Pill Head: The Secret Life of a Painkiller Addict Read online

  Dr. DeLuca’s eventual downfall was his sense of compassion. He believed in “harm reduction,” which is a set of public-health practices 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.”

  Dr. DeLuca believes that this distortion of medicine works into all medical fields, particularly pain medication, because of all the recent prosecutions. “Most doctors will use more toxic meds for way too long at way too high doses before they go to opioids. And even if you do get to opioids, the doses will be so controlled that you won’t get titration to analgesic effect. You’ll be undermedicated.”

  Dr. DeLuca came to know Dr. William Hurwitz through various conferences. “He ran the Peace Corps in Brazil,” he tells me. “He was this really idealistic, extremely bright man. I always enjoyed his company, but I think juries found him a little cold, or maybe arrogant.”

  Since Dr. DeLuca was the addiction medicine specialist and Dr. Hurwitz was the pain medicine specialist, Dr. Hurwitz wanted them to join forces. “You have to understand,” DeLuca says, “in 2000 we were coming off a decade of revelation in pain medicine.”

  He’s right—for all the media attention about the dangers of Oxy-Contin, it was a revolutionary form of pain relief for chronic sufferers. And doctors were learning more about titration and how the body really could grow to withstand higher doses of all forms of opioids that could cure pain. When used correctly, OxyContin was a wonder drug that could actually cure debilitating pain that other drugs had been unresponsive to.

  But they never joined up. Over the next year Dr. DeLuca ended up at a public-health school, got sick with hepatitis C, and became a father. Dr. Hurwitz came under investigation by the state for drug trafficking and was sent to prison.

  After Dr. Hurwitz was arrested, Dr. DeLuca joined a closed list-serv of doctors who were also facing charges. “I thought, this is just crazy! These guys are facing murder charges. I started to see patients differently, and I became scared to treat them.”

  So Dr. DeLuca quit medicine in order to testify on behalf of his colleagues. He was going into high-profile federal court cases where doctors’ assets had been seized and they’d already spent a year and a half in jail, and frankly, he didn’t want the feds coming after him, too. In order to safely defend his fellow doctors, he had to give up his own career.

  He also questions the extremely high numbers being released by the Drug Abuse Warning Network about prescription drug abuse. “Couldn’t they have done one lousy prospective study?” he asks. “Actually follow a cohort of high school students? We could have had a twenty-year prospective study by now, but for all the billions of dollars they spend, all they get are raw numbers without denominators.”

  What he means is that these numbers reflect one moment in a person’s life, not use over the course of a lifetime.

  “They could have mounted a public-health study,” DeLuca says. “We’d know a lot more about addiction, what actually happens to people who use drugs. But the government isn’t interested in that. They don’t actually care about abusers. They think they’re criminal scum. If they wanted to understand you better and treat you better, they would have studied it.”

  Opioids now have such a criminal stigma attached to them that they aren’t even available in countries that desperately need them. An article from the September 10, 2007, New York Times described in detail a woman from Sierra Leone who had breast cancer. Her tumor had burst through her skin, “looking like a putrid head of a cauliflower weeping small amounts of blood at its edges.” The cancer had also spread to her lymph glands and ribs. She was going to die, and she was going to die in extreme pain because her country refuses to import morphine for fear of encouraging addiction. The article quotes David E. Joranson, director of the Pain Policy Study Group at the University of Wisconsin’s medical school: “Doctors in developing countries have beliefs about narcotics that prevailed in Western medical schools decades ago, that they are inevitably addictive, carry high risks of killing patients, and must be used sparingly, even if patients suffer.”

  And the DEA’s very public prosecution of so many American doctors can’t be helping matters internationally.

  CHAPTER 12

  Jared’s Turn

  JARED WAS BACK TO using again daily, and it came to define everything about him. “Honestly, I just didn’t know what to do with my time,” he says. “My entire existence was occupied with going to get them, doing them, worrying about how I was going to get my next batch, worrying about where the money would come from. It consumed my entire life.”

  It’s a common reaction for anyone who initially tries to stop a negative behavior, whether it’s drinking too much, or drugs, or even anorexia. The disease becomes you, and without it, you feel lost. So Jared started using again, at the same dosage he’d been on originally. “I thought at least since I had gotten off them, I’d be able to get a good high again, like the first time I’d used. But that didn’t happen. It went right back to the level I’d ended at within a week. My girlfriend dumped me and I moved in with a roommate.”

