Pill Head: The Secret Life of a Painkiller Addict Page 14

  Heather wasn’t learning the skills she needed to live. She began to develop relationships with other patients and tried to help them through their recovery, but she kept getting called out on it from the therapists because she wasn’t focusing enough on herself. She also never got used to the common AA mantra about working the twelve steps: “It works if you work it, so work it, you’re worth it.”

  “It was just this dumb cheerleading chant we had to do every morning before going into group therapy, which never even really focused on addiction issues,” she says. “It was more about resolving really fucked-up high school issues, like one patient getting upset that two other patients were sleeping together, because everyone was suddenly discovering their sex drives again after getting clean.”

  To make matters worse, the main therapist with whom Heather had been working, with whom she was just beginning to develop a bond, suddenly had to leave because her son died.

  By the time her twenty-eight days were over, Heather was more than ready to go home. Derek flew to Florida to pick her up, but it wasn’t the happy reunion they’d both imagined. Derek was furious to discover that the rehab center was still keeping her medicated. She was taking Cymbalta, an antidepressant, Lyrica for anxiety (which was being prescribed off-label), trazodone to help her sleep (an antidepressant, also being prescribed off-label), and Seroquel to ward off panic attacks (an antipsychotic, once again, being prescribed off-label). She was on more medications coming out than she had been on going in. This is fairly standard with rehab because of the anxiety, depression, or sleeping issues that can arise with newfound “sobriety.” But Derek hadn’t been expecting all these new medications. He associated Heather’s problems with pills, and now she was taking more than ever.

  In High Society Joseph Califano discusses the biggest problem with rehab facilities: The twenty-eight-day cycle that almost every residential treatment program functions on is not determined by any sort of medical need; it is simply the reimbursement cap set up by commercial insurers. He claims that even higher-end facilities like Betty Ford and Hazelden only have success rates of around 30 percent. Both centers refute that claim and boast much higher success rates, but they also only monitor their patients for one year after leaving.

  Heather arrived home with no follow-up therapist. Her rehab center advised her to get a low-stress job (“moron job,” as Heather puts it) when she returned home. “It actually makes sense,” she says. “If I had taken on a stressful job I would have slipped up for sure. I needed to take it easy for a while, let myself be a dummy, because I couldn’t think straight. I couldn’t form sentences, and I had tremors in my hands from the combination of pills I was on. I slowly tapered off all of them over the course of about six months.” During this time, she was under the care of an osteopathic doctor who was monitoring her decrease.

  When she was feeling stronger, Heather took a job helping to run a high-end spa in Manhattan. It was the last time she would slip up. She was stressed and tried to order Xanax online, but Derek had been monitoring her email and busted her. She canceled the order. “I’d been thinking to myself, if I just had one Xanax, I can get through this week. But in reality there is no way: one would quickly become ten. Getting busted by Derek was the best wake-up call, because even after rehab, I don’t think you’re ever out of the woods. Especially with pills.”

  She isn’t even sure she would have taken the pills if Derek hadn’t caught her. “I might have gotten freaked out and thrown them away. I might have gotten them and done them all at once. But I think I’m too scared to go back to that lifestyle again, because I know there would be no coming back. Derek would leave, my family wouldn’t help me again, and I would just be alone with my drugs. That’s where any addiction is going to take you.”

  For people who don’t want to deal with rehab, or even just a weeklong detox, there are many different companies in the United States that offer anesthesia-assisted rapid detoxification, AARD, more commonly known as ultra-rapid detox. The person is put under anesthesia and given a medication like naloxone, which strips opiates off the brain’s receptors by shoving them aside and taking their place. Because naloxone is an antagonist, it is drawn to these receptors, but can’t do anything once it gets there. It’s kind of like the situation of a drunken stud who does everything he can to get someone in bed, but is too wasted to perform once he’s actually in the sack.

