Stairway to hell

Prescription painkillers open the door to illegal drug use and the possibility of heroin addiction

According to the most recent National Survey of Drug Use and Health, the number of first-time heroin users in the United States nearly doubled in 2009. From 2002-2008, the average was an estimated 91,000 each year, in 2009 it increased to 181,000—and that was two years ago.

“Dr. Charles Shaw, an Oklahoma City-based specialist with more than 20 years of experience in treating addiction, said painkillers have replaced marijuana as a drug that people are likely to use first, before moving on to other drugs. Marijuana has long been regarded as the primary “gateway” drug.

‘Many young people experiment with pain medications and become hooked,’ he said. ‘Most of the ones I see are in their 20’s and have lost everything.’”

—Associated Press excerpt

A cell phone rings. Still half asleep, Joey answers. “What up, man? …

How many you need? … Cool, be in town in an hour. I’ll hit you up then.”

It’s 2 p.m. at Joey’s mother’s house, hidden on the mountainside in Reno’s Galena Forest Estates. A snowstorm had hit the night before, covering their two acres of land in a thick blanket, obscuring the rocky driveway that disappeared under the white clouds.

While the city, along with organizations such as Join Together Northern Nevada, have been trying to combat the growing heroin epidemic in Reno, little sign of decreasing supply or demand has been evident. Just last month, two men were arrested, and later pleaded guilty, to selling heroin to Reno High School students. The problem is real: First-time heroin users are becoming younger and younger—often victims first enticed to the drug through an addiction born of prescription painkillers. This story is about a 24-year-old middleman named Joey who has been addicted for four years, and 18-year-old Austin, who started abusing opiates at 15.

Joey had just received the first call of the day, which meant it was time to get out of bed and get to work.

But first, the “morning” dose, necessary to kick-start the drug-driven day.

Systematically unloading the kit complete with syringe, cooking spoon, clean water, cotton ball, lighter and, of course, heroin, has become part of the morning routine—somewhere in between brushing the teeth and picking out the day’s outfit.

In an effort to foil his plans of getting high, his mother recently disposed of every metal spoon in the house. Her plan failed, however, as Joey has been using the same cooking spoon for months, evinced by the amount of residue from impure heroin caked on the weathered utensil.

Two tenth-gram bags of heroin cook up in the spoon, and Joey loads it into the syringe.


And … ahhh … the rush that keeps him coming back overwhelms the senses and carries him away in an ocean of euphoria. Years of experience let him complete the process without aid of tying off his arm, which is typical of users trying to expose an elusive vein, the spot where needle penetrates skin.

After a few short minutes, the rush fades. Back to reality, back to work. Back to chasing that proverbial dragon.

Rousing himself out of “the nod,” the sedated, sleepy feeling induced by heroin, Joey finds his phone to make a call, this time speaking in a practiced dialect of Spanglish.

“Hey man, can we meet up?” he says in a forced Cheech-and-Chong accent.

“Veinte … y tienes blancas?” The white boy with little formal Spanish training spoke with a native tongue. “OK, where we meet … Big 5? OK, man, I be there in 20.”

Veinte, which means 20 in Spanish, denotes the amount of tenth-gram heroin-filled balloons for today’s order. Blancas, Spanish for white, means cocaine is on the order, too, completing the recipe for Joey’s favorite cocktail—the speedball—a mixture of cocaine and heroin taken intravenously in a single syringe.

At 24, Joey has mastered the risky practice of navigating the fine line between user and supplier in the heroin market that has flooded Reno in the last five years. Working as a middleman, he connects the clandestine “Mexicans” to the heroin users in his circle, while guaranteeing a steady flowing “personal stash” to support his addiction.

Four years of regular use causes a high tolerance and a heavy habit. Typically dosing two to three bags a shot, anywhere from three to six times a day, requires a constant influx of money to support his gram-a-day habit. A habit, mind you, that would no doubt kill an inexperienced individual through overdose. But he was not ready to call it quits because of finances, so Joey got himself the middleman job, which earned him a discounted price when buying larger quantities.

Now, Joey could guarantee himself an entire gram paid for through his own customers by charging them $15 each for the first two bags, then dropping the price to $10 a bag after that. With only a small clientele, Joey has been able to support the majority of his addiction through acting as a middleman—taking his cut for connecting consumer to supplier.

