“It [was] so easy to find someone to sell you pills. It was insane,” says Nicky Rev, a hairstylist in Milwaukee. “When I got into it… I started finding out that there were so many people around me that were doing the same thing, and I’d had no idea.”
Rev started using opioids after an ankle injury. At that time, she had a prescription, but she later started trading a client: hair services in exchange for opioids. The connection eventually dried up, but Rev was already addicted.
While Rev’s struggles with painkiller addiction began with Percocet, she eventually moved on to OxyContin, taking one or two of the $60 pills per day. At that rate, perhaps not surprisingly, Rev ran out of money and resorted to selling things to her dealer or giving his daughter haircuts. Though she never traded sex for drugs, the thought certainly crossed her mind.
“[The addiction] makes your brain so sick that you don’t think about some of the things that you’re doing for it,” Rev says. “It didn’t seem that weird or out of place in my brain then.”
Once Rev settled in to her addiction, it became clear to her that many other people whom she considered stable, everyday citizens, were also taking these kinds of drugs.
“I was bartending at the time too, and I couldn’t believe how many people I was working with that would do [prescription painkillers] and were constantly medicated. These are people who had children, homes, jobs… they had a good, responsible life, according to what I thought.”
A Growing Epidemic
While drug addiction is sometimes thought of as a problem affecting only certain groups, the data on prescription painkiller abuse tell another story. In fact, the U.S. Center for Disease Control and Prevention has termed such abuse as a “growing, deadly epidemic.”
Prescription painkillers, or opioids, are medications that reduce the intensity of pain signals reaching the brain and impact brain areas controlling emotion, thereby diminishing the impact of a painful stimulus. These medications act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, gastrointestinal tract, and other organs. In addition to reducing the perception of pain, opioids can produce drowsiness, mental confusion, nausea, and constipation. The drugs also affect the brain regions involved in reward, and some people experience a euphoric response to opioid medicines.
Opioid analgesics were involved in 16,651 overdose deaths in 2010 (the most recent reliable data), surpassing deaths from any other licit or illicit drug or drug class. A 2010 survey also found that about 22.6 million people (or 8.9 percent of Americans) aged 12 or older had used illicit drugs in the current or past month, with 5.1 million reporting use of pain relievers. Only 1 in 6 users of non-therapeutic opioids said they received the drugs via a prescription from a doctor. Between 2009 and 2010, the majority of individuals using prescription pain relievers nonmedically—that is, without a doctor’s prescription or solely for the feeling the drugs produced—reported obtaining the drugs from friends or family.
Opioid abuse has been growing for years. In 2008, for the first time since at least 1980, poisoning deaths represented the top cause of injury death (deaths resulting from forces external to the body such as drowning, suffocation, or burning) in the U.S.—and even surpassed the number of motor vehicle traffic deaths. That same year, opioid analgesics were involved in almost 15,000 deaths, versus about 5,100 deaths involving cocaine and about 3,000 involving heroin.
The Key Players and Their Effects
Available with a prescription, opioids come in various forms, either alone or in combination with other substances such as acetaminophen (what many of us know as Tylenol). Two of the most common forms of opioids are hydrocodone and oxycodone.
The most frequently prescribed opioid in America, hydrocodone is also linked to more drug abuse and diversion (the criminal act of removing a prescription medicine from its intended manufacturer-to-patient path) than any other licit or illicit opioid. In 2011 there were an estimated 136.7 million prescriptions for hydrocodone/acetaminophen. Hydrocodone can be taken in formulations such as Vicodin (hydrocodone bitartrate and acetaminophen) or as Zohydro ER (hydrocodone bitartrate), a newer and highly controversial painkiller that lacks abuse-deterrent features such as crush resistance. Fearing a further surge in abuse, attorneys general from 29 states have asked the FDA to reconsider Zohydro’s approval.
Found in Percocet (oxycodone hydrochloride and acetaminophen) and OxyContin (oxycodone hydrochloride), among other products, oxycodone is a popular drug among abusers. In 2011 there were 38.8 million prescriptions for oxycodone/acetaminophen.
