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resending this FW: Apology and Zach Coughlin prescription

medications information
From: Zach Coughlin (zachcoughlin@hotmail.com)
Sent: Tue 7/31/12 1:39 PM
To: patrickk@nvbar.org
1 attachment
Zach Coughlin rx history since February 2008.pdf (1163.3 KB)
Dear Mr. King,
I am resending this too you just in case it went into your "junk mail" folder the first time I sent it (given
that it was addressed to numerous people, as sometimes results in an email being declared "junk mail"
by one's email server)....Its admittedly fairly rambling, but I believe it does demonstrate a willingness to
look within for a cause of the problems I have encountered in the last year.
Sincerely,

Zach Coughlin
PO BOX 3961
Reno, NV 89505
Tel 775 338 8118
Fax 949 667 7402
ZachCoughlin@hotmail.com

From: zachcoughlin@hotmail.com
To: tcoughlinmd@hotmail.com; davidc@nvbar.org; patrickk@nvbar.org; glennm@nvbar.org;
marybarkbark@yahoo.com
Subject: Apology and Zach Coughlin prescription medications information
Date: Mon, 14 May 2012 12:37:17 -0700
Dear Dad, Bar Counsel, Mom and Melissa,

I am sorry for all the hurtful things I have said and done in the last
year. I haven't been on my Wellbutrin/Buproprion antidepressant
for quite awhile (I pulled my pharmacy records recently to try to
learn from some things). I have taken anti-depressants since I was
18 years old. I wasn't on either my Wellbutrin or Adderall for all of
August 2011 until September 14, 2011. I was arrested on August
20th, 2011 and September 9th, 2011. The Walmart arrest involved
chocolate and cough drops. The cough drops have
dextromethorphan in them, which is a dissociative in high enough
doses. Chocolate (sugar) is, of course, an old time palliative. The
banned cough drop (the melt or dissolve very quickly and contain
30 mg in each one...so rather than powering through a whole bottle
of cough syrup to take 300 mg of DM, one could eat 10 cough drop
melts rather easily and quickly). These drops were pulled from
shelfs for awhile when they first came out a few years ago, I believe
because of the abuse potential or dangers of being able to ingest
that high a quantity of a powerful dissociative so quickly (the cough
syrup version of dextromethorpan is extremely difficult to just drink
a whole bottle of, whereas the sugary cough melts are pretty much
similar to candy). I went off the Adderall on approximately
August 2, 2011. I went of the Wellbutrin in J uly 2011, right after
the breakup of a four and half year. Okay, I went and found the
records and am attaching them to this email. I wondered whether
the switch from Vyvanse to Adderall coincided with my getting
fired from Washoe Legal Services, but actually, it does not appear
to have. I was suspended on April 20th, 2009 from WLS. Then,
my termination date was May 12th, 2009. I only started taking
Adderall instead of Vyvanse on J une 13th, 2009. I was wondering
if I became more irritable upon starting Adderall instead of
Vyvanse and though maybe that cause the problems with the family
court J udge during the March 2009 trial and then with Washoe
Legal Services. I am actually kind of relieved to see their does not
appear to be a causal connection given the chronology. I think I
just felt WLS was a bit of a dead end job for me, was ruining my
work ethic and motivation, and was, perhaps, an environment where
white males had to conform to a certain prototype to fit in, one
which I was not entirely at home with.

You can see I filled one prescription for Campral. See this forum
for evidence that tolerance to Adderall is sometimes thought to be
counteracted by a class of medications that includes Campral,
Dextormethorphan (DM is also being used to treat chronic pain
patients in some experimental studies), etc.:
http://addforums.com/forums/showthread.php?t=36078
http://www.ncbi.nlm.nih.gov/pubmed/10875724
I recall researching this in an attempt to be ultra cautious in
my use of Adderall.

