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resending this FW: Apology and Zach Coughlin prescriptionmedications information

From: Zach Coughlin (zachcoughlin@hotmail.com)Sent: Tue 7/31/12 1:39 PMTo: patrickk@nvbar.org

1 attachmentZach 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 (giventhat 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 tolook 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.comTo: tcoughlinmd@hotmail.com; davidc@nvbar.org; patrickk@nvbar.org; glennm@nvbar.org;marybarkbark@yahoo.comSubject: Apology and Zach Coughlin prescription medications informationDate: 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 lastyear. I haven't been on my Wellbutrin/Buproprion antidepressant

for quite awhile (I pulled my pharmacy records recently to try tolearn from some things). I have taken anti-depressants since I was18 years old. I wasn't on either my Wellbutrin or Adderall for all ofAugust 2011 until September 14, 2011. I was arrested on August20th, 2011 and September 9th, 2011. The Walmart arrest involvedchocolate and cough drops. The cough drops havedextromethorphan in them, which is a dissociative in high enoughdoses. Chocolate (sugar) is, of course, an old time palliative. Thebanned cough drop (the melt or dissolve very quickly and contain30 mg in each one...so rather than powering through a whole bottleof cough syrup to take 300 mg of DM, one could eat 10 cough dropmelts rather easily and quickly). These drops were pulled fromshelfs for awhile when they first came out a few years ago, I believebecause of the abuse potential or dangers of being able to ingestthat high a quantity of a powerful dissociative so quickly (the coughsyrup version of dextromethorpan is extremely difficult to just drinka whole bottle of, whereas the sugary cough melts are pretty muchsimilar to candy). I went off the Adderall on approximatelyAugust 2, 2011. I went of the Wellbutrin in July 2011, right afterthe breakup of a four and half year. Okay, I went and found therecords and am attaching them to this email. I wondered whetherthe switch from Vyvanse to Adderall coincided with my gettingfired from Washoe Legal Services, but actually, it does not appearto have. I was suspended on April 20th, 2009 from WLS. Then,my termination date was May 12th, 2009. I only started takingAdderall instead of Vyvanse on June 13th, 2009. I was wonderingif I became more irritable upon starting Adderall instead ofVyvanse and though maybe that cause the problems with the familycourt Judge during the March 2009 trial and then with Washoe

Legal Services. I am actually kind of relieved to see their does notappear to be a causal connection given the chronology. I think Ijust felt WLS was a bit of a dead end job for me, was ruining mywork ethic and motivation, and was, perhaps, an environment wherewhite males had to conform to a certain prototype to fit in, onewhich I was not entirely at home with.