The short drive along U.S. 395 has become routine for Joey since making sales has become his priority. Taking the Neil Road exit and continuing on to the rendezvous point, Joey calls his supplier to let him know his whereabouts.

“OK man, I’m here. … How long?” he says, continuing the Cheech rendition as he pulls into the Big 5 lot on South Virginia and finds a discreet parking spot between two SUV’s.

Assistant Director John Firestone works with a client at The Life Change

photo by amy beck

“Five minute? OK. … See you.”

Joey turns the car off and patiently waits, peering over his purple Ray Ban Wayfarers as he jokingly criticizes any, and all, of the surrounding population that remains clueless to the forthcoming illegal business.

Twenty minutes later, a red sedan with tinted windows pulls in and creeps by.

“Late as fuck; never fails,” Joey says as he turns the ignition.

He gets behind the red sedan and follows at a “chill distance,” careful not to alarm any suspicions among Reno’s police officers and citizens.

After following a short distance from the Big 5 lot to a nearby apartment complex, the red sedan parks below the landlord’s ramshackle garage, consisting of a thin metal sheet placed overhead on a wooden frame. Joey does the same a few parking spots down, turns the car off, exits, and enters the front passenger seat of the red sedan.

Yesterday’s customers’ money in hand, Joey speaks only by number and color.

“Veinte negras … y tres blancas,” once again like a native speaker.

“Two hunred y turty,” the driver of the sedan replies.

With a “gracias” and a pound, Joey exits the car, his pockets full of balloons. Red, blue or green for heroin. White or yellow balloons for cocaine.

He was now ready to “serve his clients,” along with himself.

Joey, only four years prior, would’ve been hard-pressed to believe this would be his future.

“I never thought that he would do anything but marijuana because he was so adamantly against the [stereotypes],” recalled his mother, Sandy. “People who did this drug had that name. Meth users were tweakers, heroin users were junkies.”

As with countless other opiate-dependent heroin users, however, Joey’s addiction did not begin with heroin, but with prescription painkillers. Although Joey had first tried heroin in 2006 by smoking the drug off foil, he saw it as “purely experimental” at the time and had no intention of continuing use.

“I didn’t even look for [heroin] after that first time, it was literally a no-thought,” said Joey.

It was not until a month after acquiring a bottle of 30 80-milligram pills of OxyContin that he first experienced the horrible symptoms of opiate withdrawal—the “sickness” that drives users back to the drug.

The 30 pills were crushed up and snorted over the course of a couple of weeks. At this point, Joey had never even touched a needle, but the powerful effects of OxyContin created an addiction as the drug supplanted his brain’s natural ability to produce endorphins.

“At that point I was addicted as all holy hell.”

And as all opiates produce cross-tolerance, the use of codeine, opium or morphine can relieve the withdrawal symptoms of heroin, and the effects are true vice versa. Thus, heroin—cheap, abundant and easy to find—was the logical cure.

Uncomfortably Numb

The supply was spent.

Fentanyl patches. No more.

OxyContin. Vicodin. All of it—gone.

In its place, a cold chill. Unbridled, everywhere. Sweating, hot flashes, bones brittle.

But all quite bearable compared to the depression. The suicidal thoughts. The lack of motivation. The desire for it to end.

Austin was 15. He discovered his grandmother’s stockpile of unused and unwanted prescription painkillers—close to a year’s supply if used as directed—and had smoked, snorted, or shared all of it within a month.

Executive Director Jackie Aust-Giray does some office work at The Life Change

photo by amy beck

Directed use requires the prescribed patient to stick the 10 milligram Fentanyl patch—untampered—on to the skin, allowing the drug to be slowly absorbed by the body over 72 hours.

Poking a tiny hole into the Fentanyl gel patch, however, allowed direct access to the powerful drug inside.

By placing small amounts of the gel on foil, Austin was able to smoke the Fentanyl through a cut-off pen. This route of administration caused his tolerance to skyrocket, and his required dose quadrupled in two weeks. Before he had even realized what he was getting himself into, the opiate addiction took hold of his life.

“It’s awful, it’s awful,” recalled Austin. “There’s no real way to describe how terrible withdrawals are. It’s not the pain, I can take the pain. It’s the mental, the sadness, the complete lack of happiness. When I’m sober, I’m a happy guy, I honestly don’t need drugs. But opiates, they took that away.”