My chronic pain levels seem to be much, much, more manageable
when I am taking Wellbutrin and Adderall. I believe that the
chronic upper back pain I dealt with for years was due, in part, to
emotional/mental stress related to not appropriately addressing my
ADHD and the spotty use of antidepressants I exhibited during
those years (if my Dad and I were getting along, I would get
Wellbutrin from him for free, if we weren't, I would rarely secure
my own health insurance or pay out of pocket for that
antidepressant, but would rather "rough it" to save money). When I
went off the Wellbutrin and Adderall, the chronic pain returned,
plus, I was basically in the early stages of a "divorce" from Melissa
(whom I dated and lived with since April-ish 2007 until May 17th,
2011. Melissa and I had been fighting since we moved into the
home/office on River Rock on February 20th, 2010. From probably
J une 2010 until she moved out on May 17th, 2011, we fought
almost daily, sometimes in a fairly hostile way (I was never
physically violent with her, but she got a bit with me). I was
existing on $400 a week in unemployment benefits, receiving them
for 99 weeks. I actually worked quite hard the entire time. I
learned a lot about a lot of different things, including some things
related to the business of law, practice management, employment
law, computers, software, hardware, cars, home improvement, I did
focus on music for about 6 months straight (though I always
continued to apply for jobs and send out resumes during this 99
weeks...Washoe County had 15% unemployment during those 3
years and jobs were in short supply and starting my own law
practice seemed overly risky), and I was basically Melissa's maid
and helper with proofreading her schoolwork for a couple years (in
my mind at least, of course she may have a vastly different view of
things). She worked a significant amount of hours and was in
school full time and was irritable, extremely emotional, and
stretched pretty thin. I implemented the "I pay for dinner one time,
then you pay for dinner one time" rule for going out to dinner, and,
of course, that took a lot of the romance out of things. I think I
became very insecure about money and my career and getting fired
from WLS was very, very discouraging. But, I worked their for 18
months. Previous to that my longest tenure of employment at any
job whatsoever was literally 4 months at Hale Lane. I am talking
ANY job, my whole life. I realize my father has concerns about
someone in recovery taking a controlled substance like Adderall,
but I have exhibited symptoms consistent with a strong case of
ADHD my entire life, and feel to potential for substance abuse
inherent to untreated ADHD presents a great risk than does taking
Adderall, though, admittedly, it is something that one must watch
and realize that it can effect one's behavior and mood, sometimes in
good ways, sometimes in bad ways. But so can drinking or not
drinking water. So can taking or not taking insulin. Same with
coffee. So, in some ways I consider adding the Adderall to the
Wellbutrin a success and feel that I may have purposefully gotten
fired from WLS because the malaise there and institutional politics
were tough to deal with. Plus, it just occurred to me there that I
could work there forever, it was an incredibly easy job, but their
was not a pension, the pay was like $55K, they didn't give me the
$5K raise after a year they promised (it seems small, but watching
them heat half and empty building for months on end to 84 degrees
round the clock because the office manager couldn't figure out how
to fix the thermostat was just irritating), and that the law just held a
different destiny for me than to be a legal aid domestic violence
attorney for years and years, as honorable and admirable as that
may be. Interestingly, a couple of the people I had the most
problems with appear to have been fired from WLS after me.
Previously, the Executive Director basically would not fire anyone
unless they embezzled. It appears I changed his approach and got
him to implement firing people as a management tool. He fired that
office manager, RK, and he also fired ZL (I believe, though she
might have just left, though I cannot imagine that because what
other job would allow her to call in sick, with full pay, 30 Fridays a
year and be accountable to absolutely no one and call herself a
paralegal with no apparent legal training at all? Plus she, allegedly,
had borrowed money from various employees without paying them
back, so...).
Speaking of borrowing money, when we broke up, Melissa stayed
at Mom's for awhile (Mom now says Melissa "uses her tears to her
advantage" and that she "feels a bit used by Melissa"), and Mom
bought her a $500 mattress from Costco (we had two very nice
memory foam beds I build with spare foam from Mills End fabrics
and all bought with my $400 a week and thrift, and I just didn't
want to give Melissa one when I felt she had been so unappreciative
of things just like my building those beds and doing the research,
etc.). We both agreed though that Melissa being an insulin
dependent diabetic undoubtedly presents challenges to her in
regulating her mood and emotions and that Melissa has
demonstrated extraordinary courage and resolve in meeting those
challenges. Then, Mom just admitted to me that Carly loaned
Melissa several hundred dollars. Apparently Carly is pissed
because Melissa is in New York City right now and still hasn't paid
Carly or Mom back (she also went in September 2011, and we were
supposed to go in J uly 2011, bought the tickets and everything
$450, but her Aunt decided to change her travel to Ireland dates, so
I basically lost that $450 due to the change fees Delta and American
charge-Melissa bought the tickets and did not think to utilize
Southwest...). Melissa also made off with at least one and possibly
two months of my rent contribution that I gave her to give the
landlord, plus, she didn't pay the landlord her contribution for May
2011, J une 2011, etc. However, as in all 4.5 year relationships,
things get blurry, etc., and she is a wonderful person.
