In the United States, like most places, there are certain things we don’t talk about much. Not for no reason: most Americans have plenty to worry about, and when these topics do arise, things can often get political fast.
But some issues are so critical as to defy whatever partisan backstory they’ve got, and must be seen as problems that afflict our whole body politic, not certain wings. Hardship doesn’t care where you’re from, or who you voted for.
And the only way to stop the spread of such problems is to talk about them.
So, as our president and elected officials edge toward a services-slashing budget that may compound or impose new hardship for millions of Americans, it’s time for me to talk about surviving life before and after opioids, and about the systemic pitfalls I witnessed along the way.
A Familiar Path, With Few Endings
In late 2009, I received a prescription for Vicodin (a.k.a. hydrocodone plus acetaminophen), one of the milder combination opioid painkillers, to treat the migraine headaches I’ve had since I was a teen. I was 23, and had recently picked a GP, as covered by my mom’s insurance plan. Like heroin, morphine and other drugs descended from opium (described by E. A. Poe here), hydrocodone interacts with opioid receptors found on nerve cells in the brain and nervous system to create pleasurable feelings, such as euphoria, and relieve pain.
I requested the prescription after finding that the Vicodin pills I had left over from an oral surgery could ease my headaches, unlike the triptan medication my new doctor had first prescribed; he obliged, providing me with one low-copay bottle per month.
And darned if it didn’t seem to relieve not only my headaches as well as leg and back pain, but also the chronic, seemingly hereditary depression I had known and shrugging-ly mentioned to doctors since high school, and had previously struggled to self-medicate for — mostly without realizing it — using relatively safe drugs like cannabis and mushrooms.
At the time, I lived at the top of so-called “Pill Hill” in San Francisco’s Tenderloin district, when a five-minute walk down Hyde Street toward Market would usually involve hearing several offers for ‘OC-80s’ or ‘roxies’ from people selling pills on the sidewalk. Back then, before one of the biggest manufacturers swapped formulas to create literally harder and harder to abuse pills (driving street prices up, and many users toward cheaper Fentanyl and heroin), those powerful painkillers could be purchased around the country for $0.50 a milligram or less.
Some items for sale were acquired fraudulently or through theft, while others were gathered from people whose older family members received too many pills but not enough income or care — part of an unintended ecosystem for prescription drugs that researchers call “diversion.” Users could swallow the pills or — more commonly, to maximize effect — grind them up and snort, smoke or inject them.
Within months, and for the next two and a half years, I was addicted to oxycodone. At first, small doses made for a long, pain-free evening, and then for a productive day’s hustle between graduate school classes and my two-to-three jobs. After a year, my multiple paychecks, curiously generous student loan payouts and credit card limit were strained by trips to ‘regular’ or ‘backup’ dealers in the Tenderloin or Hunter’s Point.
After two years, my performance at work and school had plunged, even when growing street shortages hadn’t left me sweating, aching and unable to show up. I didn’t tell my family and friends about the debt I’d amassed, nor the Fentanyl-and-heroin mixture known as “gunpowder” that was increasingly being offered in lieu of ever-rarer pills (now $1 or more per milligram on the street), nor that my period had stopped coming every month, then at all.
They were surprised, then, when I announced I’d be selling my car, quitting my jobs, and moving three weeks later to Brooklyn, where — after a last-minute, last-resort visit with a friend there — I decided I could possibly find happiness, but not opioids. So in July of 2012, a year when U.S. doctors prescribed enough opioids to give every adult a bottle, I picked up and left.
Recovery Is A Toll Road
I was incredibly fortunate to have this opportunity, and the odds were in my favor. I am white, with no arrest record. I had access to a great education, and have consistently found at least some work since I was 15. I didn’t have children or a spouse to consider, but did have family who could loan me a month’s rent, as when my paychecks from a 2013 adjunct gig ran two-to-three months late. These privileges couldn’t prevent my pain or addiction, but they soften every blow, and give me many chances to recover in life.
