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CHAPTER 1
IT STARTED WITH A PILL
A Single Irresponsible Prescription Initiated the Perfect Storm of My Addiction
IN 2005, I WAS LIVING IN FLORIDA, directly in the path of Hurricane Katrina. As the storm closed in, the blue sky faded to yellowish gray. My town's streets were empty. News stations played nonstop warnings about staying inside, stocking up on water, and preparing for the high winds and heavy rains that the hurricane would bring. Normal people complied. But not my people. We were out in the storm. Because the thing is, drug addiction doesn't take a day off. It doesn't matter what the weather is like. As the local news played yet another dramatic clip of palm trees being buffeted almost sideways, I was carefully counting my pain pills and wondering how long the storm would last.
The number of pills I had wasn't enough. It was never enough.
A day before Katrina hit, I got a last-minute appointment at a pain clinic. The place was crammed with people, standing room only. I was rushed through a ten-minute "checkup" and given a prescription for the medication I desperately needed. Then it was on to the pharmacy. However, I was out of luck. Most businesses had shut down due to the hurricane. I tried my usual pharmacy and called a dozen more, but no one answered. Then the storm came, and the whole city lost power. Two days later, when the rain and wind had eased up, I was strung out, shaking, and desperate. The people I knew who would sell me extra pills or trade prescriptions with me told me about a new pharmacy that had opened right before Katrina hit the Florida coast.
Clutching my scrip in my sweaty hand, I drove as fast as I could to this new place. Fort Lauderdale was still a ghost town. Fallen branches, debris, and even parts of houses littered the abandoned roads. I saw downed power lines and trees that had been crushed by the storm. Yet my addiction gripped me so strongly that I didn't give a single thought to my own safety. I made it to the new pharmacy and pulled into the already full parking lot. Sure enough, this was the place — and I wasn't the only person who'd heard about it.
Inside, the power was still out. Fluorescent bulbs powered by a plug-in generator lit the pharmacy with a ghostly, flickering glow. The waiting area was crowded with people moaning, complaining, sighing, fighting, and just waiting for their number to be called. This place charged almost double what I paid at my usual pharmacy. I didn't care. Nobody here cared. We just wanted our drugs.
Without power, there was no way to operate a cash register or any kind of computer. A huge, heavily muscled bodyguard stood next to the pharmacist's counter, arms crossed over his chest, glowering at anyone who moved. He wore a pistol in a shoulder holster. I had no doubt that he knew how to use it. I slid into a chair. The pharmacist called someone's name, and I watched them hurry to the counter, eager to collect their pills. The pharmacist took a wad of hundred-dollar bills from the person, put them into a lockbox, and noted the purchase in a long, thin ledger. Next. Another bottle of pills. Next.
By the time it was my turn, I'd dissolved into a puddle of anxious sweat. Hampton. I couldn't get to the register fast enough. I was so desperate that I wasn't even trying to be cool, even under the intimidating stare of the armed guard or the strangers watching me. I had the cash, and I practically threw it at the person who held my pills.
"Thanks," I croaked, wishing I'd brought a bottle of water with me. I could have taken a handful of those pills on the spot. There was still no electricity and no running water, but there were drugs. I dry-swallowed two on my way back to my car. As I turned the key in the ignition, I felt them stick to my throat. I swallowed hard again, willing my hands to stop shaking. I'd be fine now. In just one more minute, everything would be fine.
The pills were small, round, and white, with an "M" marked on one side. Four milligrams of hydromorphone, in a smooth coating. Dilaudid. They came in a prescription bottle with my name on it. The pills were supposed to take my pain away. I tried them for the first time in 2003 after I'd hurt my ankle, and it just wasn't healing. I laughed about my klutziness with my doctor at the urgent care center, who nodded and smiled and handed me a piece of paper with the prescription written on it.
"We'll order you an MRI," she said. "Come back if your pain gets worse."
I took the first pill and my pain, the dull throb that followed me everywhere I went, went away. Four hours later, it came back. So I took another pill. And another one. I never got that MRI, because my ankle didn't hurt anymore. What I did get, after my first bottle of pills ran out, was another prescription.
At the time, there was almost no information available about prescription pill addiction. I didn't know what questions to ask, or even that I should be asking questions. Alcoholism was a taboo subject, and I'd never heard of substance use disorder. I was given the prescription in a doctor's office, a place we are all taught to trust. My "dealer" was a source we are taught to believe has our best interests at heart. There was no discussion of the addictive risks of opioids. After a few jokes and a handshake, I made my exit with a full prescription of extremely powerful opioids that blasted me into the stratosphere.
