The man we’ll call Dave was hooked from the start.
Five years ago, this Macomb County business owner’s biggest problem was a troublesome case of kidney stones. Then a doctor prescribed Vicodin to dull the pain until treatment eliminated the problem.
A powerful combination of the morphinelike hydrocodone bitartate and acetaminophen, the generic name for Tylenol, Vicodin and its pharmacological cousins are among this country’s most prescribed painkillers. It and other opioids such as Lortab and Lorcet attach themselves to receptors in the brain, spinal cord and gastrointestinal tract, where “they block transmission of pain messages to the brain,” according to the National Institute on Drug Abuse (NIDA).
For many people, the effect is one of drowsiness.
But for Dave, it created a euphoric high that gave him a tremendous surge of energy and a strange sense of clarity.
“I remember it like it was yesterday,” says the 42-year-old husband and father. “It was a great feeling. I went home and started vacuuming the house, which is something I never did.”
Five years later his life was in ruin, his business run into the ground and his marriage falling apart — all because of his addiction to the prescription painkiller.
Larry Cole says he’s meeting lots of people like Dave.
An addiction counselor since 1988, Cole spent most of his career in Detroit, dealing with clients addicted to alcohol and illegal street drugs such as heroin and crack cocaine.
Then he took a job nearly two years ago at Bio-Med Behavioral Health, a methadone and counseling facility in Mount Clemens.
“When I came out here, I was shocked at the amount of people coming in who were abusing Vicodin and OxyContin,” says Cole.
OxyContin, another powerful pain reliever, is designed to be time-released, but illicit users grind it into a fine powder and snort it to obtain an immediate, heroinlike rush.
“There are,” says Cole, “a whole new group of junkies coming in for treatment.”
Cole says he can’t pinpoint just one reason why the drug seems so much more of a problem in the suburbs, but he thinks that the fact that so many more people have medical insurance and access to health care outside the inner city could well be one significant factor.
14,000 ER visits
Prescription medicine abuse has been getting a lot of media attention. Newsweek recently ran a cover story, and Time magazine and newspapers in the United States, Canada and Great Britain have covered it as well.
But the phenomenon isn’t new.
Abuse of prescription medicines has been a problem for as long as medicines have been prescribed. All that changes, it seems, are the names of the drugs making headlines at a particular time. Amphetamines and barbiturates both had their heyday. There was also a time when over-the-counter cough syrups still contained codeine, and teenagers would chug down bottles to catch a buzz.
Now it appears that the prescription medications most in vogue are painkillers.
“Because of advances in attitudes toward pain management, doctors are prescribing more of these drugs than ever,” says Cole. And as the number of legitimate prescriptions rise, so do incidents of abuse.
Last month NIDA released the results of a national survey from 1999 indicating the use of prescription drugs for “nonmedical” purposes. According to that report, abuse of pain relievers was nearly triple that of stimulants and more than double that of sedatives and tranquilizers.
There are other danger signals. According to another recent NIDA report, “Emergency room visits involving hydrocodone medications like Vicodin and Lortab jumped from an estimated 6,100 incidents in 1992 to more than 14,000 in 1999.”
Part of the reason for this is, according to Dr. Brian McCarroll, an addiction specialist who teaches at Michigan State University and is a consultant to NIDA, is that the “vast majority” of Vicodin addicts are getting hooked after first being exposed to the drug when prescribed for legitimate need by a physician.
There is also a tie-in to a resurgence in heroin use, says McCarroll. With Vicodin readily available and relatively inexpensive, users turn to it when in need of a fix.
Concerns about Vicodin addiction first received widespread attention back in 1996, when it was disclosed that Green Bay Packers quarterback Brett Favre was hooked on the drug. Since then, a string of celebrities have undergone detoxification treatment. Actress Melanie Griffith posted her “recovery diary” on a Web site, and “Friends” star Matthew Perry underwent a well-publicized treatment for addiction to the drug. So did Courtney Love, who told one reporter the Vicodin high was “smooth and sweet” but that kicking the habit was more difficult than getting off heroin.
Yet NIDA points out that “Many studies have shown that properly managed medical use of opioid analgesic drugs is safe. … [T]aken exactly as prescribed, opioids can be used to manage pain effectively.”
With the media hyping the issue, there is the danger of a backlash that could cause physicians to stop prescribing a useful medication to people who legitimately need it, says McCarroll. What’s required, he says, is a balancing act. Physicians need to be more forthright in warning patients of the potential hazards of addictive drugs, and they need to become more adept at recognizing the signs of addiction. Finally, treatment for those caught in its clutches has to be readily available. But even specialists can be deceived by patients intent on keeping their habits fed.
“Here I am, someone who’s a nationally recognized expert on addiction,” says McCarroll, “and I still find myself getting conned by a patient about once a month or every six weeks.”
