Pill Head: The Secret Life of a Painkiller Addict (15 page)

“I’ve had an accident,” she said quietly.

“It’s okay, don’t worry about it. I’ll take care of it,” I said, as soothingly as I could.

It was this moment that snapped me physically out of my withdrawal. It was the power of seeing someone need me so badly, knowing how she must have felt in that situation, the machine dragging along behind her and the bathroom floor covered with the mess, that made every physical symptom in my body disappear. Maybe it was the adrenaline rush of knowing I needed to go into emergency mode and make her feel safe at the same time.

I gently lifted her nightgown over her head and tossed it into the bathtub. She’d had a mastectomy about ten years earlier.

I’d never seen the result. She wouldn’t make eye contact. I helped her into the tub, making sure we kept the machine outside of it and the tube running smoothly into her leg, and I began to sponge her off as she leaned on me for support. I made jokes about how I’d seen much worse in college, that everything was going to be okay, that this was most likely a result of the many antibiotics she was on. She stayed quiet the whole time, except for the occasionally whispered “I’m sorry.” I told her this was nothing, that she had supported me my whole life, this was the least I could ever do for her.

I continually rinsed and added more soap to the washcloth, got new clean ones out of the utility closet, and started over. I couldn’t give her a full shower because of the Medi-Vac. I had to ask her to bend over to clean the worst of it and she made a tiny whimpering sound but quickly choked it back. I concentrated solely on the task at hand. It was almost meditative. I blocked every thought from my
brain except the goal of getting her clean and comfortable. I’d process the eventuality of the human body later.

I finally got her completely clean, into a pair of adult protective underwear I found at the bottom of her closet, into a clean nightgown, and back into bed. She was fatigued from having to stand for so long and quickly passed out. I spent the next hour cleaning the floor of her bathroom, disinfecting, and making sure everything was spotless. I went back into my bathroom and into the shower, crying under scalding hot water. I wanted,
needed
her pills. But there was no way in hell I was going to take them.

BOBBY’S SURGERY WAS A
success, and my younger sister showed up to take over so I could get back to work in New York. I was proud of myself for not stealing any of her pills, and ashamed of myself for feeling proud about something that should just come naturally to a person. But it helped to know that I was not alone in my desire. Sadly, stealing pills from elderly relatives is pretty common.

Diversion of pills takes many forms. In most cases, doctors are legitimately prescribing medication for people who are in chronic pain. Some doctors are less than scrupulous, but they are the minority. It’s quite possible that early refills for people in chronic pain, especially for the elderly, are needed because someone has been pilfering some of the pills, either for personal use (like I almost did) or to sell. Unfortunately, it’s the doctors who are being prosecuted, when, in most cases, they were just trying to help a patient suffering from intolerable pain. There’s a huge difference between the doctor who helps operate an Internet pill mill and the doctor who gets busted for legitimately prescribing painkillers to people who need them for their intended purpose.

In February 2002, a doctor in Florida, James Graves, was convicted of manslaughter in the deaths of four patients for whom he
had prescribed OxyContin. He was sentenced to sixty-three years in prison. This was at the height of the OxyContin panic, when the media was collectively ejaculating over the idea of hillbilly heroin. Dr. Graves argued that he had been prescribing the medication legitimately; he even made his patients sign “pain contracts” promising to follow his instructions. Michael Gibson, Dr. Graves’s lawyer, was quoted as saying, “If a patient lied, there was little Dr. Graves could do about it. Addicts are not dumb. They lie, they make things up and exaggerate things.”

This is absolutely true. I know that toward the end of my abuse I could have walked into any doctor’s office and walked out with a prescription for some sort of opiate. (That is, other than my
real
doctor. He’s too smart for that.) I had researched all the right things to say, knew all the problems, such as migraines, that could manifest real pain without showing any physical symptoms.

In January 2002, Barry Meier, a reporter for the
New York Times
, interviewed Dr. William Hurwitz, a pain management specialist and lawyer located in McLean, Virginia, in connection with the Graves trial. Hurwitz stated that “many doctors like himself believe that large daily doses of narcotics such as OxyContin are an acceptable way to treat chronic pain. But he says his own experience has shown him that such practices can quickly bring a doctor to the attention of law enforcement; in the past decade his medical license has been suspended and revoked over narcotics prescriptions; it has since been reinstated.”

Dr. Hurwitz went on: “When [the DEA] sees anybody prescribing these meds they think the worst and presume the worse, and if there is a bad outcome they act as aggressively as they can.”

Dr. Hurwitz had clearly already caught the eye of the DEA, so I wasn’t too surprised to see his name pop up again two years later. Dr. Hurwitz, the man who had been going to bat for other doctors, was now on trial himself for “drug trafficking.”

