Pill Head: The Secret Life of a Painkiller Addict (2 page)

John F. Kennedy Jr.’s use of methamphetamines and pills has been well documented. His supplier was a German refugee doctor named Max Jacobson. Max was one of the original famous “Dr. Feel-goods,” a doctor who just doles out whatever pills you want without really taking into consideration any sort of actual diagnosis. (His other nickname was “Miracle Max.”) Other celebrity clients of his
included Tennessee Williams and Truman Capote, and it’s rumored that he was Andy Warhol’s Factory Kids’ supplier as well.

So while I knew they were all around me, I never really questioned why there were suddenly so many pills everywhere. Even my short little
Jane
article was just out to prove that it was possible to get these pills, not why. But there are a number of social and economic factors that caused prescription painkillers to suddenly become America’s latest obsession.

Carol Boyd is a professor of nursing and women’s studies at the University of Michigan, director of the Institute for Research on Women and Gender, and a research scientist for the Substance Abuse Research Center. She has been studying the rise of prescription painkiller abuse since 2000.

“Listen,” she tells me, over the phone from her Michigan office. “I’m a kid of the 1960s. Quaaludes and Valiums were swapped all the time, so it’s not that prescription pill abuse is so unusual. Back in the 1950s and early 1960s, everyone was using Miltown, a tranquilizer that later became mostly replaced by benzos.”

But in 2000, when she was focusing her drug research on Ecstasy and other “club drugs” like Special K and GHB, she witnessed something at a sports event that she went to with her son. “I saw two different kids use someone else’s prescription asthma inhaler, and with impunity,” she says. “They just tossed it over to the next person. I decided to start including more questions about prescription drug use in our questionnaires, and we were getting hits—hits that were throwing us way off,” she said.

“Keep in mind, the National Institute on Drug Abuse had been asking about prescription pill use in their own monitoring surveys, but the wording was such that they weren’t able to home in on what the specific pills were. Oxy and Vicodin were mixed into the same category as heroin and morphine. So our own federal questionnaires were completely off the dime and didn’t catch the epidemic in time.”

It makes sense that there would be some flawed data out there because of the methods used to obtain these numbers. We suddenly had 32.7 million people using painkillers nonmedically, but almost all studies are based on questionnaires or interviews. This method of data
collection, called self-report, often lacks validity and reliability for several reasons. First, people tend to underreport their drug use, especially for legal but socially stigmatized drugs such as tobacco. They may also underreport drug use if they perceive a lack of privacy, as may happen when a survey is administered at school. Second, it’s often difficult to get these surveys into the hands of the people most at risk, since drug users tend to fly under the radar. And finally, the fewer users there are of a given drug, the harder it is to count them. Take heroin, for example. According to the 2006 National Survey on Drug Use and Health (the most recent survey available when this book was published), 14.8 million people age twelve and older had used marijuana during the past month, and 2.4 million had used cocaine. By contrast, only 338,000 had used heroin. Reaching this sliver of the pie is complicated by the reality that many hard-core drug users lack a permanent address or are in prison.

Dr. Boyd also became convinced that Ecstasy and club-drug use was starting to decline. “They’re just too dysphoric, they don’t mellow you out enough. I think Ecstasy will be one of those drugs, like peyote, that comes and goes. It burns itself out, then comes back around, then burns itself back out again.”

But prescription painkillers were different. She believes there were three things culturally that were going on that contributed to this sudden rise of painkiller abuse. The first was the rise of the Internet. We suddenly had more access to information. Say someone has a mole that looks funny; he can go online and get gobs of really important information on how to take care of it. The bad part of access to that kind of information is that you can easily find out about dosing and how to use prescription drugs to get high.

The second thing was September 11. It was harder to get other kinds of drugs into the country because of the overall security crackdown. The third was an upswing in prescribing by physicians. People with cancer were living longer, but they were also requiring more analgesics and benzos like Valium and Xanax for the pain and anxiety that comes along with debilitating diseases.

As a result, there are now more pharmaceutical drugs out there to be illegally diverted. “All of these things converge to make drugs
more available and make the knowledge about how to use them more available,” Dr. Boyd says.

