OxyContin abuse is nothing new in the United States. But in California, many believe a prescription-drug epidemic is still getting started, especially among teenagers and young adults.
That first high won’t ever come back. It lasted a few months, back in the beginning, when you could make all the world seem pleasant and right by crushing a pill into powder and snorting it. But that was a while ago, and when you’re honest, you admit it. That high is gone forever. So, why keep chasing it like this?
The chase, really, is addicting in itself.
You go on missions: One connection falls through, then another, and then you’re driving 20 or 30 minutes from Placerville to Cameron Park or El Dorado Hills and then another half-hour to some dude’s house in Sacramento.
OxyContin may be everywhere, but it’s not always nearby when you need it. Every now and then, you drive to the Bay Area for a sure hookup, but that doesn’t always pan out either, so you head for “Pill Hill,” in downtown San Francisco. You park at the curb and lean against your car, and before long, someone is sizing you up and moving in with a low voice, asking what pharmaceuticals you want.
The Bay Area is filled with pills; that’s nothing new. But these days, everybody wants Oxy, and once you’re into that stuff, nothing else will cut it.
There are days when missions fail, and you feel withdrawal edging closer, and it’s frightening—the onset of horrible pain and misery, just like what they say heroin does to you. The only goal, really, is to feel functional and healthy, like any normal person. It’s been that way for over two years now. Going three days without Oxy is rare, and it’s not fun.
The cops are still calling it “hillbilly heroin.” That’s what the cop said that night in Oakland, after a successful mission to the city, when he found the Oxy in the trunk. He asked what the pills were and then threw out the nickname; and then he dumped out the whole bag, 60-odd pills, and crunched them into the gutter. Cops are looking for what they know, the weed, the meth, the baggies of powder.
Had that cop taken them more seriously, those pills could have meant prison time.
It had been four years since Jeremy Hale first tried Oxy, two years since the addiction had taken control.
The drug had brought many foul moods and tantrums, and taken huge sums of cash. Jeremy’s mother was becoming estranged, his girlfriend distant, his infant daughter deprived of a stable life. That failed mission to Oakland was too ridiculous, like a comic portrayal of what this drug really is: a cheat who gives and then takes away.
A few weeks later, Jeremy, 24, moved into a Rancho Cordova recovery facility called D&A Detox.
Funny how it worked out: During the initial week in June that Jeremy spent at the place, only three other addicts were sharing the facility, and they were all, by chance, pharmaceutical addicts. It was an unusual circumstance but hardly a surprising one to the directors, who had spent months watching the numbers of pharmaceutical abusers among their residents steadily growing.
A recent landmark study deemed pharmaceutical abuse to be the new drug epidemic, and OxyContin—the strongest synthetic painkiller ever marketed—is generally regarded as the most widely abused painkiller in the history of the pharmaceutical industry. But most of its users are teenagers and young adults, and by and large, they’re not showing up at detox facilities.
At least not yet.
D&A Detox occupies an aging tract home on the edge of a neighborhood that’s set back a block from Folsom Boulevard. In any given week, a breakdown of its residents generally resembles the local area—lots of middle-aged men, and lots of alcohol and methamphetamine addictions.
One of Jeremy’s detoxing companions fit that profile, being an alcoholic and a middle-aged man. His goal this time was to quit Ativan, a tranquilizer he’d originally been given to relieve his detox symptoms. The other two—a former soldier in his late 20s and a woman in her late 30s—had long been making the rounds of hospitals and doctors’ offices to keep their prescriptions fresh. The group got on well, spending hours on the back patio, smoking cigarettes on old couches set beneath a wide awning, talking about their drugs, about their routines for obtaining and consuming them. They were all talkers, all outgoing.
On the subject of Oxy, Jeremy can talk for hours.
He was never much of a success in school, but it wasn’t for a lack of energy; a subject of interest can set him going, his mind jumping briskly from one observation to the next. Jeremy was 20 when he started on the drug; several buddies had begun getting high on Oxy pills from the supply of a friend’s mother, who had a legitimate prescription.
When his use became an out-of-control addiction two years later, he was living with his girlfriend, with a baby daughter soon to arrive. Chelsea is 19 months old now. As Jeremy graduated from detox and moved into one of D&A’s several recovery homes for a month-long stay, thoughts of his baby daughter tore at him harder every day. Chelsea’s young life was in his hands, he would say; if he continued as an addict, there was no way he could create a positive life for her.
But in recovery, they taught him not to think that way.
An addict must want recovery for himself, they said; the needs and desires of others must come second—those of a baby daughter included. It’s the only way sobriety can last. The longer Jeremy stayed in recovery, the more restless he became, his daughter often on his mind. But he stayed positive, applying his generally high energy to household chores and daily study sessions, in which addicts at the house read motivational literature and write essays.
“Looking back, I can’t believe how sick I was,” he said one day. “It literally ran my life.” An opiate addict, generally speaking, can lead a steady life as long as the drug supply remains constant (although overdoses are possible, especially when an opioid is mixed with alcohol, and addicts have been known to die of respiratory failure).
