On Pills and Needles

by Rick Van Warner

  Tommy had the magic touch when it came to fishing. If we had four lines in the water, his pole was almost always the one bent over with a fish on the line. He often rode off on his bicycle with rod in hand to fish for bass in the small lakes near our home, either alone or with a friend. His gift for painting and other artistic pursuits became obvious when he was very young, and his colorful landscapes and ceramics can still be found throughout our home. A gentle boy, Tommy loved all land and sea animals, dolphins being his absolute favorite. He couldn’t stand to kill even an insect, preferring to scoot one onto a newspaper to transport it safely outside.

  At the beginning of each desperate, yet futile, attempt to help Tommy keep his demons at bay, he was pensive and calm, as if relieved to still be alive. It was as though each journey served as a much-needed vacation from the drugs that so firmly had him in their grip. But it was never long before old patterns returned; a nastier or indifferent temperament was the first sign that he was again using.

  During Tommy’s first stay in northwest New Jersey, Uncle Ron made a tremendous and generous sacrifice to demonstrate what a clean and sober lifestyle looked like. For ninety straight days, he took Tommy to a Narcotics Anonymous or Alcoholics Anonymous meeting, quite a feat given the remote location of Ron’s home near ski resorts in the Ramapo Mountains. After most meetings they would go out to eat, bowl, or play miniature golf with other recovering addicts of all ages, illustrating that it was possible to have fun without adding drugs or alcohol to the mix.

  “How’s he doing?” I asked during one of the many phone conversations with my brother.

  “He’s doing pretty well, but I’m still not sure he’s committed,” Ron said. “He’s really immature for his age and continues to hold on to the notion that pot is not a drug.”

  “What about at home; how is he getting along with Mom, Delores, and the kids?”

  “Oh, the kids love him, and Mom is Mom. It’s all about her. At the same time, she’s really happy to get to know another of her grandkids. She’s getting old so we give her a lot of leeway. After all, when you’ve lived alone as long as she has, it’s hard not to become focused on yourself.”

  For a few months Tommy did well under Ron’s tutelage, even sometimes working days in Ron’s automotive business. Lazy by nature, Tommy even had the “pleasure” of changing tires on an auction lot during the frigid Jersey winter. During the occasions it was not smooth sailing, Ron found it very difficult to distinguish between what was normal seventeen-year-old angst versus the manipulative behaviors associated with addiction. Toward the end of Tommy’s first Jersey adventure, I got a sobering call from my brother.

  “Look, I hate to tell you this, but I think he’s slipping. Also, his drug of choice is the worst one to overcome and has the lowest success rate of any others.”

  We knew by then that Tommy had been using pills, having identified some found hidden in his room, and we knew from drug tests and hospitalizations that opiates were in the mix. What we didn’t understand at the time was the difference between dependency on opiates and other substances, such as the cocaine that had nearly destroyed my brother many years earlier.

  “Help me understand, what does this mean?” I asked.

  “Basically there are depressants like alcohol; uppers such as cocaine, meth, or speed; and hallucinogenics like LSD or mushrooms. Tommy has the very worst type of addiction and hardest to kick, essentially pill-form heroin.”

  “So what does heroin or Oxys do, what’s the high all about?” I asked.

  “That’s the problem, it’s not about getting high,” he said, his voice becoming more somber. “It’s about escaping reality entirely. It’s about not feeling any pain. Over all the years I’ve been in the rooms [where AA and NA meetings take place], very few opiate addicts are ever able to kick it.” He paused. “Sorry, bro.”

  Tommy had a knack for finding the person least serious about sobriety at any meeting or rehab center he attended, a point Ron noticed immediately. Usually this was a woman who was as fragile as he was. His typical pattern was hooking up with a woman in recovery, developing a codependent relationship with her, then both of them returning to the drugs. As my brother warned him countless times, the worst thing you can do for yourself while trying to get clean is get wrapped up in a relationship. “Fix yourself first,” he would say. “Only then are you capable of having a meaningful relationship with someone else.” Ron, who met his first wife in recovery, spoke from experience.

