“Pennsylvania leads the nation in drug overdose deaths for young, white men from 19 – 25…”
– from a 2015 study by Trust for America’s Health (TFAH)
Pain, both emotional and physical, is the reality of the human condition and there is no escape from the suffering it causes. Desires to be more, to have more and to feel happy quelled only by a feeble gratitude for existence do little to pacify the struggle to make sense of the absurd monotony of daily life and, for many, the chronic pain that exacerbates each moment.
“Sometimes we are so quick to get rid of the pain that we are not allowing ourselves to heal the right way,” said Gregory Krausz, MA, CAADC, LPC, Director of Addiction Treatment Programs at the Bethlehem based Mid-Atlantic Rehabilitation Services (MARS), offering intensive out-patient and counseling services. “It’s hard for someone to sit there and look at you and say, ‘your pain is not real’, that is the difficulty in deciding to prescribe or not to prescribe.”
Prescription painkillers and heroin successfully obliterate pain but the consequences are a level of addiction tending to hold one’s humanity hostage, forcing a person down a dark road. Until the public, law makers and law enforcement agencies understand the seduction of this euphoria, though, addicts will continue to be warehoused and buried as casualties of the War on Drugs.
“We have been and come to this idea that we as people, whether its emotional pain or physical pain, are never supposed to experience pain and that makes us turn to medication, prescriptions or other drugs because we are in pain and I am not supposed to feel pain, said Krausz.
In 2016, the heroin dealer on the street corner is a tweaked out former football star who let his membership to the middle class expire for a $10 bag either because he couldn’t get another prescription of OxyContin or couldn’t afford the street cost of $60 per pill. Society can no longer look at addicts as junkies, lowlifes or tweekers—the discarded remnants of humanity the burden of which our society could do without.
To understand why heroin is such a pervasive problem in the Lehigh Valley, though, one must understand the role played by pharmaceuticals, the nature of addiction, the barriers to getting clean and the convoluted path to recovery every family must navigate.
Even though heroin addiction is on the rise, it is not a new problem. The negative effects and highly addictive nature of heroin have been known since it was created in 1874 as an alternative to morphine. Adding two acetyl groups to the morphine molecule failed to curb the cravings of soldiers returning from the Civil War with morphine addictions. The use of morphine, then, was relegated for purposes of easing the suffering of terminally ill patients with cancer.
In 1995, OxyContin was approved by the FDA and Purdue Pharma launched the 80 mg tablets following year. Clinical trials for the delayed release, non- addictive formula proved effective in relieving pain in both cancer and non-cancer pain populations. In a massive marketing campaign, Purdue Pharma’s savvy advertising strategies empowered patients to request this medication from their doctors and pain management doctors were targeted for distribution and assured of its safety. Pain relief never seemed so easy and the commercial success of OxyContin was deemed a “triumph over a public health tragedy,” according to The American Journal of Public Health.
“Medication like OxyContin was designed and developed to be used to reduce pain for end stage cancer patients and it worked very well and effectively for that purpose,” said Krausz, “When we start prescribing it for let’s say a stubbed toe or when I go to the dentist and I get Percocet, there is a question of whether we are appropriately prescribing it.”
In the first four years of production, thanks to entrepreneurial marketing, OxyContin went from a $48 million industry to a $1.1 billion industry. In 2000, Purdue Pharma came out with a 120 mg drug for its sustained release, non-addictive formula. In 2002, Purdue Pharma was exposed for using tactics that identified the most reckless of prescribing doctors and targeted them for their marketing blitz.
In 2007, Purdue Pharma paid 600 million in fines for charges of misbranding their product “abuse resistant” and corporate fraud. OxyContin was not as abuse resistant as they claimed. The dosage and administration label warning, “Swallowing broken, chewed, or crushed OxyContin tablets could lead to the rapid release and absorption of a potentially toxic dose of oxycodone” actually alerted abusers to methods of misuse and addicts were sniffing, snorting and injecting OxyContin.
“Eight years ago, Mid-Atlantic opened with maybe 2 people, clinicians and the capacity to have 35 clients. Right now we are about 28 staff members and a license capacity for 250 clients and last check we were in the 240’s in terms of active clients in the outpatient. That is growth in an 8 year period,” said Krausz.
