Stories of Substance Abuse and the Pain It Causes
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Addiction: Prescription Pills
By: Nancy Nall Derringer
Throw a pebble in a pond — no, just a single tablet, say, a 30-mg OxyContin pill — and watch the ripples spread. Maybe this metaphor is wrong, but let’s run with it for a while. Let’s assume the pill is legally and legitimately prescribed, by a doctor, for relief of pain. OxyContin, when it came on the market in 1996, was considered a breakthrough medication for those with moderate to severe pain, the sort that puts patients on a roller coaster of misery. Take a pill, the pill wears off, take another pill, etc. OxyContin, formulated in a time-release formula by Purdue Pharma, needed to be taken only once every 12 hours, leaving people with severe arthritis, bad backs, injuries that left their sufferers in a world of pain, free to live with a lot less of it.
Only it didn’t work out that way. It wasn’t long before people figured out the drug could be crushed and snorted and its time-release qualities nullified, for a powerful high. It’s an opioid drug, after all, the same chemical family as morphine and heroin, delivering the mellow, warm euphoria users have sought for as long as opium poppies have been cultivated for their medicinal properties. In fact, “hillbilly heroin” soon became one of the drug’s nicknames, for its prevalence in Appalachia, a region full of people living with lots of pain and not much income.
The popularity of the drug for both legitimate and illegitimate uses made it widely prescribed
and tempting for patients to sell their unused pills to others, although that wasn’t enough to stem the demand. Sometime around 2000, drugstores started being hit by stickup thieves who demanded nothing but OxyContin. The street value of prescription Oxy is at $1 per milligram, so our 30-mg dose — considered moderate strength (the dosages go up to 80-mg) — is a $30 purchase for those who want to abuse it.
But it’s plentiful. Oxy and narcotic pain relievers like it — Percoset, Vicodin, others — are the most widely prescribed in the United States, which takes 80 percent of the world’s opioids and 99 percent of its hydrocodone. Doctors might prescribe 30 for a patient who takes five or 10 to get through the aftermath of shoulder surgery and sticks the rest in the medicine chest, just in case he sprains an ankle down the road and needs something stronger than Tylenol. Those extra pills have a way of being found — by teenagers looking for party drugs, by house burglars looting more than the jewelry box. And soon our Oxy is out on the street, being swallowed or ground and snorted for recreation, not relief.
Let’s say today it’s inhaled by one of those among us predisposed to addiction, whose nervous system reacts to these substances — alcohol, drugs — differently from the rest. For these people, the message received by the brain is very simple: You complete me.
“We’re taught at an early age to take medicine to feel better,” says Dr. Mark Menestrina, until recently chief medical officer at Brighton Hospital. “But for people with that predisposition, when we use substances, we have a very different response. We feel a lot better. We get extreme reinforcement. It’s the answer to all of our problems.”
Menestrina says “we” because he’s an addict himself, a disease he describes as “a genetic predisposition with environmental exposure.” Or, to put it in layman’s terms: Genetics loads the gun and substances pull the trigger. Menestrina had a long history of alcoholism in his family; he liked to drink himself. As a practicing family physician, he knew a drunk doctor was a problem, but in the magical thinking of addicts, decided the problem wasn’t his drinking, but the smell of liquor on his breath. So he switched to drugs.
“The only drugs I haven’t used are ones that weren’t invented when I was out there using,” he says today, with evident good cheer. Although, as you might expect, the 14 years it took him to get clean weren’t a very cheerful time.
“I lost my [medical] license, my job, my wife, my car,” he says. “I lost everything.”
It’s a common story in recovery, the only story, the one everyone knows. But this story is about that OxyContin pill. When it was swallowed by the future addict, or disappeared up that person’s nose, or into their arm, it was no longer a substance for relieving specific pain in the back or knee, but one to relieve a more amorphous sort — of addiction. Depending on who ingested it, it might have been only the first tickle of a growing dependence or just one more quickly passing high in a years-long habit. Now the ripples are moving.
Prescription-drug addiction is approaching crisis levels around the country. In 2009, the last year for which data are available, approximately 7 million Americans used “psychotherapeutic drugs taken non-medically,” the National Institute on Drug Abuse reports. Psychotherapeutic drugs target the central nervous system, and include pain relievers, tranquilizers, stimulants, and sedatives. The problem is being driven by a complex and interwoven collection of forces that encompass everything from a lousy economy to savvy marketing by pharmaceutical companies (these are medicines, after all) to the Internet’s Wild West marketplace to libertarian social policy.
“You can get a fair amount of this over the Internet,” says Tom Ghena, administrative director of Henry Ford Behavioral Health’s Maplegrove Center. “It doesn’t take a lot. An addict can be very adept at getting significant quantities of Oxy and Vicodin sent to him over the Internet. They’re good at finding docs who are selling prescriptions.”
Other doctors, Ghena says, “aren’t crooked but are overwhelmed.” Faced with large patient loads and ever-shrinking time to spend with them, some respond by reaching for the prescription pad.
“I talked to a doctor who is taking over a practice, and was just astounded at how many patients were on these drugs,” Ghena adds. Doctors treating patients with chronic pain need to be aware of the potential for abuse and dependence, and carefully manage their prescriptions accordingly.
Ghena cautions that there’s a difference between addiction and dependence. The latter can be created by treating a condition long-term; patients can develop dependence and need to be nursed through withdrawal. Addiction is increased tolerance combined with a compulsive using style, the more-more-more that leads the user down the familiar spiral. What prescription-drug addiction does, however, is collapse the time frame, sometimes drastically.
“In some ways, the addiction field hasn’t changed at all,” Ghena says. “The way we understand it is the same as it was 20, 30, 40 years ago. What’s different is, the average age is dropping, due to neurochemistry. It takes a good 10 years to develop an alcoholic pattern of drinking, but opiate addiction can develop in six months.”
Once it does, here’s what happens: Prescription pills, as easy as they can be to get, are expensive, and addicts are often cash-poor. Before long, they’re looking for something cheaper.
Again, a tangled web of factors is making a par- ticular opiate widely available at a bargain: heroin.
Those who might think of this as the ultimate opiate, the last word in hard-drug use, confined to ghettos, homeless encampments, and other nihilistic venues, should talk to Diane Montes, a Livonia youth pastor whose son, Brian, overdosed and died in his bedroom five years ago.
“Heroin? People under a bridge in Detroit do heroin,” she says today, speaking of her disbelief at the time. “Not young men in close, loving families who eat dinner together.” The Montes family was devastated to discover, too late, that Brian, a Michigan State student between his junior and senior years, had been experimenting with it.
Heroin is in abundant supply around the world, most of it entering the country via Mexico. And it’s not all being shot under bridges in the city. More than one-quarter of those seeking heroin treatment in Genesee County are under 29. Even affluent suburbs like Grosse Pointe are seeing the drug turning up in their communities.
“We’re well aware of heroin here,” says Dan Jensen, police chief in Grosse Pointe Farms, where last year one of his officers arrested a teen boy who admitted having recently used the drug. “His sister said, ‘Well, he only uses it recreationally,’ ” Jensen says.
The spreading ripples haven’t been confined to users and their families. Drugs are the driving force behind theft, petty and otherwise, throughout the area, Jensen says. Residents who fail to lock car doors, or leave their garage doors up while they run to the store, are coming home to find small electronics and lawn-care equipment missing. It frequently makes a short hop across Mack Avenue, to a drug house or a dealer, to be traded for whatever the user can get for it. These mini-crime waves come and go, and nearly always have an addict behind them.