In emergency rooms from the Northern Kentucky area to the hills of our great state I have had a front row seat in the heroin epidemic. I thought I’d give the report from my side of the railing.
What is most clear is that narcotics are a special poison to the human mind. Masquerading as pain relievers, they actually and simply serve as euphoria agents, in which state pain doesn’t register any longer. In the setting of acute injury or painful illness, there’s nothing like them, and for this we need them. But the problem is that some real “can do” and enjoyable thoughts result from their use as well, because these drugs are “turning on” the areas of the brain where we experience pleasure and feel the general goodness of life. So, people want to take them to get this feeling, which is entirely understandable. With this effect, it turns its users into “the people they want to be”, this narcotic feel-good-about-everything state. That’s what long-term use is all about, and it has nothing to do with pain. For the sadness in the heart of people with chronic pain syndromes, they serve to mitigate the misery or their existence through the artificial inducement of euphoria.
The bad news is this. After a time of regular use this effect fades, and we say the brain has adjusted and is now “tolerating” the drug, blunting the effect. And if the supply is interrupted, within hours a “readjustment” will begin, and in fact, by definition, addiction is defined by the existence of this withdrawal syndrome that follows stopping a substance. It is this withdrawal syndrome that is so awful and keeps people from going clean from narcotics. And they will do just about anything to not hurt like that and feel like that, for three days non-stop. The abdominal pain and diarrhea, and how every bone in your body hurts. And the headaches, oh the headaches. No sleep, no break from it. For three days, just you and your misery. And that cold-turkey looking back from the mirror. People say when it’s over they feel dead, like there’s nothing left of them.
It’s hard to say how long it takes before such “tolerance” develops, where you’re only treading water, and taking the opiates in any form to keep from withdrawing. I’d say if you’ve been taking one several times a day, like they’re prescribed for things like broken legs, for a period of weeks and not months, you’re probably getting there. And if you’ve been at it for two or three months, that’s probably gotten you there for sure. When you try to quit, we’ll know.
More bad news. Once a person has been to the point of addiction there is no going back to the old you. It’s like a head injury sort of, where you recover but there’s a something missing or different. And you’re a fight with your boss or a death in the family from falling back off this wagon, even after years of sobriety from them. So the problem is a gift that keeps on giving. We will be living this for many years. It’s why we already have been living this for years.
We all say it started with “the pain scale”. Around the year 2000, there was a survey or a study of some kind and the impression was that doctors don’t seem to address pain “enough”, and that people have suffered unnecessarily. So they introduced this pain scale, as no less than the “5th vital sign”, where in medical interactions, after the blood pressure, heart rate, breathing rate, and temperature were taken, the nurse or assistant would ask, on a scale of 1-10, how would you rate your pain? Ten is the worst pain you’ve ever had, and 1 is the mildest.This led to a flood of narcotics into modern medicine, most notably the slow release form of the big doper, oxycodone, as “Oxycontin” (“OC’s”). Casual prescribing of these medications was enabled if not encouraged, and soon they were everywhere. For many a bad decision maker, is was the beginning of the end of their life. Literally.
Everyone in Kentucky likes to go to Florida. In the 2000’s they were going there in buses down I-75, shopping at the “pill mills”, and bringing their loot back to what eventually became a whole lot of mouths to feed them to. The mills sprung up here, too, under deceptive names, with many Rx’s signed by foreign names. A scattering of more “legit” practitioners helped fuel the monster as well, just trying to help people feel better.
Soon people were taking them to start their day. Pop one of these and I’m cleaning the house and mowing the grass, and I’m the soccer mom I want to be. Then once tolerance develops and you need more and more, and more often, and God-forbid there’s an interruption of the supply (doctor’s out of town, lost the medicine or someone stole it, etc.), the withdrawal syndrome starts. All hell soon is breaking loose. So guess what, they come to see me. And they will lie and fake any number of painful conditions to get a shot of something that will pull them back from the hell of the end of this ride of narcotic-driven feel-good. Ideally they’d like a prescription of some as well, you know, until my doctor gets back.
Thieving, not seen in any other drug phenomenon, is universal among narcotic addicts. If they have a criminal record, it is almost always from stealing and bad checks than anything involving the drug itself, like possession. So they can’t get a regular job, which makes everything worse. Famously, they steal from their mother and other loved ones, or swipe something to pawn it. The real thief is the narcotics, which leads to the saying that they “steal your soul”. It’s what narcotic addicts spend the rest of their life trying to find. I wonder if any of them ever do. It is all so sad.
