A Pain Pill Among Friends: The Quick and Quiet Way Young People Are Getting Hooked on Opioids

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Two women share their stories of addiction and recovery.

By Elizabeth Millard

Original Source: self.com

When Lindsey Lee was 14 years old, she was hanging out at her boyfriend’s house and mentioned that she was feeling upset. A few years earlier, Lindsey’s mother had been murdered, and it threw her down a well of grief, confusion, and pain.

Her boyfriend had recently undergone surgery, and had a prescription for opioid painkillers. He offered her one as a way to take the edge off. Within a few years, she was taking 100 per day.

“When I took that first one, it made me realize I never had to feel pain again unless I wanted to,” Lindsey, now 23, tells SELF. “Whenever I felt bad, all I had to do was take a pill and then I’d feel better. And I always wanted to feel better.”

By age 16, she was hacking into her dad’s bank account and skimming money. She used six different drug dealers to make sure she could get enough pills, and forged signatures on $50,000 worth of checks to pay them. Her addiction was costing about $600 per day, and it was all she did—Lindsey didn’t eat, didn’t shower, didn’t answer the phone. She just took opioids and then drifted away.

Comprising prescription drugs like OxyContin, Vicodin, morphine, Percocet, fentanyl, and Demerol—as well as illegal drugs like heroin and synthetic versions of morphine—opioids are designed to bind to specific receptors in the body that dull pain. Between 26 million and 36 million people abuse opioids worldwide.

Research finds that one in four people prescribed opioid painkillers for long term use get addicted—and prescription levels have soared in the 2000s. In 2012, physicians issued 259 million opioid prescriptions—enough for every adult in the U.S. to have a bottle. According to the Centers for Disease Control, the number of opioid prescriptions sold quadrupled between 1999 and 2015—and so did overdoses. That’s a major contributor to the estimated 59,000 to 65,000 drug overdose deaths in the U.S. last year (according to research by the Times)—the leading cause of death among Americans under 50, more than peak levels for deaths from car crashes, HIV, and guns.

Around 2 million Americans misuse prescription opioid painkillers. But data from the Substance Abuse and Mental Health Services Administration show that most don’t get their pills from a doctor. More than 50 percent of people who are addicted to pain pills got them from a friend or family member (the vast majority of whom obtained them with a prescription). Adolescents and young adults between the ages of 12 and 25—a group that makes up nearly a third of painkiller misusers—are roughly twice as likely to get opioids from friends or relatives as from a doctor.

“In my experience, more often than not, young adults start using opiates as a recreational drug,” addiction specialist Indra Cidambi, M.D., tells SELF. “They usually obtain pain pills from loved ones, sometimes by stealing.” With no prescription to mark the start (and, one hopes, the stopping point) of opioid use, many young people and their families never see addiction coming.

For many, the shift from occasional use to addiction comes at lightning speed.

Just after turning 21, Kentucky native Keenan Beckhart was urged by friends at a party to try one dose of OxyContin, and that changed everything—way too fast.

“I’d had a great childhood, with two loving and supportive parents, but once I had that pill, I thought, ‘This is what I’ve been missing my whole life,’” she recalls. “It was perfect. Everything seemed to make more sense. I felt like this is what I needed to do anything in my life.”

Less than a year later, her apartment contained only a couch and a bed because she’d pawned everything else, and the pawn shop didn’t take furniture. Keenan, now 27, remembers bringing in her vacuum to pawn for Oxy, and the embarrassment still washes over her.

But she couldn’t stop, upping her daily dosage so much that she didn’t show up to her college finals—not that she could have studied anyway, since the pawn shop got her laptop, too.

“My whole world came down in six months,” she says. Her boyfriend called her parents and told them what was going on. After an intervention, she got sober, but later relapsed. She was seven months pregnant.

Courtesy of Keenan Beckhart

Keenan Beckhart with her mother

William Jacobs, M.D., medical director at Georgia-based treatment program Bluff Plantation, says that some people are simply more susceptible to getting a positive reaction to opioids, and that can lead more easily to addiction.

“We all have a different genetic makeup, and some people are at greater risk of developing addiction, just like you can be more or less prone to heart disease or cancer,” he says.

Based on their descriptions of their first experience with opioids, Jacobs believes that Keenan and Lindsey could be among this group. He notes that while most people get sleepy when they have an opioid for the first time, those at higher risk have a reaction like Keenan’s and Lindsey’s—euphoria mixed with certainty. They feel energized and absolutely believe that opioids have just made their lives 100 times better. When people have early reactions like that, Jacobs says, it is a good indicator that the drug will prove more addictive for them—and by the time they realize that use has become addiction, it’s often too late to go cold turkey.

