Hooked: a portrait of addiction in Lamoille County

courtesy of justice.gov

Oxy 80's

Editor’s note: This is the first in a series on opiate addiction in Vermont. Some names have been changed to protect the anonymity of the sources.

Carly sits across the counter, peeling bright pink polish from her nails. Her green eyes accented by intense eye makeup are watering, but she isn’t crying. “They always do this after I get high,” she says with a signature laugh that perfectly suits her upbeat personality. Within a few minutes, however, her pleasant smile retreats behind quivering lips as she discusses her ongoing battle with addiction.

Like many addicts, Carly’s first taste of illegal substances involved marijuana use and underage drinking. “I tried stuff in high school on and off but I was never addicted to anything,” she said. Carly admits to trying what she first referred to as “small stuff” during high school, meaning low dosage Percocet, Vicodin and on the rare occasion cocaine. “It was for fun. [It was] just partying with friends,” she said. “I never got addicted to any of it. I never felt that need to keep going with it. Just random parties. “If it was there, why not?”

Following high school Carly was employed in a managerial position for a well-known establishment in her community. She had her own apartment, gave birth to a daughter, and had begun the enrollment process to take part-time college courses.  According to Carly her life was on the right track. However, a year after her daughter was born, Carly’s life began to spiral into prescription drug addiction. It began with Oxycontin 80 milligrams, referred to as street name Oxy80’s or 80’s. An opioid pain killer, Oxycontin is similar to morphine and prescribed for moderate to severe pain.

“I found out my daughter’s father was doing 80’s behind my back. I was so mad when I found out about it. I don’t really know how to explain it but I was just like I want to try it,” she said. “Honestly I just wanted to prove something to him like ‘hey, I can do it too.’ I know that sounds so stupid now. I don’t know what I was thinking. But I did it.”

After the first initial trial of the Oxycontin, Carly was hooked: “I figured out if I did the 80, I could go to work, be an excellent manager and really work hard. Then I could go home, clean the entire apartment, cook dinner, and be a super mom. I could do anything and everything when I was on it. I started doing it every day and that was that.”

The street name of 80s does not just stand for the milligram of the drug but also the street cost. Carly and her boyfriend each were doing one a day. This cost the couple not only $160 a day, totaling $1120 dollars a week, but their apartment, vehicles and anything of value they could trade or sell for drugs.

“A little while into it I thought, ‘I can’t do this.’ I don’t want to do this,” she said. “I wanted to be super woman but not like that. I realized it wasn’t fun anymore and I had become someone I never wanted to be. We got kicked out of our apartment because I was buying them for my boyfriend and me every day. We lost everything. I wanted to quit. I tried but it was too hard.”

After losing her job, Carly discovered the Suboxone program and how beneficial it could be for someone in her situation. The Suboxone program and the opiate-blocking drug Buprenorphine are designed to help treat those with opiate addiction. During the first few days of the program the individual is given strictly Buprenorphine, after which they are prescribed Suboxone daily and can remain on this prescription until the patient choose to be weaned off. This can be a lifelong prescription.

According to Cynthia Hennard,. director of the Counseling Center at Johnson State College, the program works best for a couple of years in stabilizing the patient. “Initially it was [thought] let’s do it the briefest amount possible, and in fact when it first started it was used to detox and they weren’t maintaining people on it,” she said. “Now it is standard practice to offer it to folks for maintenance. Some people do really well being on it for years because it regulates mood to some degree. It keeps things more even if you’re going through cravings and withdrawals. It has a long half-life, so it really allows you to function more normally without a lot of impairment that you get from being on other opiates.”

Despite the benefit of using Suboxone, Buprenorphine or Methadone, there is a risk of abuse for those who are not prescribed the drugs. Recreational use will result in a high comparable to the opiate the drug is designed to wean people off of. “For people who are abusing Buprenorphine who don’t have a lot of history of abusing opiates, they get high on it and it does affect them until they build up a tolerance on it,” Hennard said. “So for someone who just uses it once in a while they get pretty high off it until their body can adjust to it.”

Carly did not take the legal approach to the program, resorting instead to finding the drug on the streets. “I didn’t want to go the doctor and tell them I had a problem because I was so petrified that they would look at me and think I’m a bad mom, a bad person, and take my child away,” she said.

