If stoners who smoke joints in the parking lot after school or ravers who pop Ecstasy pills at the nightclub come to mind when you think drug abuse, think again. The biggest abusers could be the regular person with the locker next to yours, your doctor, your dad, your girlfriend -- maybe even you.
Take "Mike," for example. He wears his lifestyle like an Armani suit. Yet all it took to get hooked for this 59-year-old chief executive officer of a Marina del Rey gym franchise was one pill.
Mike, who is also a criminal prosecutor and a recovering alcoholic, fell off a polo pony two years ago and wound up in the hospital with an injured elbow. His doctor prescribed Vicodin for the pain.
"Advil would have taken care of my problem," Mike recalled, "but the thought went through my head that [Vicodin] would be better. The minute I took it, it set into motion this phenomenon of craving -- one pill."
Vicodin combines morphine-like hydrocodone bitartate and acetaminophen, the generic name for Tylenol. It and its pharmacological cousins are among America's most prescribed painkillers: opiates such as morphine, codeine, methadone, Demerol, dilaudid and talwin. These narcotics work by causing a euphoria, decreasing the perception of pain in the brain rather than at the site of the pain.
Mike's craving lead to almost 18 months of nightmarish pain pill acquisition and consumption. He wound up "doctor shopping," visiting two or three physicians to get prescriptions at four pharmacies to get his fix. He'd take an average of 70 Vicodins a week and pop four at a time.
Mike is one of the casualties of a potent new wave of pain management pharmaceuticals, which includes Vicodin, Vicoprufen, Oxycontin, Lortab, Lorcet, Percodan and Percocet. He's also an alumnus of the Social Treatment Professional Services (STEPS) program at the Anacapa behavioral health center in Port Hueneme, CA.
"Vicodin is creating a whole new family of addiction," said Milton Birnbaum, a physician specializing in addiction medicine at the 98-bed residential detox facility. Patients follow the 12-step program similar to Alcoholics Anonymous and Narcotics Anonymous and various behavior modification therapies.
The center treats a wide range of addictions. Vicodin addicts who enter therapy there may be affluent professionals and celebrities, while others are "regular Joes." They come from all over California, the nation and world.
"Doctors prescribe Vicodin like candy," Birnbaum contended, "and there are guys running around on [movie] sets giving it out from bags." Despite the center's high rate of recovery from Vicodin addiction, Birnbaum laments the 70 percent rate of recidivism.
"The number of people in recovery who go out and get hooked again [is] monstrous," he said. "Hydrocodone is insidious because the euphoria is dangerous for alcoholics and addicts, especially if a doctor gives a prescription for 50 [pills] the reaction is, 'Oooh, boy, this is nice.'"
So it's hardly surprising that Vicodin and other pain pills are in high demand on the black market. Many customers are high school students, some of whom steal their parents' stashes from the medicine cabinet or who sell their own prescriptions.
In fact, it's probably as easy to get addicted to Vicodin as it is to score the pills. The downside, said San Diego, CA drug therapist Frank Patti, is that "the detoxification process from Vicodin is second only to [that of] heroin. I mean the withdrawals are incredible."
"Young people are using [Vicodin]. Adults are using it. Rich people, poor people, celebrities and the girl next door are all getting hooked on a drug that is cheap and relatively easy to get," Patti said.
Mike, who knows all about alcohol addiction, described the high. "You ... get an electrified numb inside," he said, "but you can function."
At least it gives the illusion that you can function.
"In reality," he said, "You're really not functioning at a high level."
Even so, pill popping is no big deal for many people. There are no dirty needles, no unexplained trips to the bathroom every 10 minutes and no paraphernalia to stash.
"You can spot a heroin addict a mile away," Mike said. "Their voice croaks, their eyes droop, they scratch themselves." But you can hide it with Vicodin. Pharmaceutical companies, Mike continued, "have taken out the dopiness, and you're inside your high. Outside, it's more subtle. People would say, 'What's wrong,' but never, 'You're whacked.'"
