“There was the addict, and there was my child… It took me 17 months to lose my daughter from the day I heard ‘Mom, I’m a heroin addict.’”
Diana was shocked to hear those words from her daughter, Brooke, in July 2015. Brooke was 17 years old, from a middle-class family on the Virginia Peninsula. She was by all accounts a normal teenager – smart, involved in her community, well-liked by friends – all it took to get her hooked on heroin was trying it once at a party. For the next year and a half, she and Diana worked together to find treatment for Brooke’s addiction, desperately searching for resources through her high school, community organizations and rehabilitation facilities across multiple state lines.
Brooke had overdosed once before her death. She was brought to the emergency room and revived. On Jan. 2nd, however, what she thought was heroin turned out to be a lethal combination of cocaine, MDMA and crystal meth. It was a small enough amount that Brooke snorted it, as she had with similar amounts of heroin in the past, but within hours she was brain-dead. She was removed from life support three days later.
An opioid crisis is sweeping the nation, with record numbers of deaths and addiction rates. It’s gotten so bad, in fact, that President Trump has declared it a national emergency. Brooke’s opioid addiction began with heroin; however the majority of opioid addictions actually begin with a legal prescription for narcotics.
Kim Dellinger, executive director of Bacon Street Youth and Family Services in Williamsburg, Va., says that Ohio and West Virginia are being hit particularly hard by the epidemic, and it’s trickled into Virginia.
“There’s a stigma around drug abuse and addiction that makes people avoid talking about it, but the fact is, right now the opioid epidemic is one of the biggest public health problems that has happened in our country. There are more adolescents dying from opioid usage in this country than in car accidents,” she says.
If you’ve ever recovered from a surgery, broken a bone or been sliced open by a scalpel, you’ve likely welcomed with open arms the comforting, relieving and fuzzy feeling provided by your prescribed painkillers. Physicians frequently scribble out prescriptions for opium-containing medications, or narcotics, to their patients – particularly those just out of surgery. Opium is the ingredient that takes you that extra step, from just relieved from discomfort to comfortably numb. You can’t get that from Tylenol or ibuprofen – for that, you need the heavier stuff.
OxyContin, hydrocodone, codeine and morphine are some of the more common opioids, which basically are drugs containing synthetic opium that attaches to neuroreceptors in the brain, putting users into a euphoric state. Opium is also the main ingredient in heroin. Oftentimes, what starts as a dependence on prescription medications for pain management leads to the development of an addiction.
Users chasing that high either accept or ignore altogether the negative side effects of opioid usage, which can include constipation, nausea and vomiting, liver damage, lethargy, abdominal distention and respiratory distress.
“Addiction is not about wanting to feel good; it’s about not wanting to feel bad,” explains Dellinger. of addiction feels horrible all the time and seeks the drugs for an illusion of normalcy. The problem is, they’ll never again attain the high they found after taking their first pill, so sobering up becomes harder each time.”
A short YouTube video, simply titled “Nuggets,” gives an astoundingly simple, yet powerful depiction of the highs and lows of addiction. It starts with a happy-go-lucky animated kiwi bird stumbling upon a gold nugget, which he curiously tries and it makes him feel blissfully high. The video shows to him desperately taking these nuggets to try and to get high again, but instead he crashes down to the ground, symbolizing the withdrawal addicts experience after coming down from an opioid high.
When a prescription has run its course, some addicts look for opportunities to steal pain killers or buy them off the street. However, that comes at a hefty price and heroin is a much more affordable alternative. This isn’t to say that everyone who recreationally takes a pain killer every now and then will turn to heroin, or even develop a dependence on opioids, but it happens often enough that it’s swept the nation as a serious epidemic.
- One in seven people in America has an addiction problem of some sort
- The population that sees the most opium overdoses and deaths is 12- to 24-year-olds
- Three out of four addicts got to that point after taking a legal prescription
Physicians began regularly prescribing OxyContin after insurance companies warned them that patients might sue for malpractice if they refused to treat their pain. According to the American Society of Addiction Medicine, 259 million prescriptions for opioid painkillers were written in 2015.
People have an expectation for doctors to treat not only their conditions, but also the pain associated with them, Dellinger says.
“Despite many doctors’ ‘take it only as long as you need it’ warning when prescribing pain killers, many patients are stuck in the mindset of ‘if there’s something left in the bottle, I should take it,’” says Dellinger. “As a society we are programmed to think we are supposed to see our prescriptions through, but if you take opioids for 30-45 days you will go through a withdrawal, no matter who you are.”
Biochemistry and genetic predisposition mean all of us have vastly different brain chemistry, she explains. Some people are able to take an opioid and hardly be affected, while others take one and say “I never want to live without this.” It’s all based on your individual characteristics. Dr. Scott Bradley concurs. Bradley is a physical medicine and rehabilitation physician with Hampton Roads Orthopaedics and Sports Medicine in Williamsburg, Va., who focuses on interventional pain management and nonoperative orthopaedic care. In this role, he’s prescribed his share of painkillers, but does so with great respect and understanding for regulations on narcotic prescriptions.
