5 14 12 Email To Dad and Melissa Apology and Zach Coughlin Prescription History

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Apology and Zach Coughlin prescription
medications information
From: Zach Coughlin (zachcoughlin@hotmail.com)
Sent: Mon 5/14/12 12:39 PM
To: melissa.l.ulloa@gmail.com; tcoughlinmd@hotmail.com
1 attachment
Zach Coughlin rx history since February 2008.pdf (1163.3 KB)
Dear Dad, 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
July 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 June 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 Judge 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 June 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 July 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, June 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
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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 June
2010. Melissa and I fought constantly from June 2010 until
our breakup in June 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 June 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 Judge 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 Judge 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.

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