What I didn't know was that just that week the doctor had probably seen a sales rep from a pharmaceutical company who had assured her of the minimal addictive risk of opioids. Opioids were by no means a new drug, but the information that this new army of sales reps were presenting to physicians was. In 2003, a massive, organized effort on the part of the manufacturers of opioid pain medications had already been in motion for ten years. Primary care and urgent care physicians everywhere were being given fraudulent information packaged as scientific studies that misrepresented and minimized the addictive risks of these drugs. It had made them the biggest-selling and most commonly prescribed drugs in America. Later in the book, we will examine the specific steps that led to what I believe is nothing less than medically sanctioned mass murder.
By seeking care for my ankle, I stumbled into a massive and dangerous sea change under way in conventional medicine. Physicians were being taught to treat pain more aggressively, while pharmaceutical companies were consciously and deliberately presenting false research on the dangers of opioid painkillers. It was the white-coat equivalent of walking past a gunfight in a bad neighborhood. I heard the gunshots but didn't realize I was in danger. I was in harm's way. I didn't know it, and neither did my doctor.
* * *
Times were different in 2003. We were more focused on the war in Iraq than the drug war in America. As a kid, the only messages I got about drug and alcohol use had come from my school's D.A.R.E. program. In school, I saw videos of people driving drunk or racing through the streets, going crazy on crack or PCP. Just say no was a slogan and rallying cry popularized by First Lady Nancy Reagan, who talked like a sweet little grandma on an evening sitcom. Addiction could be avoided with simple good judgment, and all you had to do was "say no." America's grandma reassured you, with a pat on the head, that you wouldn't get hooked, as long as you avoided illicit substances, shady characters, and "the wrong crowd." That's the message I got. And I said no, truly believing that I was on the straight and narrow. I followed the advice of all those smiling parental archetypes who seemed to cheer me on every time I made the "right choice." It was fine. Until those pain pills came along.
Up until then, I'd been a weekend warrior. The occasional joint, a few drinks with friends. There was a small margin of socially acceptable drug and alcohol use in young adulthood. I knew about hangovers; like most young adults in their twenties, I'd learned through experience where alcohol fit in my life and the broader culture. I had definitely enjoyed my college years and the period of socially acceptable excessive drinking that came with them. I wasn't a serious drinker, and I knew I'd mature out of my partying years, like most of my friends. What I didn't know was that nine out of ten people can use alcohol safely throughout their lives and not switch into an addictive pathology. However, the 10 percent who do become addicted only exhibit symptoms when their disease has progressed far beyond its early stages. Our understanding of the disease of alcoholism is further complicated by the fact that the medical diagnosis of what constitutes "problem drinking" is constantly in flux. The most recent revision was made in 2016 by the US Centers for Disease Control and Prevention. Yet rarely has the medical definition of "problem drinking" been in sync with the societal definition, which is far more narrow. The myth of "functional alcoholism" has always undermined the true scale of this deadly problem and allowed people to avoid confronting the truth that alcoholism may have existed in their families or in their own lives.
I also didn't know about pills or their dangers. I used pills casually for two years. The pills weren't a big deal, in my mind, because they didn't come from a street dealer. The packaging made all the difference; it gave the hydromorphone an air of legitimacy. It looked like medicine. For me, though, it was poison.
I bounced in and out of urgent care clinics, collecting a new prescription every time. My ankle had long since healed, but I'd tell the doctors that it hurt, and they'd reach for the prescription pad.
"Let's take care of that," they always said.
Having doctors provide the prescription meant I had a cosignature, the same way a parent cosigns for your first apartment. When someone who's smarter than you tells you that what you're doing is legitimate, it's reassuring. I took comfort in it. I didn't think to say no to a substance that could be prescribed by a doctor. That changed two years later, in 2005, when I found Dr. Leah.
Dr. Leah had been an OB-GYN in Fort Lauderdale, Florida, but was now in the pain prescription business full time. "Pain management," she called it. At the time, pharmaceutical companies were paying enormous amounts of money to help doctors set up pain clinics instead of their regular practices. These clinics advertised in the back pages of local papers — I found Dr. Leah's clinic among the many ads in the Miami New Times. I was looking for a refill on my prescription, and I had plenty of places to choose from.
IN PAIN? WE CAN HELP! said one ad. Another one said: DON'T BE SHAMED FOR YOUR PAIN MEDICATION. WE PRESCRIBE OXY! I chose a clinic nearby, and the next day, I met Dr. Leah.
She was tall, like a model, with long blond hair. She was poised and confident, in her late thirties. When I went to her clinic, I sat in the waiting room for about twenty minutes. Then a nurse took me into the back and did a "physical."
"My ankle is swollen," I told her.
She nodded, took my temperature, and had me step onto a scale. That was it. Within fifteen minutes, I had two new prescriptions for pills. Dr. Leah gave me 120 OxyContin (80 mg) and 60 oxycodone (30 mg) and told me to come back next month.
"What if I need to stop taking them?" I asked her. It was a huge number of pills, and even I knew that the dosage was unusually high.
