On Pills and Needles

by Rick Van Warner

  In Florida, ground zero for a synthetic heroin (aka Oxy) crisis that eventually spread to all fifty states, more than 650 million oxycodone-based pills flooded the market by 2010, leading to most of the state’s 1,516 overdose deaths that year. While three of our four children were coming of age during their middle and high school years, pain clinics known as pill mills were popping up like dandelions after a hard rain throughout our region. Unscrupulous doctors, many with mail-order degrees, gladly lined their pockets by doling out scripts to anyone who had cash, credit, or Medicaid.

  On streets and in schools, Oxys became inexpensive and easy to find. Disenfranchised and bored teens learned that crushing the pills into a powder that could be snorted, injected, or smoked neutralized the time-release mechanism, creating an intense and nearly immediate escape from reality. Odorless and hard to detect, the pills became a recreational favorite, especially for disillusioned kids who struggled to find their group or feel accepted. The drugs did not discriminate, and kids and adults from all types of social and economic backgrounds soon became hooked.

  The pain any of us with an addict in our life must endure, whether we are a parent, child, sibling, spouse, or friend, is the harsh reality that we are powerless to alter the course of their path. Only the person suffering from drug dependency can change course, leaving the rest of us in their chaotic wake as cringing observers. Like a car crash on the highway, we don’t really want to look but have no choice.

  As the father of three young men and a daughter, and as a son who has spent a lifetime recovering from psychological wounds inflicted during childhood from an abusive, alcoholic father, the particularly complex dynamic between fathers and children plays an important role in the stories shared in this book. The complicated, intertwining relationship between substance abuse and mental disorders is also an important topic, based on practical perspectives gained over several long and often agonizing years of trying to save our son versus any formal psychological schooling.

  This arduous journey has taken us through numerous twelve-step meetings, residential and outpatient recovery programs, and therapist offices, and we’ve come to understand that a person’s individual psyche and will to change is the only chance they have to overcome addiction. Most people accept the medical definition of addiction as a “disease,” but as the years passed, I grew to detest this label as far too simplistic for the incredibly complex stew of brain chemistry, socialization, genetic predisposition, and life experience that leads to substance abuse. One size does not fit all, and there are no easy solutions when it comes to addiction.

  In our case, we discovered that our family’s unconditional love and acceptance proved far more powerful than any programs, group therapy sessions, medicines, or doctors in helping our son survive. Only by putting conventional wisdom aside and accepting our son with love, no matter what, were we able to help him inch forward. Tough love and detachment proved highly overrated with our tremendously sensitive son, serving only to push him to the brink.

  The razor-thin line between love and boundaries is a difficult balancing act, and by no means does this book purport to offer the solution to this terrible problem or suggest that new or unique expertise can be found within its pages. It was written with a sincere desire to help others survive the trials of parenting, coping with an addict, or simply navigating life itself. By sharing the raw, honest experiences and mistakes made while engulfed in our son’s battle, along with the seemingly endless mental struggle to regain hope, we wish to offer a small measure of solace to others stumbling down the same road.

  1

  The Vanishing

  As darkness fell on the day after Tommy disappeared, his mother became increasingly anxious when her call to his phone went straight to voicemail.

  “I’ve got a really bad feeling,” Mary said. “Where could he be?”

  It wasn’t unusual for my worrisome wife to jump to conclusions that could inject panic into nearly any situation. But this time, I shared her dread.

  “Calm down, you always imagine the worst,” I replied, ignoring the growing ball of tension in my stomach. “I’m sure he just went to hang out with a friend. He knew he was grounded if he came home, so it shouldn’t be a shock that he didn’t show after all we’ve been through this week.”

  She glared back at me. “What if you’re wrong?”

  Tommy choosing not to ride the bus that day was not that surprising, since this was humiliating to a high school junior who had been driving himself to school since the previous semester. Losing driving privileges was one of several punishments leveled due to his abysmal behavior of late, which included failing home drug tests, cursing at his parents, not coming home by curfew, and being arrested with a friend for stealing change and electronic devices out of unlocked cars. When you’ve taken every possible privilege away and essentially have a child on permanent lockdown except to attend school or a job, it is very hard to determine what to do next.

  By now we had visited doctors and therapists and had tried to reach Tommy in every way possible, but emotionless detachment had replaced his sensitive and silly nature. The defiant, stone-faced look he now always gave us was both disturbing and maddening. He simply no longer cared, as if to say, “There’s nothing more you can do to me, so screw you!”

  As we learned later, Tommy was among a growing number of kids that had discovered they could experience euphoric escape from whatever pain or insecurities they wrestled with by crushing prescription painkillers known as Oxys into powder they could then snort, smoke, or inject.

  With the twentieth century winding down and doomsday techies beginning to warn about the imminent Y2K threat, Connecticut-based pharmaceutical company Purdue Pharma1 won FDA approval for a new pain pill containing oxycodone. OxyContin, unlike earlier oxycodone-based painkillers that had been used in the United States for nearly fifty years, promised up to twelve hours of relief due to “revolutionary” time-release advancements that eliminated the highly addictive qualities associated with traditional painkillers such as Percodan or morphine.