As one of millions of Americans with substance abuse disorders involving prescription painkillers, I was also fortunate to avoid becoming one of nearly a million who abuse heroin. According to the American Society of Addiction Medicine, four in five new heroin users started out abusing some kind of prescription pain medication, though experts are still debating the exact link [PDF]; during my years of addiction, I witnessed several such transitions.
Nor did I become one of tens of thousands of people who fatally overdose on prescription opioids and heroin each year, helping to make drug overdose our country’s leading cause of accidental death — in most states, with a death toll exceeding that of car accidents — even as opioid overdose and addiction rates for women ballooned around me.
If I had needed medical attention for overdose or addiction back in the Bay Area, its multiple hospitals, city services and nationally higher wages would likely have made my way forward easier than many rural users could expect. I had insurance, and was never pressed for answers by doctors or police or forced to take drug tests for my income.
I could also access and afford medically assisted treatment drugs “off the books” (a choice I don’t endorse), being fearful that having opioid abuse in my medical history would make getting treatment for pain more of a challenge later on. Before leaving California, I bought rehabilitative Suboxone at higher-than-pharmacy prices from a person who had previously sold Oxycontin to support his own habit, and now sold black-market “Subs” to support this new habit. He went missing some months later.
I tapered off with two 8mg sublingual tablets I’d bought from him, and a month later, I was living in Bed-Stuy and opioid-free just as news coverage of the epidemic had begun to bloom. I was 26 and uninsured, with no job, little money and most of a Master’s. I was also ashamed, still depressed, and getting frequent blocked calls from creditors.
During my first year, I found just enough work to live, and started piecing myself together. I got my period back, and realized my teeth needed maintenance. Occasional cannabis offered some moments of peace, pain relief and perspective, as it usually has for me, but it was expensive, inexact and hard to come by.
By my second year in Brooklyn, I was drinking every day to cope with my brain’s default mournfulness, as well as the psychological and neurochemical effects of recent drug addiction. The cycle of choosing between food, transit and laundry between paychecks wore on.
Back in California, things had been changing quickly, too. The increasingly publicized opioid epidemic still gripped the Bay Area, but medicinal marijuana prescribers and dispensaries were now in full swing. Trips home allowed me to explore the plant’s therapeutic possibilities like never before.
Suddenly, there were multiple well-labelled blends and formats to select from in clean, well-lit places; there were doctors and “budtenders” to recommend items for easing patients’ anxiety, or head/menstrual/back pain, or to help us laugh, or eat. I visited, and stayed a while, when I could.
And then I signed up for a Medicaid managed plan.
When I got sick, or fell and bruised my ribs, or needed a referral to a nearby hospital, I no longer had to forgo bus fare or groceries to pay for brief clinic visits and any prescriptions I needed. I started getting my teeth fixed.
I also sought psychiatric help, and was diagnosed with dysthymia — a form of long-term depression that no previous doctor had mentioned — and received fairly common medication that I couldn’t have afforded on my own.
For the first time in my life, I started feeling better in a lasting way, allowing me to deal with terrifying calls from creditors, address my Master’s exit exam, and get through an afternoon of chores without sinking into darkness.
And then, thanks to a hookup from a friend, I did something I’d expected even less: I became a writer.
A Search For Answers Turns Up Schwag
I’ve been close to heroin, and I’ve seen what it’s done to people’s lives … I’ve seen it kill people. But it’s a human thing: some people just have to do things like that to survive, and sometimes it gets them. – Neil Young
Being a writer has given me unprecedented joy and purpose by letting me earn my keep (if only just) by learning about interesting, impactful topics and discussing them. Happily, it has also let me use my new-found energy to investigate many things that I’ve tried to understand for nearly 15 years about medicine, the mind and myself.
For example, when I came across ergotamine, the only non-opioid drug that’s ever helped with my migraines, and finally found a U.S.- and Medicaid-approved version of it, I got to explore why that particular formulation of a more than 4000-year-old medicine derived from mold was costing Medicaid $40,000 a year for my periodic treatment alone — several times the amount I earned per year while qualifying for that government program.
