Prescribed

Beginnings

In Junky, his novel about his time in Tangiers as a heroin addict, William S. Burroughs said when he was high he could stare at his shoe all day. Out the window of the hospital room I could see only the roof of the next building over, where occasionally a great gout of steam rose slowly into the air. In the mornings, after the nurse gave me my shot of dilaudid and the great warm rush of relief ran through me, I would watch the steam billowing from the roof vents for hours. The morning sun turned it to fire, and in the evening, with the shadows creeping across the hospital roof, the steam seemed like spirits escaping. This was November, and cold. Rain all day, the weather as intricate and sad as a sonnet. When the steam wasn’t escaping, I stared at my foot. I didn’t have a shoe. 

Addiction

After a Dallas man grew addicted to Oxycontin, he smashed his hand with a hammer to get more. A Columbus woman crashed her car into a dumpster when she became desperate for Vicodin. Chris from Atlanta broke his own arm, and a man from Maine crushed himself under a car. 

The hammer to the hand and the woman crashing her car into a wall are highlighted in the White House’s 2018 anti-opioid campaign. In the hammer advertisement, a thirty-second spot aimed at eighteen- to twenty-four-year-olds that aired on social media, Kyle from Dallas says, “I didn’t know how far I’d go to get more,” and then brings the hammer down. In the second ad, an actor playing Amy from Columbus says the same thing before driving her car into a wall. Right before Joe from Maine crawls under his car and releases the jack he says, “First I took them to feel better. Then I just kept taking them.” 

Beginnings

On the way home from the hospital I watched the clouds out the window. I was beginning to come down from the drugs, and I couldn’t shake the feeling of sadness. It was raining, and I attributed the sadness of the day to the weather, until we reached the pharmacy and the pharmacist handed over the pills and then the sun came out. I swear to you it did. I think. 

Evidence

Chasing Heroin, a 2016 Frontline documentary, claims that Purdue Pharma, manufacturer of Oxycontin, knew that their product was highly addictive. They flew doctors to private parties in which Purdue officials pushed for their drug to be prescribed. They did not want it to be a niche drug, for terminal cancer patients only—they wanted it mainstream. They wanted everyone to take it, for small headaches and movement-ending car crashes. They wanted it in every medicine cabinet in the country, on every nightstand beside the glass of water and good book. They knew the dangers of addiction and overdose, but they put it out anyway, which shows me they knew people will do anything to stop the pain.

Beginnings

When the doctor came to release me, I lied and said I was still in pain. He said if I was in too much pain they wouldn’t be able to release me, but I knew about the pain scale by then. 

“Four,” I said, and he got out his prescription pad. 

Causes

Kyle from Dallas became addicted after he experimented with Oxycontin at a few parties. Amy got addicted to Vicodin after knee surgery. Chris from Atlanta, who broke his arm by slamming it in a door, found Vicodin lying around his mother’s house. 

This is the prevailing narrative of prescription addiction: pain. He started taking Oxy after he was injured. She hurt herself and had to have something to relieve the pain. He couldn’t get out of bed or walk across the room without his bones grinding together and so settled for the uncertainty of addiction rather than the agony of his injury.

According to a 2007 study published in the American Journal of Psychiatry, 78% of patients entering treatment centers for opioid abuse reported receiving prior treatment for substance abuse. Almost all of them had found ways to get opioids without a prescription, and almost all of them had used drugs other than opioids. The causes of addiction are widespread and not well-understood, even among leading researchers, but those same researchers believe addicts are often in some kind of physical, mental, or emotional distress, which means they are looking for some way to kill the pain. 

Beginnings

The prescription was for forty Vicodin. Each evening I counted them. Each morning when I took one I lamented the loss. Toward the end, after I had tried to get my prescription refilled and the doctor said no, I started cutting them in half. Then quarters, trying to make them last. 

