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

  “Please god please god please god,” I whispered. The pain had reached my neck. I ran to my bag and grabbed the bottle of Parnate. My dad came running into the room, and I shoved the bottle of pills into his hand just as the pain exploded into my head, like a fountain of churning acid that had been traveling through a narrow tube, finding its pool of release.

  I went blind, everything turned into a whitewashed nothing. My head felt like my brain was swelling ten times its size and straining against my skull, ready to burst it open. I think I was screaming or crying, I don’t remember. The next thing I knew I was in the front seat of my father’s car, head between my legs, repeating “Make it stop.” I passed out. When I came to again I was on a stretcher, surrounded by doctors who were yelling something at me, trying to stick a needle in my arm. I sat up and vomited everywhere, spewing ramen across the room, hitting a nurse. Puke filled my lap. I just remember crying and apologizing over and over before lying back down and passing out cold.

  I slept for about six hours. When I woke up, it took me a minute to realize where I was. I was exhausted and realized there were needles attached to my arm. A doctor came in after a while, holding my bottle of Parnate.

  “We’ve called your prescribing doctor,” he said. “He says you should go off them immediately. You’re going to be fine.”

  I was released a few hours later. Our trip to the wedding was delayed by one day but we continued. I felt weak and out of it for the entire drive down, but by the time we arrived in Tennessee the incident was pretty much behind me. I was happy that I was finally able to drink at the wedding, since alcohol was also on my prohibited list of items I couldn’t ingest while on Parnate. I laughed when family members asked me about it, playing it off like it was no big deal.

  In retrospect, what pisses me off the most is not the fact that the doctor prescribed it to me, but that there was no one following up on my intake to see how I had been reacting to it simply because of an insurance cap. Even after the hospital called our prescribing doctor to tell him I’d experienced a reaction, I never received any kind of follow-up phone call. I swore off antidepressants for years. Alcohol, pot, acid, and coke would work just fine for my problems. And I could eat whatever I wanted on them.

  I recently tried to track down my medical record from the hospital my father had taken me to, to find out exactly what had happened to my body during the reaction, but they only keep records for ten years. According to Dr. Bodkin, though, I went into hypertensive crisis, and my blood pressure probably shot up to somewhere around 290 over 210. “Some people die of that,” he told me. What happens is that blood pressure gets so high that it can burst blood vessels in the brain, which is why, when MAOIs were first introduced in the 1950s, there was a wave of deaths from brain hemorrhages before scientists figured out the tyramine connection. To this day, I refuse to eat anything with soy sauce.

  My other horrific antidepressant experience came from a case of off-label prescribing, where doctors prescribe medications for uses other than their intended, FDA-approved purpose. At least, I’m pretty sure it did. Right before I had quit Jane magazine and was planning on moving away, I was feeling a lot of heightened anxiety and depression, so I went to a doctor near our offices and asked for a therapist recommendation. I’d had to find a new doctor, instead of going to my normal guy, since our company’s insurance policy had changed.

  “You’re depressed?” she asked. “I can take care of that.” She opened up a cabinet stacked with samples of a drug called Zyprexa. She actually told me not to look it up on the Internet. “There have been some really good studies about how this drug is actually great for depression. But there are a lot of whack jobs on the Internet saying it’s dangerous. But trust me.”

  Of course I immediately went home and looked up the drug online. It turned out it was an antipsychotic medication for bipolar disorder and schizophrenia, but there were some testimonies saying it was found to be good for “normal” depression as well. I stupidly gave it a shot. One week after I started on it, I found myself in front of my bedroom mirror with an X-Acto knife stolen from the magazine’s art department, hacking away at my arm and chest. I’d never had any cutting issues in my life, and I’m permanently scarred now from the experience. I stopped taking the pills the next day.

  CHAPTER 6

  “Remember Valley of the Dolls?”