50-plus pills a day
For Dave, who asked that his real name not be used, his dependence on the drug escalated quickly. The original prescription called for him to take one pill every four to six hours. The bottle contained enough to last six days. When that ran out, he continued complaining of pains that no longer existed in order to keep the pills flowing. After some “doctor hopping,” he began buying the pills in quantity “on the street.”
He’d purchase 500 to a 1,000 at a time, paying $3 to $5 apiece, then sell part of the haul to a few fellow users for $8 to $10 each, using the profits to help support an ever-mounting habit.
By the time he began looking for treatment last fall, after being hooked on the drug for five years, he was taking between 50 and 100 pills a day.
“That many pills would probably kill someone who hadn’t built up a tolerance,” says McCarroll.
According to McCarroll, who’s a partner in the Bio-Med treatment center, Dave is part of an unlucky minority prone to addiction.
“Studies show that 10 percent of men and 5 percent of women are born with a genetic predisposition to become addicted to substances, be it alcohol or drugs,” McCarroll explains. “There’s something wrong with the pleasure centers of their brains compared to other people’s.
“There are, for example, people who, the first time they take heroin, will say, ‘I never felt right in my life until I had that drug.’ Their pleasure centers never responded quite right to their normal endorphins.”
For Dave, who had never had a problem with alcohol and had tried other drugs such as cocaine without falling into their grip, it was the opiate in Vicodin that pushed his pleasure button.
Despite taking innumerable Vicodins over a five-year period, Dave says he never knew until he went into treatment that the source of his addiction stemmed from the same poppies that are used to produce heroin.
All he knew was that, in the beginning at least, the pills made him feel great, and that was the only thing that mattered.
“I thought I had everything licked for a long time,” he said. While under the drug’s influence, he believed there was nothing he couldn’t do or accomplish. “I felt like I could conquer anything.”
At least for a while.
It took him two years to admit to himself that he was an addict, and another three years to decide to seek treatment.
He tried several times to quit on his own, going cold turkey, but those attempts always ended in failure. “I just couldn’t do it. It was terrible,” he says. “I’d get real bad stomach cramps. “
Caught in the throes of addiction, he was then at the point where he needed massive amounts of Vicodin just to make it through the day.
“My whole life revolved around getting Vicodins,” he recalls. “I didn’t care about my family. I didn’t care about anything. My No. 1 priority was to get Vicodin in order for me to function. The first thing I had to do when I got up in the morning was go out and chase some down.”
By his estimate, Dave spent close to a half-million dollars on the drug over a five year period.
“At one point, toward the end, I had $70,000 in cash stashed away that nobody knew about. I went through that in less than six months.”
Saying that, his chin drops do his chest, and his head begins to shake back and forth in dismay.
“I worked hard for that money,” he says. “For me to give it away like that is sad. Real sad.”
By the time he decided to seek help, Dave’s life was on the brink of ruin. He’d driven a thriving business into the ground. His marriage was falling apart.
“I was going to lose everything,” he says. “I just had to get off the drug.”
After a considerable search, he finally spotted a Bio-Med ad and came to the clinic, a nondescript, one-story office building tucked away on the south side of Mount Clemens.
Dave — despite having swallowed untold numbers of the pills over the previous five years — was stunned to learn that he was addicted to an opiate.
“I just didn’t know,” he says. “It wasn’t until I came here that I realized that, for me, there was no difference between a bottle of Vicodin and a packet of heroin. Except that Vicodins are accepted by society, and heroin is illegal.”
The news that treatment involved methadone also came as a revelation.
“I had no clue,” he says. “I thought methadone was only for heroin users. It all hit me pretty hard. I thought heroin users were the lowest form of people on earth.”
What he found in treatment were people much like himself. Many were professionals — doctors, architects, lawyers.
“People from all walks of life come through here,” says Dave.
Still, the stigma was hard to shake. Five months into his treatment program, Dave still hadn’t told his wife he was taking methadone to shake his Vicodin habit.
“I’m not sure she would understand,” he says.
A month later, he broke the news to her. Counselors at the clinic helped “educate” her about what they were doing, and why.
Along with the daily doses of methadone, Dave also attends weekly counseling sessions, both group and one-on-one.
“The methadone helped take the craving for Vicodin away,” says Dave. “It definitely helped. But it’s the counseling that has really helped pull me through all this. As far as I’m concerned, coming here saved my life”
The future is uncertain. For one thing, he does not yet know what the physiological consequences of ingesting so many pills for so many years might be. Liver damage, kidney damage, even hearing loss are all possibilities.
For now, though, life is looking infinitely better than it did just a year ago. Again able to focus on work instead of worrying about where his next fix would come from, he is rebuilding his business. He’s also working hard to repair the damage caused to his marriage and relationships with his children.
“It’s going to take more time,” he says, “but I’m starting to get my life back together.”Curt Guyette is Metro Times news editor. Contact him at 313-202-8004 or firstname.lastname@example.org