Recovery

The Ridgefield Recovery Village website shows a man passed out with a bottle of Oxycontin in his outstretched arm. The American Addiction Centers website shows a washed-out woman thrusting a bottle of pills toward the camera, as if opioid addicts just give their pills away. MentalHelp.net shows a lot of people with their heads in their hands. 

Bayside Marin bills itself as a luxury rehabilitation center. Its website uses the word “serene” often. The Wilmington, North Carolina, Treatment Center’s website uses an insignia of a sailboat. Beacon House shows a picture of a bridge. Sober Living By the Sea shows pictures of serene beaches on its website, along with the claim that it is situated in a “vibrant recovery community that features the most Alcoholics Anonymous 12-Step meetings (1300+) of any region in the world, including Los Angeles and New York.” 

In the first quarter of 2018, the Substance Abuse and Mental Health Services Administration’s hotline received an average of sixty-eight thousand calls per month. There are more than fourteen thousand drug treatment facilities in the United States. Each website I went to asked me if I was there to make a referral, help a loved one, or get help for myself. A little screen kept popping up with those three choices. When I closed it, it came up again seconds later.

Pharmacopeia

My brother takes anti-depression pills. My best friend takes Oxycontin for arthritis. My uncles both drank, and my grandfather did too, until my grandmother made him quit. She could never get him to quit smoking until near the end, when his health was declining and the first strokes had begun, but I always thought he would have rather smoked, even if it meant fewer days with those he loved. 

In 2017 more than 17% of Americans had at least one opioid prescription filled, with an average of 3.4 prescriptions dispensed per patient. In 16% of US counties, enough opioids were prescribed for every person to have one. In Arkansas, my home state, 114 prescriptions were given for every hundred persons, which means a lot of people were in pain. 

I think of how the heart also hurts, not when it shuts down, but when it takes on too much.

Half of the population of the United States over the age of twelve have drunk alcohol in the last month. According to a study by the Journal of American Medicine, from 2001 to 2013, alcohol use in the United States rose from 65% to 73%. High-risk drinking rose from 10-13%, and alcohol use disorder rose from 9-13%. In other words, more people drank alcohol, and people drank more alcohol. 

Over twenty million people used marijuana in the last month, a number that is no doubt still climbing as more and more states legalize it. I’d say those states know now that pot is not as dangerous as once described, or maybe they’ve finally figured out that people need something to self-medicate, or maybe empathy doesn’t matter as long as legalization moves the economy, that all-important measure of what’s supposed to be our happiness. 

 In a 2017 New York Times article titled “Prozac Nation Is Now The United States of Xanax,” Sarah Fader, anxiety sufferer, said, “If you’re a human being living in 2017 and you’re not anxious, there’s something wrong with you.” With forty-six million prescriptions in 2010, Xanax is now the most prescribed mental health drug, taking over the title from Prozac in the 1990s. Thirty-eight percent of girls age thirteen to seventeen have an anxiety disorder, as do 26% of boys.

I think we all do. Of the top ten most prescribed drugs in the United States, half are for treating high blood pressure, some of the causes of which are stress, tobacco use, alcohol use, hyperthyroidism, and diabetes. Another of the most prescribed drugs is for type 2 diabetes, and another is for hyperthyroidism, contributing members of the high blood pressure group. 

The top drug is for pain. 

Numbers

A student of mine once did a presentation on Adderall use at the university where I taught. He surveyed seventy-five of his peers, seventy-four of whom said they had, or knew someone who had, used Adderall in the last month. Around two-thirds said it was without a prescription. Around half said they had crushed and snorted it, which means it hit them directly, instead of the time-release of the pill. 

It was a good presentation, but the student got a lower grade than he expected. When he asked about it, I told him he had left out the most important part, which was why. 

Pain

The Pain Scale allows patients to rate their pain from zero to ten, zero being no pain at all, and ten being the worst pain imaginable. Fire, I think. Burning. Bones crushed and skin bruised, the body hemorrhaging inside. 

