Pill Head: The Secret Life of a Painkiller Addict Page 15

  “I’m feeling better now,” I told her, suddenly. “Thanks, I can handle it.”

  I went inside, made some tea, and went back upstairs.

  “Who were you talking to?” Bobby asked. “I thought I heard voices.”

  “Erica,” I said. “I had to ask her something. Want to play cards?”

  Bobby smiled and sat up in bed as I maneuvered the goo tube so it wouldn’t get stuck under her. I sat cross-legged next to her and began to shuffle. Just over her shoulder, on the bedside table, I could see the giant bottle of Percocet. I kept shuffling the cards over and over, staring at it, until Bobby dryly said, “I think they’re done.”

  The home health care nurse showed up later that afternoon. She had the east Tennessee twang that no one I knew growing up had: most of the families I knew had been imported to the town to work at one of the labs. Her hair was dark and crisp from hair spray, and she wore way too much eyeliner and Payless sneakers. I loved her.

  I sat on the bed and watched as she pulled a chair up to the side of Bobby’s bed, turned the machine off, and began to unwrap the wound. I trusted her implicitly, because Bobby had told me she was the one who first realized something was wrong with her leg. She had sent her to the hospital after dressing the wound one day, and the hospital had sent Bobby home, saying nothing was wrong. But the nurse knew necrotic tissue when she saw it and sent Bobby to another doctor, who immediately admitted her to the ER.

  As the nurse removed the foam from the trench I felt my stomach lurch. Bobby winced and grabbed my hand. I was feeling dizzy, but I refused to leave her side. The nurse gently cleaned the wound, and Bobby gripped my hand tighter while I babbled about what Netflix movies we should order next. She went along with the conversation and never once said a word about the pain she must have been feeling, but my hand quickly grew numb from her grip.

  The nurse removed a large new piece of foam from her bag and held it up to the wound, then she cut it into a matching smaller piece. As she stuffed the foam inside the trench, pulling the flesh back so it would fit inside, Bobby cried out. I could feel tears welling up in my eyes, but I held them in. I just rubbed her shoulder and arm and said, “It’s going to be over soon.” She looked at me and laughed, but I recognized the sound, it was the same scared, cracking laughter I’d spat out when I was talking to Erica.

  It was over, finally.

  The nurse turned the machine on and I watched as the plastic vacuum-sealed the wound shut, like a late-night infomercial for a machine that sealed up meat for freezing. The sucking sound started immediately, and after a few seconds we all watched as the first glob made its way down the tube.

  “Your surgery is set for the end of the week?” the nurse asked.

  Bobby nodded. As long as the machine was able to get rid of all the necrotic tissue, she was set to have the foam removed and a large flap of skin cut from her abdomen to seal up her leg. I had no idea how they were going to fill the hollow space inside. The nurse left and Bobby fell back asleep.

  I went into my room, which was my father’s old bedroom. The ceilings were high and slanted, with exposed crossbeams. I’d always stayed in this bedroom as a kid, and my cousins would sleep in the adjoining bedroom, which had belonged to their father. I’d also lived in this room for a few summers as a teenager. It had always given me night terrors. When I was a child I would wake up in the night and see a dark figure standing over the bed next to me. Sometimes it would sit down beside me. And once it left, I was convinced it was hiding in the closet next to the bed, waiting for me to fall back asleep.

  This bedroom still haunted me. I could never get a good night’s sleep in it. Now, as an adult going through withdrawal, I felt even worse in there.

  The next day, when I got out of the shower and walked to my bedroom, I smelled a strong odor, as if the cat had defecated right outside the bathroom door. I heard Bobby calling weakly for me. I grabbed a pair of jeans and ran to her room. She was standing just inside her bathroom leaning over the sink, trying to slip her nightgown over her head. Her back and legs were covered in runny feces.

  “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.

  CHAPTER 11

  How to Destroy a Doctor

  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 cou
ld 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 robbery. 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 an
d 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!”