Repeated exposure to increasing doses of opioids changes the brain in such a way that it functions normally when the drugs are present and abnormally when they are absent. Opioid tolerance (the need to take ever-greater doses of drugs to feel the same effect) and drug dependence (susceptibility to withdrawal symptoms such as anxiety, agitation, vomiting, sweating, and abdominal cramping) are two results of these brain changes. Some medications are used to help treat opioid dependence, including methadone, naltrexone, and buprenorphine.
After abusing prescription painkillers for several years and drinking excessively for more than a decade, Rev’s physician told her that if she continued on this path, it was unlikely that she’d live beyond eight more years. Three months after that appointment, Rev says, she stopped taking painkillers.
Rev took her last pill on a Wednesday in 2010, she says. The next day, her skin was crawling and she was sweating and throwing up.
“I got off the pills a couple months before I quit the booze, and that was the worst night of my life,” she says. “I would never wish that upon anybody—going through withdrawal like that. I don’t think anyone really thinks they’re as bad as they are until they try to get off this shit, and then they realize how much their body is depending on it.”
Axl*, a tradesman in Maine who still struggles with addiction, can attest to the difficulty of kicking opioids. In the past 14 years, he says, he’s been clean for three years total.
“It’s not like it comes lookin’ for me. It’s a willpower issue as well,” he says. “It changes you chemically for life… You just have to have willpower like you wouldn’t believe.”
Battling the Epidemic
Efforts to combat the opioid epidemic include prescription drug monitoring programs, which gather pharmacy data on controlled substance prescriptions. This information can then be accessed by authorized users—health care providers, pharmacists, and law enforcement, for example—to help detect sources of prescription drug diversion, including forgeries, “doctor shopping” (i.e. getting prescriptions for controlled substances from several different care providers without them knowing about the others), and improper prescribing. And in 2012, the FDA approved a Risk Evaluation and Mitigation Strategy for extended-release and long-acting opioid analgesics, the central component of which is an education program aimed at prescribers.
Meanwhile, earlier this year, U.S. Attorney General Eric Holder pressed first responders to use the drug naloxone, known as Narcan, to reverse the effects of an opioid overdose (The FDA also recently approved Evzio, another form of naloxone). According to the Department of Veterans affairs, 17 states and the District of Columbia have modified their laws to boost access to naloxone, leading to more than 10,000 overdose reversals since 2001. This comes in the wake of new research showing that community opioid overdose prevention programs, including using naloxone for quick drug reversal, can lead to better bystander responses to overdose.
Work to address the opioid epidemic is still evolving, particularly at the state level. In June 2014, Massachusetts Governor Deval Patrick announced a $20 million strategy to fight opioid abuse and addiction in his state, and leaders in other states have sought to boost awareness and increase treatment, among other measures.
The Other Side of the Fence
For Rev, working with a counselor helped her get to the root of her desires to use, and over time the urge to turn to drugs subsided.
“It was amazing how much I could feel my body talking to me,” she says. “As simple as ‘I’m hungry.’ As simple as ‘I’m tired.’ I couldn’t feel those things before. I was always tired. I was always hungry.”
Now more than three years sober, and dating a man with a seven-year-old son, “life is so much better on this side of the fence,” Rev says.
“I was living in a life with no goals,” she says of her time mired in addiction. “I was working toward nothing. And that was the loneliest place on Earth. But I was surrounded by friends. Anyone that saw me thought that I was the most popular person in the world.”
Rev now tries to help friends who have fallen into similar drug abuse.
“If people can stick it out and realize that that first day was really the worst day, everything’s better after that. You just put one foot in front of the other every day from then on out.”
For Axl, effectively addressing the opioid epidemic requires early education, more treatment programs, and a greater understanding of the issues surrounding drug abuse.
“I just want people to know… there’s hope,” he says. “There are people out there that want to do good, and turn their lives around.”
*Name has been changed