The New Gateway Drugs

Prescription Pills are fueling a new wave of unlikely addicts, as simple pain relief leads to the clutches of heroin

PHOTOS BY JODI MILLER // ILLUSTRATION BY MICHAELA SCHUETT

The women who knocked on suburban doors and asked to use the phone and then the bathroom were the first sign that something wasn’t right.

“It was about 15 years ago,” says Delaware County Sheriff Russ Martin, then an officer with the Delaware City Police Department. “They would pose as a disabled motorist and then they’d go right to the medicine cabinet.”

For Ohio State Board of Pharmacy agent Jesse Wimberly, the next sign that something wasn’t right was the growing number of people getting prescriptions written in Florida, then coming up to Ohio to fill them.

“We observed an increase back in 2009,” says Wimberly, who investigates prescription-drug compliance issues with doctors, pharmacies and patients in the Dayton and western Ohio area. “There’s an awful lot of pharmacies between here and Florida. We had to ask ourselves why were they coming here?”

The answer was simple: painkilling drugs.

Synthetic opiates (also known as opioides) like Vicodin, OxyContin and Percocet are prescribed legally for pain relief following surgery or an injury. But the potent little
pills can sink their claws into suburban housewives, construction workers and high-school football players and, once hooked, these newly minted addicts will steal other people’s pills when their own prescriptions run out, or they will steal money in order to afford the $80-plus tab for each tablet.

“It wasn’t what I would categorize as your typical offender,” says Martin of the women caught rifling through strangers’ medicine cabinets.

Then, as Wimberly and his colleagues soon discovered, “pill mill” operations began popping up in Ohio to generate and fill prescriptions for opiates. Addicts would flock to doctors and pharmacists willing to keep them supplied, no questions asked.

And it was getting worse.

For Wayne Campbell and his wife, Christy, the full impact that something wasn’t right hit after the first round of rehabilitation didn’t work for their oldest son, Tyler. The Pickerington native had earned a scholarship after walking on to the University of Akron football team his freshman year.

“We think it started during his sophomore year when injuries just started piling up,” Wayne Campbell says. “For pain relief after games and during the week, he was prescribed painkillers.”

That was in the autumn of 2008. By December of the next year, Tyler told his parents he had a problem.

“We found out in December 2009 and whipped him right into rehab for four weeks,” Campbell says. “He went back to school in January, then left again in March. That’s when we realized, ‘Holy crap, we’ve got a problem here.’ ”

Tyler’s problem had progressed from prescribed, synthetic opiates to a natural opiate—heroin. On July 22, 2011, Tyler died from an overdose of heroin he had obtained less than 24 hours after returning home from his third stint in rehab.

GETTING HOOKED

Prescription painkillers and heroin both are classified as opiates and work in the same way: Once in the body, they attach to proteins called opioid receptors, which block the transmission of pain messages to the brain and produce feelings of euphoria or detachment from reality. Physically, they slow breathing and heart rate.

Opiate addiction can happen in as quickly as one week, says Campbell, and there often has been no other high-risk behavior, like alcohol or marijuana use, to herald the likelihood of addiction.

“Looking back, you try to find signs,” Campbell says. “If there was, it’s that he always gave 120 percent to everything he did. I don’t know if that’s an addictive trait, but he was relentless if he wanted something.”

Health and law-enforcement professionals in Central Ohio say illicit opiate use and addictions are at an all-time high right now.

“Sixty-plus percent of our clients in Delaware County are coming to us because of opiates now,” says Steve Hedge, executive director of the Delaware-Morrow Mental Health and Recovery Services Board. Within the last two years, Hedge adds, “we saw a dramatic increase in the heroin usage. We’re seeing professional people coming in that you wouldn’t expect to see.”

Hedge describes the changing face of the heroin addict: “Back in the ’70s, it was the Skid Row bum with needle marks. That’s not the case anymore. It is white collar, it is middle class, it is professional folks and they’re addicted through no fault of their own.”

Paul Coleman is the president and CEO of Maryhaven, a provider of behavioral healthcare and addiction treatment in Central Ohio since 1953.

“In 2002, 38 percent of Maryhaven patients came here because of opiates,” Coleman says. “In 2011, it was 75 percent.”

According to the state health department, 1,544 Ohioans died of unintentional drug-related overdoses in 2010. Prescription drugs were factors in nearly half of those deaths, while heroin overdoses accounted for 22 percent.

Cost and accessibility often drive addicts from medicine cabinets and pills that cost $80 each when obtained illegally to shopping-mall parking lots where a deflated balloon filled with one to two doses of heroin can cost less than $10.

“Heroin is now replacing these opioids,” says Jennifer Biddinger, who directs drug-prevention campaigns throughout the state for the Ohio attorney general’s office.

“Either one can kill you,” Biddinger says. “Heroin just does it faster.”

The ring of blacktopped parking spaces that surrounds Polaris Fashion Place in southern Delaware County is a hot spot for dealers, says Martin, thanks to the easy flow of traffic and the proximity to Interstate 71.

