Tomorrow I go home. Tyson said he got me a present, and then I asked what it was. It’s oxy. What is he thinking? Like yeah, I do want it and it will be fun … but after everything I said about wanting to get my life together, about wanting to stay sober, why would he tempt me like that? Does he really want to have that shit in my body? Does he want me to be sober or a drug addict?
—Sarah’s journal, January 10, 2007
The first time I took an opioid was when I was prescribed Vicodin following my surgical biopsy. I threw up for hours, a green foul bile that was thick and viscous. A bitter taste coated my tongue that I will forever associate with painkillers.
There is technically a distinction between opiates and opioids, or at least there used to be. Opiates are drugs derived from the opium poppy plant, like heroin. Opioids are drugs made in a lab using the same chemical structure as opiates and mimicking their effects, like oxycodone. The term opioid now refers to both. Opioids are typically used to treat pain but also produce a sense of well-being or euphoria. Opioids bind to and stimulate opioid receptors in the body. When they attach to the receptors, they can block pain signals your brain is sending to your body. They also release large amounts of dopamine, which can make a person feel relaxed, happy, and high.
Prescription opioids include codeine, hydrocodone (Vicodin), morphine, oxycodone (OxyContin, Percocet), hydromorphone (Dilaudid), and fentanyl. Sarah told me that when she first tried OxyContin, she didn’t know that it was akin to prescription heroin. It was just a pill that made her body feel good and her brain feel happy. She was fifteen when she first took oxy, and within a year she would be smoking it because it brought the high on more quickly.
What we now call the opioid crisis started in the 1980s, when several respected medical journals released articles that downplayed the negative and addictive aspects of prescribing opioids for chronic pain. In the 1990s the pharmaceutical industry (and in particular the company Purdue Pharma) took advantage of these claims and began aggressively marketing opioids, chiefly OxyContin.
Purdue Pharma pleaded guilty in 2007 to fraudulently misbranding OxyContin—the company had asserted that oxycodone was less addictive than other opioids on the market. Purdue had even persuaded the FDA to place a label on the packaging claiming that the delayed absorption of the pill was believed to reduce the likelihood of misuse. In 2001 this label was removed from the packaging, and no opioid has since received one.
Between 1996 and 2001, the number of OxyContin prescriptions in the United States grew from 300,000 to 6 million. Research says that 20 to 30 percent of chronic pain patients prescribed opiates will misuse them. About 80 percent of people who use heroin begin by first abusing prescription opioids.
Sarah turned to heroin because oxy was too expensive, and she was using too much to be able to afford it anymore. She liked heroin because it made her feel like nothing could touch her. She could disconnect from her bad feelings, the shame that gnawed at her, the lack of control she had in her day-to-day life. The original point, she told me, was to feel good. And then it became about not feeling bad, about avoiding the pain of withdrawal and the deep, unending depression that took over when she tried to get clean.
Various doctors have tried to prescribe me different opiates following other surgeries, but after a couple more times trying to take them with the same results, I began listing opiates as an allergy. Because of this, I have never smoked opium or tried heroin. Sarah did not have the same aversion.