The public perception of pharmaceutical drugs is that they are legal and safe. According to the National Drug Threat Assessment Summary on Controlled Prescription Drugs (NDTA- OPD), 54.2% of non-medical users of pain killers obtain the opioids from a friend or relative for free without asking with only 25% of the supply purchased from friends, dealers or on the Internet. When that free ride ends, though, street level opioids can run $60 – $100 per pill and, in stark contrast quality heroin can be as little as $5 – $10 for a bag. Heroin becomes an ideal and economical substitute to prescription opioids.
“I am not going to say prescription medications cause heroin use because you can’t make that direct correlation between the two, but there are cases where that is exactly how their addiction started, switching to heroin because it’s cheaper,” said Krausz.
In three of the most recent National Institute on Drug Abuse (NIDA) studies, almost half of young heroin users reported previous opioid abuse prior to trying heroin. This simply is not the case, yet aggressive marketing tactics and collusion with doctors has created a billion dollar industry that preys upon the vulnerabilities of addiction and ease of access with which American’s rid themselves of pain.
“The opiates do have legitimate medical uses, they are helpful and effective and people have real pain that needs to get treated. The struggle and difficulty, I think is that we get to the point where it is over prescribe d and we believe we should have not pain,” said Krausz.
EASE OF ACCESS
Pennsylvania leads the nation in drug overdose deaths for young, white men from 19 – 25 and overall ranks 9th according to 2015 study from Trust for America’s Health (TFAH). The study, Reducing Teen Substance Misuse: What Really Works, attributed the increased in youth drug overdose deaths “to the increase in prescription drug misuse and the related doubling in heroin use by 18 – 25 year olds in the past 10 years.”
Roy, a young, white-male from Allentown, worked in a warehouse after graduating High School in 2000. He pursued associates degrees at Lehigh County Community College, hoping to become a Certified Medical Assistant and Pharmacy Technician. Roy, whose name has been changed to protect his anonymity, was no stranger to drugs. He even commented that he was like your average kid, “growing up smoking- pot and drinking” and he had tried cocaine. In 2009, a co-worker, noticing Roy was depressed, gave him a Percocet.
“That was the first time I felt that feeling. I worked harder at work that day and everything was better. It was like. . . It made me feel amazing,” said Roy, “People had them. Everyone had them. I went from extremely depressed to. . .You don’t start doing it because it’s a bad feeling. It was amazing.”
So, amazing that instead of getting a few beers at the bar the next weekend, he and a friend bought some OxyContin or recreational use. His addiction started subtly, one pill on the weekends, then one every Saturday and Sunday, then a couple during the week until it became a daily habit. One pill, turned into two and two turned into three. At the time, OxyContin was $30 for an 80 milligram pill, which meant his habit was upwards of $90 a day. A $10 bag of heroin could get the same high and before long, he was snorting heroin.
“I didn’t know how to get help. That pill went from taking all my problems away to being my number one problem,” said Roy, “I was ashamed to tell my parent I was addicted to heroin.”
According statistics from National Institute of Drug Abuse (NIDA), opioids, a group of drugs which include OxyContin, Vicodin and Percocet, are being dispensed in an alarming amount with 207 million prescriptions in 2013, and, approximately 52 million people in the U.S. over the age of 12 have used prescription drugs for non-medical reasons. With increased accessibility, NIDA announced that up to 36 million Americans abuse prescription opioids.
Krausz, who has worked in the field of addictions counseling for 21 years, said, “There is an ease of access Grandma, dad, someone had surgery at some point and there is medication that is an opiate in the medicine cabinet at home. When something happens, they feel pain or something else they go take it from the medicine cabinet.”
As a country, the U.S. is the largest global consumer of opioid drugs, accounting for 80% of the world’s global opioid supply with only 4.6% of the world’s population. The problem lies in the fact that opioids, while effective pain killers, are highly addictive, far more expensive than their illicit counterpart heroin and just as deadly. The Center for Disease Control (CDC) reported that 28,000 Americans died of heroin or prescription painkiller overdoses in 2014, nearly doubling the number of fatal heroin overdoses since 2000.