In addition to the hereditary component, other factors that can increase a person’s chance of becoming addicted include a history of trauma, especially during childhood, and easy access to drugs and exposure to family members, friends, or neighbors who use them. According to SAMHSA, people who begin using before age 18 have a higher risk of addiction, and “nearly all people with serious drug and alcohol problems start to use in their teens or early twenties.”

White people are more likely to be prescribed and become addicted to opioid painkillers. Non-Hispanic whites make up over 80 percent of the population in parts of the country where prescription rates are highest. Nearly two-thirds of opioid misusers are white.

One of the first warning signs of opioid addiction is, by definition, hard to spot—especially if no one is looking for it.

Isolation is one of the most common signs of problematic drug use, says Jacobs. “Once a person gets addicted, his or her days are spent figuring out how to get more,” he says. “That doesn’t leave much time for extracurricular activity. Things that used to be important lose their appeal. People seen as a hindrance to getting more drugs get cut off.”

Other signs include dramatic mood changes, restlessness, distraction, avoidance of family, and disinterest in activities that used to be embraced.

For Keenan, if her boyfriend hadn’t made that call, she’s not sure what would have happened. “My parents weren’t there to see what was going on, and they probably thought I was just too busy with school to check in more often,” she says. “In terms of friends, I was only hanging out with others who were using.”

Lindsey got help by sitting down with her dad, Wally, when she was 21 and telling him what was going on.

“He was completely devastated, and that was hard to see,” she says. “But that still wasn’t enough for me to want to get sober.” He had doubts that she was truly addicted, so she kept using. Then she overdosed, twice. “That was what it took,” for her to accept that she was in trouble, she recalls. “I began to see friends dying from overdoses and I knew I could be next.” Her father, however, was still not ready or able to see the truth.

Denial can be deeply entrenched—and not just for the person who’s facing the addiction.

For a few years before Lindsey had that serious talk with her father, she’d tried to let him know she was struggling, Wally recalls. He noticed the money missing from the account, and she’d mentioned taking pain pills, but he simply didn’t believe that she could have an issue.

“I thought she might be covering for one of her friends,” he says. He asked her to go into a lab-based drug testing company, and she agreed, because she wanted to prove that she had a problem. But she passed the test, more than once.

She told him the results were wrong, but it just cemented his opinion that she couldn’t be addicted. “I didn’t want it to be true,” he says. “For years, it turns out, she was good at concealing her addiction and I was good at not wanting to recognize that she had one.”

Then, one day, Lindsey’s drug dealer drove up on Wally’s lawn and stormed up to his door, demanding the $4,000 he was owed. That turned out to be the wake-up call that Wally never thought he’d get.

“I had to finally accept the fact that my child had a drug problem,” he says. “But that led to one of the best things that’s happened, which is seeing her decide that she needed help.”

Courtesy of Lindsey Lee

Lindsey Lee and her father, Wally

Help can be devastatingly hard to come by.

Only one in 10 people with a substance use disorder receive any type of specialty treatment. “To say that the need is greater than the resources is a vast understatement,” says Monique Tello, M.D., M.P.H., a primary care physician at Massachusetts General Hospital, whose nephew died of an opioid overdose in 2013.

Like other drugs, opioids affect the brain regions associated with reward, but they are particularly addictive because of the speed at which they work and the intensity of withdrawal, Cidambi explains.

“Opioids create a strong pull on the brain’s addiction pathways, that’s why they’re difficult to treat,” says Jim Scarpace, executive director of Gateway Foundation Aurora, Ill., a substance abuse treatment program. “Essentially, they change the way your brain operates.”

The neurological changes that cause dependence can be reversed in days or weeks after detoxing from the drug. When a person becomes addicted, however, the brain changes are much more complex and wide ranging, and can lead to relapse months or years after drug dependence ends.

The most effective treatment avenues for opioid use disorder include the use of other medications that work on the same neural pathways to either block the receptors in the brain susceptible to opioid effects, or satiate cravings and reduce withdrawal symptoms without producing a euphoric high. The first-generation of opioid replacement therapy was methadone, which has been used for decades to treat opioid addiction. These days, doctors are increasingly using buprenorphine or Suboxone (buprenorphine plus naloxone, an an opiate receptor blocker), and Vivitrol (also known as naltrexone), a full blocker that’s similar to Narcan—the meds that police and paramedics are now carrying to “wake up” an opiate user during an overdose.

