Pill Head: The Secret Life of a Painkiller Addict (23 page)

“I don’t even remember how I felt before Ritalin,” he told me. “After, I remember my life as a continuous series of being really psyched about things, then hating the world. I didn’t understand it.”

He eventually got Adderall added to his ADD cocktail. “It just got automatically prescribed to me,” he said. “I didn’t think anything of it at first, until a friend of mine who knew I had a prescription started asking me for them. I didn’t really know why, but then I looked closer at the bottle and it said ‘mixed amphetamines,’ and I said to myself, ‘Hmmm, amphetamines, huh?’ So I did some research on the drug scheduling system and found that Adderall was a Schedule II substance. I realized I had an endless party for free. And it was fun.”

Years later, around 2005, he was working at the local recycling center. On the job, he met a guy named Gary, who had been in a nasty car wreck years before: he’d fallen asleep at the wheel and driven into a ravine. He’d messed up his chest really badly, his clavicle was now positioned way too far over, under his chin. Gary had prescriptions for both Vicodin and OxyContin to deal with the pain. He’d take what he needed but had leftovers, so he asked Elliott if he knew anyone who wanted to buy some.

The Oxys were 40 milligrams and Gary was willing to sell them for $17 each, which was less than half the street value. Elliot’s friend Sam had always talked about how much he loved painkillers but could never get any, so Elliot told Gary he could easily get $17 from Sam.

“When I told Sam about the opportunity, he gave me $170 for ten,” Elliott said. “I wasn’t really interested myself—I guess I just had this idea that OxyContin was too intense. But soon after I sold Sam his first bunch, we skipped class and both took one. We ended up lying on the floor and watching old Genesis videos, almost crying because it sounded so beautiful. It was weird. I never even knew I liked Genesis. At least it was the Peter Gabriel era. Anyway, after that, I started buying my own pills.”

After Elliott’s night of old-school Genesis worship on OxyContin, he started taking pills about once a week, recreationally, with his friend Sam. Sam would give Elliott money to give to Gary.

Elliott would deliver the pills to Sam and then Sam would give him just one. “Every time I did it, I’d think, ‘Oh, I don’t need to do that again,’” says Elliott. “But as months went on, Gary started giving me Vicodin for free at work every now and then, just for fun. But then I started wanting them outside of work, so I’d meet him at these weird, sordid places like gas stations or car garages.”

Gary was being prescribed ninety OxyContins a month, but once Sam started buying regularly from him, he always ended up selling out within a week or two. “I had to start waiting a few weeks in between my pills, and it drove me crazy,” Elliott told me. “Gary was keeping only a few OxyContin for himself, because he had to submit to regular drug tests so his doctor knew he was actually taking them, and that there were no other drugs in his system that would interfere with the prescribed narcotics. He would save a couple of Oxys for himself and take them a few days before each test.”

We’ve already heard of some doctors doing this, and the DEA believes this sort of drug testing is a good idea from a commonsense standpoint. But they can’t officially recommend or enforce it because it strays into the practice of medicine as opposed to the legal application of the Controlled Substances Act. As a federal agency, they leave it up to the discretion of medical boards.

Gary thought OxyContin made him too slow, which is why he preferred to sell it and keep only what he needed for his tests. He much preferred his Vicodin, and as time went on, he became more and more hesitant about selling or giving any away to Elliott.

“I’m pretty open about my drug use,” Elliott said. “And it got to the point that if I couldn’t find any pills, I’d just ask people. If someone was talking about pot, I’d just say, ‘Hey, dude, know where I can get painkillers?’”

Elliott doesn’t believe that he was physically dependent on anything at the time. “It was more of a behavioral thing,” he explains. “It’s a problem I have with impulsivity.” For a while, he even slowed his drug use down after one particularly nasty incident involving a Fentanyl patch and a bunch of Gary Numan songs.

“Sam was taking the pills I was getting him from Gary at the recycling center, and taking them up to Cleveland to trade with other junkies. He got really into Fentanyl patches; he’d bring them back, bite them open, and suck the fluid out of them.”

Fentanyl patches, such as Duragesic, are applied to the skin and deliver an extremely strong opioid analgesic: a single patch can control pain for up to three days. They are mostly used to treat people with intractable cancer pain. They are also usually only provided to patients who have developed a tolerance to other pain medications. It’s recommended that patients have a tolerance equivalent to 60 milligrams of morphine a day for at least a week before going on the patch.

Sam gave Elliott a couple of patches, and one night Elliott sucked the liquid out of both of them.

