Posts Tagged ‘CDC’

Pill Mills: Prescription for a Tragic Loss

Wednesday, May 1st, 2013
My sister, Ann Bradford Morrison, 1952-2010

My sister, Ann Bradford Morrison, 1952-2010

By Emily Theroux

For me, May Day will forever be a yawning chasm of unmet expectations, a muffled cry for help I never heard.

On one side of the precipice is a younger me, stretching my arms across the open space, hoping not to fall over the brink. On the other side is my sister Ann at 21, barreling straight toward me in her sky-blue Jeep, her bags packed with elaborate stripper gowns and sequined G-strings. Tucked in a zippered side compartment of her make-up case are two pairs of false eyelashes and a vial of Valiums, her drug of choice for that particular decade.

I call her name, terrified she won’t stop in time. “Turn back!” I cry. “It’s never too late. You can start over.”

She waves at me, manic, artificially cheerful. Her mouth is moving but I can’t hear the words. Instead of stopping, she accelerates. I cover my eyes with my quaking hands, plagued by a tremor of kinship to her plight. I hear the screech of metal, but the anticipated crash never follows. Opening my eyes, I find myself in bed. I see the quilts, tangled from night sweats, thrashed to the floor. I must have been napping, just as I was the day the phone call came, three years ago today, from Tampa.

Once again, it’s Saturday, May 1, 2010, at 5:46 p.m., one agonizing moment trapped for eternity inside the cultured pearl ring that is Ann’s talisman, the one I thought I’d kept but can’t find anywhere. I awake from the dream of everything that might have been, but never from the nightmare. My sister is gone, her indefatigable life force reduced to an urn of ashes on my mantel. Whatever I once foolishly imagined was salvageable is lost to the brutal, inexorable forward slog of time.

 

A sudden death is always the hardest kind to comprehend, to assimilate. One day, I was on the phone, long-distance to Tampa, just as I had been three or four times a week since my sister had moved there from upstate New York six years earlier. The next day, the phone jangled again, jarring me awake.  I heard the  familiar voice of Ann’s partner, Paul, uttering three dreadful and unfathomable words: “Ann is dead.”

I couldn’t process it; I didn’t believe him, and I told him so. I had just talked to her, and everything was fine. She was writing her new novel, begun just two weeks earlier. She wasn’t suicidal and she wasn’t ill. She was only 57 years old.

Paul had very few details to impart to me. When he left for work that morning, Ann was awake and getting ready to begin her very circumscribed day. (Over the years, she had become agoraphobic and rarely left their small apartment. Most days, she sat in her recliner all day with her laptop and a glass of white wine, chain-smoking as she wrote.) Paul tried to call her several times throughout the day, but she never picked up. That was unlike her, and Paul grew worried, but he worked as a security guard and he couldn’t clock out early.

When he got home at 4:30, he found Ann in their bed, lifeless and very cold. The medical examiner was there, Paul was telling me. I could barely hear him for the dull roaring in my head, as if I were at Folly Beach again, where our Charleston cousins took us as children, holding a conch shell against my ear.

It appeared that Ann had died some time in the morning. The police had found half-empty pill bottles on her nightstand, but that wasn’t unusual. Ann spent the latter part of her life in chronic pain from herniated discs that developed years after she had competed as a bodybuilder.  Nothing in her life was done in half-measures. She “lifted heavy,” right along with the men, and had bulging muscles throughout her thirties.

Ann lived her life in an extreme fashion and paid dearly for her choices farther down the road.

 

We wouldn’t know for weeks exactly what had happened to her, not until the toxicology report arrived — although I already realized that if she hadn’t had a heart attack or an aneurysm (which I knew were unlikely because she was found in her bed, under the covers), it must have been the pain pills.

Ann’s body lay in the morgue that first night, awaiting autopsy. I couldn’t bear the thought of her in that place. She was two years younger than me. I was her protector, and often, her enabler; like my mother before me, I took her in when she had nowhere else to go. I couldn’t think rationally; what if she was lonely or afraid or needed a blanket?

It dawned on me that I would never talk to her again; I couldn’t ask her any of the unanswered questions that such a death inevitably leaves in its wake. I listened frantically to my voice mail; the only tangible remnant of her, if you can call it that, is the recording of a single pathetic call made late at night when she was so high, I couldn’t understand what she had been trying to tell me. She had needed me, and I wasn’t there to help her — neither that night nor the day she died.

When the medical examiner’s report finally arrived weeks later, the results were stark and unavoidable. Ann had died from a drug overdose — a combination of three prescription pain medications and a cough suppressant.  “Accident (prescription drug abuse)” was listed on the report as the manner of death.

My tragic, flawed, beautiful sister had attached four transparent, 50-microgram fentanyl patches to her skin at various points on her torso.

 

The sheer heft of the grief that followed, its ponderous weight on my chest — as if a powerful raptor were perched on my sternum, clutching my flesh, squeezing my lungs together — astounded me. There was simply no remedy for it, nowhere to flee.