SOMETHING PRETTY INTERESTING:
One thing I note from the prescription history is I filled a
Buproprion (note, I am using the terms Buproprion and
Wellbutrin interchangeably) script on 3/18/09, then did not fill
another one until 5/4/09...meaning a period of some 16 days
or so where I was either out of Buproprion or did not take it
or took less than my typical dose. I was suspended from
WLS on 4/20/09. My final termination date was 5/12/09.
That is pretty interesting. I seem to recall sometimes when
my script for Buproprion ran out and there could be some lag
time getting the doctor to fax a renewal to the pharmacy, and
I believe at one point during the past couple years I
complained to the pharmacy and the doctors office about an
extended delay in getting my prescription renewed and filled
and I specifically took them to task about the dangers of
patients suddenly going of there antidepressants and recall
being upset about what I perceived to be the doctor's office's
or pharmacies negligence in so renewing the prescriptions. I
do not believe I was blame shifting and avoiding my own
responsibilities in that regard, but it is possible I should have
done more in advance of running out of my Buproprion to
renew the prescription and or should have followed up more
on the failure to so renew after I made the renewal
request....I believe this was during that 5/4/11 to 5/21/11
period, but am not sure at this point, but I recall being upset
that somethign like 3 weeks went by and my prescription was
not ready...or I may have been late in making the request. I
seem to undervalue what Bupropion does for my mood and
behavior, I recall often thinking they were just "sugar pills"
and it was all in my mind, any benefit....But, I didn't always
believe that, sometimes finding the efficacy apparent.
Looks like I went off Buproprion between 5/21/20 and
6/17/10 as well. I went off Buproprion again between 8/12/10
and 10/6/10....I notice that my copays stopped around
7/12/10, which was went I stopped getting the reduced Cobra
premiums under the Obama bailout, and had to start paying
out of pocket (though it was essentially a wash, because the
Cobra was $180 a month, plus $20 in copays, whereas, out of
pocket was probably less overall, though it was $105 ever 3
months for the psychiatrist and the prices of Adderall and
Wellbutrin (I dropped Adderal XR probably because it cost
more) spiked somewhat during that time). Then again from
11/6/10 to 12/2/10, though its possible that I used that
10/6/10 prescription, which consisted of 120 of the 75mg
Buproprion generic versions to try to effect a discount by
taking less Buproprion per day, ie, stretch one month of a
script out 3 months or so by only taking 150 mg or 75 mg or
something, I do remember trying to save money like that. I
am very startled to see that from 5/4/11 to 5/21/11 I would
have been out of Wellbutrin/Buproprion. Melissa and I broke
up and she moved out on 5/17/11. I did have trouble with
the ignition cylinder turning the key to start the car when
trying to go to Melissa's graduation party on 5/15/11, and
was at least 45 minutes late, causing her embarassment and
pain. However, despite the fact that the key would not turn
the cylinder causing me some delay, I believe it did not cause
that much of a delay in finding some other way to get to the
graduation party, but rather, my ADHD and depression led
me to trying to do to many other things that day, misjudging
time and the ability to get a reasonable amount of things
done (I was probably trying to finish fixing Melissa's car or
something else that was no where near as important as
showing up to that party on time....but that is typical of
people with depression and ADHD, the prioritizing and
misjudging time, lateness, etc....). I do recall saying very
mean things to Melissa during that 3 week stretch in May
2011...however, both she and I were stressed out preparing
for her graduation and final exams, having a great deal of her
out of town family coming into town, my fighting with my Dad
starting on 4/28/11 and having a bad argument about
something rather small and minor, etc., and my
unemployment benefits stopping right about late April 2011
(99 weeks from May 21, 2009 start date would mean my
unemployment ran out in early April 2011, I believe).
I switched to the cheaper generic version of Adderall from the
perhaps more steady consistent Adderall XR in J une 2010.
