Smells like Dopamine
GG 258. Small, white, oblong, scored tablet. Thousands of them being mixed, compressed, stamped. Crushed with enough pounds per square inch of steel to make grains of powder coalesce into a compact nugget. Punched out onto rattling conveyor belts. Dropped through metal chutes into white plastic bottles marked C-IV in navy blue. Alprazolam, USP 1 mg. Rx only. 100 tablets. Store at USP Controlled Room Temperature (68-77 degrees F). Lurking at the bottom, patient and faithful, the FDA required National Drug Code. Four digits dash four digits dash two digits. The number I repeat obsessively in my head. Oh seven eight one dash oh one seven nine dash oh one. This NDC is warm water caressing my feet, cool relief rolling over my toes as they sink into hot sand. Until it’s not. Until it’s not enough and I lose control over the compulsion to visualize each digit, to tap my fingers on the counter in the pattern this NDC makes on the number keys, to click my teeth together as I count each individual digit up from zero. Never start from one. Always from zero. Flicking my tongue across the retainer wire behind my front teeth for the zeroes and the dashes. Clicking, flicking, typing, racing from one side of my head to the other until I am so tired I tremble. A weariness that crawls under my skin, burrowing through me until I swallow a tablet to help it overcome me. The last one ever, I swear. Just one to help me fall asleep and then tomorrow morning I will start fresh. How am I supposed to be strong if I haven’t slept? So just one or two, to sleep. To make the numbers stop. To give me the willpower I need to never do it again.
“Punch me,” he said. Max was sitting on the edge of my couch drinking my Fat Tire and strumming a guitar when he looked up and asked in desperation. “Come on, I’ll share with you. Punch me as hard as you can – in the face if you want.”
“Fuck off. I’m not going to punch you. I’ll break my hand or something. And if I break my hand I might have to miss work. And if I miss work both of us will suffer.”
“Good point….Okay, hit me in the head – no, wait, across the back – with some kind of long, blunt instrument. You gotta baseball bat around here?”
“Jesus…can’t you just say you fell and your back really hurts? I told you there’s a new doc at the ER who doesn’t know you. Whatever happened to good old fashioned lying? Why do I actually have to hurt you?”
“Because they’ve got my number, those nurse bitches. They aren’t falling for it if I don’t come in with something visible. They probably won’t even let me see the doc if I don’t have something legit. I don’t want to cut myself or break a bone or anything, but a crazy bad bruise would do the trick.”
“What are you gonna get?”
“Whatever he’ll give me. Oxy, hopefully…but even percs would be better than nothing. If I find out he’s the kind of ass who only gives out Tramadol and extra strength ibuprofen then I’ll be pissed that I had you beat me, though…” Max’s voice trailed off and he plucked a few more strings on his guitar.
“I’m pretty sure he’s liberal with the narcs,” I assured him. I didn’t tell Max that I had twenty Lortab from work upstairs in my jewelry box. I was tired of him thinking he could count on me to provide for him. Let him get his own damn drugs. Suddenly I was sort of interested in hitting the lazy ass with a baseball bat so he would leave.
“How do you know? Have you already filled some prescriptions from him?”
“Yeah…he actually called the pharmacy and asked me how to write a prescription for liquid morphine. It was kinda funny, actually. You know Lars that used to work at The Haven, right?”
Max nodded. “I haven’t seen him in a while…thought maybe he was clean.”
“He was in jail. Anyway, he had his tonsils out, and he convinced Dr. Newbie to prescribe him some kind of liquid narcotic because he was in so much pain and couldn’t swallow pills.” I rolled my eyes. “So the doc calls me and says, ‘What’s the best way to write a prescription for a morphine solution or elixir or whatever? Legally speaking?’ So I’m kinda confused and I go, ‘I’m not sure I catch your drift.’ And he says ‘Well I don’t want to be held responsible if this guy decides to drink the whole bottle and ODs or something.’”
Max laughed. “So he’s liberal with the drugs, but doesn’t want to suffer any consequences. Nice. I like him already.”
“Yeah…so I tell him how to write it, like what the proper dosing would be for the solution, and he writes it down like that exactly, repeats it back to me and everything. Like twenty minutes later Lars walks in and hands me a prescription for morphine solution and tells me how his throat hurts, blah blah blah. I was like ‘Look, dude, you already sold that story to the person who mattered. I couldn't give a shit.’” I headed toward the front coat closet of my house to get a bat but kept talking over my shoulder. “I did however explain to Lars how he shouldn’t fuck around with pure liquid morphine. I was like, ‘Ease into this buddy, it’ll fuck you up.’” Returning to the living room with a baseball bat in hand, I saw Max laughing again and shaking his head.