  As with every other piece of advice Tommy received during this phase in his life, the warning fell on deaf ears. During his second stint in New Jersey, he met a woman ten years older than him at a meeting. They soon stopped attending meetings, and she introduced him to the deadly cousin of Oxys—street heroin. Days later he took a lethal dose.

  9

  Cheating Death

  Less than twenty-four hours from the decision to jump on an airplane in our most dramatic (and as usual, fruitless) rescue attempt thus far, my stress levels were through the roof when Paul finally wheeled into the airport. With no time to spare, we threw some of his belongings in my truck, parked, and rushed to get through security.

  Safely on our way to New York, Paul asked, “What’s the plan, Dad?”

  Sadly, I had none. “I’m not sure, son, what do you think?”

  A week earlier came the news that we’d dreaded but were not shocked by. Tommy had begun using heroin. A particularly lethal batch of heroin had already caused numerous deaths in New Jersey. As whiskey is to liquor, heroin is to drugs, the substance with not only the worst reputation but also a track record to support it. Heroin is a killer that creates a dependency that is exceptionally difficult to overcome. Despite the fact that the Oxys and other pills Tommy and his friends had been snorting or smoking were just as addictive and potentially deadly, essentially lab-made heroin, there was something about hearing your kid had shot up the real thing that hit us hard and sent my mind racing.

  Maybe sending him to New Jersey a second time was not such a good idea, I thought, as my brother’s words fully sunk in. Did we simply kick the can down the road yet again, taking advantage of the only option we had to get him out of our house again without adding to our huge pile of debt? Were we still looking for a silver bullet like we had by shipping him off to Utah? What if sending him back north only added to his feelings of rejection and worthlessness? In retrospect, each futile attempt to try to fix Tommy was spawned as much by selfish desperation to table the madness at least for a few weeks as it was to try to cure him. At the same time, there seemed few other choices beyond pushing him back onto the street. Mary and I were at each other’s throats, our other children were suffering, and our home environment had deteriorated into constant tension and strife. Having both grown up in chaotic and dysfunctional households, Mary and I may have been too quick to pull the trigger on sending Tommy off to the next program in our desperation to restore calm. But none of this mattered when I heard what my brother said next.

  “Rick, there’s more,” Ron said. “He overdosed and had to be brought back.”

  Tommy had no prior experience with heroin until this point, at least to our knowledge. Typically, he stubbornly refused to heed the warnings of others, shot up a large amount, and overdosed on his first use. Looking back, it is conceivable that he simply had enough by this point and tried to end his pain. Regardless, he passed out, his heart stopped, and for a few seconds was technically dead. Only through the grace of God was he not alone. Friends performed CPR and were able to revive him very quickly without him losing much oxygen to his brain. It was more than forty-eight hours before any medical supervision entered the picture. The day after his first overdose, three recovering friends from the support circle Ron had introduced Tommy to showed up at the home of the twenty-eight-year-old woman Tommy had been staying with. In a brave intervention, they forced him into their car and then into a rehabilitation center. Four days later, now eighteen, Tommy checked himself out and reclaimed
his phone along with his other belongings. His first call was to the girlfriend, where he returned to live. Despite having cheated death, he still didn’t believe he had a serious problem.

  10

  Rise of the Opioid Kids

  In the late ’70s, Colombian cartels established cocaine distribution networks in the United States, beginning in Miami, and by the early ’80s cocaine had spread throughout the nation to become a mainstream recreational drug. Shortly after, crack cocaine, which was usually smoked instead of snorted, emerged as a cheaper alternative. Crack, often cut with other toxic substances to increase drug dealer profits, decimated many depressed inner cities and rural areas and continues to do so. During the early ’90s, the methamphetamine plague spread from largely rural northwest home garage labs to the rest of the continental United States. The crystal meth problem, depicted by such TV shows as Breaking Bad, exploded once home chemists figured out how to create their own supplies using such toxic substances as battery acid, drain cleaner, camp stove fuel, and camera battery lithium. Even worse than the original lab version created in the ’70s for West Coast biker gangs, the new homemade meth was even more addictive and featured such long-term, nasty side effects as open sores, rotting teeth, and permanent brain damage.