I also think: loss. I think of how the heart also hurts, not when it shuts down, but when it takes on too much. It can be gripped by memory and torn by grief. It can bleed on the inside, not from any recognizable injury but from the damage we’ve done to ourselves by all the uncertainties we carry around. 

I realize I am equating different kinds of pain, that the body being borne into the terrible abyss of agony is not the same as lamenting the loss of a grandmother, not the emptiness of a house after a loved one has gone, not the same as the fear that we mean nothing in the greater universe. 

I am saying that some people treat both kinds of pain the same way. 

Solace

My mother smoked. On the front porch after work. Standing at the kitchen sink looking out the window. In the car on the way to school, my brother and me in the backseat, smoke curled around us like love. Sometimes we coughed and sometimes we waved away the smoke but always it came back. My mother was barely thirty, already divorced, and it took me a long time to understand that she wanted a moment of comfort. She needed something to calm her nerves, that allowed her to feel, for just a moment, she wasn’t alone.

Narrative

The White House anti-opioid ads end with a factoid: Opioid addiction can occur in as little as five days, which some opponents of the ads say is misleading at best. The ads smack of Nancy Reagan’s “Just Say No” campaign of the 80s, with a little bit of egg-frying “This Is Your Brain on Drugs” thrown in. As if saying No were an option to those seeking relief. As if it matters to those in pain what happens to their head. As if we’ve learned nothing from a lifetime of looking back.

Pain

My friend Jeff and I used to drink together. I was in grad school and he worked at the library and late at night we’d cruise the bars near the university until they closed at two. Many times after the bars closed we would invite everyone still there back to Jeff’s house, and some nights, if the stars aligned and Jeff’s dealer was holding, a bunch of strangers would gather in Jeff’s back room to snort coke. Once it was Adderall chopped up and another time it was Oxycontin. Still another time it was crystal meth, and Jeff stayed awake for three days. He came from a poor family. He had a father who was mentally ill, and a mother who used to burn him with wire hangers she heated up over a gas burner. Jeff was a PhD student writing a dissertation on trauma studies, but I swear to you he never noticed the trauma he did to himself.

Causes

In 2010, Purdue Pharma, makers of Oxycontin, released an “abuse deterrent” formula. The new pills resist crushing and turn into a gel-like substance when added to water, making it harder to snort or inject. Research suggests that the abuse-deterrent pill, coupled with stricter regulation and prescription laws, caused many Oxycontin users to switch to heroin.

Want

There’s an old party game that asks what three things you’d want if you were stranded on a deserted island. Invariably the answers are something for survival, something for comfort, and some way to get home. No one ever asks if that’s all the same thing, or if the deserted island is our insides, surrounded by our own skin. No one ever asks why so many people feel like they already live on an island, and no one ever notices we’re all small and scared and searching for some way home.

Insulation

Another friend smokes weed. All day, every day. At night he rides his bike through the dark streets of the city after smoking. I ask him how he isn’t afraid. He says it insulates him from fear.

Pain

Julie also smoked weed to insulate herself. She drank Maker’s Mark straight and had a laugh like little bells tinkling, though some nights after drinking too much her laughter turned to tears when she talked about the trauma of her past—an assault, an abortion, an abysmal number of years spent looking back at how she might have avoided everything that came after. 

When I first met her I thought she was refined and sophisticated—the way she held her glass, the way she poured her bourbon. I thought she was handling all the things that needed handling, the dark parts of ourselves that whisper to us late at night. I had read parts of her manuscript about the assault and the abortion and the dark numb nights afterward, but I wasn’t smart enough to realize she needed help. I couldn’t hear her through all the insulation she wrapped around herself. Or maybe I couldn’t see through my own. 