“You should bring some of that home for me to try.”
“In your dreams. It’s a C-II. You know I don’t mess around with those, that’s the kind of stupid mistake that would get a pharmacist fired.”
“But all the really good stuff is in that category. All you ever get is Lortab and benzos.”
“Well beggars can’t be choosers. Set your guitar down on the couch and get down on your hands and knees. I’m gonna take one good swing so you can meet Dr. Newbie.”
My name is Dagny. I’m a pharmacist and an addict. Well, I used to be, anyway. A pharmacist, that is. Once an addict always an addict. Not so with being a pharmacist. You can yank RPh from your title and toss it into the fire just as quickly as you can smash a pesky mosquito with the palm of your hand. Or, if you’re like me, you can peel off your white coat inch by inch, after first staining it with blood and fraying the elbows and losing the middle button. You can slowly over years and years wear away at your resolve and spirituality until you almost forget the first time you pulled two Norco 5/325s out of a patient’s bottle of #270 and slipped them in the front pocket of your freshly bleached coat.
I had a professor in pharmacy school…Aldo Ocho…one of those cool teachers that liked to talk to us as if it was crucial to understand how not to OD when using drugs recreationally. This guy would ramble about how both addicts and first timers were idiots, and only idiots OD’ed. You can’t overdose on just benzos, he’d say. You have to mix. Throw in some opiates, some alcohol, some coke. Add in cold meds – something. But nobody ever died from a benzo overdose. You’ll just fall into a really deep sleep and probably sleep for a good long while, he riffed. And then when you wake up you’ll be groggy as shit. But you won’t die.
Telling me it’s impossible to OD on just Xanax made me want to try. I am anti-authority. I am rules-are-made-to-be-broken. I want to disprove and disbelieve everything people tell me. Even something that potentially perilous.
My CPAP-assigned counselor, Vicky, makes me talk about stuff like why I started using opiates, and why I moved on to benzos even though I knew I was an addict. She expects me to discuss my past history and explore my feelings, and acts personally wounded when I don’t want to. She identifies and classifies my other addictions – sex and risky behavior. She makes me attempt to explain why a pharmacist, who has everything to lose, would steal and lie just to get high.
People are uncomfortable with addictions not associated with tragedy. That’s one of the first things an addict like me learns in attempting to recover. If a woman was sexually abused, or if a young man’s parents died in a car crash leaving him orphaned, people get it. There was a good reason for that person to turn to drugs for relief. Society understands alcoholics that were beaten by their fathers or neglected by their cold, distant mothers. The concept of post-traumatic stress leading to self-medicating with street drugs is well studied. But nobody has sympathy for a pharmacist with no obvious adversity or crippling affliction who steals pills from their employer to get high. We are the second most trusted profession, after all. Who wants to think that their pharmacist is stoned? It makes people sick. And when I’m sober it makes me sick, too.
“I see from your paperwork that you graduated first in your class and had excellent scores on your NAPLEX…” Vicky chews on the end of her pencil while looking at my chart. That’s so fucking disgusting. The human mouth has more germs than any other place on the body. She’s just creating a germ lollipop.
“That’s right.” It’s our first session together, and I am still sick from not using for three days. “So, what?”
“You’re very intelligent. Do you think that using drugs is a smart thing to do?”
I looked at her with incredulity. “Are you seriously asking me that? Are you legitimately that stupid? Of course it’s not a smart thing to do. Neither is getting caught, but I did that, too.” I rolled my eyes.
“You seem angry.” Vicky’s jet black hair was freshly permed into tiny ringlets. Who still gets perms?
“Is that your diagnosis?” Fuck this, I’m gonna have to ask Larry for a therapist that’s not retarded. I am angry. Of course I’m angry.
“I’m not here to diagnose you. I’m here to help with your recovery. And I can do without the insults.” She sat silently, looking at me. For a few moments we were two male dogs meeting for the first time, our backs stiff and unflinching, our ears alert, our eyes in tune to the slightest tail movement, hoping for clues as to whether we should bare our teeth.
“Ok, well asking me stupid questions and pointing out the glaringly obvious isn’t going to help me.”
“Do you even want to recover?” Vicky leaned back, no longer in fight-or-flight. She sighed with exhausted heaviness, as if every addict she had ever spoken to was sitting on her shoulders, tugging on her curls. “Be honest.”
“Sometimes. Like a few minutes ago, I did. Now, right this second, I don’t. Right this second I want to get out of here, go downtown, and buy 2 Oxy 80s. If I’m being honest.”
“That’s understandable. This process is going to have a lot of ups and downs, a plethora of varying emotions.”