“I was at my mom’s house,” Elliott remembers. “No one was home—she was out of town. I remember getting really excited about downloading a bunch of Gary Numan songs, or something weird that I normally don’t like. That
always
happens to me when I’m high. The next thing I know, it’s morning and I’m lying on my mom’s bedroom floor covered in puke. I totally cut my drug use in half after that scare.”

I can guarantee you that there are millions and millions of teenagers and adults who have had similar experiences with alcohol. You drink too much, you pass out, you wake up covered in puke and think to yourself, “Whoa, never again,” or “Shit, I’d better take it easy for a while.” It happened to me countless of times as a teenager—the “normal” time period when, if you’re a budding drinker, you test
your limits and discover what works for you and what doesn’t. It’s messed up, but those kinds of stories don’t faze me in the slightest. I’m used to them, I’ve seen them, I’ve been there.

There are two main dangers in passing out while drunk: you may aspirate your own vomit into your lungs or you may stop breathing—too much alcohol depresses the respiratory center in the brain. The same dangers exist with Fentanyl, only more so. Just one Fentanyl patch contains enough analgesic to relieve pain for up to
three days
.

Think of it this way: when you’re out at a party you can usually tell when your friend has had too much to drink. You see him stumbling around with a bottle and waving someone’s underwear, or babbling incoherently about some old episode of
The Facts of Life
, or falling down a flight of stairs. (Guilty on all counts.) In this circumstance you may try to help by putting your friend in bed and checking on him periodically to make sure he’s still alive. In extreme cases, you may take your friend to the hospital.

But Elliott was alone when he took a massive dose of a powerful substance contained in what seemed like a very small amount. No one thinks he’s going to die from one Jell-O shot. And being alone is standard practice for a pill user: pills (and patches) aren’t social drugs, even though the media loves to portray the dangers of “pharming parties.” Sure, they exist, but usually in a much more casual way. When a bunch of the guests trade some pills at a cocktail party it doesn’t become a pharming party. It’s still just a cocktail party where some pills happened to be traded.

Elliott was lucky he didn’t die that night. But it still wasn’t enough for him to realize he should quit opiates. He did what any normal college kid would do after waking up covered in puke. He just decided to slow down for a little while.

When Emily, Jess, and
I arrive at the bar Elliott is easy to spot—the one lone twenty-five-year-old emo-looking kid, sitting in a small-town college bar. Jess and Em left me alone to talk with him. We slid into an outdoor booth, ordering beers.

“How’s school going?” I asked him.

“It could be going better,” he answered, tossing his bangs out of his eyes and taking a sip of beer. “I asked my doctor for more Adderall to help me out.”

“And?” I asked.

“He said no. I think I’m pretty much flagged in this town as a big-time drug user. But he’s understanding about it; he tells me he wants to help me but doesn’t think Adderall is the right way to go. So he put me on another drug, called Strattera. I started four days ago, but it hasn’t begun to work yet.”

Strattera is a relatively new drug for treating ADD. It’s supposed to help people focus, but in a nonstimulating way.

“I can already feel the side effects, though,” he said. “I’m impotent, for one thing. And I have dyspepsia. I’m always thirsty.”

With that he flags down our waitress and orders another beer. I order one too. The beer is intensifying the effects of Julia’s hydrocodone and I feel a rush of guilt. I’m acutely aware of the hypocrisy of interviewing someone for a book about drug abuse while I’m on drugs.

Elliott pointed to a set of railroad tracks across the street from the bar. “I know someone who died on those tracks,” he said. “This kid who also used to do a lot of pills. We started a band together, made a few demos, but it never went anywhere. One night we were hanging out here at the bar. Two hours later, he was dead. We got hold of the police report, and all signs point to suicide, but it was officially ruled an accident. He was legally drunk, but the report said that after he lay down on the train tracks, as soon as the train started coming, he pulled his hoodie over his head and curled up into a ball.”

I could see the tracks over Elliott’s shoulder, empty now, no trains in sight.

“After he died, I just didn’t have the energy to keep up with my drug habit for the first few days, which is pretty strange considering I was addicted. But I didn’t react immediately. I was in shock. It took me a few days before I could even cry, and even then it wasn’t until I finally took some pills.”

I could relate. As much as pills are an escape from your emotions,
after a certain point, they become the
only
emotion, the only one you know how to function with, a surrogate inner life.

“When I’m not on opiates, I feel like a robot,” he said. “They get me out of the robotic mode. And sometimes I get sadder when I’m on them, but it’s a sadness that feels more human to me.”

