Prescriptions for painkillers brought about the explosion in heroin use in America's suburbs
Weber County Sheriff's Department (left); Courtesy of Andi Peterson (right); Photo Illustration by Skye Gould / Business Insider
"I didn't think what I was doing was that wrong. It felt more like a have-fun-once-in-a-while thing. It was not going to lead to this crazy addiction," she told Business Insider.
The first time Peterson tried Percocet she was 16. The last time she used any substance was when she was 23, she said. She was finally free from the addiction that had spiraled from painkillers to heroin and cost her custody of her son, tens of thousands of dollars, and a year in prison.
Peterson is the face of what America's drug epidemic looks like today. She is young, white, and middle-class, and she lives not in a city but in a suburb. She has been part of an epidemic ripping through towns and cities that's left a trail of broken families and struggling addicts in recovery - and many others not as lucky as Peterson.
The US Centers for Disease Control and Prevention has estimated that the crisis costs the US $78.5 billion a year and strains state and local governments and the healthcare system. In December, the CDC also reported that 52,404 people died from drug overdoses in 2015. Those overdoses have fallen hard on places like Weber County, Utah, where Peterson grew up. Weber County's drug-overdose death rate is more than five times what it was a decade ago, and far above the national average.
Depending on the dosage, all medicine is poison
Weber County was built on a foundation of working-class jobs - in railroad and steel - which supported the middle-class for decades. But by the 1990s, those industries had disappeared after the shift to aviation and automation. That sent the county into a downturn. A similar story played out across the country. In Ohio and Pennsylvania, it was manufacturing and the steel industry. In West Virginia, it was coal mining.
At the same time that these industries were collapsing, pharmaceutical reps and medical professionals began pushing opioid painkillers as an effective and low-risk treatment for pain, based on a now debunked study that suggested fewer than 1% of opioid users become addicted.
Medical groups began telling doctors that treating pain was as essential as checking patients' blood pressure. It was a new paradigm in medicine. Purdue Pharma introduced and aggressively marketed two powerful new painkillers, MS Contin (morphine) and OxyContin (oxycodone), to fill the void.
With the explosion in prescriptions, opioids went mainstream. Clinics known as "pill mills," whose purpose was to prescribe legal opioids, sprang up nationwide. By 2011, Americans received 219 million opioid prescriptions each year.
While many prescriptions went to patients in need of pain relief, many more went to those suffering less serious ailments. In the 1990s and early 2000s, doctors prescribed opioids "for everything," Dr. Houman Danesh, the director of Integrative Pain Management at Mount Sinai Hospital, told Business Insider last year. Many primary-care doctors, who prescribe the vast majority of opioids, didn't fully understand the risks of the drugs.
Most prescriptions went to middle-class, white suburbanites who were far more likely to be prescribed opioids (thanks to significant racial disparities in pain prescribing) and far more likely to have health insurance. States with physically demanding blue-collar jobs - Ohio, West Virginia, Utah, among others - received even more prescriptions thanks to the prevalence of work-related injuries. In Utah, a third of adults were prescribed pain medication in 2014.
A slippery slope
AP Photo/Rick Bowmer
Peterson was 16 when a friend of hers was prescribed Lortab, another powerful painkiller, for back pain. The friend offered a Lortab pill to her and Peterson gave it a try, despite having never so much as drunk a beer before. She was a shy kid who suffered social anxiety, and the pills took that away. Painkillers don't just numb physical pain; they numb emotional distress as well.
"I remember feeling really good and comfortable in my own skin for once. I felt like I could talk to people," Peterson said.
Two years later she had an emergency C-section while giving birth to her son, Caden, who was born prematurely. To deal with the pain, doctors prescribed her Percocet. Peterson's son's life was in danger, and she traveled every day to the hospital to visit him. And she found that the painkillers eased her stress.
A few months later, while Peterson was working at Walmart, a new boyfriend showed up with Percocet. They finished a bottle's worth in a matter of days. After they used Percocet for a week, Peterson's boyfriend suggested they try heroin. It didn't scare her. It just seemed like a cheaper option.