Dr. Boyd believes there are four main kinds of pill users. The first group are
medical misusers
. “These are the people who have a prescription for Vicodin because, say, they had their wisdom teeth taken out. The doctor tells them to take one Vicodin every six hours, and they do it, but at night the pain is so great that they decide to take two pills every three hours or every two hours. On our initial surveys, these people showed up as nonprescription drug users, but they had a prescription and were self-treating. I would argue that that person is at risk, but probably stops taking the Vicodin when the pain goes away,” she says.

She calls the second group
medicine abusers.
This is the group that has a legitimate prescription for Vicodin for the hypothetical wisdom teeth removal, but they save the leftover pills and take them recreationally when they want to go to a party and drink. That is abuse. It’s not self-treatment. It’s using specifically to get high or create an altered state, and mixing it with another drug. But both medicine abusers and medical misusers are
not
taking the medication illegally. They have their own prescriptions.

The third group she calls
prescription drug misusers.
This is, say, the girl who has really bad menstrual cramps but wants to go to the homecoming dance. Her mother feels bad for her and gives her daughter the Vicodin left over from her own wisdom teeth removal so she can take care of the cramps and go to the dance. It’s a form of nonmedical use of prescription opiates. It’s diverting a medication illegally to someone who doesn’t have her own prescription and isn’t using it for its intended purpose.

Dr. Boyd also argues that this group probably has fewer consequences. Albeit they are still at risk, but not as affected as the biggest group, the fourth one,
prescription drug abusers
. This is the group that takes or steals diverted pills from friends or family and uses them specifically to get high.

Dr. Boyd’s concern is that when it comes to most drug research, these four different groups get lumped together, but it’s not the same story for all four. They may all end up in the last category be
cause they are all at risk for addiction, but their motivations are different and their access to the drugs is different. In order to really understand someone’s drug use, you need to know his or her initial motivation.

My only disagreement with Dr. Boyd is her belief that prescription drug misusers (the girl who is getting pills from her mom) probably have fewer negative consequences. I think it’s the opposite. Think back to that oh so quotable anti-marijuana ad from 1987, the one where the kid is banging away on invisible drums while wearing huge headphones, and his mustached dad bursts into his bedroom with the kid’s drug stash and yells, “Who taught you how to do this stuff??” and the kid goes “YOU, all right? I learned it by watching YOU.” It was genius as a pop culture idiom, but also totally true. I felt completely justified smoking pot in high school after I discovered my mom’s old copy of
The Marijuana Cookbook
tucked away behind the equally stoner-esque recipe tome,
The Enchanted Broccoli Forest
. But she had only kept the former around as a cultural artifact from the 1960s. It wasn’t until college that I discovered that recipes from the first book went transcendentally well with recipes from the second.

In Dr. Boyd’s studies, she is finding that with prescription pill misuse, younger women are using more opioid analgesics than men, and more often they use these pills to self-treat. “It’s surprising,” she says, “because it’s the first time that we’ve seen a popular drug that girls are using more than boys. The question is, why? We know that young women are more likely to experience depression, so it’s possible that young women are trying to self-treat a mood disorder. Young women also are more likely to be sexually victimized [by incest and sexual assault] and sexual assault is thought, at least by some scholars, to be etiologic to a substance abuse disorder. So a desire to cope with the aftermath of assault might be another factor. Another is that during their lifetime, women see more physicians and, thus, get prescribed medications more often. It appears that mothers may be more sympathetic to their daughters’ pain and give them diverted pain medication more liberally, maybe because it’s easier for girls to admit that they have pain. So far the data doesn’t show that girls and women become addicted to pain pills more than men, but under the
age of twenty-five years, they more frequently become nonmedical users. But again, our original studies were exploratory and cannot answer all our suppositions; in the future our work will examine gender differences and the self-treatment hypothesis more thoroughly.”

These initial findings came from two studies, the first conducted in 2003 among 1,017 ten-to eighteen-year-olds, and the second in 2005, where Dr. Boyd and her team surveyed 1,086 children in grades 7 to 12. There haven’t been any large-scale longitudinal studies of addicts to see what sorts of patterns really evolve over the course of a lifetime. But the data that we do have makes it clear that the non-medical use of prescription pain relievers has risen to scarily high levels, and the numbers have not yet begun to recede from this peak.