Melissa and I fought constantly from J une 2010 until our
breakup in J une 2011....There were news reports of the price
of Adderall XR skyrocketing out of the blue at about this time
and there was a fair amount of controversy about Shire
retaining the rights to make the generic and the generic
version being essentially, garbage, according to many
patients.
http://www.addforums.com/forums/showthread.php?
t=112229
It is pretty crappy when you think about it, these drug
companies increasing the copay from $29 on a mental health
medication once month to $180 the next...and artificially
forcing people to avoid the generic by retaining the rights to
the generic and purposefully making the generic lack efficacy.
http://www.drugs.com/answers/why-has-the-price-of-
adderall-generic-30-mg-gone-455000.html
http://motherboard.vice.com/2012/2/16/anatomy-of-the-
great-adderall-drought
http://www.thefix.com/content/pay-attention-adderall-add-
big-pharma7004
I then went off my Wellbutrin/Buproprion from 7/25/11 until
4/28/ 12..From filling the Buproprion at a cost of $20 in J une
of 2011 until recently filling the prescription in late April 2012,
the cost has gone up 300%. That medication has been off
patent for some 20 years now, it should not be rising in price,
especially during a period where the economy has struggled
so mightily. Interestingly, the cost of those cough drop melts
with 30 mg of Dextromethorphan per melt rose form around
$6.50 a box in 2007 or so to $8.88 in September 2011 for the
exact same quantity/dosage. I simply could not afford it
though on at least two occasions I called up Northern Nevada
Adult Mental Health and inquired about the possibility of
getting the cost paid for by the state or subsidized. In
evaluating the time and relinquishment of my privacy rights
(there is a fair amount of shame and worry about one's
professional reputation and how those in recovery or AA will
view one's taking these medications associated with taking
ADHD and Major Depressive Disorder medications) that I felt
it would require to achieve the savings of around $125 a
month for these two prescriptions, I never decided it was
worth it to go to NAMS, but rather just stopped paying for the
Buproprion (again, I sometimes viewed it as a sugar pill,
whereas the Adderall I felt had an effect, both for controlling
ADHD and for the supplemental uses as a treatment resistant
antidepressant and the off label use for the control of OCD.
In that time period I was put in jail 8 times and, essentially
evicted 3 times and fought with and alienated myself from my
entire family, lived a very secluded, reclusive life, etc...
exhibited poor impulse control, a temper, and symptoms
consistent with untreated Major Depressive Disorder (MDD)
and perhaps some type of hoarding behavior or Obsessive
Compulsive Disorder, including tiling the River Rock home
office, collecting car seats, recarpeting the entire home office
with scraps in a patchwork, and tiling the crumbling front
steps, and putting green carpet on the dirt lawn.
I was arrested on:
8/20/11 for petit larceny (the lost mislaid iPhone thing where
the finder said he would "throw it in the river if someone
doesn't claim it right away"). 7 days in jail.
9/9/11 for petit larceny at Wal-Mart of a chocolate bar and
two boxes of the cough medication drops/melts with
Dextromethorphan 30 mg per melt. 1 day in jail.
11/12/11 for criminal trespass at my former home law office
(i was issued 3 traffic citations days later when I went to the
opposing attorney who signed the criminal trespass
complaints office to retrieve my wallet and driver's license and
was told to leave by the RPD. While driving away the RPD
pulled me over and charged me with a "California Roll"/failure
to come to a complete stop and a couple fix it tickets, that
were ultimately fixed). 3 days in jail
11/30/11 for summary contempt during the trial for the Wal-
Mart chocolate bar and cough medication drops Trial before
J udge Howard in RMC 11 CR 22176. 1 day in jail.
1/12/12 for jaywalking while filming personal property at my
former home law office being placed in a dump truck for
hauling to the dump. 1 day in jail
1/14/12 for "misuse of 911 where no actual or perceived
emergency exists), a gross misdemeanor incident to the
domestic violence I was victimized by on E. 9th St. by my
housemates. 3 days in jail
2/27/12 for summary contempt during the trial for the
11/15/11 traffic citations "California Roll"/failure to come to a
complete stop at stop sign deal....5 days in jail
4/19/12 for contempt, I believe, for failing to fully participate
(concern for privacy rights, shame, etc) in the ordered
competency evaluation that J udge Elliot ordered I undergo
with the Lake's Crossing doctors. I spent 7 days in jail.
I am feeling better and better since starting to take my
antidepressant, Wellbutrin again, and now realize I need to be
much more diligent in filling that prescription in a timely
manner and making preparations for situations where I might
not be able to afford it. I plan to write many apology letters,
including to judges, bar counsel, opposing counsel, etc. I
always fought and worked hard for my clients though for an
extremely competitive price.
Sincerely,
Zach Coughlin, Esq.