He said that when he first came on to Vicodin, he faced the same daily stresses and problems that most people face, but the difference between him and the majority of other people is his addictive personality.
"My emotionality attached to those problems," he said, "was off the scale. I'd say 'This is the end of the world, and you don't understand.' That's how it is with the drug addict."
And the insidiousness, Mike said, also lies in such drugs' social acceptance. Carrying pills in a little bottle with your name on the label is socially acceptable. Sporting a bag of marijuana, heroin or cocaine is not.
Mike recalled a drug case he once prosecuted. It's one thing if you wear a suit and tie, if you're professional looking and talk white man's talk, he said. "But if you're blaring Snoop Dogg on your boom box and wear braids in your hair, or you're driving a rattletrap wearing 28 tattoos and one says, 'Fuck You' and you ask, 'Why is everyone looking at me? Why are they busting me?'"
Exactly. Who would look twice at a registered nurse from San Diego making her rounds, the one who gauges the pain of her hospital patients while balancing her own addiction to Vicodin?
"If the patient only needs medicine twice in a shift, maybe I would sign it out for three times and take the extra one," "Cheryl" said. "At my worst, I was taking maybe 20 to 25 Vicodin Extra Strength a day."
Vicodin pills are sold in 5 milligrams, 7.5 milligrams (Vicodin ES) and 10 milligrams (Vicodin HP).
All drugs -- opiates, stimulants (including cocaine, crystal methamphetamine and Ritalin), depressants (including methaqualude, Valium and Xanax), hallucinogenics (including LSD, Ecstasy and PCP) and cannabis (marijuana) -- are classified by the Controlled Substance Act, which regulates the manufacture and distribution of drugs on a yearly basis, and places them into one of five schedules.
Vicodin's Schedule III rating means it's accepted for current medical use and carries "some potential for abuse." Some drug experts think it should be reclassified as a Schedule II drug accepted for medical use with a "high potential for abuse."
The Simi Oaks Counseling Group drug use and abuse fact sheet lists withdrawal symptoms for opiates like Vicodin. They range from loss of appetite and tremors to chills and sweating, panic, cramps and nausea.
Besides euphoria, the effects of overdose include drowsiness, slowed respiration, slow and shallow breathing, clammy skin, constricted pupils, coma and possibly death.
Despite the dangers of overprescribing, consensus in the medical community is that pain is undertreated. Additionally, the let's-liberalize-physicians'-authority-to-prescribe mentality combined with the doctors' "burden" of writing "triplicates," or prescriptions written in triplicate form, has escalated a trend among pharmaceutical companies -- the manipulation of drug molecules.
A triplicate requires a physician to send a carbon copy of a schedule II prescription to the state and to the pharmacist so everybody can keep tabs on who's taking what. The slightest alteration of the copy invalidates it.
But even though Vicodin addiction has been recognized as a problem over the past decade, it's easier for a busy doctor to write a prescription for 50 Vicodin than to order a panel of expensive, time-consuming tests.
Despite the vicious cycle of addiction that often begins in a doctor's office, pharmaceutical companies -- in their attempts to gain market shares -- are developing new, ever more potent combinations of drugs that can still remain on schedule III, Birnbaum explained.
Vicoprufen, an "improvement" on Vicodin, combines hydrocodone bitartate and Motrin to diminish the perception of pain in the brain and act as an anti-inflammatory at the site of pain. Birnbaum said he's starting to see Vicoprufen written on regular prescription pads rather than on triplicates.
In the past, Birnbaum said, white-collar professions have had a better shot at obtaining these opiates, but they're dribbling down to lower socioeconomic levels.
Drug addiction has been around for thousands of years, maybe since the first drop of opium poppy juice made contact with the human tongue and brain. The only thing that changes are the names of the drugs making the headlines.
