Pill Head: The Secret Life of a Painkiller Addict (8 page)

Califano asserts that this is because the reasons kids turn to drugs have almost nothing to do with being informed about the dangers of using them. “The presentation on the dangers of drug use will have little impact on the likelihood that a child who is experiencing depression, anxiety, learning disabilities, eating or conduct disorders, low self-esteem, or sexual or physical abuse, neglect, or who has no hope for the future, will self-medicate with drugs and alcohol,” he states.

And he’s right.

When I was in fourth grade, my mother brought home one of those Nancy Reagan Just Say No pledge cards and asked me to sign it, making me promise that I would never do drugs. I did, and she hung it on the refrigerator. But even at age nine, as I was signing my name, I clearly remember thinking to myself,
This is total bullshit
.

Califano believes that an effective antidrug program in the schools would need to be tailored to suit the individual needs and concerns of different communities. “School curricula should be scientifically validated,” he writes. “The best programs—and there are several—provide realistic information to kids in school. They’re tailored to the types of schools; recognize gender, age, ethnic, and racial differences; and cover all substances, alcohol and tobacco as well as illegal and prescription drugs.”

It sounds ideal, but I still doubt that anything could have cured me of my innate curiosity about drugs as a teenager. It was something that seemed to be an inevitable part of my life, as necessary and commonplace as homework and the household chores. It was the
same situation with both Jared and Caleb. And by the time Heather was hooked, she could have cared less about any sort of antidrug program she’d attended in school.

But Califano is determined to keep fighting. As of October 2007, CASA filed a petition with the FDA to stop direct-to-consumer advertising of controlled substances. DTC ads for controlled substances had been banned for years, but they had been brought back during the Reagan administration.

The petition asks for two things. One, that in certifying new drug approval applications, the FDA makes every effort to minimize the drug’s potential for abuse without compromising its therapeutic effectiveness. It doesn’t do that now, as evidenced by the whole Oxy-Contin debacle. Two, that before the FDA approves any of these potentially abusable drugs, it has a risk management plan in place. “Today, they don’t really have a risk management plan until we’re already in trouble,” Califano told me. “We’ve filed the petition, but so far there haven’t been any comments on it. We’ll keep pushing.”

CALEB HAS A YOUNGER
sister named Sarah, who is diabetic and used to using needles to inject her insulin. “She became a heroin addict at sixteen,” he says. “When we were thirteen and fifteen we used to smoke pot together all the time. We’d get high, drop acid, the usual. But at around age sixteen she started doing speed, and it really drove a wedge between us. She became this monster, totally awful and unknowable, the family member from hell. And then she went from speed to heroin. I caught her shooting up one night, and I said, ‘Listen, you tell our parents tonight or I will.’ They ended up putting her in rehab.”

I find Caleb’s strong negative reaction to heroin surprising, considering the chemical similarities between heroin and OxyContin. The two seem linked in so many people’s minds.

“Having done both, I’d just say that OC is a lot better,” Caleb explains. “First of all, you know exactly how many milligrams you’re doing. It’s really hard to overdose unless you’re totally retarded, because you can control exactly how much you’re doing and the strength of it every time.”

This logic blows my mind. The public perception of OxyContin among opiate users seems to fall into two distinct categories: people
like Caleb, who think it’s totally safe because it came from a doctor; and people like Zoe, who are freaked out by it because they perceive it to be so closely linked to heroin. The fact is that although some physiologic effects, such as respiratory depression, are predictable and should be taken seriously, everybody’s body chemistry is different and is going to react in a different way to any type of drug. You have to factor in whether other drugs are being used with it, be they more typical prescription drugs or illegal ones. Also, OxyContin is different from hydrocodone in that the dosage equivalents are usually higher because of the controlled-release formula, and Oxy doesn’t contain acetaminophen, which means you are getting a pure high of the opiate ingredient.

“When I first started doing OC, I was really into the trifecta of a little beer, a little pot, a little bit of pill,” Caleb says. “All three together just put me in the perfect zone.”

Sure, the combo sounds awesome, but mixing pills with alcohol, marijuana, other opioids, or opiates like heroin and morphine is extremely dangerous because all of them are central nervous system depressants. When used together, they have an additive effect on respiratory depression, a condition in which the muscles used in breathing, such as the diaphragm, fail to respond as carbon dioxide levels in the blood increase. Again, look at the case of Heath Ledger, who was taking medications in their recommended doses, but the combination proved fatal. And when you combine a prescription narcotic with alcohol or pot, both of which already depress the central nervous system on their own, you are vastly increasing your chance of an overdose.