After his first bout in rehab, Roy relapsed. Returning to a relationship he described as “an evil love triangle.” Her using sabotaged his sobriety and they became “partners in crime” again. After a second round of rehab, Roy was clean for a long time, attending Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) meetings but, eventually relapsed again. Two years ago, he started on methadone maintenance treatment (MMT) involving the long-term prescription of methadone, a long-acting opioid agonist that alleviates the symptoms of opioid withdrawal and reduces dependence.
“In the past, people have had very negative reactions to medication assisted therapy because people in the addiction field have generally looked at abstinence only as the only effective approach or outcome,” said Krausz, “We have to look at each person as an individual when they come into treatment. Some people are going to be appropriate for methadone because it’s going to keep them alive, functioning and out of trouble and reduce the harm and risk from their behavior of using heroin.”
Part of Roy’s success of methadone is continued and prolonged participation in out-patient therapy where he attends group sessions and individual counseling weekly. According to a University of California San Francisco study funded by a NIDA grant, “Methadone maintenance is more effective in reducing heroin use among addicts than a 180 -day detoxification program that included an array of counseling services.” MMT has been implemented successfully for almost 50 years but has yet to dodge the criticism that it is just trading one dependency for another.
“I hate it because it’s another thing I am on,” said Roy. “It takes the monkey off your back. Some days I regret it. Now I have to get off of this.”
Some people never get off methadone. In much the same way a diabetic is insulin dependent because their pancreas no longer produces insulin, an addict might have to be on MMT for a lifetime because their natural capacity to produce dopamine has been impaired and their brain chemistry irreparably altered by their use of drugs.
“For certain people, their brain Is more sensitive to the substance and more prone to addiction. For other people their brains are more resilient and bounce back quickly,” said Krausz. “For any of us, if we took an opiate, whether is it prescription or heroin, over a period of time, we would all become physically dependent because of what it does to the dopamine levels in the brain.”
Heroin is converted to morphine by the brain almost instantaneously, inducing euphoria by binding with opioid receptors in the brain and altering one’s perception. Inevitably, users develop a tolerance that necessitates more heroin, more frequently not just to chase the euphoria but to function without going through the symptoms of withdrawal, which have been likened to multiplying the symptoms of the flu by ten. Furthermore, once the brain is introduced to artificial endorphins, they stop producing their own.
“Here is what happens. There is a whole class of people who are brain different,” said Cathy, a member of a Lehigh Valley based Nar-Anon group, a 12-step program for loved one’s or family members of an addict. She is one of six mothers interviewed who shared their common experience—their sons, ranging in ages from 23 – 33, are addicted to heroin, a demographic that has seen the use of heroin double within the last decade.
Cathy’s son, 33, has battled addiction for twelve years. He was an athlete for a total of eleven years and played football at a New Jersey college, graduating and going on to become a school teacher and coach. He started on OxyContin prescribed for pain management. After OxyContin, there was Percocet and Vicodin, and, when painkillers were no longer affordable, heroin was the last stop on the train.
“Addiction is highly genetic,” said Cathy. “When a drug enters someone who is predisposed to addiction, they immediately act different, their brain acts differently than a person who does not have that predisposition.”
Linda, the newest member of the group whose 23 year old son has battled addiction for the past six years added, “My son told me that he knew he was different when he started taking that drug [Aderrol], he couldn’t just take one. He had to take more. He would use his lunch money to buy more.”
For a long time, Cathy’s son was functional, fooling his colleagues. Eventually, though, the nods and other symptoms of heroin use became all too obvious. He was arrested and lost his teaching certification.
“Jail is a good. You get to a point where you know they are safe,” said Cathy, “They really need to turn jails into rehabs.”
Jails are not rehabs but, it is where many addicts end up. The current philosophy in the War on Drugs is to win through arrests because ideologically, society makes the false assumption that only “bad” people take drugs and “bad” people go to jail, which adds to the stigma of addiction that keeps people from asking for help or from parents from acknowledging their child’s addiction.
“My son won the essay contest for the D.A.R.E. program,” said Linda, “It’s been how many decades and the war on drugs is over. We lost because we tried to arrest our way out of it.”
