Hi. I’m Melissa. I have phentermine in my veins right now.
Phentermine is a controlled substance in the USA. It is available through a doctor’s prescription, which is how I have it. It is a substituted amphetamine, and acts very similar to amphetamine in the human body. It suppresses appetite and boosts metabolism. It comprised one half of the infamous fen-phen drug cocktail, combined with fenfluramine, which was withdrawn from market because it damaged heart valves. (Phentermine was apparently the not-dangerous part of that combo, so it remains on the market.)
Phentermine is meant to be used only in the short term, mostly because the human body habituates to it and it becomes less effective over time.
I’ve been on it — off and on — for literally decades.
I’ve always had issues with controlling my weight. My weight was relatively normal as a teen, but I was pudgy because I couldn’t really exercise. My knees were bad and I walked with a cane much of the time. I remember seeing a photo of a flight of stairs and having a panic attack, if that gives you any idea what the pain in my legs was like.
The knee problems cleared up in my 20s, through a combination of physical therapy and exercising to build protective muscle around the knee joints. I was very active in my 20s, partly because I was overjoyed I could actually walk and move. It felt great to lift weights and be able to climb stairs and ladders and even mountains without pain!
But even through that, I slowly gained fat, no matter what I did. Hell, I spent a month in a tent in the Arctic Circle when I was 23, kayaking every day with 300 lb of equipment; I came back to the US with ripped arms and legs but the belly fat never budged.
Later, various other medical things happened, because life happens. Broken joints, a back injury, a torn rotator cuff, etc. Anytime I fell off the exercise wagon, my weight would skyrocket. And trying to chip the fat back off after that happened was nearly impossible, no matter what I ate or how I exercised.
I gained a nice little eating disorder during all this, as weeks of trying to restrict calories to keep my weight from climbing would inevitably just result in vicious binge eating episodes.
Eventually, I weighed around 230 lbs, about 80 lbs overweight, even though I was exercising enough to ride in 150-mile cycling events during that summer. I decided I needed medical help on this.
I was given phentermine, and boy howdy, it worked. It killed my appetite so I could eat like a sensible human without binging. I lost weight steadily, even during times when I couldn’t exercise because of travel or injury or whatnot.
I dropped down to about 190 lbs. It wasn’t where I wanted to be, but it sure beat 230 lbs. I stopped taking the drug at that time because I was paying out-of-pocket for the doctor and the prescription, and I just needed to spend that money elsewhere.
And do you know what? I stayed at 190 lbs for a long time. I couldn’t get it to go lower no matter how I ate or exercised, but that weight stayed off for years.
It wasn’t all great, though. Phentermine isn’t magic.
I’ve had problems all my life with insomnia, and phentermine sure didn’t help. It’s kind of like super-caffeine: it puts your body in overdrive. I took my doses early in the day to lessen the effects at night, but it still took forever to get to sleep.
During the day, I felt hyper-alert, but also tense and frenetic. Sometimes my hands weren’t very steady. My mouth was often unusually dry.
I’ve spent most of my adult life dealing with (thankfully relatively mild) OCD, which is an anxiety disorder at its very base. Like my insomnia, phentermine didn’t cause the problem… but it sure didn’t help, either.
I spent my days feeling I was on rocket fuel, and I kind of was. I’ve always have been ambitious and active and busy, and phentermine propelled me forward into that. It was hard to quit that feeling, even though it came packaged with tension and mental exhaustion and anxiety and fear that if I stopped, the progress I’d made would stop.
The second time I went on phentermine was something like three or four years ago.
The 190 lbs that I’d maintained for a long while had vanished. My weight was creeping up again. By this time, I’d been in therapy for binge eating disorder, and I was pretty much forbidden to diet, since that’s part of the cycle. I ate sensibly, but let’s face it — I was getting older. My metabolism was just slowing.
So I went back to the phentermine doctor. It worked last time, right?
I wasn’t even so invested in getting “thin” anymore. I just didn’t want my weight to keep going up. I hated buying new clothes and having them get tight again. I hated that the impinging fat made exercise and activity more difficult. I dreaded, however irrationally, losing my ability to walk and run and move however I wanted to.
So I went back on the drug.
And it worked, again. I came back down to about 200 lbs.
However, at the time, I was also working a job that was basically working me to death. I was already having trouble sleeping. My non-work activities died off as my life was eaten by work. I was already anxious and tense and frenetic and using all my energy to propel forward.
After a while, I needed the phentermine just to get through the day, to stay upright and alert with no sleep and a brain buzzing like a hive of bees.
And after about a year and a half of that? My brain gave out.
I went on a two month medical leave from work. I needed therapy for anxiety and insomnia. I was terrified of to-do lists and going to work and I just couldn’t assemble my thoughts anymore.
My final day of work before the leave was the last time I took phentermine. The following night, I slept for 14 hours straight.
Phentermine only stays in the bloodstream for about 24 hours. It’s not addictive, per se, but the body does habituate to it, so the dosage has to be ramped up over time in order to stay effective.
