Genie in the syrup bottle - Daily Nation

Behold, I was once lost, but now I am found!


Genie in the syrup bottle

How Bill Ruthi survived a peculiar epidemic stored in Kenyan pharmacy shelves.

Toward the terrifying end, when I finally weaned off a crippling two-year substance dependence on codeine-based cough syrup, I could have given up anything, signed on any paper, for a drop of the analgesic.

At night I thought of that poor, desperate rich man mentioned in the Bible who, as the flames licked at his soul, saw Lazarus across the border of Hades reclining in Abraham’s bosom and cried out to him for a measly drop of water to cool his tongue.

In the first few days after I confronted the habit, I concluded that I had to emerge from the shadows and live again, to deal with the cause of myself-destruction and walk out of the fog. For good.

The alternative would be to cede my very soul — every waking hour of it — to addiction. In the horizon loomed the ominous possibility of being carted away to a grim recovery centre.

It had been two years since I walked into a pharmacy shop with a wheezing cough accompanied by a headache. “Take as directed,” the man at the counter instructed me as he wrote out the dose.

Looking back, the cashier might as well have typed out a life sentence. Barely 30 minutes after I took my first dosage, I looked up from the book I was reading and out the bus window. Everything started changing; a euphoric feeling settled in like the glow of the morning sun before it gets hot. There was poetry to everything. I couldn’t wait for the second dose. I was already sold, but I didn’t know it.

That was the beginning of a two-year addiction that brought me to the edge of a cliff, to the brink of loss, to broken ties and, finally, a lost job. Nearly every day during the next 24 months, my life curtsied to the keening wind of addiction.

In the hellish aftermath of withdrawal, I hauled myself out of bed, willing myself to climb into my trousers, noose my shirt with a neck tie and stride off to work. In every sense of the word, I was a functioning junkie. Little else mattered than the delirious prospect of opening a bottle of liquid cough syrup.

The factors that lead to drug and substance dependence exist in continuum: escape and pain, among others. Pure codeine is mostly prescribed as a painkiller and falls under controlled substances in Kenya and almost every other country, and may not be bought over the counter for risk of abuse and attendant addiction.

Because of this edict, users look for codeine elsewhere, with cough syrup being the easiest getaway. Almost all code-based syrups contain a measly 10mg of codeine and five per cent alcohol. This combination makes cough syrup the preferred substitute for a quick high. To attain a proper high, users have to take prodigious amounts of syrup.

A few years ago, a local society magazine published a story on former TV business presenter Cynthia Nyamai. In the piece, Nyamai traced her addiction to the pain of her divorce, saying the syrup helped her assuage the pain of her marital break-up.

As the habit dug in, Nyamai realised one bottle was not enough, and as her life spiraled south, she was soon taking an extra bottle of the cough medicine.

Bill Ruthi had no idea that he was about to change his life for the worst when he walked into a pharmacy shop and asked for a codeine-based cough syrup, but that is exactly what happened. A few sips later, he was hooked to the momentary high of the drug, and from there everything took a downward spiral. Pure codeine is mostly prescribed as a painkiller and falls under controlled substances in Kenya and almost every other country, and may not be bought over the counter for risk of abuse and attendant addiction. Because of this edict, users look for codeine elsewhere, with cough syrup being the easiest getaway. Almost all code-based syrups contain a measly 10mg of codeine and five per cent alcohol. This combination makes cough syrup the preferred substitute for a quick high. To attain a proper high, users have to take prodigious amounts of syrup, and Bill wanted proper highs...

The cold that had led me to the pharmacy that drizzly morning was long gone, but the magical delirium that awakened the endorphins-those friendly, happy hormones of wellness and delirium remained put.

My descent into codeine-addiction began on a wintry July day in 2014 during a difficult season in my life. Like nearly all addictions, escape was central. Bottle by bottle brought me to a door that I tried to close but never could. To evade curiosity and probing eyes, I darted from pharmacy to pharmacy. I was never more resourceful than when I schemed ways to get high without leaving any tracks. 

There is a common theme that the most susceptible people, those with the highest predisposition to fall into addiction, are those in the arts — singers, actors and writers. The American hip-hop artiste Lil’ Wayne had a long history with — and helped popularise — Purple Drank, a concoction of codeine-laced cough syrup mixed with soda. Wayne was once hospitalised after drinking the Purple. Another rapper, Pimp C, reportedly died of codeine overdose.

As a writer, I bought into this narrative completely, diving headlong into the abyss. I noticed that anytime I swigged a bottle of the syrup, the world appeared almost charmed. I was never so alive. My prose had never been more erratically spectacular than when in the grip of the syrup. Words tumbled from the deepest recesses of my mind.

But like the piper, there is always a price to pay, a cheque to be signed, a life apart.

I worked as a writer in the communications department of a local bank, but was by any measure a functioning addict. As months raced, I found myself digging myself into a pit. One bottle a day was routine, and soon even that was not enough. I needed the syrup to make sense of everything; I needed it to be free. I needed it to lie to myself.

As my use increased, I resolved, month after month, that this was going to be the last bottle whose cork I would twist, but that was a fool’s folly. My life was now a country in the grip of a civil war.