The withdrawal symptoms from Fentanyl, OxyContin and Vicodin were so terrible that Austin invited black tar heroin into his life that same year.

“[Heroin] is way cheaper than prescription painkillers. … A 20-milligram OxyContin was 10 bucks, and that wouldn’t do shit with my tolerance,” said Austin. “I needed huge doses, which I couldn’t afford through other drugs, but heroin I could.”

At only 15 years old, Austin began regular use of heroin, usually smoking the drug off foil, but sometimes using needles for intravenous delivery, as it proved “more efficient.” He continued to do this for an entire year—until his habit took him too far.

Austin had stolen $40 dollars from his parents in order to support his habit. When they noticed the missing cash, his parents confronted their own suspicions and decided to search their son’s room. What they found would crush any parent: numerous needles, resinated foil, cut-off pens, and four bags of heroin. At 16 years of age, bubbly, red-haired, goofy Austin—their son—was a heroin addict.

His parents knew he needed professional help. They confronted him that same night. But the confrontation would push him further down the path than they had ever imagined.

After accepting his rehabilitation ordered by his parents, Austin—always prepared to combat the withdrawal sickness ever since his first miserable experience caused by prescription painkillers—locked himself in the bathroom with his emergency stash: two bags of heroin and a “rig,” slang for a syringe.

Knowing this would be the last time he would be able to get high for months, he loaded both bags into the rig, doubling his normal dosage.

Tying off his arm to expose the vein, Austin penetrated skin with needle, and the heavier dose entered his bloodstream.

This time, however, the ocean of euphoria was drowning him.

This time, he couldn’t fight the “nod.”

Austin was overdosing on heroin.

Realizing something wasn’t right when Austin had been in the bathroom for more than a half-hour, his father knocked on the door. After a few moments with no response, he lowered his shoulder, and with a firm thrust, he forced the door open.

Austin woke up in the back of an ambulance. Confused and befuddled, he slowly pieced together what had happened.

“Yes,” he thought to himself, “it’s time to get help.”

“It wasn’t that I liked [heroin]. I definitely liked OxyContin better, Fentanyl better, [Suboxone] better. H was just cheap and abundant.”

Like Joey, Austin was first led down the path of opiate-dependence through prescription painkillers. Now, however, at 18, Austin is on a strict Suboxone regimen regulated by his parents and grandmother. He has been clean for nearly three months. During a visit, he played the classical guitar piece “Spanish Romance,” an emotional rendition so far removed from even a whisper of his past life.

The Needle and the Damage Done

John Firestone, assistant director of The Life Change Center in Sparks, said, “The fastest- growing [population of users], although it doesn’t account for the most people, are the younger folks. The story I hear that is most common is they start on prescription painkillers. And about half, or maybe a little more than half, have intermittent or regular heroin use by the time they come to us.”

An eclectic group of individuals had come together on the cool March afternoon at The Life Change Center. And not for the catered lunch of sandwiches and soda, but for a bigger purpose.

This unique group, consisting of parents and siblings of addicts, former addicts, patrons, and philanthropists, were here to combat the heroin epidemic plaguing Northern Nevada by raising awareness and educating people about these substances.

While the meeting was called for the sake of heroin, this altruistic and knowledgeable group also confronted the seriousness of prescription painkillers, and the “gateway” effect these medications can have.

“The focus is on heroin, because that’s the ‘big, scary’ drug that scares middleclass America more than, say, pills, but the reality is that pills are a far bigger problem,” said Jackie Aust-Giray, executive director at The Life Change Center. “That’s because it’s unseen. It’s going on everywhere. Nobody sees it because of the difference in the way they impact the user. Heroin use has the whole frantic cycle, and the nodding out, and eventually needles, and it’s pretty hard to hide that. Pill use? You can look pretty normal for a long time.”

Results from the National Survey of Drug Use and Health further elucidate the burgeoning problem of prescription painkillers. In 2009, the specific drug categories with the largest number of recent initiates among persons aged 12 or older were marijuana use (2.4 million) and non-medical use of pain relievers (2.2 million). This data begs the question of how many of those first-time initiates will become addicted to these opiate-driven drugs. That same year, 181,000 people across the country tried heroin for the first time, which is nearly double the amount the previous year.

“[Heroin] is no longer an intercity drug, it’s really come to the backyards and living rooms of our communities,” said Firestone, “Reno’s getting hit hard.”