He tells me that he is back to doing Oxy mainly, but that his friend Sam has cut down a lot because of a new girlfriend.

“It’s mostly an alone thing now,” he said. “I don’t really have many more friends besides Sam. There’s been an awful lot of unreturned phone calls. People realized I was doing a lot of pills. The annoying thing is that any lectures I’ve gotten on my drug use have taken place here,” he said, waving his arm, gesturing to the bar around us.

“It’ll be from some drunk guy who has heard through the grapevine that I do a lot of pills. They’ll say things like, ‘Man, you’ve got to stop doing those drugs.
I
don’t do them.’ And meanwhile he’s puking on himself.”

“Do you want to quit?” I ask him.

“The last time I stopped cold it was really bad,” he said. “I mean, it wasn’t like
Trainspotting
, where you see dead babies crawling on the ceiling and stuff, but I had diarrhea and the shakes and serious depression, and I couldn’t sleep.”

“What do you think it would take to make you stop for good?” I asked, as a pill wave rolled through me.

“You don’t do pills to intentionally fill a void,” he tells me. “It just happens unintentionally, and you stick with it. Maybe schools should teach social skills classes instead of drug-warning classes so you can learn how to meet the right person. Because what I’ve felt when I’m in love is far more potent than any drug. That’s how I know that I’m not a junkie. When I look back at the times when I’ve had love, I want that so much more than the drugs. It was the only time I wasn’t abusing pills so much.”

He finishes his beer, gestures for another. “But then again,” he continues, “too much self-reflection will just make you neurotic. I don’t know who I am whatsoever.”

LOVE MAY BE MORE
potent than any drug for Elliott, but these days the preferred method used to ease addicts off painkillers is buprenorphine with naloxone, usually prescribed as Suboxone. Buprenorphine is the opioid that Dr. Bodkin had been testing for use with depression in the 1990s and the drug Jared was given in detox. Naloxone (or Narcan) in its pure form can temporarily reverse an opiate overdose and restore breathing; it is usually injected to quickly kick opiates off the brain’s receptors. The combination of the two drugs helps addicts because the opioid staves off the cravings, while the naloxone prevents abuse if you try to snort or inject it.

In 2000, Congress passed the Drug Abuse Treatment Act, a measure allowing physicians who meet certain guidelines to use approved opioid drugs to treat opiate addiction on an outpatient basis. Buprenorphine was approved by the FDA for this purpose in 2002. Doctors have to apply for a waiver and prove that they meet the guidelines. During the first year they may treat up to thirty patients. After one year, they may treat up to one hundred patients. The reason for this cap is to make sure that doctors are able to provide adequate referrals and other forms of addiction treatment for their patients.

But the sad fact is that many addicts aren’t going to seek out treatment for themselves. That is why I favor harm reduction outreach programs having access to naloxone. If our real goal with the war on drugs is to save lives, then why not put the one drug that can save a life directly into users’ hands?

Many people would argue that this would give users a free pass to take whatever they want. If they OD they can just come right back and go on using the next day. This may be true initially, but in at least some cases the trauma of overdosing and nearly dying might be enough to give users pause and seek out more aggressive treatments for their problem.

The Chicago Recovery Alliance (CRA) has been particularly vocal in its campaign to get naloxone into the hands of heroin and other opiate users. (For the record, they claim that the whole Adrenalin-shot-in-the-heart scene from
Pulp Fiction
is total bullshit—it needs to be administered intravenously.)

CRA’s most important rule is never use alone; this might be problematic for pill abusers since they often lead such solitary drug-use existences. CRA’s website, www.anypositivechange.org, has all sorts of opiate-use safety information and can tell you how to get access to naloxone and the proper way to administer it.

“The Chicago Recovery Alliance started its naloxone program in early 1997,” says Dan Bigg, the director. “I’ve had many people overdose in my life; it’s a very painful experience to have a friend die. Naloxone is the perfect antagonist to any and all opiates. It was determined by the DEA to have no potential for abuse. It’s been out there used in the medical setting since 1971. It’s really looked at as a pure antidote.”

Naloxone training and distribution has become a well-known practice within most harm reduction centers. “I’d say at our center, 99 percent of the requests for naloxone are coming from opiate users themselves,” says Dan. “But sometimes someone will bring in his mother, and the mom will say, ‘Can I have my own in case my son loses his? Because I’ve encountered him overdosing and it would be nice to have something to actually do instead of watching my child die in front of me.’ In Cook County, overdoses kill somewhere be
tween eight hundred to one thousand people a year; it’s a bigger killer than HIV and hepatitis and infectious diseases combined. We’ve received seven hundred and fifty-one reports of pure reversal with naloxone to date.”

