30 Vicodin a day

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The patient is twenty-nine. She is intelligent and articulate, comes from a good middle-class family (her father is a lawyer, her mother a professor), and has been to college. She has no job, lives with a deadbeat boyfriend, and takes thirty Vicodin a day when she can get it. She wants to quit.

“Eleven million Americans take opiates for nonmedical, recreational purposes,” says Dr. Michael Stein, a physician in Providence and a professor of medicine at Brown University. One of these is Vicodin, which was the most prescribed medication in the United Sates in 2008. Stein has been treating addiction for over twenty years, and in The Addict he distills that experience into a book which is part memoir and part case study.

In 2005 Lucy Fields (a pseudonym) sought help with her addiction to Vicodin, and Dr. Stein was one of the few physicians in the region licensed and trained to treat opiate-dependant patients with a drug called buprenorphine. “Buprenorphine shares a basic atomic structure with opiates,” Stein explains, “but does not get the user high because its chemical properties are different.” It “quells the craving” so that the user can escape the calling of the habit.

Dr. Stein recounts Lucy’s visits over the course of a year, from the start of treatment, through a relapse, and into recovery. He also folds into the mix his own philosophy and compassion, sprinkled with anecdotes from a career devoted to the treatment of addiction, from his time as a medical student in the wards of Harlem Hospital to his current practice in Providence.

An addiction to Vicodin (or its opiate relatives Percocet, codeine, and OxyContin) is often the result of a legitimate prescription for pain. It is frighteningly easy to see the slippery trail of causality which can seduce a “normal” person into an addiction to opiates. For Lucy, however, we eventually learn that her use of drugs and alcohol began when she was thirteen. Its cause was a shattering emotional trauma which, once revealed, makes us wonder how she could have avoided seeking an escape in such a way.

Dr. Stein admits that “my purpose is not a life of self-sacrifice,” and that “outside the hospital, I am not fearless nor particularly altruistic. I do not go into the destitute corners of my hometown to rescue the drug users.” It’s nice to hear a doctor admit this, because it reveals and humanizes the man who wears the white coat. But of course, Stein has devoted his every working day to helping people, so perhaps we can disregard the self-deprecation and value his service all the more for his honesty.

The Addict is a quiet and determinedly hopeful book about humanity, viewing addiction as it does in a highly compassionate light. “When a patient calls herself an addict, she is honoring her reality,” says Stein. In writing this book he has honored the reality of the struggle of his patients who suffer from addiction.

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