Dreamland (51 page)

A Russian Pentecostal junkie named John Tkach had started a rehabilitation clinic in the Portland suburb of Boring. Tkach saw the Russian Pentecostal churches trying to hide the sight of hundreds of addicted kids. Parents who asked a pastor’s help with their addicted child were shamed as running a sinful house. Tkach sold his trucking business, took out a second mortgage on his house, and opened a rehabilitation center. A church formed around it, the first to make the rampant opiate addiction of Russian Pentecostal kids the focus of its ministry. God Will Provide, as the new church was called, rested on Jesus’s message of love, forgiveness, and transformation. Traditional Russian pastors called it blasphemy and sinful. Russian Pentecostal kids called it the Rehab Church. But soon God Will Provide had spread its church/rehab center model to Sacramento, Seattle, and elsewhere.

There, Elina met Vitaliy Mulyar. Vitaliy had crashed since those heady days when he was one of the first Russians to sell OxyContin in Portland. In 2010, Vitaliy faced a two-year prison term if he failed another probation drug test. Terrified, he turned to God Will Provide, where he felt warmth in church for the first time. He kicked heroin, became a Bible teacher, and, with a judge’s permission, went on a mission to the Ukraine and Austria as the church, fired by the new energy of its recovering-addict congregants, opened a school for missionaries.

A year into his recovery, Vitaliy encountered Elina at the center. He told her his story. She mistrusted her own capacity to change. But it struck her, the way he had risen from the street. A chaste romance followed, in keeping with Russian Pentecostal tradition, though with a modern American twist. They grew acquainted via hundreds of texts while he was on mission. Vitaliy came home and asked Elina to marry him before they ever kissed.

Two years later, their daughter was born. They named her Grace.

Nobody Can Do It Alone

Southern Ohio

On March 26, 2013, Dr. Phillip Prior died of liver cancer in a hospice in Lancaster, Ohio. He was fifty-nine.

As a kid, Prior had wanted to be a paleontologist, a herpetologist, an archaeologist, and a biologist—all before he was ten. He raised snakes. In open rebellion to his father who was insisting he cut his hair, he went to the barbershop and got his head shaved. When his family’s church urged blacks in its congregation to find their own church, Prior walked through the corridors yelling that he would never step foot in it again.

His parents prized education above all else. Prior alarmed them by spending the first seven years after high school getting a degree in auto mechanics and learning bicycle repair, and opening a bike shop in Cincinnati.

He finally entered college at twenty-four, got a medical degree from Ohio State, and worked for many years as a family doctor in Chillicothe. Later, as a recovering alcoholic, Prior turned to a specialty in addiction medicine.

He lived on a farm in Stoutsville, Ohio. He built rockets and for several years he and three others held a world record in amateur rocketry—sending a homemade rocket twenty-three miles up in the air above White Sands, Nevada. He loved to hunt. A mountain lion he killed in Wyoming was mounted on his living room wall. His garage was a meeting place for men with a zeal for auto mechanics.

Real family doctors touch lots of people. Two hundred of Prior’s friends gathered to remember him a few days after his death. His kids chose to play the Beatles’ “Let It Be” and Jimi Hendrix’s “The Wind Cries Mary” as mourners comforted the family. At his farm, friends fired up a bronze Chevy van with mag wheels he was working on before he got sick. They met again months later for a hog roast at which his ashes were scattered on the farm. Some of the ashes were shot up into the sky in a homemade rocket, along with messages from friends.

Prior’s life had been marbled by addiction, elevated by exploration, and studded by acts of defiance. He drove a simple Toyota Camry and owned a couple suits he rarely wore. But he had been a lonely voice at America’s opiate ground zero for his final half-dozen years sounding the alarm about the excessive prescribing of OxyContin as a gateway to heroin. He was one of the first in the region to urge the use of medication in the treatment of addiction—the judicious use of Suboxone, particularly—feeling that abstinence too often led recovering addicts to relapse, and, with low tolerance, to die when they did.