Combined with behavioral therapies, medication is highly effective for people suffering from opioid use disorder. But medication use for opioid addiction faces a stigma from some health professionals and legislators—including Trump’s Health and Human Services secretary, Tom Price—who mischaracterize it as just “swapping one drug for another.” A 2016 Surgeon General report on drugs in America says, “Such views are not scientifically supported; the research clearly demonstrates that [medication-assisted treatment] leads to better treatment outcomes compared to behavioral treatments alone. Moreover, withholding medications greatly increases the risk of relapse to illicit opioid use and overdose death. Decades of research have shown that the benefits of MAT greatly outweigh the risks.”

In addition to fighting addiction, some in recovery have to fight physicians and insurance companies if they want to try a medication-based approach. The situation may be further exacerbated if a GOP health care bill is enacted which cuts Medicaid, the largest payer of addiction treatment, and drastically reduces substance abuse funding.

Cidambi says that while MAT has gained wider acceptance among addiction therapists in recent years, “it is still being underutilized.” Tello says, “We have a ways to go when it comes to accepting this as an option, and that’s too bad. Because it means some people won’t be getting what they need.”

There is a stark lack of availability in some areas, limited usage in others, and insurance caps or refusals on prescriptions. For example, the FDA cleared buprenorphine for treating opioid addiction 15 years ago, but the law requires doctors to apply for a waiver to prescribe it, and then limits how many patients they can administer it to. New rules put in place at the end of the Obama administration raised the caps on waivers, but even still, the Surgeon General says, “lack of physician availability to prescribe buprenorphine has been a significant limitation on access to this effective medication.”

Comprehensive, patient-centered treatment with a long-term approach simply isn’t available everywhere. Even when it is, insurance may pay for only part of a program, or none at all. Wally says that he was fortunate to be in a position where he could pay the $30,000 it took to get Lindsey help, because insurance didn’t cover any of it. Keenan stayed for six months at The Healing Place, a traditional abstinence-only recovery program that doesn’t take insurance and uses donations and some government funding to provide free treatment to its clients.

Lindsey and Keenan were fortunate to find treatment they could afford before either made a switch toward heroin, a very common shift for people addicted to opioids.

As opioid addiction ravages families and communities across the country, the medical community, patient advocates, and those in recovery are fighting hard to sound the alarm.

The increasing attention on the country’s opioid problem raises criticisms that it is motivated by the “white face” of the epidemic. In contrast to the way the crack epidemic that devastated predominantly black communities was treated as a problem of law and order (and people who were addicted were treated as criminals rather than victims), physicians and politicians alike are facing opioid addiction like the public health crisis that it is. The focus is causing some preventive measures to be put in place, but there is a long way yet to go.

July CDC report found that the number of prescriptions dispensed has declined steadily since peaking in 2010. But it is still three times higher than it was in 1999, and doctors are prescribing pills for longer periods than they were 10 years ago, which increases the chance of addiction. “The bottom line is that too many are still getting too much for too long,” Anne Schuchat, CDC acting director, told reporters. “And that is driving our problem with drug overdoses and drug overdose deaths in the country.”

“Opioid addiction is everywhere; it doesn’t matter where you live or who you are, it’s all around you,” says Wally. “Once you recognize that this is a problem, you start to see how large of a problem it really is. And it’s huge.”

The CDC estimates that 46 people die from prescription painkillers daily. In 2014, more than six in 10 drug overdose deaths involved some sort of opioid, including heroin. Tello tells SELF her nephew Christopher became addicted to pain pills and, like Lindsey, he found that he needed more and more of the drug just to feel normal. Because street heroin was cheaper and easier to access, he shifted to that, and died of an overdose.

In her 16 years of clinical training and practice—along with her family’s trauma—Tello has witnessed firsthand the over-prescription of pain meds, as well as the stigma and under-treatment of opioid use disorder. That led, she says, “to the premature death of a really good kid.”

Physicians are looking into more ways to treat chronic pain with non-drug remedies, and treatment centers are working to lessen the stigma of addiction so more people can recognize they need help.

Most of all, people like Lindsey and Keenan are showing that as harrowing as addiction can get, there can be a path to sobriety. As of this writing, Lindsey has been sober for seven months, and Keenan for well over a year and a half.

“At some point, I woke up and saw what my life had become,” Keenan says. “It’s heartbreaking to think about what I put my family through, and what I put myself through. It makes me never want to go back.”

If you’re struggling with a substance abuse problem, reach out for help at 1-800-662-HELP. You can find more information on the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

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