What I Learned About the Opioid Addiction Epidemic
By Perri Peltz
For the better part of a year and a half, I traveled the country filming a documentary about the deadly scourge of opioid addiction in America, a plague that kills, on average, 91 of our neighbors, our friends and our family members every single day.
I hope our work offers a glimpse of the worst ravages wrought by the worst drug addiction epidemic in American history. As we collected the heart-wrenching stories of those battling the disease of opioid addiction, it was a constant battle to quell our eagerness and hope for those who seemed as if they might triumph over it, and to keep our own alarm and grief at arm’s length for those who didn’t.
In all honesty, it has been one of the great honors to work with the families who are on the front lines of this crisis. Their courage and dedication are inspiring. Their willingness to expose themselves, to share their truly terrible personal tragedies, in the hopes that their stories might be both a cautionary tale and a call to action, inspires me. All of us who worked on this project learned a lot more than we bargained for from these addicts and their families.
In a way, I didn’t just learn who they are. I learned who we are.
These families taught us that in a crisis of this magnitude, the old distinctions — the false walls we build between journalists and their subjects and between the story and those who read it or see it — even the wall between so-called “good drugs” and “bad drugs” — are worse than irrelevant. Those imaginary distinctions are destructive.
Opioids — of any variety — are extremely powerful and highly addictive drugs. They are essential medicines for easing suffering at the end of life, and they can provide effective pain relief when prescribed short-term for severe pain from surgery or a serious accident. For some, they almost seem a godsend. But they carry an immense risk. Used for prolonged periods, they can even make pain worse — a phenomenon called hyperalgesia.
Despite the enormous public health price our nation is paying for the large increase in opioid prescribing, we are not doing a better job of treating pain. The Centers for Disease Control and Prevention is urging the medical community to treat chronic pain with non-opioid medications and with non-pharmacologic strategies. It’s not at all clear, however, that the CDC’s warning is being heeded.
Unfortunately, it is still far easier for a doctor to write a prescription for a powerful and potentially lethal opioid than it is to treat pain with safer and more effective approaches. And it is much easier to prescribe medications that can cause opioid addiction than it is to prescribe medications that can treat it. Strict federal rules require doctors to obtain a license to prescribe some of those drugs, and limit the number of patients they can treat.
And so, these families taught us, we all must remain vigilant.
Just because the doctor gives you a month’s supply doesn’t mean you should take the entire prescription. Dependence on these drugs can take hold in as little as a week and tolerance continues to build with time. In time, and without proper precautions, the same drug that gives respite from pain can consign the user to a lifetime of pain, or worse.
And make sure you get rid of your opioid pain medications when you are done with them. When I started this project I had about 10 bottles of prescription painkillers in my medicine cabinet. They were all leftovers from minor surgeries and dental procedures- and being someone who likes to hold onto things, I figured, “you never know” when pain may strike and the pills would come in handy.
These families taught me that that was a terrible idea. I now understand that people who are struggling with opioid addiction know to look in other people’s medicine cabinets.
We met a 40-year-old mom who would go into medicine cabinets while she was with her son on playdates, desperate to find something to ease withdrawal. People looking for opioids will go to real estate open houses, dinner parties and any other type of gathering, and look for the nearest medicine cabinet.
Time after time, we heard the same story — a loved one returns from rehab filled with hope and steadfast commitment to recovery. But individual brain circuitry has not had nearly enough time to recover, and cravings remain high. We met many families who reported that their loved one returned and overdosed within days of discharge because they had lost their high tolerance, built over a long time, but went straight back to a pre-rehab dose. Leaving rehab can be a major risk factor for overdose.
If you or a loved one becomes addicted and decides to go to rehab, consider asking the facility about medication-assisted treatment. That means using medication to help reduce cravings and painful withdrawal symptoms. Many rehab facilities have an ideological bias against treating addiction with medication. The CDC and National Institute on Drug Abuse stress that your best chance of recovery is with medications like buprenorphine and methadone; find a facility that believes in their use. It could mean the difference between life and death.
Naloxone, more often referred to as Narcan, is a lifesaver. It will rapidly reverse an opioid overdose. Recovery can be immediate. After being rescued with naloxone, severe cravings are common, so emergency medical attention is required. Brendan Cole’s mom told us that after he was revived with Narcan, “there was no plan in place” about what to do after an overdose, and it left him vulnerable to relapse. He overdosed and died about 12 hours later.
I didn’t know that prescription pain medications like OxyContin, Oxycodone, Vicodin and Percocet, just to name a few, are chemical cousins of another opioid, heroin, and they produce effects that are indistinguishable. And they can be devastating. They are all opioids.
It is a dangerous and deadly myth that drugs such as these are used recreationally, that there is some pleasure that the addicts get out of using them. Nothing, we learned, could be further from the truth. The addict craves these drugs to stave off the unimaginable pain of no longer having them.
Opioid addiction is a ravenous beast and because increasing tolerance requires an individual to take higher doses to stave off withdrawal, the addiction spiral can happen quickly. No one ever chooses to become an addict. But once addiction takes hold, life revolves around maintaining a supply of drugs to keep withdrawal at bay.
It is no overstatement that people with addiction are suffering from a chemically inflicted disease that attacks the brain and tortures the body.
But the single most important lesson that I learned from those who have survived this epidemic and those who are mourning the victims who have not survived, is that the false imaginary walls we build between ourselves and our addicted neighbors have contributed greatly both to the depth of the crisis and to its contours.
There’s a bitter irony in the fact that those false distinctions that we draw between ourselves and those we imagine to be different from us have spared some communities from suffering the worst of this epidemic. In fact, studies show that African Americans and Latinos have largely escaped the worst of the crisis. The reason why is disturbing. Studies show that doctors prescribe narcotics more cautiously to non-white patients. It would seem that racial stereotyping is having a protective effect on non-white populations. We are appropriately responding to this addiction epidemic with treatment and not jail. We should always respond to addiction epidemics in this way. It is the humane and appropriate response.
And finally, we learned that the distinctions we draw between the addict and ourselves are false and deadly. The notion that a subset of our population is prone to addiction and driven to abuse drugs is a myth. Opioid addiction can happen to anyone. With repeated use of a highly addictive drug, it is easy to become addicted. You don’t need to have an addiction problem in your family and you don’t have to be a drug abuser looking for a high — addiction can happen when taking pain medication as prescribed by a doctor.
It took me 18 months on the road, meeting and spending time with the families living on the front lines of this crisis, to fully understand that it wasn’t their stories I was telling. It’s ours. All of ours. And we still have it in our power to determine how that story ends.
Perri Peltz is a documentary filmmaker, journalist and public health advocate whose previous film was the HBO documentary Risky Drinking. Additionally, Perri directed Remembering the Artist Robert De Niro, Sr. and The Education of Dee Dee Ricks for HBO. She is a director with The Conversation Cooperative for New York Times/Op-Docs. Before becoming a filmmaker, Perri was a journalist with NBC, ABC and CNN. She currently hosts two radio shows for the Sirius-XM Network. Warning: This Drug May Kill You premiered on HBO on May 1, 2017.