I spoke with Prior on the phone, but never in person. I intended to, but he grew ill. By the time I made it to Ohio, he was in a hospice.

“There’ll only be a handful of us who’ll ever remember who Dr. Prior is, but in southern Ohio he is the crucial doc,” said Orman Hall when we met for lunch, coincidentally a few hours before Prior died. Hall now directed the state’s substance abuse program.

Opiate addiction was everywhere in Ohio. I asked Hall how long he thought the country might be living with this generation of opiate addicts. Some Vietnam-era addicts were still using, hanging on forty years later.

“Let’s hope we can keep people alive,” Hall said. “Our experience is that people go from zero to sixty pretty quickly.”

An Ohio State physics honor student Hall had met started out using 10 mg of Percocet recreationally every other day. Eleven months later, he was mainlining a large amount of heroin daily.

Phillip Prior “was the guy who articulated the treatment approach we need to take to deal successfully with this population of opiate addicts,” Hall said. “He was the guy who painted the bigger picture of the complicity of Purdue Pharma in starting this epidemic. He was the guy who did it for me.

“The profound irony in all of this is that opiates are providing him with some level of quality of life as he expires.”

Indeed, after years fighting prescription opiate abuse and the heroin addiction that followed, Phil Prior, in the weeks before his death, was administered, and grew dependent on, the opiate painkillers that he received from hospice nurses to relieve his considerable pain. He even called a doctor to intervene when hospice nurses wouldn’t up his dose.

“He’s ending his life opiate dependent,” Hall said. “There’s an appropriate role for opiates in our health care system and how they’re being used for Dr. Prior is a prime example of how they need to be used.”

Miles north, in the town of Marion, Brad Belcher’s guerrilla tactics had ignited a discussion. One person taken up in it was Jennifer Miller, Marion County’s chief probation officer. By 2013, almost 80 percent of Miller’s caseload was opiate addicts.

Miller had begun her career in the mid-1990s as a gung-ho officer who saw her job as locking up as many folks as she could. She wrote presentencing reports that urged prison for pot smokers. But now a mother, and watching opiates take hold of her county, Miller noted how little success the old ways were having. Addicts went to prison, got out, and started using right away.

“I’ve come a long way in opening my mind,” she said when I spoke with her in 2014.

A doctor at one seminar she attended described how opiates overwhelm the brain receptors. Miller began studying addiction and brain research online. She had never imagined this stuff would be necessary to do her job as a probation officer. But the opiate epidemic turned her into a social worker as much as a cop.

In 2013, Governor John Kasich, a Republican, went around the Republican-dominated legislature and expanded Medicaid health insurance to every Ohioan, which in turn gave thousands of families a way to pay for long periods of outpatient drug treatment. The next year, Miller applied for a state grant to use the opiate-blocking drug, Vivitrol, on addicts. Four months in, Miller had a waiting list for Vivitrol, and some of the county’s worst junkies were clean. But each shot cost twelve hundred dollars and an addict needed it once a month.

“The million-dollar question,” Miller said, is how long addicts will need to be on Vivitrol. So far, no drug company had stepped forward to help defray the cost. However, in Marion County, opiates, and the Vivitrol experiment, got police, jailers, court officials, and probation officers all working together in ways that hadn’t been necessary or common before. Brad Belcher had inherited an old school building that once held a rest home. He offered it, three years rent-free, for a sober-living house with a dozen beds. So it seemed that the damaged county was rediscovering community.

“Some of the myths are being debunked,” Belcher said. “People are understanding that this is a chronic illness. People are complaining when people are shooting up in parking lots. But it ain’t over.”

Down in Columbus, as the second anniversary of Matt Schoonover’s death approached, Paul and Ellen felt the shock lifting.

They tried to piece together their shattered lives by speaking publicly about how Matt had died. That felt like therapy. Doing nothing, they thought, would have crushed them. They had known little about addiction when Matt was alive. So they learned about drugs and the brain, about
mu
receptors and endorphins, and that helped.