I obviously fall into the prescription drug abusers category. I could never be a prescription drug misuser, because that would mean giving away my stash for free. I don’t care how bad someone’s menstrual cramps are.

MY BEST FRIEND, EMILY,
discovered pills when her father had a heart attack in 2001. Up until that point she smoked pot and drank socially. She had taken Ecstasy a few times in college and shared the occasional bag of cocaine with me. At twenty-six, she was a rising star at a large advertising firm in the city, and she got high the way you were supposed to. We’d met at a birthday party through a mutual friend at
Jane
. She told me she liked my articles; I told her I loved her hair. The bond was immediate and permanent, I think because despite our shallow cocktail talk we sensed a shared affiliation with contradiction and morbidity. I learned she’d grown up the cool high school cheerleader who secretly shuttled pregnant girls two counties over to get abortions. In college, she edited a zine that dealt with HIV-positive people maintaining a healthy sense of continued sexuality. She was obsessed with the Mütter Museum of medical oddities in Philadelphia. And then there was her hair. It was a shocking platinum blond, the kind only achieved with a bottle that would probably kill a small town if it ever leaked into the water supply. Think Marilyn Monroe under fluorescent lights. It was pure chemical shine.

When she got the call about her father’s sudden heart attack a few weeks after 9/11, her boyfriend drove her back to the small town
in Pennsylvania where she’d grown up. During the drive she got a message that her father wasn’t going to pull through. He was brain-dead and in a coma. The paramedics had brought him back to life just so the family could gather around him and say good-bye. When they arrived, as Emily sat in the hospital waiting room, a nurse came in and slipped something small and round into her hand.

“Here, honey, you’ll need this tonight,” she said, patting her shoulder.

Looking back, Emily thinks it was probably a mild, generic benzo. Until that day in the hospital Emily had relied on Theraflu PM if she needed help sleeping. But that night, back at her father’s house, the over-the-counter medicine was doing nothing to stop the noise in her head. She took the mystery pill and slept, deeply.

The next day, as the family made preparations for the funeral, Emily’s boyfriend’s well-meaning sister, the town’s local pot dealer, pulled into the driveway. Emily walked out to greet her and was handed a clear sandwich baggie filled with several different kinds of pills of all shapes, sizes, and colors. “On the house, Em,” she’d said. “I’m so sorry.”

“What are these?” Emily asked.

The dealer repeated almost the same words as the nurse: “You’re going to need them.”

She took the pills inside, reached into the baggie, and swallowed the first one that touched her fingers. Her brothers and her mother were back at the hospital. She sat down on the couch. Her dad’s ashtray was on the coffee table, one and a half cigarettes ground inside a pool of ashes. As her mind settled and a warm comfortable haze enveloped her, she had a burst of practical insight and checked her father’s computer. As Emily had suspected, there was enough porn on the hard drive to keep an entire fraternity occupied for a whole semester. She erased the files and canceled his accounts. She sat down in front of the answering machine and retrieved condolences from people who weren’t even sure who they were leaving their messages for, knowing that the recorded voice they’d just heard was no longer there.

Emily doesn’t remember what she did with the rest of the pills.
The dealer who gave them to her later became addicted to whatever it was she had been distributing and soon turned to heroin. What Emily does remember is the connection between mind-shattering emotional pain and the temporary solace the pills provided. And that’s why, a few years later, in the midst of a brutal breakup with her musician boyfriend, Emily showed up at my apartment with tears streaming down her face and quoted our favorite line from
Ab Fab
: “I want total sensory deprivation and backup drugs.”

Luckily, I had just the thing for her. I gave her two Vicodins and a cup of tea. We sat on opposite ends of the sofa. She hugged a pillow to her chest and didn’t have to say anything. Instead of consoling her for her broken heart, I turned on a marathon of
America’s Next Top Model
and let the pills do their work. We spent the next four hours in silence, in the dark, with only the light from the television to wash over our glazed eyes. We didn’t need anyone, not even each other. I woke up the next morning, still on the couch. There was no hangover, no cocaine depression creeping around the corners of my brain like the Nothing from
The NeverEnding Story.
There was just a bottle of pills on the coffee table and Emily, stirring awake across from me.