The next step in the disaster was “House Bill 1”, passed by the state legislature in 2012. I was so glad to see it. The pill mills were closed, the heavy peddlers hounded into oblivion, and the rules for use spelled out, and the attitude of the prescribers was that the ride was over. But just like the Iraq war, you can win a quick battle but are you ready for what comes next? We weren’t. We still aren’t. They all turned to heroin. So the slide from popping the odd percocet or vicodin, on eventually to the “perc 30’s” (the basic is but 5 mg), to the graduation of crushing and snorting OC’s. And now it dries up, and you’re injecting heroin. A race to the bottom if ever there was one.
So hence the final ingredient in this catastrophe, and yes it is a catastrophe, is the 48 year-old war on drugs, America’s great prohibition experiment created by the Nixon-era “Drug Enforcement Agency Act of 1971”. Just like with alcohol prohibition in the 1920s, an underground network sprung up essentially over night, and now this many years later it has made it out to the furtherest hamlets of society. When the pain pills dried up, these bus-stop networks had the infrastructure to supply a certain long-acting opiate that would do the job, the one they called “this new heroin”. It could be sniffed even, to get enough of a high to “not hurt all day”. For just 10 bucks! What a deal! This is called being “strung out”. But for most, soon enough they were getting out the needle, just like the bum in the alleyway. This desperate state of affairs brings a little icing to the cake: hepatitis C. We’ll be staring down a huge medical bill rescuing all these livers when 80% of them progress to cirrhosis 20 or so years from now. And I mean they ALL have it. treatment is now available. But still.
I worked for a while down at The Bourbon Community Hospital in Paris, where they have a rehab unit, and patients come through the ER for a medical screening before admission there, and I would see them. I asked all of them, what happened? And they were so glad to tell their story, like a war veteran might. For most, it was a story that was a very long one, ten years and more of over-amping this crucial pathway of mental health and function.
They shake out about like this. Maybe a third or more had a legitimate illness or injury, and were prescribed them over months of recovery. “My doctor kept prescribing them”. After a time it was too late. A startling number were teenagers.
Another large batch, at least half, were broken hearts (incest, abuse, severe neglect), where a pain syndrome is often the maladaptation of adulthood, as “pain prone behavior”. Headaches and backaches, bulging discs, and the absurdities like fibromyalgia, these are all mental illnesses manifest as pain syndromes, and when the narcotic alleviates this problem, then IT has become the problem.
Another cohort had simple mental illness, and the bad wirings of their nervous system fell prey to the “happiness” of narcosis. Before long they were “done”, generally by a well-meaning prescriber. Accessing the medical system is, for many such “poor” citizens, a power trip and esteem builder. Few have ever paid a bill. Toss them a narcotic, and you have added the sinker to the hook and line.
Others started abusing them in high school or shortly thereafter, where they became available from the home, or by someone who was getting them by feigning illness and then distributing them. Such “recreational” starts are unusual though. And there’s no “gateway drug” to narcotic oblivion.
And not everyone has the same weakness to them. I have said that “normal” people don’t like the narcotic effect, as if their euphoria pathway is quite alright without the overstimulation narcotics cause. But unfortunately the epidemic is a sort of “thinning of the herd”, where if your mind is not “happy” enough in its own skin and you fall victim to this, your genes may not make it to the next generation. Like a selection pressure fully created by The Modern Age in Modern America. And guess what, there are a lot more broken hearts out there than anyone wants to know, generally paying for the sins of dear old mom and pop somehow.
It seems to me there are a lot of options available for people who really see the life-threatening struggle it is, but they’re such zombies already, can they ever see the light again, or gather themselves for this great struggle to recover the self? I tell them they need to re-construct their personality, so broken by this class of medications. Like a head trauma patient learning to walk again. Get work, pick up a hobby, learn a musical instrument, go to church, get in shape, and take that long look in the mirror, and try to find a you worth being. For many they’re looking up at the top of a hard box. Many.
As a syndrome that is seen in all socio-economic levels of the population, they all act like twin children of the same mother. Their excuses, their lies, their disastrous decisions, their thieving, it’s part of the syndrome. It takes me usually a minute or so to know if they’ve got the syndrome, and I look at them and I wonder, what would you have been like if not for this? Before we sent you to hell on a road paved with good intentions. Before the pain scale and House Bill 1 and the war on drugs, and before Modern Age America chewed you up and spit you out. Probably just a regular old salt of the earth pillar of society, and we could have used a better you. Won’t happen now.