Carly and her boyfriend illegally purchased Suboxone on the streets and made the transition that is normally overseen by a medical professional. She immediately knew after trying it that she’d never go back to 80s. A single dosage of Suboxone cost her $15 could be split between her and her partner. “It was a hell of a lot cheaper than the $160 a day I was spending and the high was good,” Carly said.

According Hennard this is not uncommon practice for individuals in Carly’s situation. “For the people who do opiate drugs and who abuse opiate drugs, when they can’t get their opiate of choice like heroin, Oxycontin, or [Percocet], one of the reasons they like certain kinds of Suboxone or Buprenorphine is because it can really help them not go totally into withdrawal,” she said. “It’s a good sort of backup drug for when they can’t get the drug they want. For some people they are able to manage their opiate addiction by getting street Suboxone and Buprenorphine.”

Hennard believes that one of the reasons individuals are abusing the drug designed to help those with opiate addiction  is due to not meeting general requirements of getting into the program and getting a legal prescription. However, in her professional opinion this is one of the lesser of the evils when it comes to drug abuse. “It’s one of those things where if someone is going to abuse an opiate, meaning take it illegally, to take Suboxone or Buprenorphine illegally would be one of my preferences in terms of how is it going to impact them risk-wise compared to say a full strength opiate that doesn’t have any antagonist in it,” she said.

In general although the drug is prescribed to those in the program, in the beginning stages they are issued their dosage daily and must take it in the presence of a medical professional. Yet diversion has become a serious issue. How could this be possible if the drug is taken at the clinic?

Hennard  explained that after a certain duration patients are granted permission to take their drug at home and they can wean themselves down to the minimal dosage while still maintaining themselves on the medication. The rest of the pills can be sold. “They earn take-homes by being seen as in compliance with their treatment program, meaning they are not abusing, relapsing or on other medications. Their urine screens have to indicate the presence of the prescribed drug,” Hennard said. “But they may not be checking levels adequately or they are doing infrequent urinalyses. [Sometimes the patient has] an idea when they are going to be tested, they may be likely to make sure their levels are going to be looking good for that test. The rest of the time they don’t have to be worried about it.”

And that is how Carly was able to sustain her addiction through diverted Suboxone. “It was so easy to get. It’s everywhere,” she said.  But after maintaining herself illegally on Suboxone, Carly attempted to quit the drug. 

Again, instead of seeking professional guidance, Carly chose to self-medicate and switched her drug of choice from Suboxone to Methadone. “I kind of talked myself into being okay with it; they are both given to people to get off drugs and I was trying to get off drugs,” she said. “I like Methadone better and it’s also much easier for me to get. That’s what I’ve been doing ever since. It’s a little more expensive. I’m spending $30 dollars a day now for the both of us.”

According to Hennard, Methadone is a stronger opiate replacement than Suboxone. “It has more side-effects and it doesn’t have the same antagonistic quality. [The patient] won’t get prescribed methadone unless they have a strong opiate history,” she said. “It’s a really high-maintenance program. It’s harder to get into and it does require daily dosing and daily check-in. They are much more careful of that. People who fail out of Buprenorphine programs are referred to the Methadone program. It’s stronger for opiate receptors because it’s built differently chemically.”

Carly noted that she had no problem purchasing Methadone. It was easier for her to obtain than her previous drugs of choice.

 Carly is fixated on her public persona and uses her fear of being viewed as a lesser individual as an excuse for not seeking help. “I don’t snort anything. I’ve never used a needle. I’m not a junkie. I’m not a bad person. I’m a good mom,” Carly said through tears. “But I’m a drug addict and I need help, which I refuse to get. They’re going to look at me like I’m a piece of shit, and I’m not. If I could go get help without being looked at like a piece of shit, then I would have already. Plus they’ll take my kid away, I know they will.”

Hennard said that as a medical professional any organization responsible for helping those with opiate addictions would welcome a young mother like Carly without taking away her child. “They would be absolutely thrilled and they would work with her and taper her down,” Hennard said. “If someone like that were to go to a treatment center, they would assess her, stabilize her on her current dose and wean her down. She could say ‘I am dependent on opiates and I really want to be coming off it but I will need some help.’ They would be thrilled to have her come in. It would not result in a DCF report. It would be very confidential unless she were dangerously non-compliant once she got on the program.”

According to Carly’s best friend, Ruth, at one point Carly came to her with a desire to get professional help. Carly confessed everything to her but was resistant to getting help, fearing that   DCF would become involved. Ruth noted Carly was suicidal and it had been days since her last usage.