But keeping it constant, when it’s illegal and expensive, becomes an all-consuming challenge. Jeremy remembers lying on the couch between highs, hearing his daughter’s crying, knowing she needed changing and barely mustering the energy to get on his feet. He talked about the verbal abuse he routinely unleashed on Tiffany, his girlfriend, all part of the desperation of needing more Oxy, of needing money he didn’t have.
He would show utility bills to his parents, saying, “Look, these bills haven’t been paid. I’m trying my best, but money’s tight”—and his parents would pay his bills. “I never stole, but I lied, manipulated,” he said. “I’m a real good bullshitter. I’ll play it off with the biggest, baddest story I can think of.” He was impatient in recovery, wanting to put those days of addiction in the distant past, and do it quickly. But he managed to keep steady, to stay in control. And that was something new.
As it is with any recovery program, analyzing one’s experience with drugs was part of the process, and Jeremy often mulled over his early days with Oxy. “Out of all my friends, I was the last one to do it,” he said. “And once you’re into Oxy, nothing else is going to touch you.”
For Jeremy and his circle of buddies, Oxy was a lot of fun for a few months. But then, little by little, it stopped getting them high. As teenagers, they had long been hearing of the drug—of its similarities to heroin, of its blissful high, of the proper methods of consuming it—the common knowledge that had filtered, little by little, from the East Coast, where Oxy had long since become a household name.
OxyContin was the strongest painkiller ever marketed, illegal except by prescription, carrying a Schedule II rating assigned by the Drug Enforcement Administration (DEA)—the highest level of restriction possible for a pharmaceutical. For much of the previous five years, OxyContin had generated media frenzies and claims of abuse epidemics on the East Coast, mostly in rural areas, where teenagers had long since discovered that the pill’s time-release coating—which breaks down slowly in the stomach, allowing the painkilling compound to enter the bloodstream gradually over 12 hours—could be removed. Beneath that layer is a payload of pure oxycodone, a synthetic compound based on an extract of opium. Crush the stuff into powder, and a user knows exactly what he’s got, a perfectly measured line with no impurities—unlike other painkillers, which are mixed with a secondary ingredient, often to ease the drug’s impact on the stomach, something Oxy doesn’t need because of its slow release.
The notion of purity can be an attractive thing.
Several times during detox, a staffer or fellow resident asked Jeremy, “Why not just do heroin?” It might have cost less (illegal OxyContin goes for a dollar a milligram, meaning his daily habit of four 40s was costing over a grand a week; he’s still amazed he was able to swindle and sweet-talk that much money from his family and his girlfriend).
He would respond in a mock-incredulous tone, as though it were obvious: With a bag of powder, you never quite know what’s mixed in there, but with these pills, you always know. The yellow ones are 40s, the big green ones 80s. It says right on the pill the exact milligram amount of pure oxycodone packed in there by professionals, by a company that sells pills to hospitals and doctors. And isn’t the government watching, making sure it’s all done correctly?
OxyContin was a drug that fit the times: the strongest synthetic painkiller ever made available to the public, its path to market cleared by a “war on pain” movement that had taken root within the medical community nearly two decades earlier. Through the past century, prevailing views on pain treatment have followed popular perceptions of narcotic drugs. Addiction became known as “soldier’s disease” in the years after the Civil War, when veterans got hooked on morphine after suffering battlefield injuries. At the time, addiction treatment involved a continuous supply of doctor-prescribed morphine—essentially, avoiding the ordeal of withdrawal by learning to live with a drug addiction—and by the early 20th century, widespread chronic use of morphine and opium had become a public concern.
Then came 1914, when the U.S. government, balancing international relations weighted by the opium trade, passed the Harrison Narcotics Tax Act, which restricted the market for opium and its derivatives. Political discourse over the act had focused on international commerce, but domestically, the new law functioned as drug prohibition. Its wording allowed doctors to continue prescribing morphine “in the course of [their] professional practice only,” but the Supreme Court soon found that because addiction is not a disease, the practice of prescribing opiates to addicts surpassed the bounds of “professional practice.” Thousands of doctors were arrested and prosecuted, and many of their morphine-deprived patients flooded hospitals, incapacitated by withdrawal. Many others turned to a new black market, where exorbitant prices drove them to ruin; and through the following decades, lawmakers responded to this new class of crime with ever-stricter laws, over protests from medical professionals.
Thus, drug addiction transformed from a disease into a crime, and it soon acquired the social stigma it carries today—a stigma, many argue, that has contributed much to an institutionalized disregard for the treatment of pain as a legitimate medical field. Instead, pain came to be seen as a symptom to be endured first, doctors only reluctantly applying strong painkillers for fear of abetting—or creating—addicts. A movement of physicians, picking up steam in the early ’80s, railed against this long-standing convention. To disregard pain as a medical condition, they argued, was immoral when society possessed the technology for treatment—strong drugs—and the necessary know-how for keeping treatment safe—that is, without causing uncontrollable addictions.