  Patients usually wake up feeling groggy and hungover, but the cravings are gone. The procedure isn’t covered by insurance and can cost anywhere from $10,000 to $20,000. Detractors of AARD argue that patients need a much longer amount of aftercare and therapy, since many are simply released back to their homes after just a few days. And on July 8, 2008, a popular medication used in ultra-rapid detox called Revex (nalmefene) was discontinued by its manufacturer with no explanation. AARD can seem like an easy solution for people who can afford the process and don’t believe they have the time to go to rehab, but anyone who chooses this method should make sure to have proper aftercare set up, for example, a therapist or regular attendance at NA or AA meetings. Otherwise, AARD seems like an expensive and ineffective way of dealing with the problem. Sure, you won’t suffer the same amount of withdrawal pain, but there is virtually nothing stopping you from going right back to taking whatever it was you were taking before you went under anesthesia.

  Caleb eventually cut down on his daily OxyContin use and saved the pills for special occasions. “They’re just too expensive,” he says. “I can’t afford them.” Now he takes illegally obtained methadone to stave off his cravings. According to the DEA, prescriptions for methadone have increased by 700 percent from 1998 to 2006—just another example of more pharmaceuticals being out there to be diverted. Caleb eventually stopped using the drug dealer who made him drive around to different places to pick up drugs. “If he’s not on crack, then there’s something seriously wrong with him,” Caleb says. “He’s just crazy as hell, and it got to be such a pain in the ass picking him up in the heart of the ghetto, then driving around to find some other person that he has to hassle with. The guy I use now is just a godsend.”

  And, apparently, the dealer believes that himself. “He comes to town three times a week,” Caleb says. “He drives around in this giant old green Cadillac convertible, blasting this Christian gospel sermon out of the radio. You know the kind: ‘And the Lord will strike down his enemies,’ blah blah blah. He usually has methadone, OxyContin, and Valium, and he just drives around all day making his deliveries. He’s always glad to see me, and he gives me a preferred-customer status. He’ll let me hold a few of whatever I’m buying until next week, or work with me on pay, or give me an extra pill for free.”

  But the Christian hookup doesn’t always work out to Caleb’s advantage, because product availability fluctuates. “Recently he was out of methadone, and I couldn’t find it anywhere else,” Caleb says. “So I had to take OCs every day just to maintain and not get withdrawals. I wasn’t very happy about it. It cost way too much.”

  If I were an enterprising drug dealer with a regular customer like Caleb, I would make sure I consistently ran out of methadone and only had OxyContin available. It just makes sense from a business standpoint, especially if you were having a slow week in your other drug arenas. I’m just saying.

  Caleb has been on methadone for well over a year now. “There’s absolutely no high to it,” he says. “It just delays my withdrawal symptoms.”

  But at this point going off methadone would be almost as bad as going off OxyContin. “It’s just that I never wanted to go through withdrawal in the first place,” he says. “The ’dones are really cheap, it’s been relatively easy to maintain a steady supply, and I’ve been able to delay taking everything out of my system. It’s hard to say, ‘Okay, I’m going to set aside a week when I feel worse than I’ve ever felt in my entire life. I’m going to put aside my friends, my family, my job, everything—just to check out. It’s just so much easier to keep saying, ‘Oh, next we
ek, next week.’”

  CHAPTER 10

  Fight or Flight

  MY FATHER CALLED. THERE was something wrong with my grandmother in Tennessee. I have a hard time paying attention to him, my mind shuts down a little whenever he, or even his voice, is in proximity. All I heard were the words infection, necrotic tissue, surgery. He asked me to come down to take care of her in the weeks after she was released from the hospital. “She’ll need help around the house,” I was told. The rest of the family would take turns once I left. My grandmother, Bobby, had been the only member of my family besides my two sisters who had ever showed a consistent interest in my personal life or my career. I’d even put Bobby in Jane once, describing a trip we took to Alaska together to see the glaciers and look at whales. She was the only family member who subscribed to and actually read every issue of Jane. (My mother once described it as a magazine “utterly without substance.”)

