The following is an excerpt from Erin Marie Daley's new book, Generation Rx: A Story of Dope, Death, and America’s Opiate Crisis (Counterpoint Press, 2014), that was previously published on Salon. Reprinted here with permission.
George, a funeral home director in Brockton, Massachusetts, watched as the formaldehyde pulsed its way into the body lying before him on the porcelain embalming table. It was a task that was normally just part of a day’s work, but today George was overwhelmed by emotion. He slid down to the floor, sobbing, and gripped the hand of the body on the table, willing it to come back to life.
The hand belonged to his twenty-two-year-old son, Lance.
The night before, just after the Boston Red Sox lost to the New York Yankees, George had climbed the stairs to Lance’s bedroom in the home that also houses George’s funeral business. Lance was kneeling on the floor against a chair, with his head slumped forward onto his chest. It looked like he was praying. But he was stiff and unnaturally still. A needle lay by his feet. Heroin had stopped his heart.
It was a twisted ending for the son of a funeral director, but unfortunately, it was hardly surprising. As with many young adults in the working-class Boston suburb, Lance’s heroin addiction began when he became hooked on the powerful prescription painkiller OxyContin. An opioid medication originally developed to treat patients suffering from debilitating pain, the drug has become popular among local kids, who crush the pills and snort, smoke, or even inject them for a heroin-like high. When the pills become too expensive, kids increasingly turn to heroin itself.
George, for his part, had seen dozens of such cases come across his embalming table in recent years—the sons and daughters of good parents who thought that heroin was something only “junkies” did. And even though he was well aware of Lance’s years-long struggle with opiate addiction—at one especially exasperated moment telling his son that he was saving a casket for him—a junkie’s death wasn’t what he had in mind for Lance.
Despite years of addiction and lies and close calls, he never thought it would be his son.
I met George in the summer of 2010, after reading his story in a newspaper. I had traveled across the country from California with a story of my own: my youngest brother, Pat, was also addicted to OxyContin and had died of a heroin overdose in February 2009, six months shy of his twenty-first birthday. I was seeking answers as a sister and as a journalist. Shortly after Pat’s death, I had started researching prescription painkiller addiction and had started blogging about my findings. Privately, I also began researching my brother’s life, trying to piece together his downfall in an effort to understand where he went wrong.
Pat was my baby. I was ten years old when he was born, and he was the perfect addition to the pretend scenarios for which I had already bossily recruited my other younger brother and my younger sister. And as babies are, he was incontrovertibly lovable. Even as he grew older—even as he fell into painkiller and heroin addiction—he could charm anyone with his laugh and gaping grin. He told silly jokes and poured sugar on everything and did ollies on his skateboard and played the guitar while wearing my sister’s leopard-printed slippers. He was goofy and sweet and random and endearing. He was the kind of person you always wanted to be around.
Yet, as much as I loved my brother, I could not understand his obsession with OxyContin. Nor did I know that it had put him straight on the path to heroin. I learned of the extent of his struggle too late. Also too late, I learned about the disease of addiction and about the particular insidiousness of narcotic painkillers, all of which provide a heroin-like high when abused—not just OxyContin but Vicodin, Opana, Darvocet, fentanyl, Percocet, Dilaudid, Lortab, and Roxicodone, to name just a few. (Central nervous system depressants like Xanax, Ativan, Valium, and Klonopin are also often abused due to their tranquilizing properties.) I learned that Pat wasn’t a special case; that kids just like him, all over the country, were falling victim to these pills: in 2010 almost three thousand young adults age eighteen to twenty-five died of prescription drug overdoses —eight deaths per day. Like Pat, many ended up turning to heroin after their pills became too expensive or scarce; in 2011, 4.2 million Americans age twelve or older reported using heroin at least once in their lives, and nearly half of young IV heroin users reported that they abused prescription opioids first. Like these kids, my brother was the last person you’d picture with a needle in his arm; yet they were all dying as heroin addicts: between 2006 and 2010, heroin overdose deaths increased by a staggering 45 percent. I wanted to understand why this was happening, so I quit my job as a legal journalist and began traveling around the country in the hopes that chronicling the experiences of other families affected by the trend would offer some answers.