  HERE’S A LITTLE-KNOWN SECRET about Washington, D.C. The DEA building has, hands down, the best museum in the entire city. Forget the Smithsonian—next time you’re in D.C., make sure to get over to the DEA Museum and Visitors Center. It contains a timeline of drug abuse in American history, starting with vintage bottles of Mrs. Winslow’s Soothing Syrup. The label reads: “For children teething. Greatly facilitates the process of Teething, by softening the gums, reducing all inflammation; will allay all pain and spasmodic action, and is sure to regulate the bowels. Depend on it, Mothers, it will give rest to yourselves and relief and health to your infants.”

  Each bottle was loaded with morphine. The product finally got pulled off the market around the turn of the century after babies kept mysteriously dying. I bet there were more than a few moms who were pretty bummed about the recall, because, let’s face it, if anything is going to effectively silence a screaming baby, it’s morphine. The museum covers all the basic stuff you learn in antidrug seminars in school, but what sets it apart is the amazing amount of paraphernalia on display—things like antique syringe kits found in the pages of the Sears & Roebuck catalog (some drugs with the worst reputations, like heroin and cocaine, were once entirely legal in the United States); a rabbit-and-fox fur coat worn by a former DEA agent to “blend in” with Cleveland drug traffickers in the 1980s; and an entire fake head shop storefront called Jimmy’s Joint, with its name lit up in blue neon letters.

  The newest addition to the museum is an entire wing devoted specifically to the DEA’s efforts at diversion control. The exhibit is part of its Good Medicine, Bad Behavior campaign, and it’s pretty dramatic. The pharmaceutical wing leads with an enormous medicine cabinet, opened to reveal two-foot-high bottles filled with brightly colored pills the size of English muffins. They include the most common illegally diverted pharmaceuticals, including hydrocodone, OxyContin, and amphetamines. One side of the medicine cabinet is filled with giant fake prescriptions for each drug and a list of their intended uses. The other side lists each drug’s bad side effects. The weird thing is that the fake prescriptions that list the good qualities of the drug are all written out to “John Doe II,” as if already predicting the death of anyone taking these drugs, even for the right reasons. I’m being glib—there’s also a sobering slide show of young people who have died from overdoses of various forms of drug combinations and some really informative exhibits on how all these different drugs interact in the body.

  I ended up at the museum because I had a meeting with Chief Mark Caverly, who works for the DEA’s Liaison and Policy Section. He agreed to meet with me to discuss the DEA’s work on combating prescription painkiller diversion. His office is located near the Pentagon (and, more importantly since I arrived early for our meeting, directly across the street from the Pentagon City Mall food court).

  The security for getting into the actual offices of the DEA building is pretty intense. There are at least four security guards at the main entrance, and you have to put your bags through an X-ray machine and be escorted inside by someone who works there. My contact was a member of the DEA’s press office who had been extremely helpful in setting up the interview. When we got in the elevator, there were several other people in it dressed in nearly identical dark blue suits, including a man and a woman who had obviously worked together before, but hadn’t seen each other in some time. The conversation went like this:

  WOMAN: Oh, how are you? I haven’t seen you in forever! It’s like you just disappeared! We miss you!

  MAN: Ha-ha, I miss you ladies too. I was transferred.

  WOMAN: To what department?

>   MAN: I can’t tell you.

  WOMAN (SYMPATHETIC, UNDERSTANDING NOD): Got it.

  MAN: I mean, I could, but I’d have to kill you.

  There was nervous laughter all around, followed by uncomfortable silence for the rest of the elevator ride.

  When we got to our floor I was ushered into a plain conference room. The press agent sat down too, and I realized he wasn’t going to be leaving. Mark Caverly came in and sat down and I got this nervous feeling that I was being secretly videotaped. Caverly looked like he’d come straight from central casting for a DEA agent in a bureaucratic position, with his set-in-stone facial expression, blank eyes peering through wire-rimmed glasses, and perfectly pressed suit.

  “So,” I asked, “why now? How did prescription painkillers get so huge?”