Americans by the tens of millions were suffering needlessly from chronic and acute pain, doctors asserted—pain caused by cancer and other medical conditions, lingering pain from injuries, all sorts of mysterious pain that seemed to have no cause, pain that had been deprived of serious study through most of the 20th century.
It was into this altered atmosphere that Purdue Pharma introduced OxyContin in 1995, to the relief of millions of pain sufferers. And it wasn’t long before teenagers and young adults in rural areas of several East Coast states had discovered the profound high it could produce. Purdue spent much of the late ’90s challenging claims of widespread Oxy abuse, often blaming the media for creating hype. When OxyContin was used under the guidance of a physician, the company argued, uncontrolled addiction to it was rare.
That claim has mostly stood up under scrutiny, but it says nothing of one of the most significant factors: availability. The company has come under fire for its marketing practices, among them the awarding of huge bonuses to aggressive sales representatives.
By the turn of the decade, nearly half of all Oxy prescriptions were being written by primary-care physicians—reflecting Purdue’s strategy of marketing the drug beyond its intended purpose of relieving pain from specialized medical conditions.
And then there’s the time-release coating.
Upon OxyContin’s approval, the DEA adopted Purdue’s contention that the drug was less prone to abuse than other narcotics because of the time-release mechanism. As part of its approval, the DEA required a package warning against removal of the layer, a move later deemed to have backfired—the label, government investigators later found, probably had sparked the knowledge among teenagers that one need simply wet the pill and rub off the coating, and you’re left with nothing but pure oxycodone. Crush it up and snort it, or dissolve it in water and inject it, and it brings intense euphoria.
The fortunes of Purdue Pharma, meanwhile, are currently on the downslide. OxyContin’s patent has expired, freeing generic-drug makers to bite into Oxy’s profits while likely adding to the volume of the drug’s illicit trade. In late July, the company suspended sales of its newest painkiller, Palladone, after the Food and Drug Administration said the drug carried unacceptably high health risks if mixed with alcohol. And in Virginia, a federal grand jury is considering whether to indict Purdue executives for implementing aggressive marketing strategies while concealing OxyContin’s dangers.
Because opioid withdrawal can be dangerous—it has been known to cause death in extreme cases—the managers at D&A administer drugs to keep their patients’ systems stabilized. Comparatively speaking, it’s a fairly direct approach, unlike the prevalent practice of methadone treatment. Methadone is a nonnarcotic, synthetic opioid; in treatment, an addict replaces an addictive opiate (heroin) or a synthetic opioid like OxyContin with methadone over a period of weeks.
Garrett Stenson, program director of Bi-Valley Medical Clinic, says he’s been noticing slight increases in young Oxy addicts seeking methadone treatment—but only at Bi-Valley’s Carmichael clinic, not at the downtown and North Sac clinics.
That fact, Stenson says, reflects the drug’s popularity with suburban youths, but not its prevalence. There are many addicted youths trying to detox themselves, he says; many others haven’t yet decided to quit, and still more are just now discovering the drug.
“We’re just starting to see this problem in California,” he said.
In a way, Mariann Hale wishes detox had been more painful for her son. The stabilizing drugs help to smooth the transition, making it easier. The more something costs, she reasons, the less likely it is to be given up later on.
But that first week in detox wasn’t a totally smooth process.
One day, Jeremy persuaded a friend, who had come to visit, to throw a pill over the back fence before driving away; but the directors, with their trained eyes, thwarted the plan—and then added a few days to his stint in detox, stretching it out to 10 days. Jeremy took it in stride, teetering on that shaky line that separates self-restraint from the blind impulse to indulge one’s addiction.
Mariann works as a doctor’s assistant, and she’s seen, firsthand, how easy it is to get a prescription for painkillers. She recalls times when representatives for various drug companies would take hospital staff out to dinner—“They would wine and dine us,” she recalled. “I work with people with cancer. I work with people who are dying on a daily basis. If [OxyContin] helps them, I’m all for it. But when it gets into the hands of people like Jeremy … when I found out how much he was doing, I was mortified! It’s so hard to say I have a son who’s a drug addict.”
Among recovering addicts, long-term success is rare for those who return to the lives they had led previously.
During his month in recovery, Jeremy talked about his desire to start a new life, separate from his old friends, his old routines. He talked about starting work with a relative who ran a business. But the reality, he admitted, likely would be different. He would return to his girlfriend and daughter, and his old neighborhood would be there, and his old friends too.
And how can a person discard the people who have filled his life?
One Sunday in July, toward the end of Jeremy’s time at D&A Detox, Mariann came to the recovery house for a visit. It was a gesture of outreach on her part; months earlier, she had spoken with her son on the telephone, and it had been an unpleasant conversation. She had known of the addiction, and her concern had only sparked Jeremy’s ire, as it had on several occasions before. They had only begun speaking again once Jeremy entered detox, and then only tentatively.
She brought a home video of Jeremy’s young daughter, Chelsea. She and Jeremy watched it together, and when she glanced over at her son, she saw he was crying.