  Like these earlier drug epidemics, the opioid problem now claiming thousands of American lives each year continues to be driven by greed. A far cry from the meth cooked up by a fictional Walter White in a beat-up RV, Purdue Pharma created OxyContin in a state-of-the-art corporate laboratory, launching the FDA-approved product in 1996. As with other twentieth-century prescription drugs that were initially deemed safe but proved harmful, it took more than a decade for officials to acknowledge there was a problem. When looking back over the past century at how poor a job our federal agencies and elected officials have done protecting its citizens from dangerous prescription drugs, it becomes obvious that, as in many other parts of our broken government, big lobby money has trumped public good. Uncanny parallels exist in the time cycle—from FDA approval to product launch, market adoption, user addiction, and finally regulatory action—tied to various “revolutionary” painkillers launched over the decades.

  Consider oxycodone, the first semi-synthetic opioid, which was invented by two German scientists in 1916—not coincidentally after the United States banned heroin—as a pain relief substitute for heroin, morphine, and opium. Just as Purdue did eighty years later with OxyContin, oxycodone’s creators touted the substance as nonaddictive, claims that later were proven false. Products containing oxycodone were not approved in the United States until 1939, and today several remain on the market. In 1950, a new prescription pain relief drug combining oxycodone with aspirin, Percodan, emerged. Similar to what transpired with OxyContin, it took more than a decade before regulators addressed a Percodan addiction problem. About thirteen years after Percodan’s introduction, California’s attorney general blamed it for one-third of all drug addiction in the union’s largest state, but it took another seven years for the DEA to get around to listing oxycodone as a Schedule II controlled substance with high potential for abuse. The mid-sixties Rolling Stones’ song “Mother’s Little Helper” was a nod to the largely hidden but growing prescription drug problem, aired nearly fifty years before our current opioid epidemic took hold. Despite the fact that opioid overdose is claiming significantly more lives each day than did our country’s bloodiest military conflicts, it remained in the shadows until 2016, dismissed as an affliction mostly limited to inner-city neighborhoods or individuals on the fringe of society.

  This begs the question, how many lives and families might have been saved over the past century if lawmakers and regulatory officials had done more to listen to scientific and medical warnings about the potential dangers of new drugs flooding the market thanks to the fast-growing pharmaceutical industry? Confusing, complicated warnings listed on pill bottles or read by announcers at breakneck speed on TV commercials are not enough when it comes to substances that can create dependency after short-term use. Some of these products should never have reached the market in the first place. But the Big Pharma lobby machine made sure they did and has also made sure that efforts to restrict access to pain pills have been slowed.

  Since 2003, Big Pharma has spent $2 billion on federal lobbying, more than any other industry except the insurance industry. Even more disturbing are the enormous sums Purdue and other drugmakers keep spending to protect their “golden goose” pain pills long after the growing opioid epidemic became well documented. From 2006 through 2015, Purdue and the makers of Vicodin and Fentanyl spent a collective $880 million on campaign contributions and lobbying efforts to influence legislation, according to the Associated Press and Center for Public Integrity.1 These expenditures were about two hundred times more than what advocates seeking to restrict access to medical narcotics such as OxyContin spent during the same time frame and eight times more than the powerful gun lobby spent. With an army of more than thirteen hundred lobbyists canvassing all fifty state capitols and Washington, DC, its Pain Care Forum doling out deceptive information, and with seventy-one hundred political candidates receiving opioid lobby contributions, it becomes clear why politicians and government officials have kept their heads buried in the sand for so long. Flush with Big Pharma cash, most lawmakers simply keep looking the other way or, worse, are complicit by voting against measures intended to curb abuse.

