A Look into America’s Deadliest Drug Epidemic
By Sofia Heller and Kaitlin Musante
Wedged between dirt-stained walls and a metal bench just wide enough to fit his body, Alan Wins struggled to orient himself. The cracking paint on the ceiling swirled above him as his eyes crossed and stomach flipped. He vomited, a series of loud, heaving retches that filled the otherwise empty cell.
It wasn’t Wins’ first time in jail. He had been behind bars a number of times before for driving under the influence and public intoxication and was familiar with a “drunk tank”––the crowded bodies, drunken ramblings and overwhelming stench of alcohol. This time, however, he was alone.
Swallowed by the isolation that encircled him, Wins said he sunk under the fear that he would no longer be able to deny the consequences of his opioid addiction.
“Whenever you’re separated, it means something bad happened,” Wins said. “At that moment, when I woke up and I was coherent, I remembered sort of where I started, and I thought, ‘Oh no, I might have actually done something really bad this time.’ When that fear became reality, I knew that this wasn’t going to end well.”
Opioids, which Wins was first exposed to through codeine cough syrup as a child, are a class of drugs that includes heroin, fentanyl and pain relievers. While they have been prescribed since the 1800s, their nonmedical use has skyrocketed over the past six years, with 11.5 million nonmedical users in 2016 alone, according to the National Institute of Health. The current opioid crisis has claimed the lives of nearly 30,000 drug users, making it the deadliest drug epidemic in American history, according to the New York Times.
Teetering on the edge of being added to the body count, Wins sat haunted in his jail cell.
When the police officers retrieved the then-19-year-old later that morning, they informed him that he had been arrested for public intoxication and thrown into the “drunk tank,” only to be removed after repeatedly bashing his head against the wall.
“You’re a mess, and you’re only 19,” Wins remembers the police saying. “You’re not supposed to be drinking. What are you doing with your life?”
He didn’t have an answer.
The only thing he knew at that moment was that this time, he wasn’t going to use his one phone call to ask his dad to pick him up, he said. Instead, he walked the 10 miles home along the main road, sweating in the dry summer sun, and for the second time that day, found himself alone. Accompanied by nothing other than his anxieties, he finally pulled himself out of his denial.
“[As] an addict, you think everything is okay,” Wins said. “You’ll ride that ego and listen to that inner voice that you’ll hear in your head repeatedly saying, ‘This is fine. Everything is how it’s supposed to be. It’s their fault. This isn’t your fault.’ I heard this voice a lot for a lot of years. I blamed a lot of stuff on society or my parents or whoever. At a certain point, when the silence is there and you’re walking in that kind of position, there’s no one to blame but yourself. Because no one was there but you, and no one got you into that mess but you.”
It was then when Wins finally decided to get clean. He threw his drug paraphernalia away, his faith in himself growing with each item he tossed. He was going to do to it this time, he said.
However, 18 hours later, back with the same crowd under thick clouds of smoke, the pills around him took control once again, consuming his thoughts until nothing remained but his desire to escape the world, he said.
“I wanted to run,” Wins said. “I wanted to run, and I didn’t want to feel anything anymore. I didn’t want to face any realities, and I didn’t want to be in the skin that I was living in. I didn’t want to be the person I was. I wanted to be outside and forget where or how I felt. Then, within an hour of doing that and getting the freedom, the guilt and shame started coming back. And then, I tried numbing out again.”
The cyclical nature of addiction, which plagued Wins for years, is all too common for opioid users, anesthesiologist David Samuels said. 91 percent of opioid addicts will experience a relapse, according to the National Institute of Health.
Samuels, who has removed opioids from his practice and encourages other doctors to do the same, explained that even one dose of opioids can alter a user’s brain and start the cycle of addiction.
“The opioids work in a manner where your receptors are changed so that you need more of the drug to the same effect,” Samuels said. “If you continue to take the medicine, you become dependent, which means if you stop taking the medicine, you go through withdrawal. Withdrawal with opioids is a very severe, painful process, where people end up just taking another opioid to avoid the withdrawal. Then, there’s abuse and, then, addiction, where your primary motivation is to get your next dose. You’ll start destroying relationships, stealing money, missing work, missing school because all you care about is your next dose. Every single moment of your life when you’re addicted, you’re just focused on your next dose and how you’re going to get it.”
