As a pastoral and chemical dependency counselor who has worked in a variety of mental health, ministry and addiction settings, I would like to address one of the unique mental and behavioral health needs that may be experienced in a prolonged disaster. More specifically, I will speak to the possibility of running out of psychiatric and pain medication, and the non-medical ways of dealing with pain and mental health symptoms as well as medication withdrawal.
According to the National Institute of Mental Health, almost 58 million adults in the US (one in four) suffer from mental illness, and 45% of those meet the criteria for two or more mental health diagnoses (these numbers do not include children, and the number of children with mental illness is rising). The vast majority of these folks are on medication. Additionally, there are many millions of people taking opiate pain medication on a regular basis for chronic pain. You or someone you love may be taking medication for one or more of these conditions.
Ideally, one should store an adequate supply of medication prior to a crisis event. This can be accomplished through several means: getting an extra prescription from your doctor that you purchase with cash, ordering a 90 day supply (if your insurance allows this), early ordering of refills, or by utilizing a reputable foreign pharmacy (cash, with prescription, but at a much lower cost). It is difficult to plan for every contingency, and in a prolonged disaster, it is likely that your medication will run out. The purpose of having an adequate supply is, in my opinion, to give you the option to safely wean yourself from the medication if it appears that the supply chain will not be reestablished before your bottles are empty.
Once you do have a legally-acquired supply, rotate it. Use the oldest first, and replace it with the new refills. It’s also important that you utilize some OPSEC regarding what you have stashed away, medications included. Your medication and preparedness supplies are your business, nobody else’s. You might even want to keep your medication in a safe or lock box if it is at particular risk of theft. There are plenty of addicts and dealers that would love to get their hands on that medication, particularly if it is in short supply.
If possible, you should begin to reduce your dependence on medications as much as possible before a crisis occurs. If you have chronic knee pain and need Vicodin on a daily basis, for instance, now is the time to lose that extra thirty pounds. Positive lifestyle changes now, can reduce dependence on medications when they are no longer available. A medical taper is much easier when you have medication, your family doctor to supervise it and your insurance company to assist with paying the costs. It’s also easier when your life isn’t complicated with such things such as making water potable, bartering for foodstuffs and bugging out to the boonies.
There are a couple of options as far as weaning yourself from the medication, and both should be supervised by a medical professional (preferably a psychiatrist or family doctor). The first option is to slowly wean yourself from the medication. Again, this should be done under the supervision of a medical professional if at all possible. A gradual taper will reduce the likelihood of withdrawal symptoms (or what the pharmaceutical industry euphemistically calls “discontinuation syndrome”). Discontinuation syndrome is experienced with many antidepressants and antipsychotics. Symptoms include dizziness, vertigo, ataxia (problems with muscle coordination), paresthesia (“pins and needles” feeling on the skin), numbness, headache, lethargy, insomnia, nightmares, vivid/unpleasant dreams, tremors, sweating, nausea, vomiting, diarrhea, depression, irritability, anxiety, and depression. Around 80% of people taking antidepressants have some of these symptoms when they stop their medication. A gradual taper will also reduce the likelihood of seizures if one is coming off benzodiazepines (minor tranquilizers like Xanax or Klonipin) or, to a lesser extent, barbiturates. The Ashton Manual an excellent resource to help learn about benzodiazepine withdrawal and discontinuation. It recommends a reduction of 2.5% per week (10% per month), so it would take ten months to come off of a benzodiazepine (or other medication) using this method. The second method is a quick taper, which might necessitate the substitution of another drug (in the same class) that is not in short supply. It should be noted that a quick taper usually increases the risk of seizure, so medical monitoring is crucial. An example of a quick taper would be a doctor switching someone from Xanax to Klonipin over the course of a couple months, then weaning them off the Klonipin. In a prolonged crisis, a taper of some sort is by far more preferable to an abrupt cessation of medication, but there will be plenty of people who do not prepare and suddenly run out of medication. This can create a host of problems, both mentally and physically.