Recovery

A church in Campbellsville, Kentucky now offers the hallucinogenic drug ayahuasca as a form of “spiritual enlightenment.” One participant said he was an alcoholic until he tried ayahuasca. Another said he was a heroin addict. “For me it was like putting on prescription glasses and suddenly being able to see,” another participant in the ayahuasca ceremony said. 

The beeping of the machines, the needle stuck in the back of my hand, the constant light coming from under the room door, all sent my anxiety spiraling.

Ayahuasca has long been used by Amazon tribes as a spiritual medicine. The website Ayahuasca Healings offers spiritual retreats in Peru and America. The website asks prospective customers if they want a deeper understanding of life and the universe, which implies we are all looking for inner peace. 

Pain

When my stepfather had his hip replaced, he wouldn’t take the Oxycontin they gave him. He said he was afraid of becoming addicted, so he just sat with the pain. He was among the ranks of those old men who believe that silently enduring pain shows moral fortitude, so he said nothing. 

His pills sat on the counter for months. When I realized he wasn’t going to use them, I might have taken a couple. For a bad back after driving six hours to see them. When I slept wrong and aggravated an old shoulder injury. I could almost always come up with some reason why I needed to be free from pain. 

Revelation

Lots of people have painkillers in their medicine cabinets. Most of them won’t know if you steal a few. 

Pain 

The night Jeff died—went to bed and never woke up, and we don’t know if it was the alcohol or the drugs or only a tired heart giving out—he tried to call me, but I missed the call. We’d been missing each other for months, running on different schedules, drunk on different nights. The last time we talked he sounded more slurred than I’d ever heard him. He told me he wasn’t sure how to live. I said we only had to survive, but I was already half-drunk, and the alcohol gave me courage I don’t really have.

Pain

I hadn’t spoken to Julie for several months when she died. I suppose I got busy with other things. It’s so easy to stop calling someone. So easy to let the phone ring when they call you. 

Like Jeff, Julie went to sleep and never woke up. Afterward, a close friend assures me it wasn’t suicide. That the drugs and alcohol in her system were normal, for her. 

It’s the last part that hurts, that “for her.” 

Pain

When my uncle was dying of cancer he stayed high on Vicodin. He was afraid of needles so he wouldn’t let the hospice workers shoot him up with morphine, but toward the end the pain was too much for the Vicodin to handle, so he had to ask for more, and when he got more he slipped in and out of sleep until he finally slipped out of living. When we went to visit him in the last days he wouldn’t wake up. His eyes heavy as lead, his voice so slow it was hardly even there. My mother kept asking him if he wanted to wake up, and he kept shaking his head. She rubbed his shoulder to let him know she loved him, then handed him two more pills and held the water glass for him while he swallowed. I never spoke to him again. 

Pain

The pain came from nowhere. 

I was sitting in my office at the university where I taught, and then I was on my knees. Then my back, flat on the floor, trying to find some relief. When I made it to my doctor, she sent me to the emergency room. 

I spent two weeks in the hospital and grew afraid of losing my job. Of my wife and daughters at home alone. Of the worry everyone around me held inside them. The beeping of the machines, the needle stuck in the back of my hand, the constant light coming from under the room door, all sent my anxiety spiraling. It amplified the pain in my abdomen. I wondered if I would have surgery. I wondered if I’d ever be the same again.

So when the nurses asked what my pain level was, I lied. I knew if I said one or two, they would give me Ibuprofen. Three or four and they would bring Vicodin, but five got me dilaudid, much stronger. A sweet, sweet rush that flooded through me, like nothing I’d ever felt before, like everything I’ve always wanted to feel. Like the first few drinks of alcohol, only magnified by a hundred. All the hurt of the world went away. 

When I came down from the drug hours later I asked for more. I always wanted more. When it hit me, I could watch the nurses walk back and forth in the hallway for hours, watch my foot, watch the world out the window. I could only see the roof of another building and the steam leaking from the vents in the November rain, but the more I watched, the more afraid I became of leaving.