  After winning FDA approval in 1996, Purdue launched a massive sales and marketing campaign deceptively centered on the wonder drug’s “nonaddictive” qualities. Purdue’s principal owners, three brothers who were all psychiatrists, had earlier discovered the power and profits possible through marketing directly to doctors to influence the pharmaceuticals they prescribed. The eldest was both a psychiatrist and the lead ad man behind the rise of Valium to become the first drug to surpass $100 million in sales, an achievement that won him induction into the Medical Advertising Hall of Fame. The brothers’ pioneering efforts to market to and incentivize doctors to prescribe their products essentially created the Big Pharma sales model that exists today.

  Long before big data was a marketing term, Purdue was leveraging sophisticated market-by-market databases to target doctors who would be most likely to prescribe their pain pill, focusing their efforts on those who historically were most liberal in writing scripts for opioids.2 Between 1996 and 2001, Purdue hosted more than forty national pain-management and speaker-training conferences at resorts in Florida, California, and Arizona, all-expenses-paid boondoggles designed to influence their highest potential prescribers and deputize attending doctors, pharmacists, and nurses to spread the word about OxyContin.3 By 2007 more than seventy-five tons of synthetic opioids were being manufactured worldwide, with the United States accounting for 82 percent of consumption, according to the International Narcotics Control Board.

  Purdue also more than doubled their on-the-ground sales force, with sales reps swarming doctors’ offices across the nation to push their new wonder drug, rewarding lucrative bonuses to reps with the most success. The OxyContin pushers were well armed. A starter-coupon program offered patients free limited-time prescriptions for a seven-to-thirty-day supply, enough to create initial dependency for some. OxyContin fishing hats, plush toys, and a distasteful “Get in the Swing with OxyContin” music CD were in the gi
veaway mix.

  The efforts by Purdue clearly worked. By the turn of the century, OxyContin sales exceeded $1 billion (topping $35 billion to date), and by 2001 Purdue was spending more than $200 million per year marketing it as the drug of choice for everything from wisdom teeth removal to lower back pain. According to the US Department of Health and Human Services, between 1999 and 2010, sales of opioid pain meds nearly quadrupled, as did the number of opioid overdose deaths. By 2012, doctors wrote more than 282 million opioid painkiller prescriptions.4

  When Tommy entered high school in 2007, the epidemic in Florida was in full swing. By 2010 Florida pharmacies were churning out 650 million opioid pills per year, with ninety-three of the top one hundred oxycodone-dispensing doctors in the United States working in the Sunshine State.5 More than half of the pills were not used by the patients who filled their prescriptions, research suggests. Instead, the plastic bottles were regularly left half or three-quarters full in the medicine cabinets of mothers, fathers, aunts, uncles, and grandparents, who might have taken a few after a minor surgery but disliked how the pills made them feel and quit taking them after a day or two. With the pills now fetching $5 or more each, kids soon learned how easy it was to steal a few of the forgotten pills from the bathrooms of family members or friends. In the halls of high schools and middle schools, Oxys became “as easy to get as candy at a 7-Eleven,” a police officer told me during one of many incidents involving my son. Two out of three teens who abuse the drugs obtained them from family or friends,6 and 80 percent of heroin users started out using nonmedical prescription opioids before progressing to heroin, according to the National Institute on Drug Abuse.7

  Florida, one of the least restrictive in the union when it comes to government regulation, did not have an electronic prescription tracking program in place at the time, a measure several other states had successfully deployed to curb prescription drug abuse. All this created a perfect storm. Nearly anyone could easily get a prescription from a pain clinic doctor that they could then fill as many times as desired at various pharmacies. More and more Floridians, including a disproportionate number of younger residents, soon became hooked on the white or colored pills.

  A self-absorbed generation of parents was initially oblivious to the growing problem, which was far more difficult to detect than marijuana or alcohol use given the absence of odor or signs of intoxication. By 2014, some fifteen million Americans aged twelve and older were using the prescription drugs recreationally, the US Department of Health and Human Services reported.8

  Demonstrating the widening gap between perception and reality, a Partnership for Drug-Free Kids study found that 95 percent of parents believed their child had never used a prescription drug recreationally, yet 25 percent of teens reported having done so, beginning as young as age twelve.9 Initially it seemed that the only ones who understood the spreading problem were those on the front lines left to deal with the consequences: police officers knocking on doors in the middle of the night to let parents know their child had overdosed, EMTs and paramedics trying to keep someone alive in their ambulances, emergency room doctors fighting to treat a largely untreatable patient.10 Despite clear warnings from the law enforcement and medical communities that society had a huge and growing problem to address, Big Pharma–backed lawmakers and regulators turned a blind eye to the situation.

  It was during this period of public inertia and ignorance that Tommy graduated from pot and alcohol to Oxys, marking the start of his descent into the abyss. We too were mostly clueless about the destructive forces our son and family were facing or how bad things would eventually get.