"It didn't seem like a big deal to me then," she said. "I was naive. I didn't know all the consequences that it would lead to. It just made me feel good. Normal."
Angela Stander, a coordinator at the Utah Department of Health, had heard a lot of stories like Peterson's when she worked at a youth treatment center in Salt Lake City. Again and again, white middle-class teens would come into Stander's treatment center hooked on prescription painkillers. Some had tried painkillers for the first time after being prescribed the drugs; others stole them from their parents or got them at parties.
Greater than 50% of Americans who misused painkillers in 2015 obtained them from a friend or relative who got them from a doctor. Often, Stander would see a patient leave, only to return months later addicted to heroin. Middle-class people "don't perceive themselves as addicts. Then they start to use more and more and they overdose," Stander told Business Insider.
More readily available, inexpensive, and potent
The pills-to-heroin pipeline is largely responsible for the explosion in heroin use in America's suburbs.
Dr. Ted Cicero, a professor of psychiatry at Washington University in St. Louis, conducted an extensive study on opioid users' habits in 2015. He found they overwhelmingly follow a "natural progression" from prescription pills to heroin as the price for pills becomes prohibitive.
When people like Peterson are ready to make the jump, heroin is not only more readily available and cheaper but also more potent than ever.
Skye Gould/Business Insider
As journalist Sam Quinones wrote in "Dreamland: The True Tale of America's Opiate Epidemic," as the pill crisis deepened, heroin dealers (primarily from Xalisco County, Mexico) moved in to supply a new population of users in places not traditionally known for criminal activity or drug dealing.
Suburbs hit hard by the crisis, like Weber County, were full of painkiller users primed for the switch to heroin. The Xalisco dealers, and others like them, catered their businesses to these users. The dealers offered hassle-free delivery to popular suburban locations, like McDonald's or a CVS parking lot.
Well paid by higher-ups, the dealers didn't rip off addicts with weak heroin or steal from them. Instead, they treated them as important customers, offering discounts on holidays and freebies when they were short on cash.
"Guys from Xalisco had figured out that what white people - especially middle-class white kids - want most is service, convenience," Quinones wrote.
Further, the Xalisco dealers, and the cartel-associated dealers that came after, avoided selling in black neighborhoods and to African-Americans because so many Mexicans told tales of gang violence in places like Los Angeles, according to Quinones.
Erin Marie Daly, a journalist who interviewed dozens of users for a book investigating the causes and effects of the crisis, found that young users were most often introduced to heroin by their pill dealers, who suggested heroin as a cheaper, more powerful substitute.
"A lot of them were using with friends," Daly told Business Insider last year. "The minute one friend said, 'Hey, my dealer hooked me up with this awesome, super cheap stuff - try it,' the kids would try it.
"Once they tried heroin, there was no going back. Even if they wanted to stop, they were physically unable."
'It was like breathing'
AP Photo/John Minchillo, File
After six months, Peterson's step-dad, a highway patrolman, knew something was up. Peterson was fidgety and sweating at the time from smoking heroin. He sat her down and without much prodding she fessed up. She told her parents that she was ashamed and wanted to get clean.
Her dad, Cory, was in shock but tried to be positive. He took her to the family doctor, who prescribed drugs to ease her withdrawal and told them to get Peterson into a program.
"Everything sounded really good in the doctor's office. We walked outside of the office, and I had a lot of hope that we had caught it just in time," Cory told Business Insider.
Then reality hit. Peterson went through detox and a month-long outpatient treatment program at the Alcohol and Chemical Treatment Center, the biggest in Weber County. It went well at first, she thought. But on the last day her tax refund arrived. She cashed the check and drove to her boyfriend's house. The urge was too strong. Within a week she learned how to inject heroin.
Opioids fundamentally rewire the brain and radically change thought patterns. Imagine a chorus shouting in your head "I need to use heroin" endlessly until the moment you gave in. That's what addiction feels like to the heaviest heroin and painkiller users, many say.