Pamela Butler relapsed multiple times in her thirteen-year struggle to overcome her addiction. While she first starting taking prescribed Lortab and Roxycodone to ease her pain after crushing her cheek bone, hips, pelvic bone and tailbone in a car accident, her dependence on the narcotics quickly grew. Within months, Butler was taking upwards of 14 pills a day, instead of the recommended five.
Butler said her doctors and specialists fed her addiction, readily prescribing opiates after breezing through questions about pain levels and ignoring her bloodshot eyes, shaking hands and increased irritability.
“The doctors never seemed too concerned,” Butler said. “In the beginning, they never even told me I could get addicted. I would just go in every month, they would talk to me, give me a prescription and send me on my way. They even never tried to take me off.”
This mentality that Butler witnessed is a result of shifting cultural and societal ideals around pain, Stanford University Medical Director of Addiction and professor Anna Lembke said.
“As a society, we have a much lower threshold for experiencing pain, and there’s this idea that any kind of pain can lead to trauma and psychic scars—pain begets pain,” Lembke said. “Because of this shift in thinking, doctors now feel that pain is something that patients should never have to suffer in any form and that it’s their job as the compassionate physician to do anything within their power to eliminate this pain. They are taught that in failing to do that, they are essentially torturing the patient.”
While Lembke does agree that doctors should aim to relieve their patients’ pain, she said that opioids are not the solution. The notion that opioids are an effective treatment for minor and chronic pain is a marketing trap set up by pharmaceutical companies, Lembke said. Rather than diminishing the pain, a condition called opioid-induced hyperalgesia changes addicts’ threshold for experiencing pain until even the slightest stimulus can become agonizing.
“Big [pharmaceutical companies] took advantage of structural changes in medicine and convinced doctors that prescribing opioids long term and for minor pain was both safe and medicine-based, with minimal risk of addiction,” Lembke said. “This idea is completely false, and it has had many very real effects.”
For Butler, the consequences of her addiction soon overtook her life. Her days were spent holed up in her bedroom, high off the cheapest pills she could find, and at night, she’d slip into the darkness to buy more.
“I was stuck in a vicious, never-ending cycle,” Butler said. “I would take them, and I would feel good. Then, the money would run out, and I wouldn’t have them anymore, and I would be sick. I couldn’t even get out of bed because I just felt so awful physically and mentally. It felt like it was something that I was never going to get over. It was just the way it was, and I was gonna be like that until I died or it killed me.”
As Butler’s addiction spiraled further out of her control, its repercussions expanded too. She stopped taking her kids to school, stopped getting out of bed in the mornings to say goodbye. Her marriage ended, and as her husband left, she filled his void with a new boyfriend. Months later, as she lay swallowed by the darkness in a drug-induced trance, he molested her six-year-old daughter.
Eventually, Butler decided she was going to commit to getting clean. She left Jacksonville, Florida for Miami, turning her back on the streets she lurked at night, where her pills were just a phone call away.
“I had just gotten tired of living like that, and I finally decided I had had enough,” Butler said. “I gathered up the courage at last and got it in my head that I didn’t need to be taking these pills to be happy.”
But courage alone wasn’t strong enough to fight her addiction, she said. The withdrawals soon hit hard. The diarrhea, sleepless nights, stomach cramps, sweating and shaking left her in constant torment.
“[Withdrawing] feels like your body has been hit by a truck,” Butler said. “It’s like your skin is crawling. Somebody even just touching you just a little bit feels like your skin is being ripped off.”
Butler’s isolation in Miami allowed her to prevail over the pain, and she has now been clean for the past six years, she said.
For Wins, however, a community was crucial to his recovery, which he found at a treatment center in Costa Rica.
“As someone who will find any loophole or any shortcut or any corner to cut, I needed something that was very rigid,” Wins said. “I needed something that gave me an idea of how to live because I wasn’t taught that I deserved better. Rehab broke this cycle long enough to where I wasn’t trying to justify what I was doing, and I wasn’t trying to use because it made me feel better.”
Although a rehabilitation center was finally how Wins got clean, they have fallen under fire for their high cost and low success rates in recent years. A 28 day stay in a treatment center can cost upwards of $30,000, according to the Washington Post, and it is nearly impossible to ensure long-term rehabilitation in such a short amount of time, researcher and Harvard Medical School professor of psychiatry John Kelley said. He said it takes eight years and four to five attempts at treatment for the average opioid addict to achieve one year of remission.
