On Pills and Needles

by Rick Van Warner

  By the time we reached the small surfer village on the Atlantic Ocean, Tommy was interacting with us. We were talking music, turning each other on to various bands and songs. The pawnshop where his scooter now resided was closed, meaning we’d have to repeat the journey the following day. At the second pawnshop we encountered a young man and woman in filthy clothing, their rail-thin bodies obviously ravaged from drug use.

  “Hi, Tommy,” they said as we walked in, exchanging hugs with him.

  Catching the stern glare I didn’t try hard to hide, they completed their transaction and left.

  “See you around, Tommy,” the girl said.

  Mike and I checked out the antique guns, vinyl record albums, guitars, and other oddities while Tommy waited in line. The place was as depressing as a Reno casino on a Tuesday night, with down-on-their-luck folks staring vacantly at the slot machines gobbling up their rent money. The shop was a far cry from TV’s Pawn Stars; you could almost feel the stories of woe behind the worn power tools, décor items, and glassware throughout the shop.

  “How much?” I asked Tommy, trying to help him at least preserve his dignity by handing over the money to regain his items.

  His prized electric bass guitar and banjo now safely tucked in my truck, we headed to lunch, at which Mike again lightened Tommy’s mood with typical hilarity. We returned the following day to collect the motor scooter, and I noticed that though Tommy was still fragile, he was slowly climbing back.

  22

  The Path to Acceptance

  The streets of the eastern Pennsylvania village seemed straight out of a postapocalyptic horror movie, complete with the occasional zombie shuffling slowly down a sidewalk or alley. Many once-thriving storefronts were boarded up with graffiti-covered plywood. The handful of stores, bars, and restaurants that survived were plastered with discount or specials stickers, indicating their continuing fight to survive. Most of the few cars that passed by were old and rusted out, their driving days dwindling.

  The town, once spotless and idyllic, nearly Norman Rockwell–esque the time we’d visited twenty years earlier, had not been devastated by bombs, floods, or fires. This disaster was man-made, the result of economic depression and drugs, including the heroin and black market pill epidemic that continues to destroy similar towns across America. The life forms ambling through the streets were shells of the humans they had been before heroin, meth, and other poisons of escape ravaged their bodies.

  Mary and I were here on a whim to join several friends for a fun weekend and to experience what a NASCAR race was all about in the rural North. It wasn’t until a rainy day canceled our outdoor plans that we went downtown in search of a restaurant or bar and found ourselves in this sad, beaten-down place. We were stunned that the pretty village with bright American flags and sparkling lampposts had become so dilapidated. We certainly knew the terrible impact the offshoring of jobs and the opioid and meth epidemics had on much of rural America, including my own hometown. Across the Delaware River in northwest New Jersey, the general area where Tommy had twice lived with my brother and mother, I’d driven through similar towns. This seemed worse. Our son’s struggles had removed all blinders and filters, and my eyes were now fully opened, seeing everything.

  Like the bartender from the motel in which we were staying slipping out the side door to complete a drug transaction in the parking lot. And the piercing, sketchy stares from clearly strung-out parents who were living in parts of the motel with their kids, apparently part of a section 8 housing arrangement. And the forty-something covered with track marks stumbling up the street, underwear showing, shirt fully unbuttoned, legs bloody at eleven in the morning. By now I had seen these things all too often. It was definitely not what we had in mind when we agreed to join our friends for a spur-of-the-moment race weekend.

  At last the problem was receiving mainstream attention. The opioid epidemic that began with Purdue’s OxyContin rollout and market dominance was virtually unchecked for the first decade. This was more than enough time for legalized drug pushers to establish distribution networks into states in the South, Appalachia, and ultimately across the nation. Particularly in the northeastern and New England states, the problem was compounded by easy access to heroin itself, with the drug flowing through seaports from Maryland to Maine. Tommy had managed to live near the center of both growing epidemics thanks to his two stints in heroin-flooded New Jersey.