Several indicators suggest that prescription drug abuse and addiction are currently on the rise, including those from the National Institute of Drug Abuse. According to information from 1999 on the institute's Web site, an estimated 4 million people -- almost 2 percent of the population aged 12 and older -- had in the past month used certain prescription drugs nonmedically (i.e., for self-medication and recreation use). This includes 2.6 million who used painkillers such as Vicodin.
The dosage won't affect users that much under normal conditions, said Ventura County, CA Sheriff's Captain Mark Ritchie. But he acknowledged that individuals are abusing their Vicodin prescriptions, which state on the label not to operate heavy machinery -- like cars.
"Just because their name is on the prescription bottle," he said, "does not give people the right to escape prosecution for driving under the influence of Vicodin. They're still subject to arrest."
Some addiction counselors believe that access to medical insurance and health care are significant factors in the rise in Vicodin addiction.
Most health professionals agree that narcotics such as Vicodin have their place in the medical repertory as legitimate palliatives for pain relief. But different patients have different reactions to the euphoric side of the drug.
Some people develop a physical drug dependency, but they don't get themselves into trouble trying to get the drug. If the physician won't refill a prescription for Vicodin, the patient goes through withdrawal, and that's it. But Birnbaum said that people with addictive personalities get into trouble when they seek a quick fix for unresolved issues, such as abuse and trauma.
Ernest Federer, executive director of clinical services for the STEPS program, said that people may add street drugs like ecstasy to Vicodin, or they'll have a J.D. chaser -- two shots of alcohol, Vicodin and pot.
"A lot of doctors," Federer said, "don't like to write for Vicodin because they don't want [to be responsible for] addiction. But many don't give a rat's ass."
In any case, he added, addiction to Vicodin is typically nondeliberate and gradual rather than generated by a score from Jack the Crackhead. People may have legitimate reasons for taking Vicodin, but many others "doctor shop" with a phony backache or headache, sometimes with something as innocuous as a stubbed toe.
Federer decries the system as a massive money-making scheme.
"You get a physical and psychological addiction," he said, "where you're thoroughly convinced nothing will work unless it's Vicodin." Self-discipline aside, he said, "your body's going to say, No, you want to take [Vicodin] or you're going to get sick."
Federer compared Vicodin addiction with those inherent in heroin. "A lot of people will get addicted to the feel of the needle penetrating the vein," he said, "some to the ritual of making up the rig [the shooting paraphernalia, including syringe, spoon and flame], some to the euphoria."
Heroin addicts and others with a strong addiction to opiates have fostered a black market in Vicodin, which can ease withdrawal symptoms.
It's relatively easy to get Vicodin for those who really want it. They can steal a prescription sheet from a physician's desk and copy it or tell the doctor they're going on vacation and ask for a month's supply, hoard patient medication, steal it from a shelf, bum it off a friend or relative or buy it off the streets or the Internet.
The going street rate for a 5-milligram pill of Vicodin is 25 cents. "Many people on fixed incomes will doctor shop, get a prescription for 30 and sell them for $5 a pill in a heartbeat," Federer said.
The reality is that although supplies may dry up, the addiction is permanent. "Sooner or later," Birnbaum quipped, "all addicts learn that 'sober' means 'son of a bitch; everything's real.'"
Many people begin with an innocent pain prescription that wakes up something latent in their lives. "They don't set out with the idea 'I'm going to be a drug addict'", Federer said. "It's something that gradually happens ... People learn to self-medicate as a defense mechanism. Until you develop new coping skills, a lot of people will relapse, because they'll resort to what they know: drugs, alcohol, sex, work."
"Addiction is a family process rather than an individual process," Federer said.
"A husband," he explained, "may say, 'Jody's been taking all that Vicodin, not me.' But it could be that [the husband's] a butthead and is never there when she needs [him] and [can't] see why she's taking all that Vicodin."