In reaction to Carly’s plea for help, her friend went online and did research. Despite Carly’s apprehension of calling for help, Ruth convinced her to do it. “I said you have to do it now when it’s not in your system for a couple days. This is you sober. You are willing to do it right now and you have to do it now before you change your mind,” Ruth said. “She called a couple different places and they were so worthless. They told her to call different numbers and didn’t direct her to anyone. They said they’d put her on a waiting list but it would take a long time. She went to an actual clinic and tried to talk to them. They told her it didn’t look like she needed them; she could do it herself cold turkey. There was a huge waiting list. They turned her away.”

This incident, along with her fear of having her daughter taken away, has kept Carly from trying to seek help again. She is also fearful of the reaction she will receive after coming out about her opiate dependency.

According to Carly, no one knows about her drug addiction aside from close friends. Even after losing everything and having to move in with her mother, she still believes her parents don’t know.

“I didn’t change,” she said. “I have more energy, but I didn’t change. I mean I lost everything, but I’m still me. Unless I’m not on it. When you’re not on it you can barely survive. The worst part is that you can’t sleep at night. I’m tossing and turning every three seconds. You’re not comfortable in your own skin. Going through the day is hell, but sleeping is even worse. It’s unbearable. I can’t let my family know. That’s number one. My mom and dad would die. I honestly think my mom would kill herself. I can’t do that to her. She would literally commit suicide.”

Ruth, who has known Carly since they were battling over Barbie dolls in day care, has seen Carly progressively spiral out of control through the stages of her addiction. “There has been a huge change in her. She’s always been independent and strong-willed,” said Ruth. “She knew what she wanted and was going to go for it. Then she became an addict and lost it all. She’s come to me a couple times saying, ‘I need to get off this.’ It’s always about her child. I think it really kills her that she can’t be the mother she wants to me. She doesn’t feel strong enough.”

Hennard noted how difficult it can be to get off of these drugs and encourages someone trying to do so to seek professional guidance. “Like any opiate, it can be a drug that wants you to keep taking it once you do it. It’s not a benign drug even though it’s a drug that can be prescribed,” she said. “The same thing with all the other pain medications, they are really strong and they alter your body chemistry, [which] is long lasting. I can appreciate her feeling how hard it is to come off it. It’s a serious thing.”

Throughout the interview Carly’s most sensitive subject was her child. It was impossible for her to speak of her daughter without breaking down. “I never did anything while I was pregnant,” she said. “Not even caffeine. I always put her first. I always made sure she had what she needed. I’m a good mom.”  

Unfortunately, Carly is not an isolated case of opiate addiction in a small town.  Vermont State Health Commissioner Harry Chen has called opiate addiction a “problem of epidemic proportions,” and its implications can be felt in all parts of the state. Illegal  trafficking in prescription opiates continues to be a major source of federal prosecutions in Vermont, as well as of fatal overdoses and burglaries.

According to Lamoille County Sheriff Roger Marcoux there has been enough of an influx in drug-related crimes in the county to assemble a small drug task force. “We’ve developed a local capacity to investigate drug crimes,” he said. “Basically the biggest problem that we’re seeing out of this office here is burglary that is associated with the people that are trying to get money to support their habits.”

Marcoux says he has seen drug related crimes in all demographics and involving all forms of narcotics. According to Marcoux, Suboxone is on the rise in popularity.

Marcoux believes this is an issue that can only be solved by the involvement of the community. “If you know someone with an addiction problem of any level, you should try to convince them to get help. I don’t think law enforcement will be the answer,” he said. “I think it’ll have to be a combination of education and treatment. It’s up to law enforcement to keep people and their properties safe. But really this is a society problem. It’s a problem that we all have to work together to deal with. It starts with a loved one that’s involved to try to encourage the addict to get help.”

A month has passed since the first interview, and Carly sits at the same table. Her eyes are still watery and not much has changed in her life. She’s still picking at her nail polish. “So my boyfriend wants another baby,” she says with her notorious laugh that echoes through the room. “He doesn’t get why I don’t want to. I’m not going to get pregnant like this. I couldn’t do that to a child. I want to get clean and healthy first.”

After being told what Hennard said, that they wouldn’t take her daughter away if she sought help, Carly laughs nervously: “Really? Like really? You promise?” She sounds hopeful but doesn’t ask details about recovery.

Instead, she discusses a beach wedding, dabbing at her watering eyes.