You can see I filled one prescription for Campral. See this forumfor evidence that tolerance to Adderall is sometimes thought to becounteracted by a class of medications that includes Campral,Dextormethorphan (DM is also being used to treat chronic painpatients in some experimental studies), etc.:http://addforums.com/forums/showthread.php?t=36078http://www.ncbi.nlm.nih.gov/pubmed/10875724I recall researching this in an attempt to be ultra cautious inmy use of Adderall. My chronic pain levels seem to be much, much, more manageablewhen I am taking Wellbutrin and Adderall. I believe that thechronic upper back pain I dealt with for years was due, in part, toemotional/mental stress related to not appropriately addressing myADHD and the spotty use of antidepressants I exhibited duringthose years (if my Dad and I were getting along, I would getWellbutrin from him for free, if we weren't, I would rarely securemy own health insurance or pay out of pocket for thatantidepressant, but would rather "rough it" to save money). When Iwent 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 thehome/office on River Rock on February 20th, 2010. From probablyJune 2010 until she moved out on May 17th, 2011, we foughtalmost daily, sometimes in a fairly hostile way (I was neverphysically violent with her, but she got a bit with me). I wasexisting on $400 a week in unemployment benefits, receiving themfor 99 weeks. I actually worked quite hard the entire time. Ilearned a lot about a lot of different things, including some thingsrelated to the business of law, practice management, employmentlaw, computers, software, hardware, cars, home improvement, I didfocus on music for about 6 months straight (though I alwayscontinued to apply for jobs and send out resumes during this 99weeks...Washoe County had 15% unemployment during those 3years and jobs were in short supply and starting my own lawpractice seemed overly risky), and I was basically Melissa's maidand helper with proofreading her schoolwork for a couple years (inmy mind at least, of course she may have a vastly different view ofthings). She worked a significant amount of hours and was inschool full time and was irritable, extremely emotional, andstretched 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 Ibecame very insecure about money and my career and getting firedfrom WLS was very, very discouraging. But, I worked their for 18months. Previous to that my longest tenure of employment at anyjob whatsoever was literally 4 months at Hale Lane. I am talkingANY job, my whole life. I realize my father has concerns aboutsomeone 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 abuseinherent to untreated ADHD presents a great risk than does takingAdderall, though, admittedly, it is something that one must watchand realize that it can effect one's behavior and mood, sometimes ingood ways, sometimes in bad ways. But so can drinking or notdrinking water. So can taking or not taking insulin. Same withcoffee. So, in some ways I consider adding the Adderall to theWellbutrin a success and feel that I may have purposefully gottenfired from WLS because the malaise there and institutional politicswere tough to deal with. Plus, it just occurred to me there that Icould work there forever, it was an incredibly easy job, but theirwas 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 watchingthem heat half and empty building for months on end to 84 degreesround the clock because the office manager couldn't figure out howto fix the thermostat was just irritating), and that the law just held adifferent destiny for me than to be a legal aid domestic violenceattorney for years and years, as honorable and admirable as thatmay be. Interestingly, a couple of the people I had the mostproblems with appear to have been fired from WLS after me. Previously, the Executive Director basically would not fire anyoneunless they embezzled. It appears I changed his approach and gothim to implement firing people as a management tool. He fired thatoffice manager, RK, and he also fired ZL (I believe, though shemight have just left, though I cannot imagine that because whatother job would allow her to call in sick, with full pay, 30 Fridays ayear and be accountable to absolutely no one and call herself aparalegal 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 stayedat Mom's for awhile (Mom now says Melissa "uses her tears to heradvantage" and that she "feels a bit used by Melissa"), and Mombought her a $500 mattress from Costco (we had two very nicememory foam beds I build with spare foam from Mills End fabricsand all bought with my $400 a week and thrift, and I just didn'twant to give Melissa one when I felt she had been so unappreciativeof things just like my building those beds and doing the research,etc.). We both agreed though that Melissa being an insulindependent diabetic undoubtedly presents challenges to her inregulating her mood and emotions and that Melissa hasdemonstrated extraordinary courage and resolve in meeting thosechallenges. Then, Mom just admitted to me that Carly loanedMelissa several hundred dollars. Apparently Carly is pissedbecause Melissa is in New York City right now and still hasn't paidCarly or Mom back (she also went in September 2011, and we weresupposed to go in July 2011, bought the tickets and everything$450, but her Aunt decided to change her travel to Ireland dates, soI basically lost that $450 due to the change fees Delta and Americancharge-Melissa bought the tickets and did not think to utilizeSouthwest...). Melissa also made off with at least one and possiblytwo months of my rent contribution that I gave her to give thelandlord, plus, she didn't pay the landlord her contribution for May2011, 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 aBuproprion (note, I am using the terms Buproprion andWellbutrin interchangeably) script on 3/18/09, then did not fillanother one until 5/4/09...meaning a period of some 16 daysor so where I was either out of Buproprion or did not take itor took less than my typical dose. I was suspended fromWLS on 4/20/09. My final termination date was 5/12/09. That is pretty interesting. I seem to recall sometimes whenmy script for Buproprion ran out and there could be some lagtime getting the doctor to fax a renewal to the pharmacy, andI believe at one point during the past couple years Icomplained to the pharmacy and the doctors office about anextended delay in getting my prescription renewed and filledand I specifically took them to task about the dangers ofpatients suddenly going of there antidepressants and recallbeing upset about what I perceived to be the doctor's office'sor pharmacies negligence in so renewing the prescriptions. Ido not believe I was blame shifting and avoiding my ownresponsibilities in that regard, but it is possible I should havedone more in advance of running out of my Buproprion torenew the prescription and or should have followed up moreon the failure to so renew after I made the renewalrequest....I believe this was during that 5/4/11 to 5/21/11period, but am not sure at this point, but I recall being upsetthat somethign like 3 weeks went by and my prescription wasnot ready...or I may have been late in making the request. Iseem to undervalue what Bupropion does for my mood andbehavior, I recall often thinking they were just "sugar pills"and it was all in my mind, any benefit....But, I didn't alwaysbelieve that, sometimes finding the efficacy apparent.

Looks like I went off Buproprion between 5/21/20 and6/17/10 as well. I went off Buproprion again between 8/12/10and 10/6/10....I notice that my copays stopped around7/12/10, which was went I stopped getting the reduced Cobrapremiums under the Obama bailout, and had to start payingout of pocket (though it was essentially a wash, because theCobra was $180 a month, plus $20 in copays, whereas, out ofpocket was probably less overall, though it was $105 ever 3months for the psychiatrist and the prices of Adderall andWellbutrin (I dropped Adderal XR probably because it costmore) spiked somewhat during that time). Then again from11/6/10 to 12/2/10, though its possible that I used that10/6/10 prescription, which consisted of 120 of the 75mgBuproprion generic versions to try to effect a discount bytaking less Buproprion per day, ie, stretch one month of ascript out 3 months or so by only taking 150 mg or 75 mg orsomething, I do remember trying to save money like that. Iam very startled to see that from 5/4/11 to 5/21/11 I wouldhave been out of Wellbutrin/Buproprion. Melissa and I brokeup and she moved out on 5/17/11. I did have trouble withthe ignition cylinder turning the key to start the car whentrying to go to Melissa's graduation party on 5/15/11, andwas at least 45 minutes late, causing her embarassment andpain. However, despite the fact that the key would not turnthe cylinder causing me some delay, I believe it did not causethat much of a delay in finding some other way to get to thegraduation party, but rather, my ADHD and depression ledme to trying to do to many other things that day, misjudgingtime and the ability to get a reasonable amount of things