Opiate medications can cause dependence even in recommended dosages, so withdrawal is often an issue. The symptoms in withdrawal run from very mild to very uncomfortable. Withdrawal from opiate pain medication such as morphine, codeine, Vicodin, Oxycontin, Percocet, Tramadol, Propoxyphene and other natural derivatives or synthetic mimics is rarely fatal in healthy adults. Those in severe withdrawal often feel like they are dying. The symptoms are so severe that medical interventions today include allowing addiction to continue indefinitely (methadone clinics) and “detox under anesthesia”. Nevertheless, complete freedom from opiates is indeed possible, even without any medical intervention unless medical problems arise. Within 12 hours after the first missed dose of medication, withdrawal begins. Symptoms can include agitation, anxiety, muscle aches, increased tearing, insomnia, runny nose, sweating and yawning. Later on, symptoms become more severe, and can include abdominal cramping, diarrhea, dilated pupils, goose bumps, nausea, and vomiting. Care for a detoxing person like you would anyone else experiencing those symptoms. Be aware that there may be intense drug-seeking behavior at times, but generally people just feel like they have a bad case of the flu. True addicts will tell you that opiate pain medication is the only thing that helps with this “flu”. Keep them hydrated. Symptoms will subside in 2-3 days.
Dealing with chronic pain without access to medication is not easy to think or talk about, but it is a distinct possibility. You can only stock up on so much prescription medication, Ben-Gay and Tylenol. Heat and cold therapy can help with pain, as can massage, chiropractic techniques, stretches, exercise and even hypnosis. Talk to your doctor about non-medical ways to deal with pain and begin to research alternative therapies. The time to learn about these things and become proficient in their use is before we need to use them full-time.
If someone in your group is experiencing medication withdrawal, there are some things that can be done to ease their discomfort. Support is important, so as long as they are not in a medical crisis, they should be encouraged to talk to someone, preferably someone with some experience helping hurting people – a doctor, nurse, minister, counselor – you get the idea. The next step is creating some sense of balance. Try to get them on some sort of schedule. This will be particularly difficult in a disaster, but it must be done. The body rejuvenates itself as we sleep, so sleep is essential. They should also be given tasks to do – as much as they are able. Keep them busy. A healthy diet, exercise, plenty of water, a multivitamin and some omega 3 fatty acids (found in fish oil and fatty fish, such as salmon) can also go a long way to help. Finding some time for spiritual growth through prayer and scripture reading as well as studies with other believers has been beneficial for many. Massage, pet therapy (even just having a pet around), art, music, reading, even dance are all things that can help people on the road to recovery. Try to make some time for a couple of these healthy activities. These strategies are helpful for anyone not only for withdrawal from psychiatric and pain medication, but for anyone under intense stress. Their use promotes mental, physical and spiritual health, and they should be a part of every comprehensive self-care strategy.
Herbs are also a possibility, and some herbs can help with mental health symptoms or even ease the physical symptoms of withdrawal itself. Their use is beyond the scope of this article, but if you have them and know how to use them, Valerian, Kava Kava, St. John’s Wort, and even Vitamin B-12 supplements (and the B vitamins in general) all have practical applications in a protracted disaster. Melatonin can help with sleep patterns (as can a sleep mask and a set of ear plugs). Herbals should only be given as a temporary measure, however, as they may have a similar mechanism of action as the prescription drugs they are replacing. The ultimate aim is to get the person to be comfortable experiencing life without any pharmacological assistance.
Medications are very important, and we often hear about stocking up, but there are many folks who will run out of medication that helps them function without physical and emotional pain. I pray that this article will assist the preparedness community in becoming aware of this issue, preparing for it, and meeting the needs of such people when a crisis does occur.
References:
The Ashton Manual: Benzodiazepines – How They Work and How To Withdraw, Ashton, Heather C, 2002.
Management of Withdrawal Syndromes and Relapse Prevention in Drug and Alcohol Dependence; Miller, et. al; American Family Physician; American Association of Family Physicians, July, 1998
What Is Discontinuation Syndrome?
Substance Abuse, Anger, and Omega-3 Fatty Acids; Amen, Daniel G.; Brain in the News, March, 2008
Medline Plus entry on Vitamin B-12 (National Institutes of Health):
Natural Treatments for Anxiety and Depression; Amen, Daniel G; Brain in the News, December, 2009
: “Rice revealed that the bunker beneath the White House where she was sheltering with Dick Cheney began to run out of air. ‘There were so many people in the bunker that the oxygen levels started dropping and the secret service came in and said we’ve got to get some people out of here. They literally went around telling people that they weren’t essential and they had to leave.’ Government communication systems were failing and Bush had to resort to an unsecured line to talk to Washington. Rice said: ‘Despite all of the sophisticated hierarchy, sophisticated command and control equipment that we had, at that moment much of it didn’t function very well and people instead did whatever they could to communicate messages.'” (Thanks to “Mr. Smith” for the link.)