  In 2007, Purdue was finally held accountable with its admission that it had provided misleading information while building its OxyContin empire. It absorbed the $600 million in fines rather easily given the profits it continued to rake in from its multibillion dollar cash cow.

  Sadly, it took nearly another decade before elected officials and regulators, whose silence had been bought for many years by the powerful Big Pharma lobby, decided they could no longer afford to ignore the issue. President Obama proposed $1.1 billion in budget spending dedicated to combating the opioid and heroin epidemic in 2016. In various states several of the same politicians who for years gladly accepted Big Pharma contributions suddenly woke up, staging press conferences to announce bold new programs. Most of these election-year initiatives did little to address the root causes of opiate addiction but instead were Band-Aid approaches, such as arming police, fire, and emergency medical personnel with naloxone, a drug that can save lives by reversing the effects of an overdose. Making the drug available to men and women on the front lines of the opiate epidemic—first responders who are far more expert in the subject than the talking heads often seen pontificating about it in the media—was a positive step that has already saved many lives. But it is a Band-Aid solution that treats only the symptoms, not the cause.

  As was the case in Florida with the initial pill-mill shutdown, the moves to cut off the opioid spigot were staged for maximum publicity, with TV news outlets gladly obliging. But there remains no concerted strategy for what comes next. Typical of our bloated bureaucracies in Washington, DC, and state capitols, there seems to be a complete lack of coordination or a strategic game plan for tackling a problem that continues to kill so many.

  When states began restricting access to prescription pills containing oxycodone, opioid-dependent users like Tommy didn’t just stop using; they switched to the original and even more dangerous killer, street heroin. It was cheaper and a major game changer. Heroin and black market copycat versions of Oxys are often laced with powerful, deadly chemicals such as fentanyl to extend supply and profits. With street dealers now in the driver’s seat, heroin flooded the market, introducing a broad demographic of prescription-pill addicts to a drug once considered an inner-city scourge. Unlike the factory-precise pills addicts had grown familiar with, the street heroin killing kids today is often cut with enough nasty chemicals that even hardcore users cannot gauge strength levels. As drug dealers’ profits soar, the death count rises.

  The two regions where Tommy spent his teens and early twenties had the highest heroin death rates, according to a CDC report analyzing 2010–12, the period that included many users switching from harder-to-get and more expensive Oxys to heroin. During this time the heroin overdose death rate more than doubled in the twenty-eight states measured, rising 211 percent in the northeast and 181 percent in the South.1 Prescription opioid fatalities were less than one-half of a percent lower.

  The utter devastation this epidemic brought to families across the nation, as well as entire neighborhoods and small towns such as the one we visited in Pennsylvania, caught the attention of the mainstream media and Hollywood in 2016. Producer Rob Reiner and his son made a movie about his son’s struggle with opioids. The overdose death of Prince, reportedly linked to Oxy addiction, has further pushed the subject into the spotlight. Yet the death stats keep climbing. More than ninety Americans die each day from opioid overdose. To put this in perspective, about twelve soldiers per day died during the Vietnam War, and statistically less than two per day lost their lives during the height of fighting in Iraq and Afg
hanistan. But there has been no public outcry or marching in the streets related to this epidemic. Shrouded by the stigma of inner-city heroin addiction as portrayed in ’70s pop culture, addiction still occurs mostly in the shadows, slowly decimating families across the economic and demographic spectrum.

  Tommy slept twelve straight hours following our stressful waiting-room debacle and return home. I read a full psychiatric profile that had been conducted on him nearly two years earlier while he dozed. Mary had tried to get me to read it several times before, but I was too raw and couldn’t bring myself to do so. Social anxiety disorder combined with mild depression was the official diagnosis, but the report had no real recommendations on how to address it.

  We were convinced that a person’s mental state is at the root of most substance abuse, but how to tackle this remained the dilemma. We’ve learned that long-term opioid abuse can rewire brain circuitry, but to some extent isn’t that what any prescription drug for psychiatric disorders does? How can you use drugs to treat a condition in a person prone to abuse drugs?