  “I think there were some societal influences,” he said. “And I’ll give you my personal opinion. As a society, we turn to pharmaceutical drugs for everything. If you have a common cold, if you want to grow hair, whatever the medical condition is, we, as Americans, turn to pills to solve the problem. If you go to a doctor’s office and don’t get a prescription, most people feel shortchanged. They want medicine. And beyond that general acceptance of pills and pharmaceuticals, I think there’s a perception of safety with pharmaceutical drugs. When you talk to people about heroin or cocaine, they know there’s a danger to it. You don’t know what it’s been cut with, so you don’t know how strong it is. You don’t know what your reaction is going to be. And with pharmaceutical drugs, for the most part, they are FDA-approved and created under sterile circumstances. Add to that the fact that you get some of the same physical responses taking pharmaceuticals as you would with any opiate, like heroin. People taking Vicodin or hydrocodone, which is probably the most popular pharmaceutical drug in the United States, get the same rush as they would taking heroin, but you’re taking something that people perceive to be safe.”

  Caverly was partially responsible for one of the nation’s currently most successful prescription-monitoring programs, called KASPER (Kentucky All Schedule Prescription Electronic Reporting). A prescription-monitoring program, or PMP, is exactly what it sounds like—a method of tracking an individual’s entire history of prescriptions, regardless of the doctor who had prescribed it. Kentucky was one of the earlier states to be hit with a particularly large Oxy-Contin abuse epidemic. “When I was working in Kentucky, we were seeing OxyContin being traded for services. It became a coin in trade. People who needed their car repaired would pay the mechanic in OxyContin instead of cash. I can rememer working cases in eastern Kentucky where a whole family would go to a doctor—literally, you’d have the mother, father, and maybe two or three kids—and they’d all jump in the car and drive down to the doctor on the same day at the same time, and they’d all walk out with their own prescriptions for the same drugs, typically oxocodone or hydrocodone.”

  I found Caverly’s surprise about trading pharmaceuticals for favors rather quaint. I’d been doing that ever since I’d first gotten into pills, and not just with opiates. On one occasion, a bartender I knew at Mars Bar, a famously filthy dive on Second Avenue, contracted gonorrhea. I had a particularly sexually active friend who kept a stockpile of the antibiotics used to cure it (procured from the Internet), so I traded Valium with my friend for the antibiotics and then traded the antibiotics to the bartender for a night of free drinks.

  Anyway, Caverly doesn’t have any theories as to why Kentucky became such an epidemic state, but he does believe it goes back to our general culture of pharmaceutical abuse and believes that PMPs can help curb that problem.

  “I think there are thirty-six states with active prescription-monitoring services right now. These are state programs; they’re not operated by the federal government. I was part of a group that worked to get KASPER through the state legislature. The resistance we primarily got was from the privacy level, the concern was, ‘Big Brother is going to know what prescriptions I’m getting,’ and people didn’t like it on that basis. The success of the prescription-monitoring programs is that they don’t authorize anyone that doesn’t already have the authority to look at the information (i.e., the DEA). To me, that addresses the privacy issue. And from a law enforcement perspective, it just saves a tremendous amount of time.”

  The privacy issue still isn’t exactly resolved though. Yes, the DEA can already gain access to your complete medical records, but doctors in states that don’t currently have PMPs only have access to the files made under their own care, not any other doctors you may have been seeing.

  In the past, when the DEA was working on a case where a complaint was filed against a particular physician, the only way to find out what the doctor was prescribing was for the officers to go to each pharmacy within a several-mile radius of the doctor’s office and get copies of computer records.

  “It was very time-consuming. And then you had to put all the information together to see if there were any suspicious prescribing patterns. With a PMP you just make a request for a report.”

  The DEA claims that over 90 percent of the PMP reports in Kentucky and other states are actually being requested by doctors themselves. They want to know if their patients are abusing drugs. It’s a tool that helps them weed out potential drug abusers from people who are in legitimate pain and need access to these powerful meds. And doctors need to watch their backs now, since many are being thrown in jail for their often-legitimate prescribing practices. But that’s a whole other story.