Addicts, instead of receiving treatment for their disease, are handed the “mandatory minimum” for possession or dealing and the burden of rehabilitation is placed on the prison system. It costs about $42,000 per year to incarcerate an inmate in Pennsylvania, according to an estimate from the Vera Institute for Justice. Pennsylvania has the 6th largest prison population in the nation with 51,000 inmates with a 40% growth rate between 2000 and 2011 that is largely contributed to incarceration for drug offenses, according to statistics from the Bureau of Justice Statistics, Corrections Statistical Analysis Tool (CSAT). Not by coincidence, the expenditures went up 76%.
After prison, Cathy’s son went through a long-term rehabilitation program, getting his life back in order and becoming a personal trainer. After two and a half years of sobriety, he has recently relapsed.
“Just like any other medical condition, addiction is a relapsing disorder the relapse rates for heart disease and diabetes are no different,” said Krausz, “The evidence in research says that whether its inpatient or outpatient or some combination, six months or longer is the most effective to have long lasting treatment success in recovery.”
Simply detoxing is not enough. Withdrawal occurs in two stages. The first can last a few weeks and is brutally painful, physically and mentally. In the second stage, the addict experiences Post Acute Withdrawal Symptoms (PAWS) as the brain chemistry gradually rebalances and production of dopamine returns. PAWS is a major cause of relapse.
“Most of the evidence and research when you look at it, says that whether it is inpatient or outpatient or some combination, 6 months or longer of treatment is the most effective to have long lasting success in recovery,” said Krausz, “It is important to make sure someone’s using the whole continuum of care. If they just go for detox, 4 -7 or 4-10 days, and come out with nothing, the relapse rate is significantly higher.”
The frustration of seeing one’s child relapse and consistently having to anti-up the money for the programs is overwhelming but, like other chronic diseases, there is no cure, only treatment and maintenance. Medical assistance helps many people get treatment.
Janet, whose son, 28, has a form of Autism [Asperger’s Syndrome], overdosed three times He detoxed in a medically induced coma.
Janet said, “He had no insurance and he wasn’t in school so he was on medical assistance and he was in a program from April to August of last year. Medical assistance covered everything.”
When her son applied for unemployment, though, his medical assistance was discontinued. Without access to treatment, the downward spiral began again and he wound up homeless until his unemployment ran out and he went back on medical assistance. It took four bouts of rehab to get clean because, like so many parents understand, they have to admit they are addicts and want help form their addiction. Janet calls this the “art of waiting.”
Whether medical assistance or personal insurance covers the cost, the cost of treatment within the continuum of care is astronomical. Many times, insurances will necessitate proof of need by insisting patients come to detox with the drug in their system. In many cases, these admitted to “allowing” their sons to use to qualify for a 4 -10 day detox program. Programs can cost upwards of $10,000 a day.
Linda said her son was in a 60 day inpatient program and they wanted $10,000 up front. Then, he transitioned to a sober living facility. Daily drug testing was $15. In outpatient treatment, she paid $600 room and board per month. After insurance, his three months of intensive outpatient treatment cost $140,392.
“I called them up, flipped out,” said Linda, “They said it was a formality, they have to show the insurance company that they tried to get the patient to pay. Sign a form that it was a hardship and it would be forgiven. The annoyance was that I had to sign that it was a hardship when I shouldn’t.”
Eileen said her son, 24, has been in and out of 20 detox and rehabilitation programs within 6 years at a significant cost. Her participation with this group of women has helped her cope her son’s addiction.
“It takes time to realize how you are enabling him and that’s where the strength of the group comes in, to realize what to do and that it’s ok and you have the right to change your mind,” said Eileen.
When Linda removed her son from her parent’s home she said, “It was heartbreaking. To call someone to get the strength to do that I didn’t call my best friend of 20 years, I called Cindy because my best friend wouldn’t understand.”
The people that are seeking drugs are people in pain, emotional or physical, and their needs are not being addressed and, in fact, there is a growing consensus that their vulnerability to pain is being exploited by pharmaceutical marketing strategies that push pills on the public all too easily.
Janet said, “If I’d seen a person walking down the street before this, I would think ‘loser’ or someone with no direction. I have already driven down the road and my son was the one walking and I just about drove past him because I know how I raised him. I see them now, I just wonder what their story might be and I have total compassion.”