After six months of research, I determined that very careful patents around the medicine’s finicky spray nozzle and water content seemed to account for the 11,600% markup from the drug’s raw import price. I shared my discovery about such common pharmaceutical practices with online audiences, and now, to save all of us money, I buy the drug myself in pill form outside the country, when I’m there, for about $0.25 a dose.
I’ve also tracked the opioid epidemic, which I’d personally exited just as the news took hold. I learned veterans are one of the hardest-hit groups, having received opioid medicine for everything from post-casualty pain to PTSD, in some cases, statistics show. For some patients, such heavy painkillers may even make their health problems worse.
I found reports that opioid marketers, prescribing doctors and manufacturers were frequently facing scrutiny for their statements and practices around those drugs, but with little apparent on-the-ground effect. Meanwhile, programs that have been shown to curb the consequences of opioid abuse seemed to mostly end up spurned by lawmakers.
I discovered, too, that scientists have increasingly recognized cannabis but also mushrooms, ketamine, MDMA and other “recreational” drugs as important sources of physical and/or emotional relief for many serious conditions, from PTSD and depression to Alzheimer’s, cancer and M.S. In some cases, these therapeutic effects were ones that I’d witnessed in myself and those close to me since adolescence, often aligning with historical and “folk” use, but which I’d been too embarrassed or (especially pre-broadband) uninformed to accept.
I also learned that studies have shown these ‘soft’ drugs have a minute risk of overdose when taken by themselves. Generic painkillers such as ibuprofen and other NSAIDs, meanwhile, which are sold over the counter, cause tens of thousands of U.S. hospitalizations per year, and thousands of deaths, though exact estimates tend to vary.
I learned more about the legal history of many such recreational drugs and plants, from their political, racist early prohibition (a reason to say “cannabis,” not “marijuana”) to their seemingly inexplicable continued rejection today — especially so in light of evidence that medicinal cannabis laws reduce arrest, lead to a stark drop in opioid overdose deaths and can offer pain-sufferers a cheaper, safer, broadly preferred alternative.
As a group, Americans show they’re increasingly aware of legal cannabis’ potential benefits for health, opioid abuse, crime reduction and the economy, and are ready to dig in. But despite the findings of many such polls and studies, our federal government keeps targeting cannabis as grounds for incarceration, and re-launching counter-productive legal crack downs, rather than medical research.
Current federal leaders have said repeatedly that cannabis is not a medicinal substance at all, just as members of many administrations did before them. In doing so, it seems, they chose to reject the clear definitions and determinations that have been agreed upon by a majority of medical experts and regular citizens in the U.S. and a growing number of nations around the world.
At the same time, the U.S. assigns more favorable legal status to around 50 different opioids than it does to cannabis or psilocybin mushrooms, all but a handful of which are manufactured prescription drugs (think “opium poppy straw”; heroin, originally a prescription drug, has been retired). As of last year, the U.S.was also producing more opioid prescriptions than it has residents. And according to recent statistics, another American dies from opioid abuse every 10 minutes.
In the past few years, I’ve also had particular opportunity as a business writer to explore the costs of such policies, and to bring those numbers to light.
I found that cannabis — which currently costs the country billions per year in arrests and incarceration (not counting the cost of lives lost to opioid addiction or other treatable illness), and remains unavailable to millions of patients who need it, including family and friends of mine — stands to deflate the patent-prone pharmaceutical industry by at least $4 billion per year, according to estimates.
I discovered that comparatively cheap programs like syringe exchanges, low- or no-cost medication-assisted treatment and safer injection sites (a.k.a. supervised consumption spaces) have been shown to reduce public disorder, save lives and bring down the cost burden for police and hospitals.
And that the cost of the decades-old drug Naloxone, which reverses overdose, has risen right alongside opioid abuse.
I also found it should be far cheaper for taxpayers to house and care for the homeless than to force them to cycle between streets and emergency rooms, and give coverage to the uninsured rather than drive them into debt. Studies overwhelmingly suggest, too, that our country could save untold billions by providing low- or no-cost birth control and teen pregnancy prevention programs to women facing strained motherhood, employment limitations and frequently Medicaid-paid births.