“A plethora, huh?” I smirked.
“That word just means -”
“I fucking know what plethora means.” Jesus Christ. Angry doesn’t even begin to cover it.
“Of course you do. I apologize. Which brings me back to how intelligent and well-educated you are. I really want to understand when and why someone with your lot in life decided to use drugs.”
In junior high I started trading my Ritalin for more interesting things like pot, ‘shrooms, and Jim Beam. Weed and booze were comforting during high school and early days at the university, but as soon as I received my acceptance letter into the college of pharmacy, I knew that the weed would have to go. I missed it, because booze made me horny and forward and daring when I just wanted to be slow and contemplative and happy. But we were warned. As future pharmacists we were warned about substance abuse of any kind. And yet we talked of nothing but drugs. Medicine for diseases, sure, but also drugs of abuse and drugs that were for legitimate medical purposes but could also get you high. After the two hour lecture on the mechanism of action of opiates and opioid alkaloids, after discussion on Mu and Kappa receptors and dilated pupils, I decided to get high. It sounded so wonderful. It was even better than it sounded. It was nirvana.
Being high for the first time is coming home. It’s everything you ever imagined about heaven and love and pleasure. It’s waves of warmth and enlightenment, and shadows that hide the truth about the reasons you need to escape. It’s being young again, when your grandmother softly stroked your hair and you didn’t yet know what it was like to feel the hunger. It’s butterflies of hope in your belly, goose bumps from the crescendo of a Rachmaninoff piano solo. And then it’s gone. Like an orgasm, that started to build and came over you swiftly. You want to hold onto the moment just before the climax, the most perfect moment of all, because once you reach the peak the fleeting moment of ecstasy will pass, and it’s only down from there.
Dopamine. It’s what makes us crave the drug, the sex, the late night text message. Once you’ve tasted the pure dopamine flooding your synapses, you can never stop wanting it. And the cruelty of it all is that there will never be another first time. It’s a cliché but it’s legit. You get that perfect high just once in your life, because it is unexpected and unknown and you didn’t imagine it was possible. But that’s the thing with ecstasy. It is once easy and then forever impossible. You can strive, but it is a pinnacle that can never again be reached in the same way. You will never again feel like you did when you read the last line of Grapes of Wrath, or when he first told you that you were beautiful, or when you found out you got into pharmacy school. Nothing will ever feel as good as the first time you got high. No drink will ever burn like it did the first time whiskey scorched your throat. The high definition will never look as lifelike as it did during that first documentary on bees.
The first time I ever saw Oscar I was high, in a meeting of boring executives where I was trying to stay awake. He sat across from me, not looking in my direction. Appearing very serious, I could tell he was also bored from the look in his dark green eyes, a look of turmoil and longing and anger. I immediately wanted to have him. I stared at him for a solid hour, as my high dissipated from euphoria to the tired warmth of stoned to the desperate hunger of post-opiate blues. He glanced at me once, fleetingly, as if to acknowledge my staring and invite me to save it for later. He didn’t smile, but his head seemed to dip ever so slightly, seemed to suggest that he knew who I was even though I hid it so well.
He wasn’t easy, I’ll give him that. After the morning session, at the lunch of boxed sandwiches with not enough mayo and too much mustard, he barely looked up when I sat down across from him.
“Enjoying yourself?” I asked. Having refueled with Vicodin, I was no longer hungry.
He made eye contact, let his eyes wander down to my mouth and then returned them. “Absolutely. Thrill a minute. You?”
“Second greatest thing I’ve ever done in my life.”
He smirked, and rolled his eyes just a little, as if to say Okay, I’ll take the bait. “Well the other thing must have been pretty fucking fabulous.”
“I’m sure you will be.”
His head jerked slightly and he seemed at loss for words. “Huh? I’ll be what?”
“The greatest thing I’ve ever done in my life.” I gave him an innocent, girl-next-door smile.
He laughed hesitantly. “That’s quite a series of assumptions you’re making.”
“Maybe,” I agreed. “Or maybe I’m psychic.” I sound bored.
Nervously, he rolled his wedding ring around his finger and then took a few more bites of sandwich. “You’re a pharmacist, huh?” He looked down at my obligatory name tag, which advertised me as the Pharmacy Manager. “You’re a psychic pharmacist?”
“Yeah, I’m the PIC.”
“PIC?”
“Pharmacist in Charge. Which means I get paid three dollars more an hour than my staff pharmacist, do ten times the work, and have to put up with endless demands from the corporate dicks.” I took a sip of the flat punch and added, “Sorry, you’re probably one of those corporate dicks.”