Once a person becomes hooked, it becomes difficult and expensive to get them back to anything like a stable life. Even for those like Peterson, with supportive parents and good health insurance, it can take years to get clean, if ever. Justin Hatch, the program director at ACT, told Business Insider that patients frequently take up to seven stays in treatment to reach "full recovery." Peterson would go to treatment more than five times over the next two years.
Getting high "required no thought," Peterson said. "It was like breathing."
The destruction that opioids have wrought on suburbia is directly linked to how difficult the addiction is to cure on an individual level. There is no standardized treatment for opioid-use disorder, and many treatment centers are built around treating alcoholism, essentially a different brain disorder.
Medication-assisted treatment, which uses prescription medication to reduce cravings and is considered to be the gold standard, has gained advocates in statehouses and Capitol Hill, but is expensive and not yet widely available.
Hard-hit counties have started to take matters into their own hands. Weber Human Services, the substance-use service authority in Weber and Morgan counties, has worked to make MAT more available and accessible, both through public funds and outreach to doctors and treatment centers. But its use is still more the exception than the rule.
It's why, even with attention growing for years, and hundreds of millions in public funds allocated to combat the problem, through major acts of Congress - the Comprehensive Addiction and Recovery Act and the 21st Century Cures Act in 2016 - and state and local actions, the end to the crisis is not in sight.
'One more overdose, I was done'
Robert Done has been a police officer in Pleasant View, a suburb in the shadow of the Wasatch Mountains, for more than a decade. As a night patrolman for years, Done saw the epidemic at its worst. He picked up teenagers "high as kites" in their cars, broke up parties where pills or heroin was on the tables, and got called in when kids overdosed, a common occurrence a few years back.
Weber County, where the town is located, has the third-highest drug-overdose death rate in Utah at 30.8 deaths per 100,000 in 2015.
One night, Done had to respond to four overdoses, one after another. They all died. "I almost told my chief that if I got one more overdose, I was done. It's not a pretty sight," Done told Business Insider.
There's no shortage of middle-class suburban counties that have been ripped apart by overdose deaths. Norfolk County, Massachusetts; Scioto County, Ohio; Armstrong County, Pennsylvania. The list of places with spiking overdoses goes on.
There have been efforts to greatly expand access to naloxone, a life-saving drug that reverses overdoses. Advocacy organizations and nonprofits like the Clinton Foundation have given out tons of naloxone kits to those at risk, and the CARA Act includes measures to make it more available to the public, police, and first responders.
In Utah, a group called Utah Naloxone has handed out thousands of free kits for years. And the Utah state government announced in December that pharmacists could dispense naloxone without prescriptions.
There was no naloxone on one of the most harrowing days of Peterson's life. Not long after leaving her first stint in treatment, Peterson and her boyfriend rented out a townhouse using money that he received from a $100,000 life-insurance policy after his father died.
After word got around, the townhouse became the spot for young addicts in Pleasant View. Peterson and her boyfriend burned through the rest of the money while dealers turned friends sold dope in the living room and kids shot up in the rooms upstairs. The house was littered with baggies, drugs, needles, and spoons.
One night, a kid Peterson barely knew overdosed in the bedroom. Everyone in the house scattered, leaving Peterson alone with him, a needle stuck in the kid's arm.
Done pulled Peterson aside at the scene and told her that she was going to be next if she continued using. He'd met her dozens of times before, on patrol, and had taken to trying to help her escape her addiction. He told her that if she entered treatment they wouldn't charge her for anything, so she did.
But that wasn't enough of a wake-up call. She failed out of treatment, again. It was another two years of treatment and relapse, arrests and jail time, drug court and parole, and finally a year in the Utah State Prison before she broke free. She has been clean since, she said, and she has begun the long process of putting her life back together.
Andi Peterson is one of the lucky ones. Far more of the victims of the crisis end up stuck in the relapse cycle or, like the young boy in the townhouse, overdosed and alone.
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