On the whole, I’ve determined, human suffering is very expensive to society.
Unlike most basic human services, or cannabis (even with the necessary R&D), it seems. Or, if administered properly, Medicaid: a 1965 program established for low-income Americans, as an investment in all Americans, which recipients broadly seem to adore — but which, time and again, politicians threaten to gut.
When Silence Speaks Volumes, Every Raised Voice Counts
Since I ended my addiction and started over, I’ve grown stronger thanks in very large part to the generally low-cost, standard care I’ve gotten through Medicaid. Like many who rely on it to become healthy, productive citizens again after abusing drugs, I’ve been able to get treatment for the lifelong depression and physical pain that led me to opioid addiction in the first place. When I received codeine for a recent ailment, I used it sparingly and threw out the rest.
As a result of free and low-cost care, I’m now more capable than ever of participating in and contributing to our genuinely tricky society — whether by examining its strides and missteps, buying ever more stuff or by earning enough (if only just) that I no longer qualify for Medicaid, and may have to consider scaling back or ending my modest care regimen.
In the past five years, I have also been lucky enough to experience plenty of relief from using cannabis — a drug which, though I’ve known it nearly half my life, continues to be functionally illegal and highly punished (if very popular) where I live. The result of this, and the fact that New York’s medical marijuana program is highly restrictive and insurance incompatible, is that most cannabis in the state is still expensive and inexact, making self-treatment of any kind even more difficult. As long as it’s on the illicit market, it can also end up in the hands of minors whose brains and judgment aren’t ready yet, and constantly puts young people of color in jail.
So, as I prepare to face some hugely uncertain markets ahead, I find myself reflecting on the enormous impact that Medicaid has had on my life — namely, in allowing me to finally live it — and how, for the majority of Americans who’ll rely on Medicaid at some point in their lifetimes and taxpayers as a whole, it works so well (I’d buy in). I find myself thinking and talking about how far the U.S. has come on cannabis, too, and how much further we should’ve gone by now.
As I watch our electeds play Russian roulette with our health over in Washington and in state houses, I’m also driven to consider how such daunting ideas — like the fact that cheap, effective care is and may increasingly be denied to millions of my neighbors for the seeming sake of corporate gains — used to affect me when I wasn’t as well.
During my decade or so of young adulthood before I got treatment for depression and pain, such grim thoughts could deeply sadden, discourage or immobilize me. Now, thanks to the self-sufficiency and footing I’ve built on Medicaid, these facts just make me angry, and determined to channel it into change.
And the only way to ignite change, of course, is by clearly identifying the problems at hand, and demanding certain answers:
It is a problem belying our country’s best values that the needs and opinions of millions of Americans suffering in illness, poverty, unemployment and incarceration go ignored, regarding both the road ahead and threats to extant programs and laws that are shown to improve health and quality of life.
It is a problem all but precluding our right to life, liberty and the pursuit of happiness that the vast majority of us are effectively given neither sight nor agency in a market which fundamentally corners our basic needs and funnels wealth upward to a small few who, as a group, knowingly profit from pointlessly restrictive patents, or destructive environmental policies, or cannabis prohibition, which has rampantly served to criminalize communities of color for generations.
But perhaps the biggest, most profound American drug problem of all — that is, the most cruel and self-enforcing condition that our basically well-meaning population has always had to endure — is that our country’s highest elected officials, whose well-better–than-average incomes and medical care come from workers‘ tax dollars, are broadly aware of this structured, unimaginably wasteful human suffering.
Therefore, I must finally ask members of ‘both’ parties one question regarding their actions in these areas (ideally, in the snidest tones imaginable):
Not cannabis, I’d wager — a decision which, given the evidence, your voters’ stated positions and your behavior, you might do well to rethink.
Americans are sick of dying in the ‘war on drugs,’ and we will stand on the right side of history with or without you. Cannabis will no longer be a government tool for enslaving and oppressing people of color, nor for foisting pain and undue cost upon us all.
So, please consider this not my open letter on the matter, but rather an open, standing invitation.