Dan is hoping that someday naloxone will be available as an over-the-counter drug.

Just as parents who know their child has a peanut allergy keep a prescribed epinephrine auto-injector on hand, people who suspect their kid, friend, or loved one is abusing opiates should be trained in the use of naloxone and have an injector kit in their house.

But there are two main problems with this. Few parents like to admit to themselves that their kid has a drug problem, and even fewer are going to take the time to go to a harm reduction center to get the training they need. Most people think of harm reduction centers primarily as needle exchange programs for heroin addicts. But they provide all sorts of counseling, HIV education and testing, access to buprenorphine treatment for opiate addiction, and naloxone training. I won’t lie to you—these centers (many of which are located in inner city areas) can seem pretty scary to a white, suburban parent. The only thing I have to say to that is, parents, get over your illusions. If your kid has a bottle of Oxy hidden in his backpack, he is in no better situation than anyone else you might see milling about outside an HRC. And the people you will come in contact with
there
are at least taking responsible steps toward treatment and the spread of HIV.

“I heard from a guy from Rochester, New York, who was trying to keep his brother, who was using opiates, safer,” says Dan. “He was willing to do whatever it took to get his hands on naloxone, even fly to Chicago. Luckily he was able to find it in one of the New York programs. Once you realize naloxone is out there and what it has the potential to do, it’s hard
not
to have it as part of your life.”

I agree with this with all my heart. So much so, that right after I got off the phone with Dan, I walked five blocks down from my apartment to visit the Lower East Side Harm Reduction Center to get properly trained and have my own naloxone kit. I’ve slipped up enough times in my life with pills, and still spend my fair share of
time around other users, that it just seemed morally irresponsible not to know how to bring someone back from an overdose.

The Lower East Side naloxone program started later than CRA’s, in 2004. They were working with the New York Academy of Medicine on a study of its effectiveness, and it proved to be a success. Most of the current funding for the program comes through the city. The center also gets a lot of businesspeople in suits who show up after work at night.

“These people are really responsive to the naloxone program,” one of the counselors tells me. “They’re chipping [slang for occasional use], they’re not really fully in the lifestyle. Since they aren’t using as much, they have a lower tolerance and are in more danger of overdosing. They know that and really want access to naloxone just in case.”

I told the counselor about the book I was working on. I admitted that I had slipped up after getting clean the first time and wanted to have naloxone on hand, just in case. My training was done by a charming, fast-talking, slightly frazzled woman named Yolanda, a recovering addict herself. She was utterly thorough in teaching me how, when, and where to inject naloxone. Having already talked to Dan, I felt ahead of the game, but she gave me a ton of take-home literature and some sound advice.

“When you call the ambulance,” she said, “don’t tell them that it’s an overdose. Tell them your friend has stopped breathing. They’ll come faster that way.”

I don’t know why this surprises me. It shouldn’t, but it also depresses the hell out of me.

I signed a form stating that I had gone through training, and then she took me to meet with the prescribing psychiatrist who works on the premises. We talked about my reasons for wanting naloxone: that I didn’t feel I was in any immediate danger but that I liked the idea of being prepared, and my desire to help anyone I might happen to be around who was overdosing.

When it was over, Yolanda brought me a small blue pouch containing my naloxone and all the materials that come with it. Yolanda and I had already gone over everything that came in the pouch dur
ing my training, but when I got home I took everything out and lined them up on my coffee table.

There was a bottle of 0.4 milligrams of naloxone, a sterile 3-milliliter needle, alcohol prep pads, rubber gloves, a copy of my naloxone prescription (“In case the cops bug you,” Yolanda had told me), my certificate of completion for opioid overdose prevention signed by a member of the NYS Approved Opioid Overdose Prevention Program, a pamphlet in Spanish and English on how to use all the materials, and my favorite thing of all, a single-use Bio-Barrier Face-shield for administering the “kiss of life” to someone who is overdosing. I love the idea of being a hero, but I’m deathly afraid of cold sores.

To this day, I carry the pouch around with me everywhere I go. Luckily I’ve never had occasion to use it, or have someone use it on me.