But, added Stephanie Bell, a coordinator for the Drug-Free Delaware agency, increased attention from law enforcement is driving the transactions into surrounding neighborhoods. Delaware County also holds the dubious honor of having the cheapest heroin in the area.

“Heroin costs $6 to $7 a balloon in Delaware County,” Bell says, “but then it’s $20 two counties up and $30 a few more counties up.”

COMING DOWN

Many of the law-enforcement personnel and addiction-treatment professionals fighting the opiate problem have been around long enough to remember the 1990s, when use of cocaine and crack was at its peak. This battle scares them more, they say, often because the addicts’ personal battles scare them more.

“It’s not a high,” says Hedge. “It’s not about the buzz. It’s to keep from feeling the pain. It’s physiological addiction.”

Sarah Mayer, 28, just passed the three-year mark in her recovery from OxyContin and heroin addiction. The Hilliard resident says her four-year ordeal “wasn’t partying by any means,” though she got sucked into the vortex when she was experimenting with drugs introduced by an ex-boyfriend.

Though Mayer began using OxyContin, then heroin, for the euphoric high each produced, the addiction quickly became more about avoiding being “not high,”
she says.

“It was like the worst flu times 10 on top of the worst panic attack times 10,” Mayer recalls of the crashes that followed highs. “It was like drowning where your brain is screaming for oxygen.”

Campbell remembers the only helpful glimpse he got inside his son’s addiction came about a month before Tyler’s death.

“You think they’re all about trying to have fun, getting high, but no, they need [opiates] to avoid withdrawal,” Campbell says. “Tyler told me, ‘If the pain level is zero to 10, my day starts at a minus-five. A non-addict starts their day at zero and I need to do something just to get to zero.’ ”

Recovery is possible, but it’s highly dependent on someone seeking help as quickly as possible, say Hedge and Coleman.

“There’s a better success rate if they haven’t been addicted long,” Hedge says. “Overall, there is a less than 50 percent success rate.”

Coleman frames recovery a little more hopefully. For a patient who complies with all the demands of treatment—medication that brings him through withdrawal, counseling, attendance at self-help groups—“the rate of recovery can be as high as 75 to 90 percent,” he says. “On the other hand, if a person goes through detox, then into outpatient treatment but then says, ‘I’ll go it from here on my own,’ then their chances drop to less than 10 percent.”

It took six rehab stints at Maryhaven over two years before sobriety took hold for Mayer on Oct. 31, 2009. But the hard work isn’t over and probably never will be, she says.

“I attend 12-step program meetings three to five times a week,” Mayer says. “I don’t have cravings anymore, but I’m honest about what I feel and I’ve found other ways to deal with stress.”

Coleman also draws hope from a mini-trend his staff has seen emerge in 2012: “The length of time between the first use of prescription pain pills and [the first use of] heroin is decreasing.”

In a strange way, Coleman says, “this is a good thing. People are saying it’s because it’s become harder to get the prescription opiates.”

Wimberly, who works for the state pharmacy board, confirmed that it has become harder to obtain pain pills. Since Gov. John Kasich signed House Bill 93—the “pill mill” bill—into law in May 2011, he and his colleagues have had the authority to go after and shut down the illegal pain-management clinics that had popped up throughout the state. Every known pill mill in Scioto County, which is widely regarded by health and law enforcement agencies as the origin of the epidemic, has gone out of operation, Wimberly says.

Now, in addition to keeping a tight rein on doctors and pharmacists, he adds, the Board of Pharmacy is working hard to identify patients who “doctor-shop” in order to keep themselves supplied.

“I’m comfortable to say we’re all working together now: the attorney general’s office, the governor’s office, the Drug Enforcement Administration, the state medical board, the local law-enforcement agencies, even the IRS because financial offenses are often involved,” Wimberly says.

That’s the supply side. Shutting down demand is where Biddinger gets involved, producing videos and literature to take into schools where she warns kids and parents about the dangers found in their medicine cabinets.

“We’re a culture of ‘take a pill to feel better’… but you don’t need 40 Vicodin for a wisdom-tooth removal,” Biddinger says. “I’m focusing on the ‘don’t even do it’ message.”

So is Campbell. In the aftermath of his son’s death, he’s found a calling to try and stop addiction before it can start. Along with friends, neighbors and other family members, he started the Tyler’s Light organization. It began with 300 black silicone wristbands printed with the phrase “Just Say No for TC” that they distributed at Tyler’s funeral.

But 300 wristbands weren’t enough when 1,500 people showed up, so they made another 1,000. “Then another thousand,” Campbell says, “then 5,000, and now we’re buying them in lots of 10,000.”

They’ve changed the design of the wristband to incorporate Tyler’s favorite color, turquoise, and the color yellow to represent light. Campbell now speaks to groups throughout the state about opiate addiction. When the Tyler’s Light group organized a 5K run/walk this spring to raise money and awareness, nearly 2,000 people showed up.

“That’s hope,” Biddinger says. “When you have that many people marching through a community, that’s a day of hope. They’re saying, ‘We won’t tolerate having this here anymore. We’re taking our community back.’ ” n

Jane Hawes is the editor of Columbus Parent magazine.