The DEA had recently realized it needed to create a “principle of balance” to determine the guidelines of access to pain medications and the approaches to containing abuse, addiction, and diversion. It published a report on its website: “Prescription Pain Medications:
Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel.” It outlined succinct descriptions of the circumstances under which a doctor could be persecuted. But suddenly the report was pulled from the DEA website with no explanation except that it had contained “misstatements.” Some doctors believe it was pulled because it contained language that would have cleared Dr. Hurwitz of all charges. Instead, Dr. Hurwitz was initially convicted of more than fifty counts of narcotics distribution. He was sentenced to twenty-five years in prison. Thankfully, two years later his sentence was reduced to five years because of errors by the judge. After Dr. Hurwitz’s practice was shut down, two of his patients committed suicide because of their debilitating and chronic pain.

Doctors can cut patients off medications if they believe their patients are abusing them, but it’s absurd for a doctor to have to act as a policing agent with every single patient. Obviously there are many red flags a doctor can watch for, but there seems to be a witch hunt going on in the United States for doctors prescribing pain medication. This problem was expertly detailed in the
New York Times Magazine
cover story from June 17, 2007, “When Is a Pain Doctor a Drug Pusher?” I’ll tell you when. It’s when a shady doctor is working in tandem with a pharmacist to set up an online pharmacy, or an un-ethical doctor is doling out prescriptions to a wealthy client or a celebrity because he’s getting paid to do so. I know of one ridiculously famous musician who travels on tour with his own personal doctor, who writes him prescriptions for whatever he wants. Except for extreme situations like this, doctors should be treated as medical experts who are using these drugs for their intended purposes. But the sad fact is, many doctors are now terrified to prescribe these drugs, even if their patient is suffering horribly.

Siobhan Reynolds, the founder of the Pain Relief Network, is one of the nation’s biggest activists for pain relief and support for doctors who are being prosecuted. She started the network when her own husband, Sean Greenwood, died of a rare congenital connective tissue disorder called Ehlers-Danlos syndrome. Sean’s body didn’t produce enough collagen, a chief component of connective tissue,
so his joints were too loose (the medical term is “hypermobile”) and he experienced severe arthritic pain and horrific headaches. There is no cure for this disease. Sleep disturbances are common, and those affected can develop heart disease and diabetes from inactivity.

Siobhan and Sean eventually found Dr. Hurwitz, who was willing to prescribe the levels of OxyContin Sean needed to live something resembling a normal life. He was finally walking around, actively partaking in their son’s childhood. For the first time ever, Sean was taking his son to school and helping him with his homework.

Dr. Hurwitz knew that he was taking a huge risk by prescribing the amounts of Oxy that he was for Sean. But he still had faith in the government. After six months, however, he was arrested, and Siobhan had to scour the country for doctors willing to treat Sean’s pain. Most kept him at a “safe for them” dosage, which actually did nothing for Sean’s pain. Every now and then she would find someone who would give Sean the doses he needed, but then, like clockwork, they too would get arrested for “overprescribing” and Sean would suffer with his pain.

One symptom of Ehlers-Danlos syndrome is a weak vascular system. Siobhan believes that because of all the untreated pain Sean was experiencing, he couldn’t sustain the blood pressure rise. One day Siobhan had finally found a doctor who was willing to mail a powerful liquid form of an opiate to them, and while they were waiting for it to arrive, Sean died of a cerebral hemorrhage in front of Siobhan and their son.

Siobhan has since shared her experience with doctors all across the country and has testified on behalf of those who are being prosecuted. Her main issue is that “The vast majority of meds that are on the street that are actual pharmaceuticals are not from doctors at all. They’re from hijacked trucks and other forms of diversion way up in the supply chain, and that is the DEA’s fault. They want to cover that up by prosecuting doctors.”

It’s a strong accusation, but one that theoretically makes a lot of sense. Think of Caleb’s first major Oxy hookup, from the truck rob
bery. Or Heather and her theft of prescription pads, or Jared’s friend who was stealing from the pharmacy. And then there are my postings on MySpace. With the exception of Heather’s first visit to Dr. Feelgood, none of us were getting the drugs that we were abusing from doctors.

But it’s much easier for the DEA to follow a simple path of prescriptions from a prescription monitoring program than to get inside the mind of an actual criminal. Remember when I interviewed Mark Caverly at the DEA and I was put through a rigorous screening process? All of my belongings were x-rayed, my bag was opened and checked, and I had to walk through a metal detector. After the interview, I was sitting in my car in the DEA parking lot rummaging through my bag for the car keys, when I noticed Clover down at the bottom of my bag. I hadn’t looked inside Clover in months, and when I did, I discovered four 4-milligram Dilaudids, half a hydrocodone, and an 80-milligram morphine pill. I couldn’t believe my luck at not getting busted, and I still wonder if I hold the dubious award for being the first person to successfully smuggle illegally obtained drugs directly into—and out of—DEA headquarters. Even if it was an accident.