Sharing grief publicly required taking care not to go too far in using it to push public awareness of the plague. Grief could become an occupation. But so many parents around the country were facing the loss of a child to this now. Strangers told them about addiction in their own lives. Ellen, in fact, felt she had suddenly been let in on a national secret. Addiction was everywhere. “People try to keep this happy façade,” she said. “You realize there are a lot of people who suffer in silence.”

It soothed her to write occasional letters to Matt and speak to parents with addicted kids on the topic “What I Wish I’d Known.” A main point: that after three weeks of rehab, no addicted child is “fixed.”

In Ohio, opiate prescribing had declined 40 percent. The legislature had a roster of bills aimed at regulating prescription opiates and expanding treatment options. One of them was modeled on the Counseling Center, the treatment clinic run by Ed Hughes in Portsmouth. The bill required counties to provide addicts with a full range of services—from housing and psychological counseling to help finding work. Still the state’s problem raged. The Department of Health released numbers for fatal drug overdoses in 2012: a record 1,272 Ohioans had died that year, and of those 680 were due to heroin. In one three-month period, fully 11 percent of all Ohioans were prescribed opiates. Officials expected the number of heroin overdose deaths to more than double in the next couple years.

One way to view all that had happened was as some enormous social experiment to see how many Americans had the propensity for addiction. I ran this idea by an addiction specialist named Dr. Richard Whitney in the wealthy Columbus suburb of Dublin.

“That’s an interesting way to put it: Let’s feed this to everybody in the society and see what pops up,” he said. “Let’s, as a society, watch all of our potential alcoholics become opiate addicts instead. Had these opiates not appeared, I think we’d have seen a similar number of alcoholics, but later in life. My field used to be middle-aged alcoholics. It usually took twenty years of drinking to get people in enough trouble to need treatment. But with the potency of these drugs, the average age has dropped fifteen years and people get into trouble very quickly with oxycodone, hydrocodone, and heroin.”

Nationwide opiate addiction had achieved a few things—albeit at frightening cost. There was the remarkable change of heart regarding prison and treatment that was under way, especially in red states, and led by Republican politicians.

Parents seemed to be losing their fear. A PR consultant named Barbara Theodosiou near Fort Lauderdale had two sons addicted amid the height of the Florida pill mill boom. Figuring there must be others like her, she started a website—addictsmom.com—and a Facebook page with the motto “Sharing without shame.” By 2014, the page had grown to fourteen thousand mothers, who consoled and prayed for each other as they wrote in the rawest terms about collect calls from jail, forty-thousand-dollar rehabs, syringes found in sofas, funerals planned, and their kids reaching three hundred days clean of the morphine molecule. Theodosiou added a page for grandparents raising their addicted kids’ children. At times the comments reached the pitch of a primal scream of maternal agony, a kind of mass group therapy for a drug epidemic in the virtual age.

“For 6 long years I’ve begged, pleaded, screamed, yelled, cried, grounded, took things away, called the police, kicked him out & not to mention the countless hrs feeling guilty & terrified for him,” one woman wrote about her heroin-addicted son who’d just been thrown out of rehab again for a dirty drug test. “And the thousands of dollars spent on rehab, hospital bills & therapist as well as bailing him out of jail. I have prayed prayed prayed & prayed . . . ”

A deeper understanding was emerging of how addiction was created in the brain. Functional MRI scans had revealed a lot since the 1990s about the brain’s pathways of reward.

“It verified a lot of what we did intuitively,” Whitney said. “Once people get addicted they really lose the power of choice. It takes thirty to ninety days for the brain to heal enough to make decisions. Otherwise, it’s like putting a cast on a broken bone and expecting someone to run five miles.”

Nationwide, attitudes toward addicts and addiction seemed to be shifting, though slowly. Addicts were not moral failures, deviants, and criminals—the image that stuck in the popular mind following the Harrison Act. Instead, they were coming to be seen as afflicted with a disease that happened to manifest itself in stealing and conning in the relentless search for dope to calm the beast.