  During his freshman year in high school, Tommy had once been on ADD medicine that he claimed helped him stay focused and do better at school. But we soon learned he was abusing pain pills, and we feared having him take any prescription meds that could be abused. Psychiatrists he saw along the way were all about pushing pill solutions, usually after only fifteen-minute consults—that is, if you were lucky to get in to see one at all. They seemed to be experimenting with various pharmaceuticals to find the right combination that worked, yet none ever had time to get to really know Tommy or evaluate underlying causes that might be at work. Eventually he manipulated these doctors to get the types of meds he favored to numb his pain. By this point, Tommy knew as much about various pills as the doctors did, and we sensed he was simply using them to feed his addiction. Our concerns were later justified after he turned eighteen and insisted on visiting unscrupulous doctors at pill mills or new psychiatric offices throughout the region.

  To their defense, the medical professionals we interacted with over the past eight years appeared overwhelmed and harried by skyrocketing demand. The opioid epidemic, overall pharmaceutical explosion, and deteriorating societal conditions combined to create a very untenable situation in Florida and elsewhere. If any legitimate psychiatrist found Tommy had been abusing drugs, they immediately dismissed him as a patient, likely for liability concerns, leaving him to choose from the quacks and pill pushers lining their pockets during the pharmaceutical gold rush.

  Through a doctor friend, Mary obtained a prescription for a nonaddictive substitute for the Suboxone, methadone, or other withdrawal meds used at most detox facilities. Predictably, Tommy at first threw a fit.

  “That won’t help,” he said. “Just get me some Suboxone.”

  We were determined not to repeat past mistakes and remained firm in our decision.

  “No, Tommy. This will help with the nausea and cramping. It will help get you off the drugs without just making you dependent on something else.”

  “But I’ve been taking it since yesterday, and it has done nothing,” he whined.

  We didn’t back down. About a year earlier, we had noticed sluggish and dopey behavior that usually was the precursor to a full relapse. Instead of Oxys or heroin, we found he had been taking far more Suboxone than the doctor advised and was also buying additional supplies from friends. As has often been questioned with methadone, this was a not a substance that helped him overcome addiction; it was a crutch that kept the dependency going in a much more functional way.

  After a visit to my therapist David’s office, at which he lauded our decision to detox Tommy at home, I laid out a written plan on a piece of graph paper for next steps. I felt we had never really checked the box on finding a medicine that might even out Tommy’s anxiety. Despite our past experiences and our concerns about psychiatrists and pharmaceuticals, I felt he should at least try a low dose of something that might help balance his brain chemistry. A low-dose of ADD medicine I’ve been taking for years has helped, I believe, temper past feelings of depression and mood swings. A college friend who had become so imbalanced through LSD use that his delusions persisted even when sober had found balance through lithium and gone on to become a wealthy and happy family man. Perhaps during the chaos of past years, we’d never truly given Tommy the opportunity to find the right medicine that could help him. On the other hand, I rationalized, because he was actively using Oxys, nothing would have worked anyway.

  Mary disagreed. Tommy had become irritable and nasty. She was fed up. Strangely, I was calm and resolved.

  “He needs your patience and acceptance,” I told her. “I know this is the right thing to do. I’ve got this.”

  His detox recipe seemed to be working, and we did our best to help him celebrate his twenty-fourth birthday two days after coming home, sharing our love and acceptance despite nursing the latest wounds to our hearts. We even baked him a birthday cake, which of course he couldn’t eat, his body still working hard to overcome the poisons he had put into his system the previous several days. Tommy was thoroughly depressed and defeated. At first, I couldn’t tell if it was because he was upset that his latest attempt at death by overdose had not succeeded. Over the next couple of days, however, it became clear through our brief conversations that he wanted to live.