I was disappointed that
harm reduction wasn’t mentioned even once at the DEA’s first ever National Symposium on Pharmaceutical Diversion, which took place on November 2, 2007. The symposium brought together a panel of experts in law enforcement, industry, public policy, science, health care, and medicine “for a public discussion on the complex issues surrounding the diversion of pharmaceutical drugs and efforts to combat this growing problem in America today.” It was also a chance to tell the world about the new anti–prescription drug ad campaign the DEA was launching. I sat in the auditorium for three hours. Here’s what the conference boiled down to. John Walters, the director of the Office of National Drug Policy Control, read off a bunch of stats; he then talked about how the DEA is targeting rogue Internet pharmacies. The ONDPC announced that it has partnered with the National Association of Chain Drug Stores to provide open letters to parents to teach them to control substances in the home and dispose of pharmaceuticals properly. Stephen Pasierb, the president and CEO of the Partnership for a Drug Free America, talked about how kids believe prescription drugs are safe to use because they came from a doctor; he also pointed out that these drugs are important and vital to the
medical community and we need to educate America about this.

Next up was Joseph Rannazzisi, the deputy assistant administrator of the DEA Office for Diversion Control. He talked about the evils of Internet pharmacies. Then we heard from Sharon Brigner, the deputy vice president for the Pharmaceutical Research and Manufacturers of America. She talked about how PhRMA had partnered with DARE (ahem,
useless
) to create a curriculum for fifth, seventh, ninth, and twelfth graders about abusing prescription products. PhRMA also joined up with Partnership for a Drug-Free America to talk with health-care providers who encounter prescription drug abuse to find out what kinds of resources they need. A good step, I think. Dr. William Jacobs Jr., the president of Nexstep Integrated Pain Care, Inc. (a chronic-pain facility in Florida) emphasized the importance of getting opioids to those who need them and called for mandatory training in medical school curriculums on how to better assess the risk of substance abuse in patients. According to him, this doesn’t currently exist. He also talked about NASPER, the National All Schedules Prescription Electronic Reporting Act. This is a nationwide prescription-monitoring program that would replace the current patchwork of individual state programs. NASPER was passed unanimously by Congress and was signed into law by George Bush, but so far remains unfunded.

The American Pharmacists Association sent Michael Moné to advocate on behalf of giving pharmacists access to patients’ universal electronic medical records. No! This idea flies in the face of all privacy and ethical issues in the book. The only people who should have access to your medical records are your doctors, and in certain specific situations, members of your family.

Francine Haight is a nurse and mother who lost her son Ryan to a prescription drug overdose from pills he bought online. She formed a nonprofit organization called Ryan’s Cause that focuses on education for families and communities about online pharmacies. Which is great, except that when Francine spoke about her son’s overdose, she said he overdosed on Vicodin. This simply isn’t true. Ryan Haight died from a combination of generic hydrocodone (Vicodin), morphine, Valium, and oxazepam. Francine’s vilification of Vicodin
alone at this national symposium, which was being broadcast live on television and picked up by media outlets everywhere, is, frankly, irresponsible. Misconceptions like this only contribute to the world’s fear of using opioids for chronic pain relief. I feel terrible about Francine’s loss, but she should have been clearer, especially in this massive forum, that the biggest danger comes not just from buying drugs online, but mixing the illegally bought prescription drugs together and with other substances.

Lastly came Lieutenant John Barnes from the Prince William/Manassas Narcotics Task Force. Barnes spoke about trying to quell the sale of prescription drugs by the people who were legally prescribed them.

There was a Q & A session afterward. Unfortunately, since the symposium was open to the public, it attracted a bunch of student activists who used this opportunity to get close to DEA officials in order to bitch about why medicinal marijuana hadn’t been legalized everywhere yet. I had my hand raised constantly, but was never called on.

The main point that I wanted to raise was why isn’t anyone focusing on the actual nature and study of addiction itself? Isn’t that where the heart of all this is?

A few months later, during the Super Bowl, I saw one of the new educational diversion control commercials that the symposium had promised would be coming out. In it, a drug dealer was complaining that business was down because his customers were now dipping into their parents’ medicine cabinets.

They still weren’t getting it. This was just one small fraction of diversion. Any drug dealer worth his salt carries at
least
benzos on him these days. It was “Just Say No” all over again.

It turns out that what may actually be the future cure of addiction is a vaccine. In the March 3, 2008, issue of
Newsweek,
the cover story’s author, Jeneen Interlandi, wrote, “In the current jargon of the recovery movement, addiction to alcohol, drugs or nicotine is a ‘bio-psycho-social-spiritual disorder.’” Sounds about right to me. She continued, “The emerging paradigm views addiction as a chronic relapsing brain disorder to be managed with all the tools at medicine’s
disposal. The addict’s brain is malfunctioning, as surely as the pancreas in someone with diabetes.”