When she was 18, Arielle would come home every day and embark
on what she calls an “Easter egg hunt." She wasn’t looking for candy.
Arielle was hunting behind stairwells and inside closets in her suburban
Long Island home for the OxyContin bottles her cousin brought home from
work at a pharmacy and was hiding from her mother around the house.
“I
found them one day, and I wanted to try them because all of my friends
were already hooked,” said Arielle, who asked that her last name be
withheld to avoid hurting her chances of getting a job. “I would see [my
cousin] nodding out on the couch and not really being present, and that
was how I wanted to feel. My best friend had just passed away, so I was
numbing out the feelings.”
It took about a year before Arielle
moved from prescription painkillers into the illegal drug that killed
her best friend: heroin. She snorted it for the first time after tagging
along with a friend who was going to buy some. "I was like, 'I love
it,'" she said. Heroin was cheaper than prescription pills -- about $10 a
bag, compared to $60 to $80 per pill -- and gave her a more potent
high.
Her friend helped her inject the drug. “It was a feeling
that I don’t think anyone should experience. Because once you experience
it, you want to experience it over and over again,” she said. “ Next
thing I know, I’m addicted.”
Arielle landed in a Long Island jail
last year after she was caught breaking into a house and stealing money
to buy drugs. Now 26 and living at a substance abuse treatment center,
she says she's all too aware that her story isn’t unique.
Between
1996 and 2011, the number of people who ended up in substance abuse
treatment centers in Suffolk County, where Arielle lives, as a result of
heroin
jumped 425 percent,
according to a 2012 special grand jury report from the county’s Supreme
Court. During the same period, the number of people who landed in
substance abuse treatment for opioid pill use spiked 1,136 percent, the
report found.
Long Island is one of many areas of the country
where heroin addiction is reaching harrowing levels, according to
Gregory Bunt, the medical director at Daytop Village, a New York-based
substance abuse treatment center. The crisis is
getting renewed attention after actor Phillip Seymour Hoffman died last month from an apparent heroin overdose. The rise in heroin use
mirrors a decade-long spike
in abuse of prescription opioids -- painkillers that are a medical
cousin to heroin, but are legal as long as they’re prescribed by a
doctor.
In recent years, more prescription drug abusers have
started turning to heroin for a cheaper high as the price of pills
skyrockets on the black market, Bunt said. Two factors have contributed
to the cost increase: opioid addiction boosting demand and doctors
becoming more cautious about prescribing opioids, decreasing supply,
Bunt said.
Another reason for the price increase: The Drug War, according to
a January 2012 report
from Radley Balko. Government crackdowns have made it difficult for
even reputable doctors to prescribe pain pills. To fill the void,
doctors and others looking to make a buck off the prescription pills
created so-called "pill mills" -- offices that prescribe pain medication
in high volume and often serve people addicted to the drugs.
The result: Nearly four out of five people who recently started using heroin used prescription painkillers first,
according to a 2013 study from the Center for Behavioral Health Statistics and Quality.
“A
lot of people who got in trouble with the prescription opiates are
switching over to heroin, and they get more for their buck, so to
speak,” Bunt said. In his experience, he added, much of the heroin
available today is laced with other additives, like additional
painkillers -- making it more dangerous.
“Once you inject the heroin that’s available today, you’re at very high risk for fatal overdose,” he said.
See full-size image here.
Infographic by Alissa Scheller for The Huffington Post
For
decades, opioid painkillers, like oxycodone, hydrocodone and morphine,
had been used successfully to treat conditions like intense pain at the
end of life for cancer patients and acute pain after an injury like a
broken bone.
But everything changed when OxyContin -- and the
marketing campaign that came with it -- started in the 1990s, experts
say. The drug, developed by Purdue Pharma, had a time-release mechanism
that spaced out its effects over a longer period of time.
In
dozens of seminars in ritzy hotel conference rooms
across North America, the company sold doctors on the idea that the
time-release function made OxyContin perfect for a population of
patients who were suffering from chronic pain. Representatives also
argued that the drug's spaced-out effects made it less likely that
patients would get addicted -- which was the main factor deterring many
physicians from prescribing opioids for chronic pain.
