‘It’s the brain that has to be changed’

A glimpse into the world of opioid and substance addiction.

Matthew Kramer

Narcan has given police officers and other first responders some light in the dark, swirling mess of the opioid addiction epidemic. Narcan is a drug that can, when used early enough, revive a person who has overdosed on opioids. It’s been hailed as an actual miracle drug.

Addiction activists, however, caution against giving Narcan too much credit. “Narcan brings you back out of it, but often that doesn’t work except for right then, because you didn’t further treat them. If you revive them with Narcan and let them back out on the street, often they go out and get another bag. They’re mentally obsessed. It’s the brain that has to be changed,” said M, an Island woman who has been sober for almost four decades. She asked to remain anonymous for family reasons.

In a cafe on a dreary late winter morning, M sat with a cup of coffee and recounted how legal drugs ravaged her family. It’s a story that combines alcohol and drug abuse with a flawed system that her daughter exploited to maintain an even greater drug dependency and abuse.

Where it begins

“I think I should start with my drug use. For context, I was a senior in high school when J.F.K. was shot, and in health class, they told me that if I smoked marijuana, it would lead directly to heroin, and that only black jazz musicians did it. This was the experience that I started my drug use with,” said M. “So I thought. ‘OK, where can I find a black jazz musician?’ and ‘I’ll never do heroin.’ I went off to college, found marijuana, found black jazz musicians, and within a year or so, I was shooting heroin. So they might have been onto something.”

M wasn’t given reliable information in school, and that didn’t help her introduction to substances. “I think so much about it is education. When you give someone information, it has to be credible,” but, she admits, “I don’t know if that would have changed me.”

According to the Massachusetts Department of Health, 16 people have overdosed and died on Martha’s Vineyard from 2012 to 2016, and according to death certificate data from all six Island towns collected by the substance misuse subcommittee of the Dukes County Health Council, 20 people have died from alcohol-related causes from 2012 to 2016. The subcommittee also found that the proportion of substance abuse–related deaths on the Island more than tripled from 2010 to 2015, from 2.5 percent to 7.9 percent of deaths, and prior to 2014, alcohol contributed to 65 percent of substance misuse deaths; after 2014, it was found to only be 34 percent of substance misuse deaths. Addiction to drugs and alcohol is a serious problem on the Island, and its persistence is often misunderstood.

M came from a family with a history of alcoholism, but at the time, she said, “Little did I know that girls could be alcoholics. Nobody talked about it. It was funny if you saw somebody drunk. Kids were dying all the time, but it was for some other reason, not that they were drunk driving.”

In the ’70s, M moved to the Vineyard with her husband when she was pregnant with her first child. She recounted the lack of knowledge that doctors had surrounding alcohol use while pregnant. “I still had sort of stopped doing that stuff when I was pregnant,” she said, “but doctors said it was OK to have a beer — that it would make your milk come in. We had no idea. I pretty much drank throughout my pregnancy, not like a crazy person, but I drank and smoked and everything else, because it kept your weight down.” M had her daughter, and all was well for a while.

“In 1976, I went to a party,” she said, “and the next thing I knew I was lying on my living room floor with mud on my clothes, twigs in my hair, having no idea how I got there. I came to find out that I had been at the bars, fallen on my face — they continued giving me drinks. I drove. I climbed around the cliffs in East Chop, no recollection of that ever, I’ve never gotten it back.”

M stopped drinking after that night, but continued to smoke marijuana.

Since attending almost 40 years of Alcoholics Anonymous (AA) meetings, she said, “[Drinking is] all fun and games until one day you can’t. A lot of people can have a couple of drinks. OK, some people can’t, and you don’t know which you are until you’re like me and you wake up on your living room floor one morning. Alcoholics have blackouts. A blackout is not passing out. You’re still doing stuff, you’re driving, you’re dancing on the bar, you’re doing stuff, but you have no concept of it whatsoever. Nonalcoholics would just pass out if they drank too much. Alcoholics go into an alternative universe. If you have a blackout, trust me, you’re an alcoholic.”