But one thing gradually came into focus at the periphery of that pervasive fog: I needed to understand what combination of circumstances made it possible for my sister to procure a substance as potentially deadly as fentanyl, which I knew she’d never been prescribed before. A strong opioid originally developed as a surgical anesthetic, fentanyl is 100 times more potent than morphine and “very easy to overdose on,” according to a Toronto drug program coordinator, particularly when more than one patch at a time is used.

My sister had always been an expert manipulator. She started drinking straight vodka at 15, filching it at first from my parents’ liquor cabinet and later persuading an 18-year-old friend to buy it for her. She stowed the bottles in her bedroom closet with a hoard of  emergency “puke bags.”

Within a year, Ann graduated to street drugs — heading to Rochester’s Midtown Plaza in search of a dealer known as “Frog,” who was rumored to lurk in the mall’s underground parking garage. This punk-ass kid sold her an ample supply of “black beauties,” an amphetamine that had my erstwhile A-student sibling speeding her brains out for three days and then crashing for the next two, a devastating routine that caused Ann to flunk out of the eleventh grade and led my poor, clueless parents to surmise that she was “manic-depressive.”

By this time, Ann had also become a proficient “doctor shopper.” By 17, she could talk circles around a physician three times her age with a prescription pad in his hand. She consumed quantities of sedatives, speed, opioids, and muscle relaxants that would have flattened a horse.

Once, during an overnight hospitalization after Ann swallowed six Quaaludes, the emergency room doctors were astonished when she emerged from a coma they had predicted she wouldn’t survive. My mother, jaded by a decade of Ann’s escapades, shocked the chief resident when she deadpanned, “It’s the God’s honest truth: You couldn’t kill her.” Sadly, I believed from then on that Mama’s pronouncement must have been true — until the day it happened.

The fact that Ann stayed alive as long as she did, I realized later, was not so much a miracle as a one-off, an aberration, a fluke of cosmic proportions.

 

According to a November 2011 study of prescription painkiller overdose deaths released by the Centers for Diseases Control and Prevention, Ann ranked in every single parameter defining people most at risk for overdosing on opioids:

  • People who obtain multiple controlled substance prescriptions from multiple providers — a practice known as “doctor shopping”
  • People who take high daily dosages of prescription painkillers and those who misuse multiple abuse-prone prescription drugs
  • Low-income people and those living in rural areas
  • People on Medicaid (who are prescribed painkillers at twice the rate of non-Medicaid patients and are at six times the risk of prescription painkiller overdose)
  • People with mental illness and those with a history of substance abuse

The only endangered demographic that Ann didn’t belong to was rural residents.

 

I knew several months before Ann’s death that when the Medicaid doctor who prescribed her pain meds finally balked at her request for an increased dosage, Ann “fired” him and lit out for a local pain clinic. Earlier, she had continued to frequent the doctor while supplementing her “stash” with prescription painkillers supplied by illegal Internet “pharmacies,” which sold controlled substances to customers who lacked valid prescriptions.

Illicit “pain clinics” soon began to spring up, taking advantage of lax state regulations, particularly in and around Houston, Los Angeles and South Florida. Addicts and legitimate pain sufferers alike flocked to these locales to stock up on their scrips of choice, arriving by the busload. (Ann, I should add, was a card-carrying member of both groups; plagued by chronic, unrelenting back pain and unable to afford surgery, yet also hooked on the prescribed remedy for it.)

The Obama administration’s first National Drug Control Strategy for reducing drug use and its consequences, published in 2010, included initiatives to help states address doctor shopping and “pill mills,” drive illegal Internet pharmacies out of business, and crack down on “rogue pain clinics” that failed to follow appropriate prescription practices.

But coordinated efforts to root out the criminals, monitor addicts, and expand addiction treatment services came too late to help my sister. A year after she died, Florida state lawmakers finally passed legislation designed to derail “the Oxy Express.” By that time, according to state attorney general Pam Bondi, her state had become “the epicenter for pill mills in the nation, and prescription drug overdoses cost at least seven Floridians’ lives per day.” In 2012, two years after Ann’s death, the FDA targeted 4,100 illicit online pill vendors with criminal charges, seizure of illegal products, and removal of websites.

Ann slipped through the cracks — or, more accurately, the gaping fissures in prevailing drug policy. Even worse, I’ll never know who helped her do it. She didn’t tell me the name or location of the clinic, and Paul couldn’t remember it or find any record of it. I couldn’t track her former Medicaid doctor, either. Addicts are secretive people, and Ann took hers with her to oblivion.

 

Dredging up the details won’t bring my sister back, but who knows? Maybe persisting in my quest to find out what’s being done about the problem will some day avert this nightmare for some other tormented family.

Failing that, may it restore my dreams to flashbacks of a less complicated time, when Ann and I, at 4 and 6, lay on our backs in the grass and gave names to the shapes we perceived in the mobile cumulus clouds above us. When the sky was finally dark enough for stars, we watched them twinkle “on,” one at a time at first and then a gathering expanse of them, a canopy of gemstones against velvety blackness.

If there was some kind of order to it, a pattern of galaxies or constellations, our untutored eyes couldn’t discern it. Too young to fathom either limits or infinity, we settled for random bursts of wonder, daring to imagine that such a spectacular light show had been devised for our viewing pleasure alone.

Logic was not what we were looking for anyway; unfettered splendor was what we had in mind.