  During high school, I had spent every summer with Bobby in Tennessee. I’d sneak booze from her liquor cabinet, and we played card games for dimes on a large, round green marble table she’d had custom-built. Her house had been designed by her and my long dead grandfather. It has glass walls that stretch the entire length of the back of the house, looking out over a long, curved stone porch and a sloping lawn that leads down to dark woods, teeming with birds and deer. When I was a teenager, she was the only member of my family who ever made me feel like I could do something productive with my life. When I had first gotten my job at Jane my father had congratulated me, but what stuck out the most in my mind was him laughing and saying, “I’d always thought you’d be in jail by now.” But Bobby, who had worked as an editor for years, told me about the Kennedy side of my family, which ran a small newspaper dynasty in Michigan. “It’s in your blood,” she said, and raised her glass of bourbon in salute.

  I didn’t know what to expect when I arrived in Oak Ridge, but I knew that I was going to do the caretaking sober. I didn’t bring a single pill with me. I wanted all my faculties if I was going to be taking care of the one woman who had made me feel worthwhile. As for her injury, all I knew was that she had fallen a few months ago and developed a small cut on her left calf. Over time it had become red and infected, and then it became seriously infected. The tissue in her leg had become necrotic.

  When I arrived I ran straight up to Bobby’s bedroom. She had the blankets pulled up to her chest. One of my cousins was sitting on the edge of the bed. We all hugged hello and Bobby said, “Do you want to see it?”

  I nodded. There was a strange slurping sound coming from the other side of the bed. She pulled down the blankets to reveal a foot-long, four-inch-wide trench dug into her calf. The inside of the trench was stuffed with foam, vacuum-sealed with some sort of clear plastic wrap, and hooked up to a clear tube that ran down her leg, onto the floor, and into a Medi-Vac, the source of the sucking sound. It was a large, whirring machine that constantly siphoned pale pink goo out of her leg with a wet, straw-at-the-bottom-of-a-milkshake sound.

  None of this did anything good for my sudden onset of pill withdrawal.

  The next morning I woke up early, snot pouring out of my nose and onto my pillow. I was freezing cold and my legs had the shakes, but I forced myself downstairs to prepare breakfast and coffee. I’d had minor bouts of withdrawal before, in between pill hookups and when I’d moved up to Hudson, but those were nothing compared to how I was feeling now. While I was trying to make toast my arms began to shake and my bones felt as if they were being clawed apart. I fought the sensations, took deep breaths, brought everything up to Bobby on a tray, and set it on a card table my cousin had set up in the room. I helped her to the bathroom and sat on the bed with her while she ate, trying not to look too sick, but I kept blowing my nose. She, of course, went into grandmother mode, but I convinced her it was just a mild cold.

  “I’ll run out and get some DayQuil when I get groceries,” I said.

  She listed a bunch of items she wanted me to pick up, and as she was talking she reached over to her bedside table and picked up a bottle, opened it, and swallowed two pills. The act itself caused a Pavlovian response in me. When she put the bottle down, I saw that it was Percocet and felt a tremor course through my entire body. I couldn’t hear anything she was saying. I just stared at the bottle, fighting with myself not to devise a plan to get inside of it. I refused to let myself fall that low, to steal pills from my sick grandmother.

  I had to ask her to repeat some of the grocery items she was craving and took off for the store. I drove the long way, wondering what would have happened to me if my mother hadn’t remarried and moved us away from this town when I was in the fourth grade. I’d probably still be stuck here.

  Oak Ridge, Tennessee, was one of three towns built to complete the Manhattan Project. The farmers who originally lived there had all been kicked out under eminent domain, the law that allows the government to seize private property for its own use. It was called The Secret City, and lived up to its name. I remember very little about my childhood in Oak Ridge, and what I do remember is always cloaked in shadow.

  The town is filled with sirens built onto the telephone poles, and a few times a year they go off as a test, in case anything goes wrong at the laboratory. Our teachers taught us to crawl under our desks with our arms covering our heads.