  His new roommate wasn’t an idiot. He could hear Jared crushing up pills and snorting them every morning before work. He began to make some phone calls to Jared’s friends, asking them if there was a problem. Finally a close friend of Jared’s who had gotten out of the drug scene after high school came to visit him.

  “He said ‘Dude, you loo
k like shit,’” Jared remembers.

  Jared didn’t say anything to him about his condition, but while they were catching up, his friend mentioned that he needed to hit up a drugstore to fill a Percocet prescription for a recent sports injury.

  “I became manic,” Jared says. “I was, like, ‘Let’s go get the Percocets, let’s go get them now,’ and my friend was, like, ‘What is wrong with you?’”

  Jared kept on raving about how they had to go to the drugstore immediately to fill the prescription, even though it was 10:00 P.M.

  And then something inside him switched. He heard himself. He heard how insane he sounded. He thought about the time his mother had gotten home from surgery with a bottle of Percocets, and he spent three hours in the bathroom, shaving off the markings and ridges on Tylenol pills and shaping them to look similar to Percocets, and then switching her bottle out with his fakes.

  “I just laid everything out to my friend,” he says. “No one had ever told me that what I was doing was fucked up in such an accusatory way. I’d had girlfriends who called me out on my use before, but I’d always lie and just say I’d only done one pill. Or I’d just flat-out deny it. Money was another big issue for me at the time. What had started out as such an easy thing—my friends giving me pills—had turned into serious debt. I’d been given $30,000 as a graduation present, and it was all gone. I was $15,000 in credit card debt. I couldn’t pay my rent. I thought I was going to have to start stealing.”

  Jared’s friend listened to his entire story and said two simple words. “Tell someone.”

  Jared called his brother, a doctor. He initially wanted to find a way to quit without having to go to rehab. He also lied to his brother about his use, telling him that he was only snorting about ten pills a day, when at this point he was actually up to forty pills, with three to five 80-milligram OxyContin chasers spread throughout the day.

  “He pretty much told me that I had to tell my parents. So I did. I called them and laid the whole thing out to them. They drove to Boston to get me.”

  Jared knew he was going to be away for a while, but he didn’t want to lose his job. “So I went into my boss’s office and told her I had nut cancer and needed testicle surgery,” he says. “I figured she wouldn’t ask any questions.”

  He was right.

  Jared’s parents made all of the arrangements and found a facility nearby. But he could feel the panic setting in. He had just run out of the last of his pill stash. So he went to a regular doctor and confessed his addiction.

  “I told him, ‘Look, I’m going to rehab. I’ve got a problem. Either give me some pills now or I’m going to go out on the street and get them. I just need something to tide me over until the withdrawal treatment starts.’”

  The doctor wrote him a prescription for ninety Percocets.

  “So now it was a day before I was supposed to go into rehab, and I had this huge bottle of Percocets, so I began to just inhale them,” he says. “I was freaking out. I literally could not picture getting through a single day without them. I couldn’t understand how the rest of the world was walking around without them. I had lost touch with how you could possibly talk to someone or do your laundry or even watch TV. My parents knew I had the Percocets, so they were crying hysterically and I didn’t care, I just kept crushing and snorting them because I knew, ‘Last chance.’ I’d gotten so good at this point, I could crush and snort an entire pill in under a minute.”

  Jared’s parents were terrified he was going to run away, so they kept a vigil by the front door of his apartment. But he didn’t, and before he got in the car with them the next morning, he stuffed as many pills as he could inside his shoes.

  “I was smoking cigarettes in their car, which I wasn’t allowed to do, swallowing pills at every chance I could,” he says. “Once it came out that I was using, and everyone knew, I just didn’t care. It all roared out. I’d been trying to hide in a suit and pretend I had a normal life for so long, and now that the secret was out I just didn’t give a fuck anymore. We pulled into a 7-Eleven, and I just took off, running into the bathroom and shutting the door. I was crushing up pills on the back of the toilet seat when my dad burst in, picked me up, and threw me back down on the ground, like a raving maniac.”

  Jared’s dad pulled him back to the car and soon they arrived at the rehab center. The admitting nurses quickly found all the pills he’d stashed in his shoes. They checked him in, and Jared spent about a week detoxing his body before he was able to enter into the full rehab routine. The detox consisted of buprenorphine to ease him off the painkillers (so he wouldn’t go through an immediate withdrawal), along with some muscle relaxers, Tylenol, and sleeping pills to gradually ease off all the symptoms he experienced. “It was bad, but it was better than that week when we’d quit pills without anything,” he says.

  Jared spent that first week mostly isolated from the other people in the rehab center. He had a roommate, though.