There have been studies that looked into the correlation of blackouts and alcoholism dating back to the 1940s. A scientist named E.M. Jellinek found that blackouts were a strong indicator of alcoholism. Other surveys have found, however, that a little over half of undergraduate college students have experienced a blackout, while other statistics put the percentage of American adults with alcohol use disorder around 6.2 percent, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Blackouts are thought to be caused when blood alcohol content rises rapidly. The brain then has trouble bringing actions and events from short- to long-term memory storage. This is why people experiencing a blackout can hold a conversation, get into an argument, drive, or have intercourse, and have no memory of it the next day. It is also why people around them often do not realize that it is happening. In one study cited by a paper published by NIAAA, memories were found to fade 30 minutes after the event occurred.

“Alcoholism is a progressive, fatal disease,” said M. “It wants you dead. It has a personality and it will settle for you just being drunk and ruining all of your family members. Some people, like me, can bounce on the bottom for 10 years. I was at the level where most people would say ‘Holy crap.’ I was proud of the fact I could drink all of the other guys under the table. I drank 23 beers one night. I couldn’t drink 23 waters. Alcoholics do that; nobody in their right mind would do that. The disease of alcoholism goes on in your body whether you’re using or not. They’re saving you a place in line, and the line is moving. For me that’s enough — thank God — to scare me.”

Recovery

Sometimes it takes traumatic experiences for addicts to realize that they need to get sober. For M, it wasn’t the night she blacked out, but when an accident almost killed her and her child.

“I didn’t know not drinking and sober weren’t the same thing. I didn’t know you couldn’t be sober and high at the same time. It sounds so stupid, I know. So for four more years, I smoked pot like there was no tomorrow. I would wake up in the morning and roll an entire cigarette pack and smoke the entire thing. I coughed for three years. But in 1980, on Labor Day, I went into a local restaurant downtown with my little girl, who was 5. I go up to make myself a cup of coffee, and I’d probably had six or eight joints by then, it was about 1 in the afternoon, and they used to have glass coffee brewers instead of the stainless steel which they have now. I grabbed one and I broke it all over myself and all over my little girl. Her face peeled right off, her eyelids peeled right off. I took off my clothes and my entire torso peeled off. Just everything was a big bubble,” she said.

M and her daughter were airlifted to Boston, and in the burn unit until the end of September. When they were released, they returned to the Island, and M accepted that the accident was caused because she was high. “The friend who I’d always smoked with gave me a joint, and the next day I was smoking a pack of it again. I couldn’t believe it. How could this happen? I thought I had quit; I was three weeks without it. So I went to my first AA meeting, and I’ve been sober ever since,” she said.

Prescription abuse

M was able to break the cycle of her addiction and stay sober. However, her daughter, D, had troubles of her own, and doctors, like the ones that saved her life when she was 5, helped maintain her supply of drugs. It was the ’90s, before the databases that are now in place where doctors can check how many other doctors are prescribing drugs to their patients.

“Doctors began giving her drugs when she was 18 years old. I’m talking about it starting with Ritalin, and then it moved on to Wellbutrin. One time she overdosed and almost died with 13 legal prescriptions written by different doctors. They put her in a psych ward, and let her out with nine,” said M.

In the ’90s, there was also a mentality in the medical industry that doctors were not prescribing enough for pain. Dr. Charles Silberstein, a psychiatrist at Martha’s Vineyard Hospital, said, “It really is the cause of the opiate crisis. We were taught that we were undermedicating our patients who were in pain. I think it was 1996, Purdue Pharmaceuticals came out with Oxycontin, which is a long-acting opiate, and they really heavily marketed it to doctors. They said, ‘You’re undermedicating pain, and this is a safe drug because it’s long-acting. People aren’t going to get high from it.’ It was really pushed.” Sales for Oxycontin grew from $48 million when it first appeared on the market in 1996 to $1.1 billion four years later in 2000, according to a paper by Art Van Zee published in the American Journal of Public Health in 2009. According to the Los Angeles Times, Oxycontin sales were just below $2.5 billion in 2015, and steadily decreasing from a high of just over $3 billion in 2010, in part because of the attention it’s drawn in the opioid crisis.