  Besides its nuclear history, Oak Ridge is different from most suburban towns in that most of the houses were built up in the ridges, so they can’t be seen by aircraft. All of the winding roads make it sort of like driving through a low-rent, prefab government housing version of the Hollywood Hills. All the houses look the same; there were only seven different versions of the same model with a few sub-models thrown in as well. The town’s residents were later granted land at a cheap price to build their own homes.

  Bobby didn’t find out what my grandfather was doing at the lab until after the bombs were dropped in Japan. One morning in August 1945, she turned on the radio and learned what her husband had been working on. He called her almost immediately after to explain. After she hung up, she sat by the phone and wept.

  On my way to the store I drove past the children’s museum. It was housed in a building that had been an elementary school in the 1950s and then, when I was a child, converted to a day-care center on one side and a day facility for mentally disabled elderly people on the other. The school’s decaying gymnasium in the center of the two wings separated life and death. The bathrooms were located on the old people’s side of the building, and twice a day, we kids would march down the hallway until we hit the stench of prepared food from the cafeteria. The old people weren’t allowed in the bathrooms while we kids were inside, but if you had to go anytime that wasn’t designated, you had to make your way alone down the old school’s hallway through the safety zone of the gymnasium. Past the old men with rotten teeth, drooling and grinning as they wandered the hallway. Sometimes one of them would follow you inside the bathroom.

  On several occasions when my father or mother would pick me up from day care, I would have shit or pissed my pants rather than go inside that bathroom on my own.

  When I got back to the house from the grocery store I swallowed three DayQuil, then fixed lunch for Bobby and brought it upstairs. She was dozing and the goo tube had become wrapped around her leg. The Medi-Vac was making a scary buzzing sound, so I quickly unraveled the tube until the sound stopped and I saw another glob of pink jelly get sucked through the plastic.

  She woke up and told me that the home health care nurse had called and would be coming by soon to change the foam in her leg trench. I watched as she ate her lunch. And after I had cleaned up the dishes I came back upstairs to her bedroom.

  “I just hate that you’re seeing me like this,” she told me. She loathed not being in control, and so did I. I was feeling worse and worse and was beating myself up inside. I knew that I needed to be entirely present in order to properly take care of her. We were two invalids, but I had to keep my sickness secret. I lay down on
the bed next to her. The back wall of her bedroom, like the rest of the house, was one huge window that looked out over the lawn and into the forest beyond. We sat there together quietly for a while, just staring at the woods, when my fingertips suddenly went numb and I wasn’t able to catch my breath. The light in the trees suddenly looked strange, disorienting.

  “I’ll be right back,” I said and ran outside, grabbing the cordless phone in the kitchen to call my older sister, Erica. We’d always been close. She pretty much raised my younger sister and me until she went away to college when I was in seventh grade. But she’d become increasingly busy raising her own two kids, so much so that our adult friendship seemed to be taking a backseat. I understood this completely, but sometimes I couldn’t help but feel jealous.

  She was completely unaware that I had an issue with pills, but as far as I was concerned, I hid that fact from everyone.

  “I think I’m having a panic attack,” I said, when she answered.

  “Just breathe slowly,” she said. “Concentrate on the air going in and out of your lungs.”

  “I can’t even breathe,” I said, laughing to make it sound like I wasn’t scared, but my voice cracked and shook. “My fingers are numb.”

  “You’ve got a lot of responsibility down there,” she said, her voice maddeningly soothing. “It makes sense that you’d be nervous and scared.”

  I got angry. She had no idea what I was going through. I briefly considered telling her the truth, that I was going through withdrawal, but when I played out that scenario in my head, my anger softened. She’d want to fly down, she’d have to find someone to take care of the kids and her business—I couldn’t do that to her. I was alone in this, and that thought distracted me enough to snap me out of my panic attack. I knew I could take care of my grandmother, and suddenly I was pissed that Erica thought I was too weak to do it, when she had no idea what I was actually going through. I held onto that anger to get me through.