Caleb’s sister eventually got out of rehab with a methadone prescription. Both of them were still living in their parents’ house. Sarah tried several times to help Caleb get off pills, but he kept slipping up, and eventually she just caved and gave him the number of one of her former dealers. “I’d heard from some of my friends that she might have been using crack at the time, but I don’t know that for sure,” Caleb remembers. “But she got me in touch with one of her people, this messed-up junkie who said that she knew people who had OC. This lady was so off her shit, she was like a forty-year-old baby. She’d
been doing crack and heroin for so long she couldn’t keep a cell phone for three days without losing it. She couldn’t have $100 in her pocket without it immediately getting stolen from her in the street. She was a mess. She took me to another guy who told me, ‘Listen, this bitch is crazy. Let me be your hookup.’ And from then on I had a steady hookup for OC without having to drive to Tijuana.”

Caleb’s new dealer would drive from motel to motel as a liaison. He never held the pills himself. He just knew every single person in Los Angeles who was holding. Caleb would pick him up, he would give Caleb directions, and he’d take him to the people who were selling.

“At one point he got locked up for something for a couple of weeks,” Caleb says. “He left his phone with a guy who
does
keep pills on him all the time, so then I just started going directly to him. Which was great, because that other guy could get really paranoid and weird, and it was such a pain in the ass having to pick him up in the heart of the ghetto to find some other person who he has to hassle with to get them.”

By this time, Caleb had given up on almost every other kind of drug for getting high. “Everything else has such a downside. Ecstasy leaves you all shaken and awful, coke keeps you up all night, pot makes you sleepy, and alcohol makes you act like an asshole. But on pills, I’m still me. I’m just happy. You just have a lovely sort of buzz to everything you do. Pills have a big downside to them, but it’s not in the high itself. They’re just too expensive for me to do them all the time, and the comedown is hell. So now I’ve started taking methadone when I get cravings.”

Caleb’s level of denial is terrifying, given his own sister’s drug use. But it’s an easy denial to slip into, because even though he still lives at home with his parents, and goes out to dinner with them all the time, they never know he is high. If the people he lives with can’t even see the problem, there’s no way he can see it for himself.

Heather’s attempts at writing
her own prescriptions by stealing prescription pads weren’t always successful. “One time I stole a page
out of my medical records, because I noticed the nurse was photocopying my prescriptions,” she says. “Since they always write in this crazy language that no one understands, I could now see exactly how they were being written. But it didn’t work. Thank god nothing major happened,” she says. “I’m sure the pharmacies could have called the police or something if they wanted, but most of them would just refuse to fill them, or would end up calling the doctor to check and see if it was legitimate.”

William is a Los Angeles–based pharmacist at one of the major national chains. He sees people trying to fake prescriptions at his drugstore all the time, but he backs up Heather’s assertions that the police don’t usually get called. Even if they do, often little happens.

“There are a couple of ways that people forge prescriptions,” he says. “If someone steals a prescription pad from a doctor’s office, we usually get some sort of email blast about it, but only if it’s a doctor’s office we work with a lot. That way we can keep an eye out for prescriptions from that particular office, and call to verify that they’re legitimate if a scrip comes in. But if someone steals a pad and we don’t get notified, it’s really hard to verify those prescriptions, because the pads are legitimate and we’re not required to confirm every prescription that comes in. I’m pretty flexible about what I’ll fill, but there are some definite tip-offs when I can tell something is out of the ordinary.”

The first for him is someone who doesn’t have insurance, but is willing to pay cash for an opiate prescription. Another one is a customer who specifically requests a brand name as opposed to a generic, and is willing to pay for the difference. “It’s my understanding that the street value for the brand medications is a lot more than for the generics,” he says. (For someone without insurance, in New York State, a prescription for thirty Vicodin costs around $70, versus $20 for generic hydrocodone.)

One day William was working when a customer came in with a preprinted prescription for OxyContin, but it still had a doctor’s signature on it. It was from a doctor’s office in Nevada.

“We just weren’t comfortable with it,” William says. “So we told the customer that we were going to have to verify it, and they were
fine with it, almost as if they’d been expecting us to say that. They told us the doctor’s office was closed but to call the doctor’s cell number, which was on the prescription. I looked up the doctor’s office, faxed it to them anyway, and they were open. They looked at the cell number that supposedly belonged to the doctor, and it was actually the number of another patient, who must have been waiting for a call from us so he could pretend to be the doctor. The doctor wanted us to press charges, so we called the LAPD and they weren’t exactly helpful. If you tell them, ‘This person was just trying to forge a prescription,’ their response is, ‘If we come right now, are we going to be able to arrest them? Are they still there?’ And of course they aren’t, this guy had already hightailed it out of there. The cops usually tell us to forget it and then get mad at us for making the system so easy for people to manipulate.”

