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

  Here’s how. Humans have opiate receptors distributed throughout the brain, with higher concentrations of receptors in areas such as the basal ganglia and thalamus. These receptors are proteins located on the surfaces of nerve cells, or neurons. Neurons communicate with each other by sending out chemical signals called neurotransmitters. In the peripheral nervous system, nerve endings that deliver pain signals to the central nervous system are called nociceptors. For example, nociceptors in your fingertips might tell your brain that you’ve just touched a hot stove, or that the joint you’re smoking has just burned down to your thumb and forefinger.

  This pain signal is regulated by the rapid entry of calcium into the cells through calcium channels, cellular gatekeepers that control the release of neurotransmitters. Calcium channels concentrated in neural (nerve) tissue are called N-type channels. Scientists are trying to find new ways to treat pain by targeting these channels. The challenge is to control pathological pain (that is, pain that is not useful in helping a person avoid injury) without the undesirable, yet common, central nervous system side effects of respiratory depression and dependence.

  Normally, opiate receptors are activated when your body produces endorphins, which are involved in a ton of normal body functions, such as respiration, nausea, regulation of hormons, and pain modulation. Morphine, heroin, and opioids (synthetic opiates) like Vicodin, OxyContin, and Percocet metabolize into replications of endorphin molecules that fit into pain receptors and flood into your body, making you feel euphoric. These endorphin replications differ, depending on the drug. Vicodin metabolizes into something called hydromorphone, and OxyContin, a controlled-release formulation of oxycodone, metabolizes into noroxycodone and other metabolites, but for all of these painkillers the end result on your body is similar. Your pupils constrict, your pulse slows down, your breathing becomes slower, and your blood pressure falls. Anxiety melts away and you feel utterly relaxed. Of course, pain goes away too. The reason why opiates can be so addictive is because after the brain starts getting them consistently, it stops producing endorphins on its own.

  All of this, of course, depends on a lot of factors. Not everyone’s body responds the same way to opioids. Variables can include age and weight, and in a lot of cases, totally unknown influences or something as simple as a sensitive stomach. I have a lot of friends who can’t stand Vicodin because it makes them nauseated. Other people can overdose and die if they drink alcohol on even one or two painkillers, while a lot of people (myself included) have taken pills as strong as morphine and Dilaudid, gotten wasted on cheap beer and champagne, and woken up fine the next day. That’s not to say it couldn’t still happen to me. It’s a total crap shoot, which makes these pills even more dangerous when used incorrectly.

  Regardless of how or where someone gets their first taste of prescription painkillers (through a friend, a surgical procedure, a parent’s medicine cabinet, or, say, a journalism assignment), the one common factor that can contribute to continued, abusive intake is that there’s a presumed element of safety to prescription painkillers that doesn’t exist with any other kind of drug out there, except maybe benzodiazepines like Valium or Xanax.

  Even for the bravest thirteen-year-old, smoking your first joint is going to be a little bit terrifying, but that’s part of the initiation, part of the excitement. It’s the gateway to your cool older sibling’s life or your foray into the bad kids’ world that you’ve always looked at wistfully from afar. But with pills, you know that somewhere down the line, it came from a doctor. A safe, kindly doctor who knew just what you needed and would never distribute something that could potentially hurt you.

  During my years of pill abuse after that initial first bottle, I knew I wasn’t alone in my use, so I didn’t feel much shame. All I had to do was turn on the TV or go to the movies to see that everyone else was doing it too. The media hadn’t dubbed us “Generation Rx” for nothing. In the American remake of the Japanese film The Ring, the doomed private-school girls in the opening scene aren’t looking to raid the liquor cabinet when their parents aren’t home—they just want to know where the mother hides her Vicodin. On the television series House, the brilliant doctor saves life after life while popping loads of Vicodin. The awesomely trashy ladies from Sordid Lives are downing Valium in practically every scene.

  Pill use is a ubiquitous element in celebrity tabloids too. Witness Winona Ryder’s inexplicable shoplifting spree in 2001: she was busted with several illegal bottles of prescription painkillers. According to USA Today, she had used six different aliases while seeking prescription drugs. She had thirty-seven prescriptions filled by twenty doctors over a three-year span, a method known as “doctor shopping.”

  Mischa Barton’s younger sister has checked herself into rehab for painkiller abuse, as have Robbie Williams, Matthew Perry, Melanie Griffith, Jamie Lee Curtis, Charlie Sheen, and Kelly Osborne, just to name a few. Conservative kingpin Rush Limbaugh was booked on charges of doctor shopping for his Vicodin addiction. When Nicole Richie was arrested for driving the wrong way on the highway in Burbank she admitted to police that she had taken Vicodin that night (citing menstrual cramps). For a while, Lindsay Lohan’s own father wouldn’t stop talking to the press about his famous daughter’s addiction to painkillers. And because the autopsy report showed Heath Ledger’s death to be an accidental combination of oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine, the specter of pills will unfortunately always hang around his name.

  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 because 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.

  CHAPTER 2

  “I Want Total Sensory Deprivation and Backup Drugs”

  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 immedi
ate 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.”