Wins said he sought treatment in Costa Rica partially due to the rising costs within the United States.
“Somebody who has been on the street, addicted to heroin, is not going to be able to go to rehab if it’s going to cost 30k, and they’re going to need insurance,” Wins said. “The odds of that happening, of them having a spare 30k, is insanity. Prices need to change, or the government needs to pay.”
In order to prevent the epidemic from escalating even further, doctors must work to build infrastructure inside of the medical field to treat addiction, Lembke said. This system would be most effective as a multi-modal approach, which she said includes both FDA-approved medication and psycho-social intervention.
Solving the crisis, however, will require more than just reforming treatment centers, Lembke said.
Bev Kelley-Miller, who has been a forceful voice in ending the epidemic since her daughter Megan died of a heroin overdose in 2015, said she believes reform must start in the prison system.
Kelley-Miller experienced the prison system’s problematic approach to addiction firsthand after a judge denied Megan’s request for in-patient treatment during her nine-month stint in jail, leading her to relapse upon release. That relapse soon led to Megan’s death by overdose––a fate that many other former inmates met, as well, according to the New York Times. A recent study in North Carolina found that former inmates were 40 times more likely to die of an opioid overdose in the first two weeks after being released from prison than someone in the general population.
This issue stems back to the court’s systematic lack of understanding on the nature of addiction, Kelley-Miller said.
“The court system doesn’t hold a medical degree, but they determine whether you get medication or treatment,” Kelley-Miller said. “It’s not conducive, and it results in a lot of people’s lives being taken by this drug. They don’t understand that relapse is a human condition. It does not just have to do with addiction.”
The solution in the prison system lies within both educating lawyers and judges and making the counties, rather than the state, responsible for the cost of incarceration to eliminate any consideration of the budget, Kelley-Miller said.
In order to prevent the opioid crisis itself from expanding further and claiming even more lives, Kelley-Miller said that teenagers need to be informed.
“While my daughter thought she was having fun, she never signed up to be addicted,” Kelley-Miller said. “But, she crossed a line and got hooked at a young age. It’s that peer pressure, the desire for sense of belonging, and the frame of reference that ‘everybody does it, so it’s OK’ that makes schools so dangerous. We really have to take a hard look there and teach our kids at an early age how bad [opioids] are so they don’t fall into those traps.”
In pursuit of that goal, Kelley-Miller travels around Wisconsin, where she resides, sharing her daughter’s story with high school students. She displays pictures of her daughter––a blonde 22-year-old, smiling broadly––beside her death certificate so that the students are able to see the concrete reality of an otherwise abstract crisis, she said.
“I try to make it personal because people always think, ‘Oh, that can’t happen to me. I know what I’m doing. That just happens to other people,’” Kelley-Miller said. “But when I go into those classrooms, you can hear the silence in the room because now they’re making that connection. If it could happen to my daughter, it can happen to anyone.”
While Kelley-Miller said she believes her work benefits the high school students, she is eager to speak to middle school students in order to prevent an even greater number of kids from using.
At Harvard-Westlake, students at the Middle School are educated about types of drugs and their dangers through a series of lessons from the organization Freedom from Chemical Dependency (FCD). In addition to teaching hard facts, the officers from FCD share their personal struggles with addiction, mimicking a method like Kelley-Miller’s.
“I think that hearing from someone with direct experience with addiction made a much larger impact,” Harvard-Westlake student Francis Ross said. “They were able to tell us from firsthand experience what addiction is like, what things it does to your body, like how it can make you feel sick or feel no strong emotions, and what long term effects it can have, such as its effects on your memory. They made sure to introduce these ideas to us in a forceful yet effective way, and I feel it was really helpful in deterring me further from harmful substance use.”
Wins is all too familiar with the long-term effects that FCD teaches and said he believes the short-term high comes nowhere close to justifying them.
“There’s a moment in your emotional state where you have to ask yourself if these feelings that you get, the few moments where you feel good, are worth it,” Wins said. “I can promise you and anyone who reads this that those moments are not worth it. They are not worth the pain, the suffering, the longevity. It was fun to be that rebel and be outside of that circle. But, [ultimately], there’s always the end. There’s always the end of how it felt like to know that you’ve thrown every opportunity that you’ve had away.”