From Pain Pills to Heroin, Understanding Opioid Addiction
The Centers for Disease Control reports that overdoses from prescription opioid pain relievers are the driving factor in the 15-year increase in opioid addiction and death. In our series Facing Addition, 88.9 WCVE’s Charles Fishburne reports on one man whose 20-year addiction to opioids, started with a prescription.
David Rook’s 20-year struggle with opioid addiction began when he was very young.
David Rook: I was about, somewhere between 13 and 15 and I injured myself jumping on a trampoline. I went to a doctor, I was prescribed Vicodin.
Addiction often begins this way, according to Dr. Kirk Cumpston, Associate Professor in the Division of Toxicology of Emergency Medicine at VCU.
Dr. Kirk Cumpston: Pain is a large motivator for these people and so they want to get rid of the pain, they don’t want to have any pain and so they take the opioids to get rid of that.
Rook: I don’t think I was hooked at that point, I was definitely hooked on the feeling, but I didn’t go chasing the drug at that point. But every opportunity, from that point forward, that I could use to get pain pills, I did.
Cumpston: The emergency room is always open and you always have access to a physician that could prescribe you opioids.
Rook: Towards the end of that, you know, all my doctors were figuring out that I had game with them and that I was, you know, and I was kind of manipulating the system and as they cut me off that’s when I resorted to buying heroin. It was cheaper, it was easier, it was faster, no prescriptions, no monitoring, so it was a more simple way to get the high.
Rook says this was just the beginning.
Rook: I checked my values and my morals at the door at times to maintain my use. It boiled down to stealing. I’ve been convicted of felony larceny and felony possession of narcotics.
He said to stop was unbearable.
Rook: The physical addiction to it becomes so great that without it you become sick, flu-like symptoms, you know, vomiting, upset stomach, body aches, hot and cold chills, stuff like that. And with the mental obsession that comes along with that my brain just always told me use, use. It’s just like your brain tells your heart to beat or tells you to breathe, like me not using them, it was like trying to hold my breath, like my body was going to make me do it, my mind was going to use whatever it could to trick me into using.
When opioids travel through the bloodstream to the brain, the chemicals attach to specialized receptors called mu opioid receptors that trigger the same biochemical brain processes that reward people with feelings of pleasure that promote basic life functions, such as eating and sex. Whether taken to induce pleasure or to reduce pain, the body can develop a tolerance requiring more frequent or higher doses of the drug. Some users become physically dependent, others also become addicted. And for both categories, severe withdrawal symptoms can encourage continued use of the drug.
Yan Zhang: The more we learn, we feel like the more complicated it is.
Dr. Yan Zhang, Department of Medicinal Chemistry at the VCU School of Pharmacy is working under a $1.9 million dollar grant to study better ways to treat pain and to help ease withdrawal.
Zhang: We hope we can adopt an alternative so people try it out and see if we can come up with a new solution and hopefully, within a few years, we can actually see the highlights of this research and it can provide some alternative treatment for drug abuse addiction.
But Zhang says many things contribute to addiction and Dr. Cumpston agrees.
Cumpston: There are multiple factions that can contribute to addiction from past genetics in the family versus the environment that they are in.
Fishburne: What do you think?
Rook: I think there is some of all-of-the-above. I think with opiates, especially, it’s easy if you begin taking it for an injury… it’s easy to find yourself taking it for the drug. But there are those who can come off that, go through the illness and never use it again. Then, there are those of us who, whatever part of the brain it triggers, just can’t stop using, and I guess that is the true definition of a substance abuse disorder is when your brain takes over and just tells you that you just have to have it. But I think it is a culmination of things that play into it. It depends on your background, for some people socio-economic placement and then also genetics. Addiction has run in my family, not in the immediate generation, but before, my parent’s parents both had trouble with substance use.
For David Rook decades of addiction would reach a turning point March 6th, 2012.
Rook: I was arrested on a probation violation. I was put in jail. Stayed in for about six weeks. When I was released I was court-ordered to the McShin Foundation to complete six months here.
It changed his life. After detox, he was surrounded by people who understood and knew how to help him.
Rook: I just invested in my recovery. I used the same energy that my brain had told me I needed to chase drugs to chase recovery.
The Institute of Medicine says more than 100 million Americans suffer from chronic pain and calls for a “cultural transformation” in how Americans understand it and approach pain management.
Cumpston: People have pain. And so, that’s one of the most common presentations to an emergency department is pain, and physicians want to do what is best for their patients.
Dr. Kirk Cumpston was a member of a task force established by the Virginia Hospital and Healthcare Association’s Board of Directors, which just this year, examined ways to reduce opioid abuse, particularly as it related to emergency room practices.
Cumpston: The task force basically wanted to try and limit the amount of opioids that were prescribed, the duration that were prescribed, trying to prevent getting opioids from multiple providers.
Meanwhile, Yan Zhang has a message for young people tempted to try drugs recreationally.
Zhang: Don’t even try it. Because if you start it, from animal studies we found even one dose of heroin could induce withdrawal syndrome. And once that starts, you actually enter the fast cycle, and take on and on.
His son is 11 and he worries about today’s young people even as he works to find a better treatment for withdrawal.
And David Rook? Clean for four years now, is operations manager of the McShin Foundation Recovery program, where he was employee of the year. He’s been awarded Richmond City Jail’s “Beloved Volunteer of the Year” award, elected chairman of the board for the Virginia Association of Recovery Residences and even invited to the White House.
Rook: You know there are very cool things that have happened. You know, luncheon at the White House, being invited to receptions at the Governor’s Mansion and you know, getting placed on boards and things, that’s all great. But the true blessing of recovery is that I get to be a father, a son, a brother, a partner with my girlfriend, I get to participate in my kids’ life. I like the guy that I am looking at when I look in the mirror.
And, Dave Rook says he no longer goes to bed at night feeling worried or ashamed. And when he wakes up, he no longer feels sick. Charles Fishburne, WCVE News.