Editor’s note: This is part one of a two-part series on opioid addiction on the Kenai Peninsula. For the second part of the series, check the Sunday Jan. 3, 2015 edition of the Peninsula Clarion.
If he hadn’t fallen off a ladder, Tom’s life might have been completely different.
The fall led to a serious injury, and the serious injury led to the narcotic painkiller Vicodin. Before long, he was taking upward of 30 pills a day, using up the entire supply from his doctor suspiciously quickly. He started buying them from wherever he could, raking them in and spending nearly $9,000 each month on pills.
No one knew.
He held down a full-time job and made a good living. But the whole time, he knew the spending and the pills needed to stop. Then, two years ago, he started taking Suboxone. The drug is also a narcotic, but it’s used to treat both pain and addiction to other narcotic pain relievers.
“I stopped taking pills that day,” Tom said. “It saved me. I haven’t taken a Vicodin since.”
Tom has been taking the drug ever since, slowly whittling down the dose, and said he’s gearing up to quit. For the first time in years, he won’t be on anything at all, and he said he’s ready.
The December day he went to see Dr. Michael Merrick in Kenai, he was lucid and friendly, down to one small dose a day.
Merrick is one of a few doctors on the peninsula who treat patients addicted to opioids, sometimes called narcotics — Oxycontin, Vicodin and Percocet, among others. This includes heroin addiction.
Suboxone, a brand-name drug, is part Buprenorphine and part Naloxone, or Narcan, two generic chemical compounds.
When it hits the bloodstream, it mimics the effect of an opioid.
Some patients have been with him eight or nine years, a continuing management of their addiction. Some get off Suboxone quickly; some stay on for years. It depends on their personalities and how comfortable they are, he said.
“To me, it’s like any other disease,” Merrick said. “Like diabetes. I give you pills, we work on it, we manage it and we bring you down over time.”
In another room of Merrick’s practice in Kenai, a professionally dressed young woman waited patiently as the doctor wrote her a prescription for Buprenorphine. Alissa has been taking the pill, another drug to treat opioid addiction, for about seven years, and she’s also ready to quit. It will be the first time since she was 19 that she will not be taking some type of painkiller.
“Yes, I’m scared, but I think I’m ready to do it,” Alissa said. “I want to be off the pills by the end of 2016. That’s my goal.”
Alissa said the drug changed her life. But even though she’s being treated and fully functional, she said she is terrified of what would happen if anyone found out she was taking opioids, even in small doses.
She carefully orchestrates her doses so no one will know. She takes one early in the morning and then one before leaving work. She developed hobbies to keep herself away from falling back into the habit. She came to see Merrick on her lunch break. She said the only person who knows is her husband, and she wants to keep it that way.
A widespread problem
Heroin has drawn national attention in the past several years, but opioid addiction has been a consistent problem since the 1990s. Doctors were encouraged by pharmaceutical companies and professional medical associations to more aggressively treat chronic pain with opioids, and so many wrote prescriptions for high doses of painkillers.
Patients took the pills and gradually built up a tolerance, eventually becoming addicted to the high doses. Some patients also began lying and diverting the drugs onto the street for high prices. Dr. John Nels Anderson, a family practice doctor in Soldotna, said he knew of one patient who would collect the pills and sell them immediately, raking in about $7,000 per prescription.
“You hate that,” Anderson said. “We all know that we’re having some people who lie to us. You try to cut that down, you try to trust people until they prove otherwise.”
The medical community tried to rein in the problem by reducing the number of prescriptions. Gradually, the number of painkillers on the streets fell, but the addicts were still there. Many turned to heroin, which was cheap and easy to find. Many were young people who became addicted to painkillers they found in their parents’ medicine cabinets.
That’s how Anderson sees young women who are pregnant and addicted to heroin or other opiates.
“What we’d like to do is get all the moms off drugs, period,” Anderson said. “We try not to have any moms on heroin. If we have moms on heroin, we put them on Suboxone.”
For some patients, Suboxone is the best option. Buprenorphine, the drug Alissa takes, is a generic form of Suboxone. Some patients do better with Naltrexone, a monthly shot that blocks the effect of alcohol and opiates. Some patients do better with Methadone, but doctors can’t prescribe that — it’s only available in clinics. Methadone is used to treat moderate to severe pain but can also be used to treat narcotic drug addiction. In Alaska, the only Methadone clinics are in Fairbanks, Anchorage and Juneau, and spots are limited.
Stigma
The negative stigma that surrounds addicts poses challenges. Some doctors won’t treat them, and the public opinion toward addicts is decidedly negative.
An October 2014 study from the Johns Hopkins Bloomberg School of Public Health found a broad swathe of the population believes drug addiction to be “more of a moral failing than a medical condition.” Of 709 participants from various states, 22 percent said they would be willing to work closely with a person with a drug addiction, while 62 percent said they would be willing to work with someone with a mental illness.
Substance abuse is classified as a mental disorder in the Diagnostic Statistical Manual, the international guide for psychological conditions. Any substance that stimulates the reward system of the brain can be addictive. Merrick said he has many patients that have to take their drug of choice just “to feel human.”
It is possible to abuse Suboxone, Buprenorphine or Methadone, just like any other opioid. However, Suboxone is composed partly of Naloxone, which causes withdrawal if injected, which reduces the temptation to abuse it.
Merrick said that patients who want to abuse will abuse and patients who want to quit will quit. Abusing the drugs is a personal choice, and those who want to quit have to really commit to it, he said. He will keep working with a patient as long as they are willing to keep doing it, he said.
“Heroin is like cigarettes,” Merrick said. “It’s not that they don’t try. It’s that cigarettes are very available.”
Thomas said he’s been approached by people wanting to buy his Suboxone, but he’s always turned it down. The drugs cost about $7 for each dose without insurance, and he could make some significant cash. But he wants to quit, and says he doesn’t ever think about going back.
“I was toxic — it was horrible,” Thomas said. “I’m ready to stop taking Suboxone. I’m burnt out. I don’t want to take nothing no more.”
Alissa said one day, when she gets off the Buprenorphine for good, she wants to come forward with her story. She grew quiet when asked about doctors declining to treat patients for addiction.
“To me, that’s the saddest thing,” she said. “To know that they could help (addicts), but just don’t want to.”
Reach Elizabeth Earl at elizabeth.earl@peninsulaclarion.com.
Photo by Elizabeth Earl/Peninsula Clarion Dr. Sarah Spencer of the Ninilchik Community Clinic demonstrates using a naloxone pen, an overdose rescue medication. She instructs her patients and their families on how to use it in case of an emergency.