"You won't have any problems," she told me. "We'll just taper you off at ten to twenty percent of your dosage per day until you're completely off the medication. We can do that at the clinic or you can control your dosage at home."
She handed me the prescription. "We'll see you in a month."
I lasted three weeks.
At first, I felt fantastic. A euphoric rush happened when those pills dissolved in my stomach. Opioids flick certain circuit breakers in the brain and flood you with feel-good chemicals like dopamine. For certain people, this is an elusive sensation. I didn't realize how much anxiety and depression I had until the medicine did its work and cleared away my mental fog. I felt so clear. So strong. It was the best feeling in the world, and I would do anything to hold onto it.
I was full of energy, my mood was positive, and I was even more productive at work than usual. I left the prescription pill bottle on my desk, where anyone could see it. This wasn't classic impairment, like a drunk stumbling along the sidewalk. It was simply the best boost I'd ever felt. I was totally functional (or so it seemed). If any of my coworkers noticed, I just told them that it was my prescription from the doctor. My ankle didn't hurt. I was doing great. If I took the pills more frequently than the doctor's suggestion, so what? Dr. Leah told me that I could adjust my own dosage to "manage my pain threshold" and stay comfortable.
When the prescription was almost gone, I realized I had another week before I could go back for a refill. I panicked. The long days without my medicine stretched out in front of me. I felt nauseated. How would I get by? I picked up the phone and, with shaking hands, dialed Dr. Leah. Luckily, the receptionist was able to get me an appointment for the next day — for an extra $100. I was happy to pay that amount out of pocket. Soon I had more pills, and my fear of running out of them went away. Within minutes, the familiar euphoria washed over me and the world felt right once again. I could get back to work, back to life, back to feeling normal.
This prescription was gone in less than two weeks. The next one, even sooner. I couldn't afford an extra $300 per month to cover my early visits to Dr. Leah, so I found another clinic that would prescribe to me. And then another one. I rotated among as many as five pain doctors as I juggled those pill bottles. The whole time, I somehow knew that what I was doing was risky, but I didn't recognize my progression into active addiction. I just couldn't put two and two together. After all, this was my medicine. It came from a doctor. I had pain, and this made the pain stop. I wasn't an addict. Addicts looked different, smelled different, did different drugs. They were shaky and lived in alleys. They weren't like me. I had listened to the D.A.R.E officers. I was sure I didn't know anyone with an addiction, especially not myself. Whenever I started to worry that I might get into trouble, I would take another pill, and it soothed me. My anxiety evaporated. My depression cleared, like clouds parting to reveal a blue sky.
I wasn't the only one coping with this problem. South Florida, where I lived, was the epicenter of the prescription pain medication epidemic. The pill doctors who advertised their practices on the back page, where I found Dr. Leah's clinic, seemed to pop up overnight. Pain pill–specific pharmacies suddenly were everywhere. They appeared in strip malls, wedged between laundromats and 7-Elevens. Their signs lit up with bright neon, the colors of a billiards hall. I should know: I visited them. I sat in their crowded waiting rooms, sweating, waiting to pick up my scrip.
Looking back, those "clinics" were nothing more than pill mills. I was one of thousands of drug-seeking zombies. It was an open market for opioids, with hawkers in physicians' white coats on every corner. They pushed OxyContin like snake oil, as if it were the elixir of life.
What many people fail to understand about addiction is that, for many people, the negative consequences of the drugs don't show up immediately. The symptoms do not sync up with the progression of addiction. This is important because when we think of the word "disease," we think of overt, tangible symptoms like fevers, blisters, and tumors. Addiction progresses in an asymptomatic way, and that is what makes it so dangerous.
I used prescription pills for a long time, and although my behavior was beginning to change, I wasn't truly suffering yet. If anything, I was doing really well. Seems backward, right? But anyone who has experienced addiction or seen it up close knows that there's often a period where everything seems to be OK for the addict. We can handle it, for a minute. We don't realize that, while we're handling our addiction, we're actually digging our own graves.
I kept using pills, through the stressful times and the good ones. They were my safety net, my security blanket. I worked on one political campaign after another. I landed multiple senior-level staff positions within the Democratic Party. My star was rising. Sometimes I used being so busy as my excuse for needing the prescriptions.
My rationalization skills developed with ninja-like precision as my addiction progressed. I justified my usage and need by focusing on any excuse in my life, real or imagined. It sounds hokey, but I really did have a devil on one shoulder and an angel on the other. And over both of their competing voices, I heard the message of the pills, loud and clear: You need more! You need more now! Sometimes it was clear to me that the only reason I took them was that withdrawal was so horrible. Those feelings, hard to ignore, were easily masked by more medication.
(Continues…)
Excerpted from "American Fix"
by .
Copyright © 2018 Ryan Hampton.
Excerpted by permission of St. Martin's Press.
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