  After my meeting at the DEA I drove over to the Substance Abuse and Mental Health Services Administration (SAMHSA) to meet with its esteemed director, Dr. Wesley Clark. According to his official bio he has led the agency’s national effort to provide effective and accessible treatment to all Americans with addictive disorders. SAMHSA works closely with DAWN, the Drug Abuse Warning Network, to compile the National Survey on Drug Use and Health. These stats are considered the gold standard when it comes to tracking abuse trends, and they’re what the DEA relies on for its numbers.

  “You want to know how long we’ve had a problem with pills?” he asks me when we sit down in a small conference room. “Remember Valley of the Dolls?”

  Again, as with the DEA, my interview was being monitored by a media rep. I was slightly offended. In the magazine world, it’s considered the ultimate in bad form for a publicist to sit in on an interview. I was quickly learning it was different for book research. Or maybe it’s just standard government practice.

  “If you want to track trends,” he continues, “then you’re relying on data streams, and the data streams show that indeed there has been an increase in prescription drug abuse. But I am fond of saying if it can be abused, it will be abused. Look at ‘cheese heroin’ in Texas. Adolescents discovered that if they mixed Tylenol PM with low-grade heroin and snorted it, it accentuates the high.” Cheese heroin has killed at least twenty-one kids in the Dallas area since 2005. Writer Jack Shafer wrote in Slate that the stuff looks like finely grated parmesan cheese, and this may be the source of the term. Or it could be a bastardized version of the Mexican slang word for heroin, chiva. Of course there’s always South Park’s version—that it’s fon-to-due.

  “We think we have a pain problem now,” Dr. Clark says, “but we haven’t seen anything yet. What happens when all the baby boomers turn sixty-five? Baby boomers are more active than their predecessors. Exercise is promoted as an essential function of cardiovascular health, but as this generation gets older, problems like degenerative joint disease are going to start to develop, so they become more prone to injury.” Which means more and more painkillers out there to be illegally diverted.

  It’s the same theory that Dr. Carol Boyd had, and it makes a lot of sense. Think about it: the baby boomers were notorious for their drug experimentation, and they aren’t going to question for an instant if a doctor hands them a prescription. My own mother, the quintessential baby boomer (ex-hippy, now firmly ensconced in academia), has had a series of small surgeri
es over the past few years. When I first confessed to her that I had a problem with painkillers she said, “Well, they do feel awfully good.”

  Dr. Clark and SAMHSA don’t work on supply reduction of drugs, like the DEA. What they are interested in is demand reduction. “What you are getting into is a whole philosophical thing,” Dr. Clark says. “What is the philosophical imperative to want to change one’s mind about drug use? The National Institute on Drug Abuse argues that people want to change their mood because they want to feel good or feel better. People who have depression do seem to get some beneficial effects from the mild euphoria, but they will do better with cognitive behavioral therapy or with antidepressants, which have their own side effects but aren’t nearly as problematic.”

  Unless you eat soy sauce.

  I ask him who he thinks should be responsible for spreading that message.

  “I think it’s multiple sources,” he says. “We think parents need to begin the message, the faith community needs to articulate the message, peer groups need to articulate the message. People who have bad experiences need to tell other people. If you want to feel good, there are a wide range of less toxic activities that can make you feel good about yourself, whether it’s a ballgame, or a hobby, or a church or temple, even meditation.”

  The problem is, I still can’t imagine doing any of those things without taking a few opiates first.

  Joseph Califano Jr. is the chair and president of the National Center on Addiction and Substance Abuse (CASA) at Columbia University. Under the Carter Administration, he was also secretary of Health, Education and Welfare from 1977 to 1979. He recently came out with a book called High Society: How Substance Abuse Ravages America and What to Do About It. He shares my doubts about the effectiveness of current antidrug programs. In his book, he particularly takes the Drug Abuse Resistance Education program to task. DARE was founded in 1983 and is now found in 75 percent of the U.S. school districts. It’s taught by policemen “who are paid to show kids how drugs are used and describe the experience of those who use them, and has repeatedly been found worthless,” he wrote. “Extensive research led by Steve West at Virginia Commonwealth University, and published in the American Journal of Public Health, concluded that DARE was ‘ineffective’ as a prevention method and ‘a huge waste of time and money.’”