“Hey, Em,” I said, yawning and stretching. “Let’s take pills and go look at art.”

At first, the refills
were easy. I’d already established a relationship with my original online pharmacy, so I never needed to re-fax my fake papers or talk to another doctor-for-hire. In fact, they called me to schedule refills (to this day, I
still
get calls from online pharmacies). I was making an associate editor’s salary at the time, which meant I could barely afford food after I paid my rent and bills. Luckily the pharmacy took credit cards. It also helped that the pills kept me indoors on most nights, so I didn’t spend money at bars.

The pharmacies that still call me these days are mostly offering mild sedatives or muscle relaxers. It’s much harder to get anything stronger now, because of the Drug Enforcement Agency’s crackdown. In 2003, as I was becoming more and more addicted to my FedEx’d
Vicodin, the DEA established a special pharmaceutical Internet coordination section. They had formally recognized online pharmacies as an epidemic as early as 2000, but prior to 2003, different DEA divisions handled the cases independently.

The DEA’s Office of Diversion Control (“diversion” meaning controlled substances being illegally distributed, i.e., pharmaceuticals) was initially established as a regulatory arm of the agency. Its classification system for illegal drugs and legal controlled substances regulated by the federal government came about in 1970, when Congress passed the Controlled Substances Act. (The DEA wasn’t actually created until 1973; prior to its formation, drug scheduling was over-seen by the Bureau of Narcotics and Dangerous Drugs.)

This system assigns federally regulated substances to one of five categories, depending on how relatively safe or dangerous they are, how great a potential for abuse or likelihood of addiction they pose, and whether they have any medical value. Schedule I drugs are those that have high abuse potential and no currently accepted medical use; for example, heroin, Ecstasy, and psilocybin, a component of psychotropic mushrooms. Cocaine isn’t on this list, because it still has a limited medical use as a local anesthetic for some eye, ear, and throat surgeries, so it falls under Schedule II drugs, which are legally available only by prescription. These drugs have a high level of abuse potential and users run the risk of physical dependency. Drugs in the Schedule II category also include narcotic painkillers like morphine, oxycodone, and codeine, and drugs used for attention deficit disorder (ADD), like the amphetamines found in Adderall. Vicodin and hydrocodone are classified as Schedule III controlled substances, meaning that they have been determined to have less potential for abuse relative to Schedule II drugs, but still may have the potential to be abused and to cause addiction or dependence.

The Office of Diversion Control initially started out inspecting large-scale drug manufacturers and distributors. But around the mid-1980s, the DEA began to see evidence of new kinds of pharmaceutical diversions, and the ODC began to change accordingly. It started to get more involved in criminal investigations and investigations of pharmacies and doctors who were illegally selling drugs
they had access to. About ten years later, in the mid-1990s, the ODC started to see an even larger scale of diversion going on. Once Internet shopping became the norm, the volume of drugs being pumped out to consumers online exploded.

There are two main types of Internet pharmacies. The first is a legitimate, registered pharmacy that decides to make extra money by selling its wares nationwide. The pills originate from the usual supply medical chain: drugs manufactured in the United States that have been made available to the pharmacy through a distributor and have been accounted for. The pharmacy will align itself with a doctor or doctors who are willing to write bogus prescriptions for anyone with a credit card. Following a typical pattern, in 2004, a pharmacy in Fort Worth, Texas, that had been illegally employing doctors in the Caribbean to authorize its Internet orders was taken down by the DEA.

The other type relies on drugs that are manufactured in other countries and then smuggled into the United States. The DEA took down a major operation in 2003 whose supply source was in India. The leaders of the drug ring set up a receiving warehouse in Philadelphia, then moved the operation to New York to set up an order fulfillment center. They hired dozens of people to count pills, place them in packages, and send them to buyers via UPS.