  Efforts to change this pathetic situation continue to be countered by profit-protecting pharmaceutical companies. While they publicly espouse support for efforts to curtail opioid abuse, behind the scenes pharmaceutical lobbyists continue to fight back in every way possible.

  In the same year President Obama trumpeted his administration’s $1.1 billion initiative to tackle the opioid epidemic, maximizing publicity through a Prescription Opioid and Heroin Awareness Week, he quietly signed into law legislation greatly reducing DEA-enforcement powers. Authored and sponsored by elected officials beholden to the drug industry lobby, the Ensuring Patient Access and Effective Drug Enforcement Act of 2016 effectively loosened restrictions put in place earlier, requiring the DEA to warn and work with law-bending drug wholesalers and distributors such as pain clinics before prosecuting them. Behind a public smokescreen that spotlighted legitimate patients such as seniors who were having a tougher time getting their prescription opioids under the new, tighter system, Big Pharma won again, rolling back some of the strides to restrict access.

  Easy access to the drugs opened a doorway that led to full-blown addiction for Tommy and countless other central Floridians when pill mills began popping up like mushrooms on a rain-forest floor flooded with direct sunlight for the first time. As is well documented, Oxy pills were easy to find whether you were looking for them or not. At one point around this time, long before I knew the first thing about the drug, our family doctor had prescribed a bottle for relief from some excruciating back pain I’d been experiencing. The following day with my back hurting during my drive to Miami, I realized that I’d forgotten the entire bottle on a high shelf in our kitchen. Calling Mary, I asked her to put them in a safe spot. It was too late; the bottle was gone. Since this was before we’d discovered Tommy was using, and likely before he’d even found his way to the drug, we were perplexed. Mary suspected the painter, who just happened to have begun a job at our house that day. Insulted and somewhat perturbed at being accused, he insisted that neither he nor his crew had anything to do with the missing bottle of Oxys. But nearly a week later the phone rang and he apologized. He and his wife had discovered that his twenty-something son had an Oxy problem and later found my now-empty pill bottle in their trash.

  In 2010 the DEA led a major sweep across our region to shut down many pill mills being run by unscrupulous doctors, and the following year Florida lawmakers passed two laws mandating electronic prescription-tracking systems and various other measures designed to restrict pain pill access. We were pleased at the time, believing that would aid our efforts to kee
p Tommy away from opiates. The crackdown initially worked, with Oxy use dropping for the first time in years. But like trying to plug a hole in a dike under pressure from a wall of storm water, a new leak sprung up in its place in the form of street heroin. With family medicine cabinets now empty and pharmacies under scrutiny, substance-dependent users could no longer afford or find the pills they’d become hooked on. They turned to the only option left, the street, with deadly results.

  Drug dealers gladly picked up the slack, and the problem worsened. Unlike the lab-made products they’d relied on, at least understanding something about dosages and effects, the black market opioid pills and heroin were often cut with dangerous chemicals such as Fentanyl, said to be up to one hundred times stronger than morphine. Intended for doctors to deliver via hospital IV or patch to patients recovering from surgery or battling severe, painful conditions, Fentanyl dramatically amped up the impact of any opioid it was mixed with. It was and is cut into heroin or street versions of oxycodone or Percocet to stretch drug dealer supplies and profits. Almost immediately, the Orlando region and other areas saw a frightening spike in overdose deaths.

  Tommy first found his way to heroin in New Jersey but discovered the black market pill forms upon his return to Florida. The feelings of boredom, restlessness, and invincibility that led to reckless and stupid behavior during my own teen years remained alive and well in my son. Only this time it was not alcohol or marijuana being used by restless youngsters. Self-medicating kids seeking an escape now had tiny, nearly impossible to detect pills at their fingertips—agents of death that parents such as Mary and I initially had no clue about. Lacking odor or obvious symptoms, opioid use was relatively easy to hide from parents, school officials, and other authority figures. There was no smell of booze or weed on their breath or clothes. There were no telltale signs of bloodshot or glassy eyes. The opioid kids typically showed few if any signs that anything was wrong—that is, until it was nearly too late.