People who are inclined towards addiction could very easily substitute one substance for another but will still retain similar patterns of behavior and issues. Long-term treatment plans are more likely to treat the underlying problems of addiction, which in many cases are the emotional and psyho-social problems they are medicating through their addiction.
“The whole stigma keeps people from getting treatment, staying in treatment and stops the parents from getting the help they need because of the shame,” said Linda, “They are afraid to reach out to take them to an anonymous support group because they are afraid of who knows or who might find out.”
JUST FOR TODAY
Recovery is the elusive brass ring of addiction. While it may seem like the person is cured, it is an on-going struggle to maintain sobriety and stave off relapse. Pain does not end and there are so many reasons, both emotional and physical that can trigger cravings.
“Just like any other medical condition, addiction is a relapsing disorder,” said Krausz, “What is interesting is that the relapse rates for heart disease and diabetes are no different than the relapse rates of addiction.”
Yet, when someone tells us they are in addiction recovery, we often do not have the same reaction as we do when someone recovers from bypass surgery. Often it is with a furrow of the brow and a wince that we receive the information, looking at them deceptively and waiting for them to show symptoms of relapse. It is quite possible that you know more people than you think who are in active recovery.
Kristi Heinick, 27, of Easton, quietly boasts her clean date as August 28, 2012. Two days before that date, she used heroin she purchased right before attending her own baby shower. She was on parole and 32 weeks pregnant. Even when she used, she knew her parole officer would be drug testing her and that she would fail but she did not think her parole officer would send her to prison.
“Now, I am really thankful my parole officer did it. I absolutely hated him because he had a choice, he didn’t have to send me to prison. He could have sent me home and said you need to get into rehab by this date,” said Heinick.
Instead, he sent her to Cambridge Springs State Correctional Facility, one of only a few Pennsylvania prisons that supply methadone to inmates.
“I was pretty much told that if I didn’t go on the methadone, that I would keep using,” said Heinick, “Being that I was pregnant, I was told that if I stopped using and wasn’t on something like methadone or Suboxone, that [Khloe] would pretty much go through the same withdrawal I was going through and there was a very high risk of miscarriage.”
At 37 weeks, she was transferred to Bowling Green Brandywine: Detox Services, an inpatient facility where she gave birth to an amazingly healthy baby girl, Khloe Rose, whose presence at the interview was a delight. At three years old, she was happily playing with Mickey Mouse figurines and then zipping through Apps on the iPad, entertaining herself in a most well-behaved manner.
“I feared the baby would be born deformed or have mental disability,” said Heinick, “When she was born, she didn’t breath for a minute and it was the longest minute of my life and thankfully she s 100% healthy by the grace of God, nothing wrong.”
Statistically, Rose is an anomaly. In 2013, the number of infants born with Neonatal Abstinence Syndrome (NAS), otherwise known as drug dependency, was 27,000. NAS babies are born into this world in pain so much so that they wail inconsolably, shaking, clenching and, at times, gasping for breath. These babies must have constant monitoring and care yet, hospitals send them home with the very person who caused this condition and, in some cases, is still using several drugs to function.
In 2003, the year the “Keeping Children and Families Safe Act” was passed to reduce the number of infant fatalities by mandating hospitals alert Child Protection Services before sending a baby home, approximately 5,000 NAS babies were born and, over the last decade, that number has grown to 130,000 according to NIDA.
In December 2015, Reuters published an investigative piece, Helpless and Hooked, filing 200 Freedom of Information Act requests with federal, state and local agencies to review 5,800 child fatality reports across the U.S. and identifying 110 examples. Their story featured a Lehighton woman, Tory Schlier, 20, who accidentally smothered her 6 week old son, Brayden Cummings, three weeks after she took him home from the hospital while on a combination of methamphetamines, Methadone and Xanax. She wrote in a subsequent letter from the prison, he was “Scared to bring a helpless life into the world,” and “I was an addict. We should have been supervised.”
An average length of stay for an NAS baby is about 17 days, costing $66,700. In comparison, a healthy baby is released after 2 days at a cost of $3,500 the majority of which is subsidized by Medicaid. In 2012, PA Medicaid records showed 1,122 infants diagnosed with NAS costing an estimated $17.3 million. Khloe stayed in the hospital for 14 days and Heinick visited daily for twelve hours a day at Easton Hospital, where her mother, Sue Brown, 52, worked.