My pharmacy fit the former model. The pharmacy address was featured prominently on my pill bottle, and the fact that I had to talk to a “doctor” meant the pharmacy was at least trying to put up a legitimate front. But suddenly my online pharmacy disappeared and its number was disconnected. The afternoon it happened I had noticed that my current bottle was getting low; I only had about ten pills left. My pharmacy was usually pretty good about sending products overnight, but sometimes there would be a delay of a few days, so I liked to reorder before I completely ran out. At this point I was up to about four or five pills a day. I’d take my first two Vicodin toward the end of the day at work, then keep popping extras as the night went on. There was no way I was going to let my last ten pills disappear before I had a supply lined up. So I simply made another Internet search for “buy Vicodin” and found another source. From then on, whenever I started
to run low on my pills, I’d just call the pharmacy and reorder. If the pharmacy had been shut down, I’d do another Google search and start the whole cycle over again, with ever-increasing frequency.

Caleb likes to claim
that his OxyContin addiction started with MTV.

When I first got to know him, he was twenty-five and living above his parents’ garage in the suburbs of Los Angeles. He’s your typical LA native—tall, blond, a splash of beach bum freckles across the center of his face. As a teenager he did tons of drugs—acid, pot, speed, coke. He doesn’t even remember the first time he took Vicodin, but he knows that was the first pill he ever tried. It was just after he graduated high school, and he was bored with pot and how tired it made him feel. Someone gave him two Vicodins that he washed down with a beer. “I just got that sort of tired-wired buzz that I really like,” he remembers.

After that night, he started asking around, bugging people who he had heard through the grapevine had their own prescriptions from dental work, broken limbs, minor surgeries. “The great thing about it was that I could do anything on Vicodin,” he remembers. “Work on music or drive or whatever. But the problem was that I could never get it steadily. The pills would come and they’d go. At one point I got a bottle of a hundred that was prescribed to my sister, and when that bottle ran out it was the first time I felt withdrawal. I didn’t even realize that’s what it was, I just thought I had gotten the flu.”

After about two years of taking all the Vicodin he could get his hands on, Caleb saw a show called
MTV True Life—OxyContin
. “I saw all these testimonials of people saying that Oxy was better than Vicodin,” he remembers. “They called it hillbilly heroin. They explained that it was all the opiates of Vicodin without all the acetaminophen added.”

Acetaminophen, the active ingredient in over-the-counter painkillers like Tylenol, is also found in prescription narcotics like Vicodin (hydrocodone and acetaminophen) and Percocet (oxycodone and acetaminophen). Yet acetaminophen is a much less powerful pain-
killer than the narcotic drugs with which it’s combined. Eliminating it as an ingredient in these stronger painkillers lessens the damaging effects the pills can have on your liver and gives you a pure rush of the really powerful goods.

“I was like, ‘Oooh, I want to try that,’” Caleb says. “Which is embarrassing because the show was about all these people who were having problems with it. They weren’t making it appealing, but I already knew what it felt like to do pills, and I knew that if I could get a hold of this one, it would feel really good. The problem was, I couldn’t find them anywhere.”

Caleb went on a mission. He asked everyone he knew, specifically targeting people he’d gotten Vicodin from in the past and his regular pot dealers. Finally, a friend of a friend got a steady OxyContin supply because he knew a crew of people who were robbing trucks that delivered the pills to pharmacies. Hillbilly heroin was officially all over the California suburbs.

I take offense to the phrase “hillbilly heroin.” Not just because I’m originally from Tennessee and have a strong sense of state pride, but because it’s a contradiction. In most major cities, the current street value for pills usually follows the $1 per milligram rule, so an 80 mg pill of OxyContin usually goes for $80 if you’re a first-time buyer (regular customers can usually work out discounts). The street value of a bag of heroin is around $10 to $20. If you go by the rules of the hillbilly stereotype, you’d assume that their version of heroin would be less expensive than the original. Like buying generic toothpaste instead of Crest. I understand that the media needed a cute, buzz-worthy phrase to document the rise of OxyContin abuse in rural areas, but in terms of street value for a similar high, OxyContin is more like sucker’s smack.

I tried for weeks to land an interview with Dr. J. David Haddox, who is Purdue Pharma’s (the makers of OxyContin) senior medical director and official spokesman. But Purdue’s media relations department wouldn’t let me near him. I imagine it was because I made the dumb mistake of telling them the title of this book. I was told curtly that there were enough third-party medical experts out there for me to talk to, but I think the main reason Purdue didn’t
want me to talk to Haddox is because the company got in a ton of trouble for the way it initially marketed OxyContin to doctors. Not to mention all the lawsuits that came a few years later.