.

The driver carried a border-crossing card, an entry permission given only to Mexican citizens. He also carried his wife and two small children and a load of heavy drugs: four pounds of methamphetamine in the passenger’s backrest, and seven and a half pounds of heroin between the engine and the dashboard.

Last year, Customs and Border Protection agents seized more than 930 pounds of heroin in Arizona, which is almost one-third of all heroin seized along the entire southern border. Agents acknowledge that they catch only a small fraction of what goes through.

Much of the heroin that enters this country comes hidden in cars, concealed in suitcases, squeezed inside hollowed fire extinguishers, or strapped to the thighs, crotches and chests of Mexicans and Americans who cross between the two countries.

To the special agents assigned to Homeland Security Investigations, a division of Immigration and Customs Enforcement, mules are the first link of a knotted chain that may or may not lead to the agents’ ultimate prize: a top drug trafficker.

“It’s about preventing the narcotics from entering the community,” said Jesus Lozania, the agent in charge in Nogales. “It’s taking down the organization from the bottom all the way to the top: the mules, the people who coordinate the logistics, the persons who handle the money after the narcotics are sold in the United States. That cash has to make its way back to Mexico.”

It is about building conspiracy cases bit by bit.

That morning at the border, three special agents noticed the black letters stamped on the bricks of heroin: LEY. “That’s probably from the Chino Leys, probably Sinaloa,” said one of the agents, who declined to provide his name because he works undercover.

The Chino Leys, he said, are one of the drug distribution organizations in the Sinaloa cartel, which controls the routes that slice through Arizona, aimed for the Northeast. Cleveland, New York and New Jersey are main destinations for Sinaloa’s heroin these days.

The driver said he had borrowed his cousin’s car to come to Nogales to buy sweaters. The disbelieving agent pressed on. The driver crossed his arms.

“The guy’s not talking,” the agent said.--Fernanda Santos

HUNTINGTON, UTAH Staying Clean in the High Desert As she drives to work each morning, past horse ranches and nodding oil pumps, Marsha World stops to give her son, Kolton, a pale yellow pill to help keep him off heroin for another day.

There are few options for drug treatment in the high desert of central Utah, a remote expanse of struggling coal mines, white-steepled Mormon towns and some of the country’s highest opiate death rates.

The lone doctor licensed to prescribe one addiction-treating drug has a waiting list. The main detox center is the county jail. So mothers like Ms. World occupy the lonely front lines of a heroin crisis that has reached deep into the remotest corners of rural America.

The sun was just skimming over the sagebrush hills when Ms. World climbed out of her car and palmed that day’s naltrexone pill for her 30-year-old son. Unlike other medications Mr. World has taken over 11 years of addiction and rehab, jail and relapse, this one seemed to help.

Mr. World was in a treatment program ordered by the local drug court, and Ms. World had promised the judge she would keep the pills at her house and bring one to him. Every day.

The rate of prescription overdose deaths among the 32,000 people sprinkled across two neighboring counties in this corner of Utah is nearly four times the state average. Addiction has rippled through ranks of miners who relied on pain pills after years of digging coal and working in the power plants.

Karen Dolan, who runs the Four Corners Behavioral Health center in the nearby town of Price, the only substance-abuse facility for miles, said three of her staff members had lost family members to addiction. At the power plant where her husband works, some of his co-workers’ family members have died of overdoses. Heroin accounts for 31 percent of the clinic’s admissions, up from 3 percent in 2010.

“People call every day and say, ‘Do you have an opening?’” Ms. Dolan said. “We don’t have any money to pay for medication-assisted treatment, and we don’t have prescribers to provide treatment.”

After years struggling with heroin addiction in Salt Lake City, Mr. World moved back in 2013, to the community where he had grown up in a loving family that went to Mormon services on weekends. (He is no longer a part of the church.)

But it was no sanctuary. When Mr. World found a stray Chihuahua on the road a few months ago, it turned out the dog’s young owner was in jail because of an opiate addiction. And getting drugs here proved just as easy as in the city: One Facebook message to an acquaintance did it.

But it has been more than 300 days since he last used. His days now are work, therapy, random drug tests at the sheriff’s office and morning visits from Mom.

“Love you,” she said after he took his pill. She hugged her son and his boyfriend goodbye, and drove to her job at the dry cleaner.--Jack Healy

MILWAUKEE In the End, Uncomprehending Sometimes they call themselves “the last responders.”

They work in the county medical examiner’s office, in a low-slung brick building downtown in the shadow of an old Pabst factory. Here is where they take over after a drug addiction has been more powerful than pleas from family, 12-step programs or even Narcan.

“We’re the end of the line,” said Sara Schreiber, the forensic technical director, walking through the autopsy rooms to talk about the office’s part in the opioid addiction epidemic--a crisis that has hit especially hard here.

Last year, 299 people in Milwaukee County died of drug-related overdoses. One of them was the medical examiner’s own son.

Adam Peterson died in September at the age of 29, found unresponsive in a friend’s apartment. “At this time I am not speaking publicly about Adam’s death, and I appreciate your forbearance as my wife and I work through this issue,” his father, Brian L. Peterson, the medical examiner, wrote in an email.

Dr. Peterson has continued his work despite his grief. He oversees a staff of nearly 30 people--administrators, toxicologists and laboratory employees--who have perhaps never been more overwhelmed. They are confronting a surge of drug-related deaths in Milwaukee County, the most populous county in Wisconsin, with nearly one million people in the city and suburbs.

They have witnessed an alarming rise in drug-related deaths for years now: 251 deaths in 2014, 255 in 2015, and they surpassed those figures in 2016. Dr. Peterson’s son was among those who died last summer in a surge of overdoses that in seven weeks took more than 70 lives.

Ms. Schreiber has witnessed much of the epidemic. The victims have been mostly middle-aged; more male than female; more white than black.

As she walked through the laboratory, she pointed out the epidemic’s effects. Now, the machines that analyze blood to help determine the ever-more-toxic blends of drugs are running far more often. They’re juggling more cases and analyzing more specimens than before.

Ms. Schreiber and her colleagues struggle with questions that they cannot answer. What can they do to stem the epidemic? How can they influence people while they are still alive?

It’s hard to know where to begin, she said. “You can’t outrun it.”--Julie Bosman