George was one of the first people I encountered. He told me the story about embalming his son as we sat in the receiving room of his funeral home, surrounded by the proverbial mementos of death: prayer cards, dried floral arrangements, a casket stuffed with billowy waves of satin. He choked up as he talked about Lance, and I choked up too, unable to maintain my reporter’s distance. It was my brother’s story all over again.
A familiar refrain: He was a good kid. We tried to save him. We loved him so much, but he loved the drugs more.
And: I never thought it would happen to our family.
Embedded in these sentiments was an element of denial, and it fascinated me. How did we allow ourselves to believe that it would never come to this? Like George, I knew rationally that my brother was on a terribly dangerous path: a fatal overdose was practically inevitable in the course of repeatedly ingesting highly potent synthetic opiates and, later, shooting heroin. My family and I did everything in our power—or thought we did—to help Pat. And yet, while I feared the worst on a conscious level, subconsciously I really didn’t think he would die. In the handful of Nar-Anon meetings I attended, I tried on the phrase like a too-small shoe: “My brother is a heroin addict.” But in my heart, I didn’t believe it. If someone had pressed me on the issue at the time, I probably would have said that Pat was going through a bad phase. I believed he would pull through.
I went on to meet many others like George. Always the same story: My son was kind, athletic, popular. My daughter was beautiful, intelligent, loving. How did they end up on this brutal path, and why weren’t we able to stop them?
I turned to the experts. There is nothing new about opiates, which—in one form or another—have wreaked havoc on societies for centuries. But in drug treatment centers across the nation, substance abuse counselors and medical officials described the latest wave of destruction, fueled by the rise in popularity of prescription painkillers. Their facilities are inundated with opiate addicts—mostly young heroin abusers whose addiction began with pills. Often, they relapse within weeks, if not days, of their release from rehab, because the drugs create such agonizing cravings that even if the body doesn’t physically need another hit, the mind does. I was repeatedly told that the long-term success rate for young opiate addicts is extremely dim. When I asked one inpatient program director about his facility’s statistics, he simply gestured to the dorm rooms surrounding him.
“Why do you think you don’t see any fifty-year-old opiate addicts here?” he said. “They all die.”
It was a harsh prognosis, but the statistics back up his claim: nearly forty Americans die per day—about fifteen thousand per year—from painkiller overdoses, representing a threefold increase over the past decade. This unprecedented rise in overdose deaths in the United States parallels a 300 percent increase since 1999 in the sale of opioid medications. And as painkiller abuse has skyrocketed, so has heroin addiction: in many areas of the nation, efforts to crack down on the abuse of prescription medications have had the unintended effect of driving opiate addicts to heroin for a cheaper, widely available high.
I found further evidence of the far-reaching scope of the pills-to-heroin epidemic in stories of the devastated families who had begun contacting me through my blog, wanting to share their stories of addiction and, all too often, death. They talked of the code of silence that surrounds addiction; the distaste of society toward addicts like their sons and daughters, who were written off as weak-minded, self-indulgent, and aimless because of their drug abuse. And although I have always considered myself a fairly compassionate person, I began to realize that I had been guilty of that mind-set as well, before addiction happened to someone I loved.
Ask the average person to describe a heroin addict, and they’re likely to use words like Dirty. Desperate. Diseased. Needle users. Crazy. Homeless. Scum. Junkies. They are not likely to describe their next-door neighbor’s son, their sister’s daughter, their student, their own child. But the stories of those who have been swept up in the current opiate addiction epidemic illustrate a different truth.