As long as such perceptions go unchallenged, Federer continued, they become reality in the family system. "People are like an onion," he said, "and every onion has a core. Over time, the onion builds layers around itself. So too, stressful life changes add layers to the person's core personality. The person loses parts of himself and learns to compromise for survival."
But the bottom line in addiction is that the person forfeits the core personality altogether.
"The greatest fear people have is losing control," Birnbaum said. "Addicts are the most sensitive to this fear. They are hooked on people, places and things, but they wind up losing control over everything."
Kelly, a former health care practitioner in Ventura, lived the hell of this fear. She's been in and out of support groups and hospitals throughout the vicious cycle of her addictions, including Vicodin, for most of her 48 years.
The complex factors that led to her Vicodin addiction were already taking root at age 12, when she was diagnosed with a chronic, life-threatening medical condition. Doctors introduced her to an endless array of drugs. By the time she reached her teens, she said, she made an easy jump from prescription to illegal drugs and going out and getting drunk with her girlfriends.
"My father," she said, "made me feel stupid and worthless and said I had shit for brains." She added that she never had any feelings of self-worth, so she used her body to attract men.
During her succession of brief sexual encounters, she began to realize that drugs were safer and more dependable than her partners.
When a doctor gave her a generous 100-pill prescription for Vicodin to ease her migraine headaches, she said she crossed over a line.
She explained that when people held her accountable for things, she'd pay a lot of lip service or run away.
"There was this big hole in my life," she said, laying a hand over her heart. "I lost friends, projects ... how old do you have to be? Life's hard, and if you have to piss away 47 years to learn things and some people learn them at 21, well..." she continued with a wistful smile.
Kelly claims to be more self-confident these days.
"I feel my whole life was a paradox," Kelly said, "because the things I tried so hard to control I lost -- money, health, relationships, a home."
She said that when she stopped caring what people thought about her, she realized that she had control of this person called Kelly. "I was in control," she asserted, "not my father, my ex-boyfriends or ex-bosses. That was a powerful motivation for me."
Federer, who sees thousands of patients, concludes that Americans want immediate gratification: "Why suffer when I can have it now?" His advice to those who come in for treatment is, "Get over the hurdle. Admit you have a problem. Focus on what has to be done."
"People detoxing are so compromised they don't have a clue," Federer said. "Their whole body, mind and organs are out of whack." Sometimes, he said, they get medication to help them through. Or others are told that they're going to have to feel a little pain. But the important thing is to get them and their family engaged in treatment.
The identified patient, or IP, may come in for treatment, but others are a contributing or main factor.
"If we have someone here 28 days and discharge them to a husband who's a dealer, the success rate is going to be [problematic]," Federer said.
For every addict, there are friends, co-workers and clients who must deal with the big holes in addictive behavior every day.
Are there any real solutions?
Federer thinks society needs to rethink the compromise of morals and values it's adopted. Additionally, he said, we have to hold physicians responsible to a point at which they recognize they can't monitor pain by putting their hands on a patient. They have to keep records to determine if prescriptions for Vicodin and other highly addictive drugs have therapeutic benefit.
Kelly said she thinks addiction to drugs like Vicodin is an insoluble problem.
"I think doctors make up their own personal guidelines to protect themselves," she said. "They either don't prescribe narcotics at all or only in limited amounts and will not refill prescriptions. It's like this power they have. But they're just as scared and confused as the patients, maybe more, because they have more to lose."
Mike is more pragmatic.
"The war on drugs has been lost. It's over, and we ought to sign the surrender papers," he said. "It's never going to stop. You can line people up and shoot them and it won't stop. Put people in jail and it won't stop."
It's time to legalize drugs, he said.
"Those not addicted to drugs are the majority, but we keep making all these stupid laws based on people like me who have a problem. It's completely unfair to have the vast majority of society regulated by the actions of people who have an addictive personality."
This article originally appeared in the Ventura County Reporter.