Dr. Scott Bradley concurs. Bradley is a physical medicine and rehabilitation physician with Hampton Roads Orthopaedics and Sports Medicine in Williamsburg, Va., who focuses on interventional pain management and nonoperative orthopaedic care. In this role, he’s prescribed his share of painkillers, but does so with great respect and understanding for regulations on narcotic prescriptions.
“There is a lot of regulation on writing a prescription for more than seven days, so if I’m writing a prescription for chronic pain, it comes with an opioid agreement that holds the patient responsible,” Bradley says.
On top of this, he checks with the state’s prescription monitoring program for signs of drug-seeking behavior, such as the patient visiting multiple providers or pharmacies. If patients need a refill, they must not only return to the office to get a new, hard copy of their prescription, but also submit to urine tests and reevaluation. Patients seeking a different medication altogether are required to return their unused pills for disposal.
“Pain is subjective,” Bradley says. He explains that mood, emotion and mental health play into diagnosing, along with pain levels, and health care workers need to recognize that there are bigger components than just what people see up front.
Additionally, there are many avenues to addressing pain and many alternatives to narcotics. Physicians are put in a tough spot when patients demand narcotics, however, because of how important patient satisfaction is to a practice’s reputation.
“People are trying to chase their pain, thinking ‘if one helped a little bit, two must help a lot,’” Bradley says. “We try to recognize patterns that people aren’t taking their medicine like we want them to or they are misusing them. To halt the epidemic, we have to change the culture. We want to save these medicines only for patients who are in severe pain and even then, minimize the dosage.”
Which brings us back to why people turn to heroin. When they are unable to get an opioid from a provider or affordably on the street, they often turn to its more affordable cousin, heroin. But there are many dangers looming each time a user goes to inject, snort or smoke heroin, because of how easily it can be laced with something else. The Centers for Disease Control reports that heroin deaths increased 20.6 percent between 2014 and 2015.
China and Afghanistan are home to vast poppy fields, and have become some of the largest sources of opium for heroin production. A huge concern surrounding heroin users, particularly when it is sourced from abroad, is the uncertainty about what the opium could be cut with to enhance the high.
One contributor to heightened mortality rates is fentanyl, an opioid 10 times as strong as heroin, far more concentrated and able to cause overdoses by being absorbed through the skin. You may recall a viral news story from just a couple months ago in which an Ohio police officer took all the necessary safety precautions while addressing a fentanyl situation, but overdosed hours later after wiping a seemingly innocuous powder from his uniform. It took four doses of Narcan – a drug that blocks opium from attaching to neuroreceptors and stops an overdose in the process – to save his life.
Between 2014 and 2015, the death rate from synthetic opioids like fentanyl increased 72 percent. The next level up, though fortunately not seen as often, is carfentanyl, an elephant tranquilizer than can trigger an overdose with a dose the size of three grains of sand.
In 2015, the U.S. saw an average of one overdose every 16 minutes. Hospitals saw roughly 136,000 opioid-related emergency room visits and 33,000 overdoses ended in deaths, but that doesn’t have to be the case. Can anything be done to stop the opioid problem? Dellinger says being proactive is key.
One proactive measure is responsible and safe disposal of unused narcotics, so patients aren’t tempted by half-full pill bottles sitting in their medicine cabinets. To counteract this, a landfill-safe pouch has been engineered to help people easily get rid of excess medication. Simply inserting the pills and some warm water and shaking the pouch around deactivates the drugs. The whole thing can then just be thrown in the garbage. It’s cost-effective, private and easy to use.
Organizations such as Bacon Street Youth and Family Services hope that education and raising awareness on the epidemic will lead to fewer overdoses and that taking a proactive approach to treatment will prevent deaths. Once a month, the center offers a free training session on Narcan administration.
“If we don’t take proactive steps to address the issue, we’ll have to take reactive steps,” Dellinger says.
Bradley agrees. He also says that everyone of caregiving age should be educated on what overdoses are and trained to recognize the signs of one. “Most people envision an overdose as someone slumped over and not breathing, but agonal (or gasping) respiration is a sign, too, and should be addressed immediately,” he explains.
Up to 90 percent of overdoses are accidental and are caused by someone simply looking for a way to stop pain, or again reach the euphoric high they once could. As Dellinger says, it gets harder each time. Additionally, a person who’s had an overdose in the past is more likely to overdose again, she says.
Opium performs a little dark magic on the human brain. It can numb us, take away pain and make us feel euphoric all at once, but those feelings come with heavy side effects and an incredibly high rate of addiction. Brooke’s story was not unlike many others, in that all it took was one rush of opium-induced euphoria to become hooked. The truth is, mothers like Diana lose children every day to the opioid epidemic that’s swept the country, though opioid addiction is prevalent among all ages and demographics. Brooke’s story is, sadly, not all that unique.
Each day, people are introduced to narcotics that they develop a relationship with and aren’t willing to let go of, or try heroin for the first time and love the feelings it comes with. It’s accidental – no one means to become addicted – but taking proactive measures, providing education and working to end the stigma of “let’s not talk about addiction” can reduce addiction levels, overdoses and deaths.
That little kiwi bird from the video could be any of us.