  The night before Tommy disappeared had been a particularly bad blowout, with me losing my cool and regressing to one of my late father’s meanest traits, name-calling. It was not the first time this had happened. In fact, as much as I fought to break the cycle of yelling and verbal abuse that I’d endured myself, there were times I failed.

  After picking Tommy up from his job at a sub shop, it was clear that he was completely stoned. His report card days earlier showed plummeting grades, and I sensed that drug use was behind his defiance and lack of motivation.

  “What’s going on with you?” I asked on the ride home.

  “Nothing, why?” he replied.

  “It’s like you’ve thrown in the towel since quitting the crew team. Your grades have slipped, and it seems like all you want to do is go to your friend’s house.”

  “Okay, Dad, you’re right, I’m giving up,” he replied, not trying to disguise his sarcasm.

  “Don’t be a smart-ass,” I said. “I’m worried about you.”

  “Don’t worry, as soon as I save up enough money I’m going to get my own place, and you won’t have to worry anymore; I won’t be around to bother you.”

  “That’s not what I’m saying, Tommy. I’m trying to figure out what’s going through your mind and want to help you.”

  “You want to help me?” he snarled. “You and Mom need to stop asking me so many questions!”

  After dinner, I was pulling into the driveway after a brief errand when I saw my youngest son, Barry, then fourteen, put something in the garbage can that was next to the street for collection day, then run back through the garage. Suspicious, I parked and looked inside the can. On top of the tied trash bags was an unopened red can of Coca-Cola, which felt full when I picked it up. On closer inspection on my garage workbench, I realized that the metal top actually twisted off, revealing a hard plastic canister inside with a bag of marijuana concealed inside it. I immediately lost my cool. Barry had now somehow gotten caught up in Tommy’s nonsense, I thought, storming in the house to confront Tommy.

  “What the hell is this?” I demanded. “And why are you having Barry do your dirty work for you? Is he smoking pot too?” My fears were not unfounded, as I learned years later that Tommy had introduced both his older and younger brothers to occasional pot smoking during their high school years, but thankfully no other drugs.

  “It’s a Coke can,” Tommy replied, defiantly looking me in the eyes as if to say, Go ahead, what are you going to do to me? By now all his privileges had been removed.

  “Listen, this has to stop now!” I shouted. “It’s bad enough that you’re turning into a loser, now you want to drag your brother down with you?”

  “Whatever,” he said, attempting to walk away. I grabbed him by the shoulder and spun him around to face me.

  “Don’t you walk away from me, smart-ass!” I yelled. By now Mary, Barry, and young Jessie were observing my temper tantrum, and latest loud argument with Tommy, from up the hall. “This is our house, and you’re going to live by our rules. Get it?”

  “Fine,” he said without a hint of remorse.

  Repressed anger is like a vicious, caged animal, ready to slash and gore anyone within striking distance on the awful, embarrassing occasions it breaks free. It repulses and disgusts me, and is always immediately followed by sincere regret and apologies to those I’ve unintentionally hurt. Yet as hard as I try to overcome my inner anger, it still lurks in my battle-scarred subconscious. Only through counseling and faith have I found sustained periods of peace.

  My son’s blank stare and lack of response had been infuriating, and all the angst and worry that had been building over his erratic behavior boiled over that night. Words hurt much more than physical punches or slaps, as sadly both my sons and I know. Thankfully, I’ve gotten better at muting this ugly side of myself with age and have become more adept at beating back the beast during the heated moments when it seems ready to burst through the cage door. While the name-calling associated with my moronic outbursts stopped some time ago, rarely a week goes by that I don’t loathe myself over the damage this might have caused to my sons. It took subsequent years of Tommy’s detoxes, rehabs, and relapses, and the work I did on myself through support meetings, therapy, and reading, to eventually let myself off the hook. In retrospect, I had far less impact on his decision to disappear that fateful Friday tha
n I then imagined.

  “Relax,” I told my wife, still trying to calm her as the night got darker. “He’ll be home in the morning or sometime tomorrow. It’s not the first time he hasn’t come home, but he always comes back the next day and apologizes.”

  “I don’t think he will this time,” she said.

  “He will,” I assured her.

  He didn’t.

  As Saturday evening approached, my temporary relief over not having our unmotivated, defiant son in our house began to turn into genuine concern, although I was not yet ready to share this with Mary. My mind raced with terror over finding him dead by an overdose or from violence or even suicide. As darkness fell we decided we must act.

  We enlisted the help of our youngest son, Barry, and thanks to Facebook, we found that our son had spent the previous night at the house of an older girl he’d recently started seeing. It turned out that my wife had found the same girl hiding next to my son’s bed at 4:00 a.m. a week earlier—having snuck in through his window after we’d gone to sleep. The girl popped up from the floor that night, extended her hand with a smile and said, “Nice to meet you, Mrs. Van Warner,” and then lied about her name.