Thread by @abgutman

Kurt Cobain died 28 years ago today.

Nearly every obituary or writing on his legacy mentions drug.

Nearly none mention the ways that US drugs laws and stigma failed him — pushing him to treatment that didn't work.

The same forces fail others today.

🧵
inquirer.com/news/kurt-coba…

Everything Cobain did was different — even his drug use.

Around age 19, the workers at grocery store next to his Aberdeen, Washington apartment went on strike. He didn't want to cross the picket line but he also didn't want to drive to buy beer. He used LSD instead.

Solidarity.

In 1987, at age 20, he used heroin for the first time with a friend.

He suffered from a chronic, undiagnosed gastrointestinal problem. It was a source of pain and discomfort.

He did notice that his pain went away.

Around the same time, Nirvana played its first concert.

At this point, Cobain is not a voice of a generation.

He is a high school drop out, traumatized by his parents divorced, without stable housing or solid income, and who suffers from chronic pain.

That's so common in people's addiction story. All the vulnerabilities were there.

Nirvana released Bleached in 1989.

Dave Grohl joined Kurt Cobain and Krist Novoselic in 1990 to form the Nirvana we know and love today.

The played Smells Like Teen Spirit for the first time in April, 1991.

Nevermind was in the works.

In fall 1991, just around the release of Nevermind and Nirvana's catapulte into global fame, Kurt Cobain took a decision: to use heroin daily.

He later wrote that he stomach pain pushed him to the brink of suicide. Heroin was his only relief. inquirer.com/news/kurt-coba…

Current narratives of opioid addiction focus on people getting "hooked" on drugs because of a prescription.

As a journalist who talked to many, many people in addiction, people often describe a deliberate choice — just like Kurt.

They found what works. Can you blame them?

The next few months in Kurt Cobain's life are wild.

Nevermind comes out at the end of September, 1991.

By January 1992, Kurt not yet 25, the album took the #1 spot in the charts from Michael Jackson and the band played SNL.

Heroin was there for it all.

The spring of 1992 is when Kurt's relationship with treatment started — in part because he found out that his wife, Courtney Love, is expecting a child.

He got methadone in Australia while on tour.

An LA Times interview shows how he, like many others, misunderstood the drugs.

The way I understand the story: Kurt was in detox before the a tour. He didn't have access to heroin. He started losing weight. He went to an Australian doctor that prescribed him methadone pills.

From a September 1992 LA times interview: latimes.com/entertainment/…

"I had a habit again."

In this quote, Cobain reveals a profound, stigma rooted misunderstanding of opioid use disorder — one that is pervasive to this day even among physicians. The notion that methadone replaces "one addiction with another."

It's false. inquirer.com/news/kurt-coba…

I wish I could say "we now know..." but we knew that even then.

For *decades* there is a recognition that methadone works to remove the opioid *addiction* even though the person would still be chemically dependent.

That's a major difference. It's about recovery, not sobriety.

I have big questions about Cobain's methadone use.

According to Charles Cross' Biography of Cobain, Heavier Than Heaven, there was an 8 month period that the rock star was on methadone.

How? How did he bypass the American requirement to go daily to get the dose in a clinic?

But my biggest question is why did he stop?

1992. Back from tour. He gave up methadone. He contemplated suicide.

Who managed his treatment? Was his dose adjusted?

He wrote in his journal: “I bought a gun, but chose drugs instead.”

Courtney Love convinced him to go to detox.

What followed was probably the most painful events in Kurt Cobain's life. They are always told through the frame of addiction.

Let's think about them, though, through the frame of coerced sobriety.

Hear me out.

August, 1992.

Cobain entered detox at the Cedars-Sinai Medical Center in LA.

Courtney Love was going into labor at the other side of the hospital.

She dragged him over.

"You get out of this bed and you come down now! You are not leaving me to do this by myself. Fuck you!”

In Come As You Are: The Story of Nirvana, Michael Azzerad quotes Courtney Love on her delivery story.

Cobain was connected to an IV, in withdrawal. He was vomiting and fainting. Love held his hand.

Frances Bean was born health with Cobain's big blue eyes.

Cobain missed his daughter's birth not because he was strungout or wasted — but because he was detoxing.

Would he have been able to be present for his daughter's birth if he continued his methadone?

Those are the questions we don't ask when we, collectively, demand sobriety.

I'm going to skip the Vanity Fair-affair. It's gross and I hate it. The contempt America has to women in addiction, particularly mothers, particularly Black mothers, is so evil.

All you need to know: Cobain missed his daughter's birth for nothing. He used heroin the next day.

This thread is getting long but bare with me — this is where things get extra interesting.

Fall 1992, Cobain started treatment with a controversial doctor called Robert Fremont who specialized in treating Hollywood's rich and famous. He also had a past of drug use himself.

Fremont utilized a controversial and illegal treatment: he gave Cobain buprenorphine.

Buprenorphine is similar to methadone, a long acting opioid that eliminates cravings. It's considered extremely safe.

According to most accounts I read, it worked. inquirer.com/news/kurt-coba…

Today buprenorphine is considered the first line of treatment for opioid use disorder. People can continue to take it for years. If they are well, who cares if there is technically opioids in their blood?

Also, unlike detox, it's backed with evidence. inquirer.com/news/kurt-coba…

I'm very unclear how consistent was Cobain's buprenorphine treatment between fall 92 and summer 93.

He definitely engaged with some form of treatment again, and again.

He even got day passes from rehab to perform in the MTV music awards. (Hi Axel!)

In summer of 1993, Dr. Fremont died.

California was cracking down on his license and he was facing criminal charges for prescribing buprenorphine.

Was his prescription pattern was within today's standard of care? Stay tuned. I requested records.

From Heavier Than Heaven:

In 2002, the FDA approved buprenorphine for the treatment of opioid use disorder.

But it is still not like any medication. Providers need to get a special waiver to prescribe it and they have patient limits.

In some states, lawmakers are trying to make it *harder* to prescribe.

It is still illegal for *any* physician to prescribe methadone. To get methadone, patients need to stand in line daily in a clinic.

There seems to be little urgency to change that — even as a person dies of an overdose in the US every five minutes. inquirer.com/opinion/commen…

In March 1994, Courtney Love staged an intervention.

It was them, his marriage, Nirvana or the drugs. Nirvana or the drugs.

A few days after he flew to detox in LA, like half a dozen times before.

He lasted two days. A week later he was dead. inquirer.com/news/kurt-coba…

In her public eulogy to her husband Kurt Cobain, Courtney Love delivered a scathing indictment of the push toward abstinence: "You go home and you tell your parents, 'Don't you ever try that tough love bullshit on me, 'cuz it doesn't fucking work.'" inquirer.com/news/kurt-coba…

"The goal of addiction treatment should be to ensure wellness and safety, not abstinence from any and all substances — Kurt Cobain tried that, multiple times, and it failed him... America must stick to evidence with empathy, not demands of sobriety." inquirer.com/news/kurt-coba…

Prologue:

After Kurt Cobain died, the Seattle based Sub Pop records offered the University of Washington to open the Come As You Are center for youth in addiction. Everyone welcome. No pre-conditions.

Sub Pop sold and the project never materialized. archive.seattletimes.com/archive/?date=…

End notes:

For more, read Come As You Are by Come as You Are: The Story of Nirvana by Michael Azerrad and Heavier Than Heaven by Charles Cross. Any error in the article/thread is mine, not theirs.

Thank you @alisonmccook for editing me on this!