Going off phentermine, for me at least, just meant stopping taking the pills. I didn’t have any withdrawal effects. It just wasn’t there anymore. My weight started going up again, but I was also starting to sleep and I started to normalize mentally enough to start fixing my life.
The time on phentermine left me with anxiety and depression that required yet more drugs to treat (hi, Celexa!), with a reputation at work that I had to repair, a bevy of abandoned creative projects, with cracked molars from clenching my teeth (!), and with not a whole lot of weight loss to show for it.
Is it phentermine’s fault? No. I think most of those things would have come to pass anyway. But phentermine sure didn’t help.
There is a study on the nature of addiction, wherein rats were given the option of drinking either regular water or drugged, addictive water. When the rats were kept in cages under unhappy circumstances, they opted to drink the drugged water, even foregoing food in order to drink it. But when the rats were kept in a rat paradise — lots of other rats around, things to do, etc. — they really didn’t care about the drugged water.
The study is one of the first to show that a major component of addiction is unhappiness, to put it in very simplified terms. Addiction isn’t just the body begging for more of a drug on a chemical level; it’s also a symptom of having an emotional pit somewhere that needs to be filled by something.
Is phentermine addictive? Not really, not physically. But there is a pit inside my head somewhere, a nagging, neverending, sucking need to be able to control my body’s weight, something that I have shown myself I can’t do alone. And here’s a pill — so little and simple — that actually does what I cannot.
The last time I went off phentermine, when I left work for two months, I had a couple bottles of pills left. My dosage was three pills per day, and I cut myself off soon after a refill.
Those bottles have been staring at me from a corner of my towel closet. I couldn’t bring myself to get rid of them. I’d paid money out-of-pocket for them, and they weren’t cheap. I don’t know what I was going to do with them. Something in the back of my brain thought I might need them, someday.
Last year, work sponsored an employee health plan, where employees could gain incentive dollars by doing different healthy things, like getting an annual checkup and getting your cholesterol tested. One of the big incentive items was a sort of Weight Watchers-like program, with a personal online wellness coach.
My weight was back up above 220lbs. I signed up for the wellness coach. I didn’t have a whole lot of time for exercise, but I spent 10 weeks watching what I ate.
The result was… nothing. I’m still hovering between 220 lbs and 230 lbs.
And here in the closet were little white pills, and I know they work. I could start taking them again until they are gone and then be done with them. I could take only one per day, one third of my old dose, just a little boost per day. Maybe that’s all I need. I can just kick-start a new food and exercise regimen, give myself a leg-up to get started.
In Game of Thrones, magic is described as a sword without a handle, a tool that damages you as you wield it. Later in the same book, Jon Snow reasons that when you’re under attack, a sword without a handle is better than no sword at all.
So I took the pill.
It’s right around here where the ghost of William S. Burroughs pops up behind my shoulder and says, “That’s junkie talk.”
I never told anyone I was back on phentermine last time, and I certainly haven’t told anyone this time (until now). I listed it for other doctors on my prescriptions list so I could avoid drug interactions, but I didn’t tell my husband, my friends, anybody else.
Hell, I didn’t even tell my therapist about phentermine being a component of taking my medical leave. He’s been working with me for a year and a half, helping me pick up the pieces after I ran myself into the ground, helping me rebuild myself into something better and stronger and hopefully a lot calmer. Yet he doesn’t know about the phentermine.
This is partly because I don’t need to be told that it’s a problem. I fucking know that. I stopped taking it, and that’s the end, right?
The other part is that admitting I used it and let it help crash the airplane of my life would be admitting that I am so weak that I can’t control my own body.
I am not ashamed of mental illness. I am not ashamed that I lost a house to foreclosure. I am not ashamed of being gender non-conforming. I am not ashamed of being atheist, of being female, of being liberal, of so many things that others seem to think shameful. I am not scared to speak out about any of these things.
But admitting that I’m using a diet drug?
Or, even worse, that even after using a diet drug for years and years, I’m still over 220 lbs?
Yeah, that’s failure.
That’s what I am scared to face.
This weekend, I drove through part of West Virginia. I saw dozens of billboards offering treatment for opioid addiction. There are Narcan advertisements on TV.
I am hopeful that this is the start of addiction becoming less taboo in this country. I am bitter that this process didn’t start happening until drug addiction became a “white people problem,” but that’s the subject of a different thinkpiece.
Opioid addiction is far beyond what I am suffering. My issue is petty and small in comparison. I may even be ashamed to admit my problem because I feel on some level that I’m complaining about a cracked dish when the kitchen is on fire.
But being quiet feeds the fear.
So here I am at Boston’s Logan Airport, waiting for a flight home. My brain is buzzing like a hive of bees, my shoulders are shrugged up around my ears because I can’t relax, and my teeth hurt. I am writing as fast as I can on my phone so I can finish and post before I get scared and delete these words. I at least know the scale will be kind to me when I get home. I at least know what the cost will be.