“Well I work in the corporate office, and I have a dick, so…” He looked at me for a response. He knows how to play this game.
“Hmm…would you say you’re an average corporate dick or a big corporate dick?” I tried not to sound interested, and the hydrocodone was making me not care about acting inappropriately to someone who could have me fired.
“I’d say I’m a huge corporate dick.”
“I’ll be the judge of that.” I gave another innocent smile and said, “I’m Dagny.” I held out my hand to offer a shake and he reached across the table and took it firmly. He had big hands with just the right amount of roughness.
“Dagny? Your mom a big Ayn Rand fan?”
“You’ve read Atlas Shrugged?”
“Sure, who hasn’t?”
“A lot of people I’ve met in my life, actually. But then again I’m from a small town where reading is slightly less important than flossing.”
He chuckled. “I’m Oscar.”
“Your mom a big Sesame Street fan?”
His smile turned into a laugh and he said, “No. Funny story, though. When I got a bit older and started watching kid’s shows I saw Oscar the Grouch and decided I was going to be an angry green monster. My mom rued the day she named me that.”
“Are you still an angry green monster?” I reached across the table and pulled a crumb off his arm. He looked startled that I had touched him. I bet he’s surprised he’s having this conversation at all.
“We’d better get back to the meeting, huh? After all, it’s the second greatest thing you ever done in your life.” He winked, and I knew he wanted to play ball.
“Yeah, better get it over with so we can move on to the greatest thing.” I pulled a pen out of my purse and wrote my phone number and address on a napkin. Handing it to him, I gave him a wink back. “Whenever you can find the time.”
Usually my post-workday stupor made me forget everything that had happened during the day, but I kept thinking about Oscar. I was glad I didn’t have his number. Sometimes I get so high I do crazy things, like text someone and make a fool out of myself. But I kept thinking about him, and I wondered when he would text or call or come over. I didn’t wonder if he would, just when. I opened a bottle of beer and texted Max. Max was a loser who thought he was going to be a famous singer-songwriter like James Taylor. He was decent singer, but his songs were dark and weird because he was constantly stoned or high or drunk.
Watcha doin
Hey, Dag. Tokin. U?
Drinkin a beer
U score Vikes today?
Nah. wasn’t at the pharmacy. corporate meeting bullshit today. I’m almost out and I don’t work tomorrow either. u got anything to get me by?
Um. . .Ima get you some Oxy tomorrow. got a dime bag tonight if you wanna come over
Nah, i try to avoid weed. hard to explain if they ever make me do a random piss test. ;-)
but opiates are easy to explain? haha
Yeah. I get a legit Rx every 6 months just in case. Drop by tomorrow with some Oxy, k? I’ll hit you back on Sunday with some 10/325s.”
K
My phone moved in a buzzing crawl across my coffee table. The incoming number was unknown, but I knew it was Oscar. “Hello?”
“Oh, Dagny? This is Oscar, from the meeting today. Were you sleeping?”
“Nah, I don’t sleep. What are you doing, Oscar the Grouch?” I traced the geometric pattern on my couch with my finger. Line. Corner. Line. Corner. Arc. Patterns helped me concentrate when the narcotics made it difficult. Oh seven eight one dash oh one seven nine dash oh one.
“Just calling.”
“You wanna come over and have a beer or something?”
“Yeah…I’ll stop by in a little while.”
“My appetite is back,” I offered Vicky. A trifle of myself that I assumed would be uninteresting. “I guess just from not using…”
She wound two fingers through the long silver chain around her neck and said, “Oh?” She waited in silence, which made me nervous. I wanted her to ask me questions, to lead me somewhere, but the more minutes of the second session that passed the more she was quiet until the silence was humid and heavy and I needed to swipe at the dank air with words to be able to breathe. “Are you eating regularly, then?”
"Yeah, pretty regularly. I crave sweets mostly. At the weirdest times…just out of nowhere I want to shove a cupcake down my throat.”
“At the weirdest times? I’m sure that’s not the case. Maybe the cravings just seem weird because you haven’t explored the ‘why’ behind them.”
“Or maybe my neurotransmitters are just so out of whack that when I’m low on dopamine and serotonin my brain shouts at me to eat sweets. Since I can’t use drugs anymore.”
She considered that in silence and sucked on her pencil before speaking. “Well, then it’s not weird…it’s your body trying to get something from you.” She tapped the end of the gnarled, wet eraser against her cheek. “Sugar can be an addiction, too. I’ve counseled several women that ate to avoid intimacy.”
Oh seven eight one dash oh one seven nine dash oh one. I looked up from watching my fingers tap the pattern of alprazolam’s NDC on an imaginary keypad. “What, like they got fat to avoid sex?”