done (I was probably trying to finish fixing Melissa's car orsomething else that was no where near as important asshowing up to that party on time....but that is typical ofpeople with depression and ADHD, the prioritizing andmisjudging time, lateness, etc....). I do recall saying verymean things to Melissa during that 3 week stretch in May2011...however, both she and I were stressed out preparingfor her graduation and final exams, having a great deal of herout of town family coming into town, my fighting with my Dadstarting on 4/28/11 and having a bad argument aboutsomething rather small and minor, etc., and myunemployment benefits stopping right about late April 2011(99 weeks from May 21, 2009 start date would mean myunemployment ran out in early April 2011, I believe).

I switched to the cheaper generic version of Adderall from theperhaps more steady consistent Adderall XR in June 2010. Melissa and I fought constantly from June 2010 until ourbreakup in June 2011....There were news reports of the priceof Adderall XR skyrocketing out of the blue at about this timeand there was a fair amount of controversy about Shireretaining the rights to make the generic and the genericversion being essentially, garbage, according to manypatients. http://www.addforums.com/forums/showthread.php?t=112229

It is pretty crappy when you think about it, these drugcompanies increasing the copay from $29 on a mental healthmedication once month to $180 the next...and artificially

forcing people to avoid the generic by retaining the rights tothe 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 until4/28/ 12..From filling the Buproprion at a cost of $20 in Juneof 2011 until recently filling the prescription in late April 2012,the cost has gone up 300%. That medication has been offpatent for some 20 years now, it should not be rising in price,especially during a period where the economy has struggledso mightily. Interestingly, the cost of those cough drop meltswith 30 mg of Dextromethorphan per melt rose form around$6.50 a box in 2007 or so to $8.88 in September 2011 for theexact same quantity/dosage. I simply could not afford itthough on at least two occasions I called up Northern NevadaAdult Mental Health and inquired about the possibility ofgetting the cost paid for by the state or subsidized. Inevaluating the time and relinquishment of my privacy rights(there is a fair amount of shame and worry about one'sprofessional reputation and how those in recovery or AA willview one's taking these medications associated with takingADHD and Major Depressive Disorder medications) that I felt

it would require to achieve the savings of around $125 amonth for these two prescriptions, I never decided it wasworth it to go to NAMS, but rather just stopped paying for theBuproprion (again, I sometimes viewed it as a sugar pill,whereas the Adderall I felt had an effect, both for controllingADHD and for the supplemental uses as a treatment resistantantidepressant and the off label use for the control of OCD. In that time period I was put in jail 8 times and, essentiallyevicted 3 times and fought with and alienated myself from myentire family, lived a very secluded, reclusive life, etc...exhibited poor impulse control, a temper, and symptomsconsistent with untreated Major Depressive Disorder (MDD)and perhaps some type of hoarding behavior or ObsessiveCompulsive Disorder, including tiling the River Rock homeoffice, collecting car seats, recarpeting the entire home officewith scraps in a patchwork, and tiling the crumbling frontsteps, and putting green carpet on the dirt lawn.

I was arrested on: 8/20/11 for petit larceny (the lost mislaid iPhone thing wherethe finder said he would "throw it in the river if someonedoesn't claim it right away"). 7 days in jail.9/9/11 for petit larceny at Wal-Mart of a chocolate bar andtwo boxes of the cough medication drops/melts withDextromethorphan 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 theopposing attorney who signed the criminal trespasscomplaints office to retrieve my wallet and driver's license andwas told to leave by the RPD. While driving away the RPD

pulled me over and charged me with a "California Roll"/failureto come to a complete stop and a couple fix it tickets, thatwere ultimately fixed). 3 days in jail11/30/11 for summary contempt during the trial for the Wal-Mart chocolate bar and cough medication drops Trial beforeJudge Howard in RMC 11 CR 22176. 1 day in jail.1/12/12 for jaywalking while filming personal property at myformer home law office being placed in a dump truck forhauling to the dump. 1 day in jail1/14/12 for "misuse of 911 where no actual or perceivedemergency exists), a gross misdemeanor incident to thedomestic violence I was victimized by on E. 9th St. by myhousemates. 3 days in jail2/27/12 for summary contempt during the trial for the11/15/11 traffic citations "California Roll"/failure to come to acomplete stop at stop sign deal....5 days in jail4/19/12 for contempt, I believe, for failing to fully participate(concern for privacy rights, shame, etc) in the orderedcompetency evaluation that Judge Elliot ordered I undergowith the Lake's Crossing doctors. I spent 7 days in jail.

I am feeling better and better since starting to take myantidepressant, Wellbutrin again, and now realize I need to bemuch more diligent in filling that prescription in a timelymanner and making preparations for situations where I mightnot be able to afford it. I plan to write many apology letters,including to judges, bar counsel, opposing counsel, etc. Ialways fought and worked hard for my clients though for anextremely competitive price.

Sincerely,

Zach Coughlin, Esq.