Another way that people can forge prescriptions is by simply impersonating a physician and calling one in to a pharmacy. But in order to do this, you need to know the doctor’s DEA number. A DEA number is a specific code given by the DEA to anyone who is permitted to prescribe or distribute scheduled drugs. The idea is that it helps track controlled substances. Every physician and pharmacy has one and there is a general pattern to the numbers and letters.

At William’s particular pharmacy, which was formerly another chain entirely until his current company took it over, the DEA number never changed. So it’s hardly a foolproof tracking system. Also, depending on what schedule the drug is, a doctor doesn’t always have to be the one phoning in a prescription. It can be a nurse or an assistant or anyone pretending to be any of the three, as long as he or she has access to the right DEA number.

“For phoned-in prescriptions, it all depends on how they deliver the information,” William says. “If they’re hurrying and just want to give out the information, nine times out of ten I would believe that. Not that most physicians or nurses are rude, it’s just more believable.”

Here’s another interesting fact. You know how you always have to go way in the back to find the pharmacy in a drugstore? It’s designed as a theft deterrent, since it’s far away from the exit. “My
pharmacy is a little different,” William says. “The space is an older design. Pretty much anyone could come in, hop over the counter, take what they want, and run out before anyone could even react.”

“The other thing is that if someone works in a pharmacy, and they’re brave enough to do it, they can get away with a lot.” We’ve already seen this with Jared’s friends, but William tells me a story about a bigger heist.

A lot of the neighboring pharmacies within William’s chain know each other well. They do relief shifts if someone calls in sick, and they go to other pharmacies if they’re out of stock on a particular medication. One day, at one of the neighboring pharmacies, a guy walked in wearing the customary uniform and said he was from the nearby branch and needed to pick up some supplies for his store. He knew the system and no one even questioned him—they just let him right into the back. He got away with $20,000 worth of OxyContin. “I would never let something like that happen at my pharmacy, though,” William says. “This robbery took place at a twenty-four-hour one where everyone was busy and didn’t really have time to focus on anything.”

Heather was always really
bummed out when a pharmacy would call a doctor to verify a prescription she’d stolen, because it meant that she could never go back to that particular doctor. The times that it did work for her was when she would steal a blank prescription, then trace the wording directly from a legitimate scrip onto it, just changing the date. This is pretty much impossible to do now, since no doctor in his or her right mind would ever leave a patient in a room alone with a prescription pad. But any doctor can make a mistake and leave a pad out, especially in a busy hospital.

At that point in her life, pills, and the search for them, were all Heather cared about. “I wound up losing my job at Fresh,” she says. “I was taking days off or just not showing up. I wasn’t the same person who had started out at that job. I wasn’t the same person who had been promoted three times in quick succession. They were just,
like, ‘What the hell happened to this girl?’ If I woke up and didn’t have any pills, my priority for the day was not a company event at Bergdorf Goodman; it was getting to whatever doctor was going to give me pills right away.”

Because of her senior title, Heather found another job pretty quickly, at Nars, another huge cosmetics company, but she lost the job almost immediately. “I don’t remember a minute of it,” she says. “And they fired me quick. I deserved it. I maybe worked five hours in a month before they canned me.”

I wasn’t quite at the point in my painkiller use where I’d just not show up to work in order to find pills. But a large part of the day in my cube was usually spent hunting on the computer for more sources.

Upon graduation from college,
Jared was still such a highly functioning addict that he managed to score a coveted job as the assistant to a major book publisher in Boston, about an hour away from his school. He met a few people in Boston who were selling pills, but they weren’t coming in as frequently as he needed to keep up his habit, so he ended up traveling back to campus all the time to score.

At this point, Jared was snorting thirty to forty Percocets a day and still topping that off with a few Oxy.

“I always had shit in my nose, and about a year into my job I was just, like, ‘I can’t do this anymore.’ Obviously, for my job, I was supposed to read a lot of manuscripts to see if they were good enough to pass on to the publisher or one of the other editors. I literally did not read a single thing. I’d just say, ‘Yeah, I read it, it’s not good.’ I’d reject everything, because what if I lied and said I’d liked something, and then one of the editors read it and said, ‘This sucks, what the fuck is wrong with you?’ It was just safer to say everything was bad.”

“I knew I needed to try and get off the pills,” he says. “My friend who had originally started stealing pills from the pharmacy for us back in high school was in a similar place, so we decided to just go to his parents’ house for a week while they were out of town and quit
cold turkey. I used the vacation time I’d built up, and it was the worst week of my life. It was like living in a nightmare. I couldn’t sleep, I couldn’t eat, I was shitting all over the place every five minutes. I was crawling out of my skin. We took benzos, but that never really helped. I was just burning for an opiate so badly that taking anything else was like a slap in the face. And the worst part is that I knew the opiates were one phone call away; it could make all of this terror disappear.