The DEA is so successful at prosecuting doctors on murder charges for “overprescribing” when accidental deaths occur because the Controlled Substances Act states that as long as a doctor writes a prescription in the course of his or her professional practice for
a legitimate medical purpose,
he is exempt from prosecution. This means that juries with limited to no medical background decide whether a woman suffering from severe pain with a very large dose of morphine in her system is being “overprescribed” by her doctor. The fact is, even the CDC admits most opiate overdoses happen in combination with some other form of drug.

The DEA has now created an environment of fear, where doctors are terrified to prescribe opioids to patients who desperately need them. But they need to step up their efforts at controlling diversion higher up on the distribution scale. Mark Caverly told me that while the DEA is allowed to conduct unannounced, on-site inspections of anyone who has a license to distribute controlled substances, these
inspections happen only every two or three years. The auditors count bottles and check inventory histories, but they don’t look inside all the bottles. Schedule II narcotics are required to be kept in a vault, but Schedule III narcotics like Vicodin and Percocet are only required to be kept inside a cage. I was once able to pick the industrial-strength lock to the front door of my apartment building, with minimal previous breaking and entering experience. How hard can it be to pick the lock on a cage?

According to the DEA, the safeguarding regulations are detailed and stringent, but they have remained basically the same since the 1970s. Now that the illegal market is so extremely strong for these drugs, it might be time for a safety update.

Dr. Alexander DeLuca is
a skinny man with lots of energy who tends to pull at his hair when he’s frustrated. He’s another vocal advocate from the Pain Relief Network, but he came to find himself in that position by surprise. During the 1990s he had been chief of the Smithers Addiction Treatment and Research Center at St. Luke’s Hospital in New York. During his tenure there he built a research institute into the clinical fabric of the center, writing a new computer program to easily track all of the center’s patients through their treatment. “Nobody did that in addiction medicine, and we were finding out all sorts of fascinating stuff about our treatment programs,” he told me over tea in his apartment on Central Park West. “In some of our programs, there was a zero success rate! What I realized is that it literally meant there was no way to leave! The treatment wasn’t adequate, and I wanted more. So I worked on getting grants to generate academic quality research. I brought in over $3 million in just a couple of years.”

He shakes his head sadly as he takes a sip of the coffee he made for himself. “My wife was smarter than me,” he says. “When I got the job, she told me, ‘Alex, your career life expectancy is now measured in years.’ I didn’t believe it. It was my home. I built it!”

Dr. DeLuca’s eventual downfall was his sense of compassion. He believed in “harm reduction,” which is a set of public-health prac
tices that help reduce the negative effects of substance abuse by providing, among other things, counseling, needle exchange programs, and HIV testing. He wouldn’t turn away a patient who wasn’t willing to sign on to abstinence on the first day, knowing that relapse was almost certain. Dr. DeLuca always allowed Alcoholics Anonymous to hold meetings at his facility, but he also allowed Moderation Management to hold meetings. This organization, which is essentially a support group for people who recognize that they have a problem but aren’t ready to commit to full sobriety yet, focuses on harm reduction, reducing, for example, the amount a person drinks, sometimes to the point of complete sobriety, sometimes not. (It’s worth noting that Audrey Kishline, the woman who created Moderation Management, left it, went back to AA, then got into a drunk-driving accident that killed a twelve-year-old girl and her father.)

The press got wind of it and suddenly there was a media firestorm about how Dr. DeLuca had turned the Smithers Center into a Moderation Management program. He was fired on the grounds of no longer supporting the “program philosophy of total abstinence.”

Dr. DeLuca quickly released his own press statement on the matter: “I have been surprised to find myself cast as a speaker for the harm reduction movement,” he wrote. “I have received hate mail, solicitations to write books, and multiple requests for interviews to discuss whether abstinence or moderation is the best treatment for alcoholism. This is about as rational as asking whether coronary bypass surgery or medication is the best treatment for heart disease.”

He believes the problem lies in a clash of cultures. “On the one hand we have a tradition of ‘tough love,’ ‘hitting bottom,’ ‘confronting denial,’ and avoidance of psychotropic medications. On the other hand, a more modern and medical approach works directly with ambivalence and motivation, and is often accompanied by pharmacotherapy for the craving, anxiety, depression, and insomnia so common in early recovery.”

He goes on to dispel the myth that harm reduction promotes permissiveness by comparing it to its other more accepted uses in all other fields of medicine. “If a person is overweight and has an elevated
blood sugar and is at risk of developing adult onset diabetes,” he says, “a physician might recommend a strict diet and exercise program. But if the patient cannot or will not comply with the recommendations, the physician doesn’t send him away to return when he is ready to accept the diagnosis and be compliant. Rather, the physician might start drug therapy while continuing to work with the patient on his resistance to, or problems with, the diet and exercise regimen. This is harm reduction. We accept the refusal or inability of the patient to do the best thing, and try our hardest to do the next best thing.”