  By Sunday, as Tommy’s withdrawal symptoms began to subside, we were facing a difficult decision. For the past three years we had taken our sons along with several friends to a music festival held in a beautiful setting along the Suwanee River in northern Florida. We were scheduled to depart, complete with RV, tents, and gear, just four days from now. A handful of friends were flying in, with Big Mike scheduled to be the first to arrive the following day. At first, Mary, Paul, and Barry were adamant as they weighed in independently. Under no circumstances should Tommy attend.

  “What are you going to do about Tommy?” Barry asked on a call. “I don’t think he should go.”

  “We’ll have to see how he’s doing,” Mary had said after we briefly disagreed about the subject and I wouldn’t back down. “One day at a time.”

  “You’re crazy!” Paul said. “What are you thinking?”

  I found myself in a different place, the transition complete after the wasted hours on Friday in the clueless clinic. I was clear and certain. The worst possible thing we could do for our son at this point was to isolate him, just as the worst thing two days earlier would have been to leave him to detox in a ward full of strangers and interns. I knew he needed me, needed all of us, and that our love and acceptance was the most important thing we could give him to help him pull himself slowly up from the floor. Anything less would trigger the feelings of rejection and worthlessness that had knocked him down so many times before. This time I refused to leave his side, regardless of what anyone else thought.

  The following day on the drive to the airport to pick up Mike, I got Paul and Barry on a three-way call to make my position clear. After patiently listening to their concerns, several of which seemed somewhat selfish, I cut in.

  “Look, this is not your decision. You’re not the parents, we are. I appreciate how much you are trying to help and also how hard you’re trying to protect your mom and me. We both know how much you’ve been through and that your hearts are in the right place. But Tommy needs us now more than ever. We bought the tickets as a family, and we’re going to go as a family. I’m not expecting you guys to do anything special, just treat him like you always do. Just accept him and love him like normal.”

  “I understand,” Paul replied. “We just don’t want you to get hurt.”

  “I get it,” Barry said.

  “I’m going to be straight with you,” I said. “Tommy felt so guilty and low following Sarah’s death that he felt like ending it all. He told me that the hole he dug was so deep he didn’t see any other way out. There’s only one way he can get out, and that’s through his family. We’re already on the right path, an
d he’s feeling better.

  “I know you’ll have to see the proof for yourself, but he’s in a different place this time. He was clean almost a year before this. This was a major slip, yes, but it also came after the death of someone he loved and spent nearly two years with. I get it. I also know that the last thing he needs is to be shipped off somewhere or babysat while the rest of us go up there. He knows Mike, he knows Jen, and he has you guys and tons of friends. This will be the best thing for him now. It’s not like he’s going to score H or Oxys at a hippy festival, and if he smokes a little weed, oh well. The most important thing is that he will be with us. Plus, the music will be good for him.”

  “Understood,” Paul said.

  “Got it,” Barry said.

  “I love you both.”

  “Love you too, Pops,” Paul said.

  “Me too,” Barry said.

  During this period it was difficult to keep Mary at bay. While she nurtured and showed him great love and affection, she couldn’t seem to keep from asking him useless backward-looking questions about what had happened or premature forward-leaning questions about what would come next. To a lesser extent, I also occasionally found myself wanting to probe him for clues about his relapse.

  Living in the present is probably the most difficult thing any person can do, especially in our culture of consumption, materialism, and immediate gratification. Through more than a decade of on-again and off-again therapy, I’d become conscious of a flaw in my psyche, yet was rarely able to practice what I knew would ease my mind—appreciating each day and each moment of life itself. I grew to lament that I’d wasted far too much of my life feeling sorry for myself about the past or worried about the future, when the only thing I really had control over was the present. Too often I was envious of friends who had great relationships with their dads. Other times I’d use the darkness and dysfunction of my childhood as a crutch, an excuse to eat or drink to excess or retreat from meaningful connection with my wife, family, and friends. My father was a loner, and in some ways so am I.