D had been in and out of rehab since high school. Under most normal circumstances, doctors are the ones who heal people, but M attributes much of her daughter’s access to drugs to doctors, ultimately sustaining her addiction. “It’s hideous what [the doctors] did to my daughter,” M said. “I would plead with them over and over, I would go to the detoxes and say, You cannot give her drugs, and they would give her something. She would say, ‘This is supposed to help me.’”

“There was one doctor who came to the Island, and his schtick was that he would get people off of drugs. Great. He listened to me for an hour, and I told him pretty much what I just told you,” said M. “All was well. He said, ‘I hear you, we’ll do our best not to let her get any of this stuff.’ One night she was in our driveway, and it was probably three o’clock in the morning, and she was out in our driveway building a stone wall out of gravel. She was so high on what turned out to be Adderall. If you’re really unfocused, they give you that drug to help, and it works, but if you’re not, it’s speed. So she went to see that doctor and she was already speedy because she was getting it from a different doctor already. She had about 10 of them. She was going to all different doctors, getting what they thought was the only ’script.”

M went to the State Police to try and get the doctors’ medical licenses taken away. There were no grounds for revocation, because each doctor had acted within the law according to their medical license.

“If you follow the timeline of this story, everything that happened followed legitimate drugs from doctors,” said M. “Doctors get kickbacks for the drugs they prescribe. I’m sure they’re well-meaning somewhere, but they’re so uneducated, and it hasn’t happened to them. They don’t have dead or almost-dead people in their life.”

It’s a sobering reminder that doctors make mistakes too. “I think many doctors know what it’s like to get somebody hooked on a medication that destroys their lives,” said Dr. Silberstein. “It’s the opposite way that we want to think of ourselves as doctors. Most of us went into this field because we want to help people, and make a difference for the positive. It’s really frightening to realize that we’ve promoted an epidemic.”

The Martha’s Vineyard Hospital has a policy that controls and manages which drug representatives are allowed inside the building, and whom they’re allowed to interact with while there. “Say, for instance, there’s a new insulin on the market,” said director of pharmacy Dave Caron, “I think it’s great to have a drug rep in here to give me the lowdown on how it works, some literature to review, but what we don’t want to have happen is for them to leave that clinically focused meeting and go to doctors and say, ‘Oh, by the way, your pharmacy team at the hospital endorsed this, and it’s the best insulin known to mankind.’ That’s what we don’t want to have happen. We don’t limit access to pharmaceutical vendors; we manage it.”

The hospital doesn’t allow drug representatives to give healthcare practitioners samples of medications, and it also adheres to guidelines put out by the state in regards to drug representatives taking doctors out to lunch and other kinds of gifts. “We’ve gotten a reputation over the years that we just don’t do that,” said Mr. Caron. “We have a decision-making body at our hospital called the Pharmacy and Therapeutics Committee, and we review clinical information as it relates to the most appropriate choices of medication that go on our formulary.” Mr. Caron stressed that their top priority was patient care.

Pop culture can often romanticize drugs and promote an early start. For teenagers, M said, “Everything at your age should be sexy, everything at your age should be fun. We all had our turn, and it was a blast, and no one should ever take that away from you, but the drug thing is something else.That can end your life. It can end your life quickly. If it doesn’t end your life, then it takes down everyone that you love and gives them a miserable life.

In response to the opioid epidemic, doctors around the country have become more aware and cautious about prescriptions. Locally, the Martha’s Vineyard Hospital has worked to limit the effect of heavy marketing of drugs in the way Oxycontin was in the ’90s. There is more work to be done. Substance abuse and addiction isn’t going away, but with continued awareness, support, and policy changes, it can be cut back.