“No…to avoid intimacy. The two are different. Obviously sometimes intimacy leads to sex…” She took a slow breath and wrote something on her pad.
“And far too often, sex leads to intimacy,” I laughed to dismiss the comment before I finished it, “and ruins everything.”
Vicky frowned and wrote something else. “Were you ever abused physically or sexually?”
“No. Just spanked hard.”
“Do you think that you try to avoid intimacy?”
“Um…yeah.” God she’s slow. I basically just said that. “I don’t like people to really know me, if that’s what you mean. But I don’t avoid sex. I love sex.”
“Okay…” Vicky looked uncomfortable, but she made a valiant attempt to hide it by pretending she had an itch somewhere in her mound of chemically induced curls.
My inhibitions have never been much to speak of. I will pretty much say anything to anybody, but the substances made my openness worse. The only thing I liked as much as pills was sex. But I never fell in love, at least not after Chico. I used men until I was bored of them and then I moved on to someone new. I intended for that to be the case with Oscar, but like my drug use I was not as in control as I thought I was.
Oscar never showed up that night. I was shocked, even thought that maybe he’d gotten in a car accident or something. I waited up until 3 a.m. wondering if I should call and check on him. But deep down I knew that he had just changed his mind. He did have a wedding ring, after all. Maybe there are men in the world that don’t succumb to offers of sex.
A week later I had almost forgotten about him, but his eyes had stuck with me. I felt like I would never forget my first failure. What did I do wrong? How did I fuck that up? Mid-afternoon during an unusually slow Thursday he showed up at the pharmacy in a suit and tie. Walking up to the counter, he looked arrogant.
“Well, if it isn’t the huge corporate dick. This is a pretty rough part of the city for a clean cut guy like you. You here to fire me? Or maybe apologize for standing me up?”
Oscar shrugged and tried to act nonchalant. “Something came up. My daughter was sick. Anyway, nights aren’t really an ideal time for me to hang out.”
“How many kids do you have?”
“Three. Two girls and a boy.”
“Young still?”
“Boy is two, girls are five and seven.” He was looking past me at the shelves of drugs. “Anyway, I should have called back.”
“Yeah, you should have. But I’m over it.”
He shifted his gaze back to my face. “You work tomorrow?”
“No.”
“Well maybe I’ll come over to your place.” He was still looking me in the eye, which was starting to ruffle me.
“Whatever. I won’t hold my breath.”
“I mean it this time. I’ll come, promise.”
I laughed. “Oh, if you’re at my place you’ll come, alright.”
His cheeks turned pink and he looked around to see if anyone was listening. But he quickly reverted to a look of powerful confidence. “I like your white coat. Wear that for me tomorrow. Just that.”
Lifting my eyebrows, I laughed again. “Well, now…that’s the spirit. You’re not as lame as you pretend to be, Oscar the Grouch.”
Life is a constant letdown. For that second that you are experiencing specific ecstasy for the first time, it feels as if anything is possible. As if you can relive that moment as many times as you want – every hour of every day if you want – and that this new perfect thing will stay perfect because it IS perfect. But it immediately starts to crumble. Each time, ecstasy tricks you. And even though deep inside you know you can never reach it again, you keep swallowing pills and reading your favorite lines and trying to make someone think you’re beautiful. You try desperately to find something new that can give you the dopamine you need to remember what pure ecstasy is like. You try new hobbies and sleep with new people and eat new sugary baked goods and start questioning the purpose of trying anymore.
I mean, don’t get me wrong…I can still get high. It takes about 180mg of Oxy to get me high, to even come within miles of that first time, if I’m swallowing the pills and not crushing and snorting. But I know what to expect nowadays. I know the entire pattern, and it just makes me tired. I know when the butterflies will turn to nausea and I will vomit. I know when the goose bumps will turn to a thousand crawling ants and I won’t be able to itch them away. But I’m a pharmacist, which means I also know when I can snort and get high and when I need to just take a few to not get sick. I know to wait until I get the post-opiate anxiety before I start on the Xanax, because if I take them all together I might not wake up. Respiratory depression is much worse than regular old I-hate-my-life depression. Just ask Max's family.
"So where is this guy, now?" Vicky asked me as she signed off on my final paperwork.
"Who, Oscar?"
"Yeah, are you together? Is he in support of your sobriety?"
She's not going to like this one. "Uh, not exactly. Oscar's in rehab."
Her head jerked up and her eyes widened. She shook her head. "Goddamn dopamine."
"Yeah." She's not so bad, this one. "Yeah...Muthafuckin' dopamine."