  “This guy had ‘wet brain,’ which is almost like brain damage. It comes from really late-stage alcoholism. He had gone totally crazy—he’d been drinking cologne by the time they brought him in. He wouldn’t talk and he couldn’t stay in his bed. As far as I know, he never left the detox wing.”

  Once Jared started to come out of his detox, the center sent people his own age to his room to talk to him about the program and slowly assimilate him into rehab.

  “I did not buy into the whole God shit,” he says, echoing Heather’s sentiment. “For the first twenty-eight days I was there, I was, like, ‘This is fucking horseshit and all of you people are totally insane.’”

  Jared’s other main issue with rehab was that he not only had to stop taking pills, but also stop drinking and doing any other kind of drug as well.

  “I was, like, this is not what I signed up for,” he says. “Then someone who worked there, who was an ex–pill head, told me, ‘If I had more fun doing pills than I do now, I would go out and do pills again.’ I was, like, ‘You’re full of shit.’ But then he said, ‘Were you having fun on pills? Because usually people who are having fun on drugs aren’t in here.’ And he was right. Being on drugs was horrible, and I’d already forgotten that.”

  Jared was initially supposed to stay in rehab for twenty days. He ended up staying for four months.

  “They felt I wasn’t ready to leave yet, and deep down I knew they were right,” he says. “The thing was, I had no idea what the fuck I was going to do with my life. That was the scariest part. Once I got over the physical pain of detox, it actually took about three weeks for me to start feeling somewhat human. You get over the bad hump early, but you’re still a long way from right.”

  After being in the program for twenty days, Jared went on the antidepressant Effexor, which he still takes today. And once he realized he was going to be in rehab longer than he initially thought, he knew he had to come clean with his boss. “She was so cool about it,” he says. “She said that as long as I was definitely going to come back, then she’d hold my job for me.”

  Jared still fought the idea of a “higher power” guiding him through his rehabilitation. “What I realized,” he says, “is that my higher power is just a piece of myself, and when I want to get in touch with it for strength, I can.”

  By the time Jared left rehab four months later, he was hungry to get his life back.

  “I was motivated in a way I hadn’t felt since before I’d ever done pills,” he says. “I started to remember what I wanted to do with my life. It’s like my whole pill life was just this crazy sidetrack that I became so obsessive with that everything else just faded away. And then I remembered, ‘Oh yeah, I wanted to have a career and become financially independent.’”

  There were a couple of other guys in Jared’s rehab center around his age who were wrestling with the same problems. So they made a pact, to “try and fuck a lot of people and really kick ass at work.”

  Jared did just that, but he also hooked up with a sponsor, attended regular AA and N
A meetings, and began trying to mend his relationship with his parents.

  “They got me out of that life,” he admits. “They saved my ass. Now I’m on a payment plan with them to repay all the rehab costs, which is superfortunate for me. A lot of people don’t have that option. But my dad still doesn’t believe that addiction is a disease. In his mind, he just thinks, ‘You fucked up.’ And I have to let him believe that. I’m done trying to explain this thing to people who don’t get it.”

  Jared admits he is always tempted to go back on pills. “That shit sticks in your brain like a hook or something,” he says. “I still think about pills every day. It’s almost like your brain used to be this certain way, and then you do something like what I did to it, and it becomes warped, like a piece of driftwood. It’s never going to unwarp.”

  Joseph Califano from CASA thinks this is an apt analogy. “Whatever the substance, the brains of addicts are ‘rewired,’ becoming pre-disposed to cravings,” he wrote in High Society.

  “My view of pills is not normal, and it never will be,” Jared agrees. “It just is what it is now. I have dreams about buying pills and snorting them. The way I deal with it is to play the whole scenario out, right to the end where I ended up in rehab. Mentally, you can’t just start over with pills. There’s no reset to the beginning, where none of this happened.”

  Jared is proud now to admit that his idea of fun is going shopping for CDs, or staying home and watching a movie, or going out for coffee with friends. He’s also learned how to deal with his social anxiety on his own.

  “It just takes work,” he says. “It was a lot harder at first, and sometimes I’ll still get it bad. I’ll try to avoid social situations, but if I have to, I know I won’t take the shortcut I used to. When I was on pills and felt able to talk freely, I felt like I had all this confidence, but I don’t think I was actually saying anything interesting. Now it takes work and practice to go out, but that’s the way it’s supposed to be. The other thing that helps is that there are always others. You find AA and NA people everywhere. It’s like this whole underground network of people that you don’t have any idea exists until you become a part of it. And it doesn’t exist, until you need it to.”