Take my own family: my siblings and I were raised in a suburban, middle-class town where the streets were named after trees and doors were left unlocked. We were neither rich nor poor. We rode our bikes to the ice cream store and played soccer in the grassy fields by the park. We had sleepovers with friends and built secret forts and begged our parents in vain for a dog every year for Christmas. We were typical American kids living in a typical American town. Growing up in the 1990s, we were educated in school on the dangers of illicit drugs like cocaine, methamphetamine, and even heroin. But we never learned anything about prescription drugs—they never registered on the radar as something dangerous. Medications like Ritalin and Adderall were being increasingly prescribed to children and teens, who developed an easy familiarity with pill bottles. Meanwhile, our parents’ medicine cabinets were filling up with all the medications being pushed by direct-to-consumer advertising on television—everything from antidepressants like Prozac to erectile dysfunction treatments like Viagra to sleep aids like Ambien—making prescription medications seem like an innocuous part of everyday life. Indeed, while Americans constitute only 4.6 percent of the world’s population, we consume 80 percent of the global opioid supply and 99 percent of the global hydrocodone supply.
Against this backdrop, our generation grew up to become the new face of opiate addiction. Today’s typical opiate addicts are likely to be young—under the age of thirty, a substantial proportion in their teens. They come from suburban and working-class homes. They are educated. They are involved in organized sports, student government, and extracurricular activities. Usually, they begin abusing prescription drugs in high school and are often addicted to heroin by the time they hit their twenties. Many times—as in Pat’s case—their families have no idea they are using opiates, or to what extent, until it’s too late. Many families, including ours, are shocked to learn that heroin is involved.
I sought out young addicts to hear their side of the story—what it was like to first become addicted to painkillers and then heroin. I asked them the questions I wish I could have asked my brother. They helped guide me to a profound revelation: by the time Pat died, he wasn’t even trying to get high anymore—he was just trying to feed his body’s craving. The perception that addicts are worthless, selfish junkies who don’t care about anything but getting loaded—and the notion that they are having fun doing it—is a common one. But it could not be farther from the truth. Not one addict I interviewed mentioned the word fun in connection with his or her addiction. By contrast, they knew they were hurting everyone around them, and they hated themselves for it. They lived a tortured existence that paired this horrible realization with a physical dependence on a drug that would send them into excruciating fits of withdrawal if they failed to get their next dose. Sadly, their loved ones sometimes berated them for their “choice” to do drugs—as I did on several occasions with Pat. But while individual choice is certainly an element of one’s drug abuse, it does not account for the complexity of the disease of addiction.
Addiction is literally a disease of the brain. The National Institute on Drug Abuse defines addiction as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” While the initial decision to use drugs may be voluntary, over time, drug abuse causes structural and functional changes to the brain that are critical to judgment, decision making, learning and memory, and behavior control. These changes can lead to the compulsive and destructive behaviors exhibited by those with the disease of addiction (which is not the same group as all those who try drugs). As David Sheff puts it in his book Clean, “People aren’t choosing to use. Using is a symptom of their disease.” Thus it is reprehensible that we, as a society, view addiction as a moral failing that deserves punishment rather than as a chronic, progressive illness of the brain that requires treatment.
I can say this now, but I so wish I’d understood this when my brother was still alive. I never had the chance to show Pat compassion, because I was too scared, ashamed, and uneducated about the reality of his addiction. Too often, I reacted to his addiction with anger, and while it was an anger that stemmed from love, it was unhelpful, and likely hurtful. I wrote this book in an effort to help others who are like Pat. In sharing my journey to understand Pat’s addiction, and in sharing some of the stories of those I met along the way, I hope more people will be willing to face the truth about opiate addiction—especially if it is happening to someone they love. I do not know if Pat would have wanted to have his life immortalized in this way, but I hope he would understand that in this case, silence equals death. To find meaningful solutions to a problem, the problem must first be recognized. Speaking the truth about what happened to Pat, and what is happening to so many others, is the first step.
My brother died alone in a bedroom, slumped over a needle, steeped in secrets I wish I had known. I cannot go back in time and fix my failings, but I can try to give him a legacy. In Pat’s short life, he showed great compassion toward those who were viewed as different, and he—like all addicts—deserves the same.