Part of the lure of codeine syrup is that, unlike alcohol, there is never any danger of a hangover, and, unlike pure codeine, it is not regulated. But as it is with all destructive habits, there is the other darker side to it and you walk blindly into it and soon it catches up with you. I crossed the rubric late 2016 after I took a sabbatical without bothering to report that I wouldn’t be showing up for work.

TERRIFYING LIFE OF ITS OWN

By then, my addiction had taken on a terrifying life of its own, made worse by an anxiety disorder that I had tried to outrun without much success since childhood. I would rouse my limbs in the morning and wait for the mind to catch up, until it couldn’t.

Writing began to look like work while all along it had never been a job to me, but a hobby that I got paid for.

In the end the company couldn’t put up with my erratic work, and soon I received the pink slip. It was then that I looked into my soul, into the opportunities I had blown. This would have to end or I would spend my entire life tethered to a drug and unmoored from reality. By then I had burned through cheque after cheque and was walking on a tight rope across a waterfall and would plunge into the churning waters.

While I mourned the loss of employment, it could never come close to the biggest loss of all. For months, my wife and I had discussed the toll my addiction was having on our family. I would promise to kick the habit for good, but the resolve was without spine.

“You said you would change,” she confronted me.

“Well, this is the only thing keeping me alive,” I responded, with no hint of remorse.

On a Sunday morning my wife told me she couldn’t stand me and my self-destructive habit, so she had resolved that we could not be together; that the man she knew was no longer there, but his pale shadow.

That was when I finally looked up from the script and the soundtrack of my life. It was too late. Her mind was finally, and firmly, made up, and there was no need to talk about it anymore. I looked outside the window, broken, and the air went out on me.

As I took my infant daughter in a hug, nothing in the world could have been sadder.

Those last few weeks as I tapered off from codeine were a living hell. My head rung at night, sleep came in fitful spurts. Though a physician had advised to check into a recovery centre, I decided not to after I visited a rehab facility and saw recovering people — young men — whose eyes were glassy and distant. I chose, instead, to beat it cold turkey. I lost appetite; my appearance was that of a scarecrow.  The road back has been strewn with shards of glass, but I am no longer tethered to a stake. I am becoming; I feel the sun in my face. Now and then I pass by a pharmacy and an almost uncontrollable prodding urges me to check in for just one bottle. But no, thanks.

In the dark days, just before I began tapering off my addiction, I sat with a church minister in his office for a talk. As I rose to go, he told me that, in light of my unraveling light, there would be a message.

“This whole ordeal, this mess you indulged in, could result into a positive thing. You could turn your mess into a message.”

I think I just did.

***

Every 19 minutes someone in the US dies from an accidental drug overdose. Most of the time, it is from prescription narcotics called opioids. In Kenya the number of health professionals (doctors and nurses) abusing these opioids in the form of Pethidine, a strong painkiller that has the components of heroin and cocaine, is on the rise.

Speaking to HealthyNation on this matter, Dr Nelly Bosire, a member of the Kenya Medical Practitioners and Dentists Board, says the drug has severe side effects on its users, some of whom have become addicted to it. The most affected cadre of health professionals are nurses and anaesthetists as they are the ones who are in custody of the drug and therefore also administer it.

“It is easily accessible to health workers because, as I am seated here, I can order for Pethidine which will be readily given to me for medical purposes, and this makes health workers prone to abusing the drug,” says Dr Bosire.

She says the affordability — (between Sh30 and Sh40) of the drug, which is used to treat pain, particularly during childbirth — and availability have not made things any better.

“Until recently, Pethidine used to be among the drugs in the list of essential medicines. But when the ministry (of Health) realised that it was being abused, it struck it off the list and replaced it with a different pain killer,” explains Dr Bosire.

Pethidine, also known as Meperidine or Demerol, is a morphine-like synthetic opioid pain medication usually given by injection and provides pain relief for up to four hours. The most common side-effects are dizzziness, drowsiness, sweating, and feeling sickly.

Besides relieving pain, Pethidine poses a risk of addiction and is more toxic than other opioids, especially during long-term use.

Veteran doctors know the tell-tale sign all too well and observation alone can help them narrow down the culprit — dilated pupils mean cocaine, but constricted pupils mean an opiate.

Pethidine is a strong analgesic for any form of pain, but when wrongly administered or taken in overdose, one portrays same symptoms as a cocaine or heroin addict.

As a relaxing agent which works on the nerves and brain to reduce the pain and stress a patient feels, doctors and nurses have been found to abuse it for the same reasons, to an extent of becoming addicted.

“We may not have local statistics detailing the magnitude of the problem, but over the years the cases have risen significantly,” says Dr Bosire. In some cases, hospital staff have been busted stealing the drug or illegally altering patient records to fuel their addiction, says Dr Bosire.

For much of the 20th century, Pethidine was the opioid of choice for many physicians. In 1975, 60 per cent of doctors prescribed it for acute pain and 22 per cent for chronic severe pain.

-Elizabeth Merab

***

WHEN YOU TAKE PAINKILLERS CONSISTENTLY THREE THINGS HAPPEN...

1. The sensitivity to pain increases through rebound, so the more opiate painkillers you take, the more pain you experience.

2. The feel-good effect lasts for shorter and shorter periods, so you need to take more and more tablets to feel the effect.

3. Once it wears off, you go through irritability, mood swings and increased sensitivity to your normal stressors (withdrawal).