The opioid epidemic in the United States has progressively gotten deadlier over the past 3 years. Now, in 2018, we are well informed and not so naive as to believe these deaths fit into the stereo typical category of an addict who is a lost cause.

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So, who are these people and how did they get here? There is an unwarranted and unjust stigma around these deaths which we want to challenge. By identifying the people, giving them names, social statuses, highlighting the familiarity of their lives to ours, we begin to understand, and even relate. Breaking down the steps that lead to their crisis, and focusing on the factors that helped them overcome it - we asked the humans of our community to tell us how society and the healthcare ecosystem is helping us tackle this anything but humane issue.

This is part one of a two part blog series - this week we meet Jessica Moss, a University graduate, a former addict who now works directly in the addiction environment at Clear Recovery Center in LA helping others like herself achieve sobriety.

To Hell and Back: My Journey with Opiates By Jessica Moss

I was in my first year of Graduate School at the University of Washington when I injured myself in a movement class. I herniated a disc in my lower back and was in extreme pain. L5. I had five years of sobriety under my belt, attended AA meetings, had worked the 12-steps of Alcoholics Anonymous and thought I had a strong and lasting foundation of sobriety. When I was offered opiates and muscle relaxants for my back, I thought I would be fine.

I was prescribed Vicodin for the pain and Valium for the inflammation. I neglected to tell the Doctor that I was a recovering addict and alcoholic, my first mistake. I picked up my prescriptions at the school pharmacy and took the first dose. Immediately I felt different. The pills triggered that odd mental switch and the physical craving that are unique to drug addicts and alcoholics. Once the pills were in my system, the foundation of sobriety I had built disintegrated. I was an addict experiencing pain relief and wanting more.
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Painkillers were never my drug of choice, I had struggled in the past with alcohol and other forms of drugs, but never painkillers. They made me nauseous, itchy and tired. But before long I was abusing the Vicodin and Valium and eventually that led to Oxycontin. I started to hide my pills around the house so my fiancé wouldn’t know how much I was taking. I took more than prescribed. Then I began to buy Adderall from friends so I could get high on my pain medication and stay awake for school. I started to manipulate and lie to doctors so I could get prescribed more and more. I was taking up to 20 pills a day to function. It was only a matter of time before I started drinking again. Just like that five years of sobriety went down the tubes.

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Opiate addiction is an epidemic in the country. According to the National Institute on Drug Abuse, more than 115 people in the United States die after overdosing on opioids a day. The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement.

The Ultimate High

I will never forget the feeling of Oxycontin and Morphine. I went to the hospital over five times in a year to get my fix of morphine and Oxycontin. Trip after trip to the hospital for odd injuries like kidney infections, torn PCL’s, herniated discs that would not seem to heal. I remember lying on the hospital bed awaiting that injection and as soon as the morphine hit I felt like an angel, like I could truly fly. There is no better feeling in the world so much so that I sold all my furniture, spent all my savings and student loans, sold my soul and integrity all to chase that feeling.

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Recovery

It is not suggested to detox from opiates on your own. One opiate abuser stated that he would never forget being a grown man and lying on the floor of a rehab crying for someone to put him out of his misery because his withdrawal was so painful and severe from opiates. I recently have watched a friend detox from heroin writhing around on the floor, crying for days, sweating, vomiting, kicking at the air as she withdraws.

When I began my journey into treatment I put myself in a detox because I knew I wasn’t strong enough to endure the pain and agony of withdrawing, I also knew that I needed to be with a medical team that would hold my medication because I cannot be trusted with administering any type of medication, even Bendaryl by myself. Once an addict always an addict. I went into detox for five days and was given a mixture of vitamins, supplements, and low doses of benzodiazepines. I was able to detox in a comfortable way but I was tapered off so that I wouldn’t get addicted to the Ativan they were giving me. I did not want Suboxone or Methodone. That would have prolonged the addiction process for me. The people that were on Suboxone and Methadone ended up leaving detox and getting high the day they got out.

The detoxification process from opiates usually begins with tapering off. It is best to do this in a nurse assisted facility because opioid withdrawal can be very uncomfortable and unpleasant. It is not until someone can detox from the substances they are physically addicted to before they can begin significant treatment and abstain from future drug abuse.

When I reflect back on my life 1 year ago I am in awe. I was about to be evicted from my one bedroom Seattle apartment for the third time. I was sleeping on the floor because I had sold my bed to get money for drugs. I had $6,000 in parking tickets and two dents in my car. I was in massive debt and unable to hold down a job. My relationship with my family was beyond disastrous and seemed irreconcilable. I had untreated sexual trauma as a result of my drinking and drug use. I was unreliable and irresponsible and thought the world was out to get me. I was a burden to everyone around me and I hated myself. I thought my life was over before I boarded that plane and today I have a life that is beyond my wildest dreams and that is thanks to Clear Recovery Center and Clarity House for placing their faith in me and giving me a chance to become the woman who I have always wanted to be.

Advocates for change

In October 2017, President Donald Trump declared the country's opioid crisis a "public health emergency’’, numerous government officials, policy advocates and healthcare experts have asserted their positions and focused resources into prevention and treatment solutions.

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The Vermont Hub & Spoke model is a system providing Medication Assisted Treatment, supporting people in recovery from opioid use disorder. Medication Assisted Treatment (MAT) uses medication such as methadone and buprenorphine, as part of a comprehensive treatment program that also includes psychosocial adjustment and counselling. Medication Assisted Treatment is not the only treatment for opioid use disorder, but it is the most effective treatment for most people.

From Massachusetts General Hospital, experts such as Dr Sarah Wakeman have shed enormous light on the issue through her blogs and is driving major change through her work as Medical Director of the Substance Use Disorders Initiative. Boston Medical Center’s, Michael Botticelli advocated to expand the usage of naloxone, improved education for providers around prescription painkillers and provided clean syringes for injection drug users to limit the spread of HIV and Hepatitis. Botticelli criticized the nation's previous approach to dealing with drug issues stating that "We can't arrest and incarcerate addiction out of people". He believes the focus should be on treatment rather than incarceration. Addiction is a disease, and not a crime.

We know there are many more unsung heroes who are making small to mammoth contributions to help tackle the problem we are faced with. Next week, the Physician weighs in on his experience with patients like Jessica and how doctors have a responsibility to educate themselves and ask more questions before prescribing opioids. Watch this space for Scott G. Weiner, MD, MPH, Dept of Emergency Medicine, Brigham and Women’s Hospital.