“My mom is the strongest person. She sat in every rehab, every jail, every courtroom I had to go to,” said Heinick, “She never gave up or turned her back on me, never kicked me out and called every day to see if I was OK or if I was still alive even after I stole all her rent money and got almost got her kicked out. She still let me come home.”
In 2010, Heinick overdosed on heroin while watching Sons of Anarchy and was revived by an EMT who administered Narcan, or naloxone, a prescription medicine that essentially knocks the opioids away from the brain receptors that induce hypoxia thereby reviving the overdose victim.
“She was the first face I woke up to when I overdosed,” said Heinick.
There is a fine line between euphoria and overdose. The opioid receptors in the brain are also in the brain stem, a part that controls automatic processes critical for respiration and regulating blood pressure. These receptors suppress the body’s ability to deliver oxygen to the brain, inducing a state of hypoxia that in one moment creates that euphoria and in the next could claim the life of the user.
The number of hospitalizations in Pennsylvania due to heroin overdoses increased by 162% between 2000 and 2014 and no less significant is the 225% increase for pain medication, which according to a January 2016 report published by the Pennsylvania Health Care Cost Containment Council (PCH4) cost tax payers $12.2 million.
Heinick’s downward spiral started when she was only 15, used marijuana and cocaine when she partied with her friends. They started using pain killers— OxyContin, Percocet and Vicodin—to soften the come- down of the cocaine, a habit that eventually cost her $100 – $300 per day.
“All you can think of is, ‘How am I going to get high today? How am I going to get the money to high’ and you will do whatever is possible,” said Heinick.
She was taking 12 pills just to function and so she would not experience withdrawal from the time she was 18 to 20. At the time, she was a med tech at an assisted living center where her mother was the activities director. Even knowing she would jeopardize her mother’s job as well as her own, she forged personal checks from the patients and stole prescription painkillers. She was caught and criminally charged.
“I knew I would get caught knowing the next shift would do a pill count and that a pack of Vicodin was missing,” said Heinick, “At the time I didn’t care.”
At the time, Brown denied that her daughter would do such a thing even when the police questioned her. They both lost their jobs. Heinick started selling things she found around the house and even became a “middle man” in street corner deals to support her habit. For every ten bags of heroin she delivered, she got one.
“When I was using, I always told myself this was it. I would either die in prison or die from these drugs and I thought I would never get clean enough to go through the withdrawal to get myself together,” Said Heinick.
Heinick has risen above the stigma to talk about heroin addiction and her four years of sobriety. Now a student at Northampton Community College, she wants to develop prison rehabilitation programs as a counselor so that others can find hope in their struggle to recovery.
“I hope someone could stumble across my story and say, if she can do it, then I can do it,” said Heinick.
For so many former addicts in recovery they must forgive themselves. Moreover, society must forgive them for the transgressions they committed when they were controlled by painkillers or heroin. They need a second chance because their addiction does not make them morally bereft. If anything, recovery makes them more human, appreciating the fragility of that humanity. Extending compassion is the only human response.
For each person, the experience of pain is unique to their level of tolerance. While some people embrace their pain in blatant indignation of their humanity others sublimate or assuage their pain with external remedies, creating a false reality that, for a moment, commandeers one’s perception of reality and imbues it with a sense of euphoria. Prescription or otherwise, the U.S. has little tolerance for pain.
The reality is that addiction is the disease that is killing families and costing communities in the Lehigh Valley millions of dollars annually for rehabilitation, medical treatment and incarceration as well as public anti-drug education.
Part II of this story will feature a mother Barbara Matott, who, through the loss of her daughter, Jaclyn, has tried to make meaning of addiction and the role both healthcare and the criminal system contributed to her death in Easton.
About the Contributors
Tara M. Zrinski
As an Adjunct Professor of Philosophy at Northampton Community College, Tara teaches courses on Philosophy, Ethics and World Religions both online and on campus. She was…
Cassandra Srager is a freelance photographer currently based in the Lehigh Valley area and a recent graduate of the School of Visual Arts of New York City.