“This
campaign focused on convincing doctors that they shouldn’t worry about
addiction, so the medical community was taught to believe that addiction
to opiates was relatively rare,” said Andrew Kolodny, the director of
Physicians for Responsible Opioid Prescribing.
The pitch was
convincing, Kolodny said, because no doctor wants to believe that
they’re keeping a patient in pain unnecessarily. By 2001,
OxyContin had exceeded more than $1 billion in sales,
and by 2003, nearly half of the doctors prescribing OxyContin were
primary care physicians, according to a 2004 report from the Government
Accountability Office.
“As prescriptions began to take off, it
led to an epidemic of opioid addiction,” Kolodny said. “We all became
much more likely to have opioids in our homes, so it created a hazard.”
“We
have now this incredibly unusual public health crisis that’s
essentially caused by physicians, caused by the health care industry,”
said Meldon Kahan, the medical director of substance use services at the
Women’s College Hospital in Toronto.
Chart via the Harvard Kennedy School.
In 2007,
Purdue and three of its top executives pleaded guilty
to misleading doctors, regulators and patients about OxyContin’s risk
of addiction. The company agreed to pay more than $600 million in fines.
In 2010, Purdue developed a version of the drug that was harder to
crush and snort or inject than the original, aimed at deterring abuse.
In April,
the FDA banned the original OxyContin and all of its generic versions from hitting the market.
Purdue
Spokesman Raul Damas wrote in an email statement to The Huffington Post
that “like any public health issue, opioid abuse is the result of many
factors, not just one drug or one company.” Brand-name OxyContin
represents a
small share of oxycodone-based drugs on the market, and Purdue
has taken steps
to curb the addiction epidemic, like paying for addiction hotlines and
working with law enforcement to help them better identify pills that are
frequently abused.
“The recent increase in heroin abuse is an
unfortunate result of many different factors, and what often gets lost
is that prescription opioids play an important role in helping patients
and physicians address the very real issue of chronic pain.” Damas
wrote. “Purdue has led the development of abuse-deterrent opioids, but
these efforts need to be complemented by public education and treatment,
so that we address demand, as well as supply.”
People typically
become addicted to the prescription pills in one of two ways, Kolodny
said. The majority of younger users, like Arielle, find the pills lying
around at home or at friends’ houses. But the other demographic
suffering from prescription painkiller addiction -- middle-aged
Americans -- typically get the pills from their doctors for things like
chronic back or head pain. Once their bodies adjust, their doctors have
to up the doses to mitigate the pain.
Betty Tully experienced
this phenomenon firsthand. She went to her doctor in January of 2001,
looking for a fix for the pain that had plagued her lower back for
decades. Tully’s doctor said he had just the thing, a new “miracle drug”
that could help her pain without putting her at risk of addiction. He
started her on 20 milligrams of OxyContin. Soon, she was asking for
more, so he upped her doses.
“By June, I was an absolute zombie. I
couldn’t work anymore, I couldn’t drive my car anymore. I left my car
running one day on the street,” the former real estate agent said. “I
was calling his office and screaming that I needed this medicine.”
By
the end of 11 months, Tully was on 280 milligrams of OxyContin per day.
The mother of two, who had held down jobs since she was 12 years old,
refused to leave the house for fear she’d miss a dose and go through
terrible symptoms of withdrawal like nausea and profuse sweating. When
she decided to get clean, it took her six years to completely get off
the drug, and she says she’s lucky she was able to finally kick the
habit. Indeed, according to Kolodny, "middle-aged women getting pain
pills from doctors" are dying from overdoses at some of the highest
rates in history. In 2010,
40 percent of U.S. drug overdose deaths were women, many of whom died from abusing prescription pills.
“I should be among those statistics,” Tully said. “There’s not many people that can take that much and be breathing every day.”
CORRECTION:
Language was changed to clarify that while 40 percent of drug overdoses
in 2010 were women, not all of them died from taking prescription
pills.
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