Posts Tagged ‘opioids’

An Addict by Any Other Name, Please

Tuesday, June 4th, 2019

Addiction and Recovery

By Bob Gaydos

  What’s in a name? Maybe, recovery.

"New" me, at 73.

Bob Gaydos

Addiction — to opioids, alcohol, heroin, other substances or behavior — is a medically recognized disease, something for which treatment is available and prescribed so that the person who suffers from it can be returned as a contributing member of society. That’s the official, appropriately concerned line put forth by government agencies, the medical community and those who work in the field.

    Unofficially, which is to say, to much of society including members of the aforementioned groups, a person with the disease of addiction is commonly referred to as an addict. A drunk. A junkie. A cokehead or crackhead. An alkie. A pothead. A pill-popper. He or she is often regarded as someone who is weak-willed, immoral, untrustworthy, rather than someone suffering from a disease. A liar. A loser. Someone not worth the time or effort — or money — to associate with, never mind help.

   One of the major obstacles to persons seeking treatment for addiction is the stigma attached to the disease. It has been framed seemingly forever as a moral issue, a crime issue. Rarely — only recently — has it been framed as a health issue. We have waged a war on drugs as we tried to cure cancer or diabetes.

    Words matter.

    Researchers at the University of Pennsylvania lbast year released a study with the key recommendation to stop using the words “addict,” “alcoholic” and “substance abuser.” The study found the words carry a strong negative bias. Basically, the researchers said, they label the person, not the disease. Study participants not only displayed a reluctance to associate with persons described with those words in fictional vignettes, the researchers said participants also displayed “implicit bias” to the terms themselves when given a word-association task. They were subconsciously reacting negatively to the words.bbb

     If just the words can stir negative bias in people, imagine what an actual person carrying the label “addict” can arouse.

     The Penn researchers said their study was consistent with previous research that found some doctors, even mental health professionals, less willing to help patients who were labeled “addicts” or “substance abusers.”

     The researchers did not discount the fact that conscious bias against persons with addiction — for example, how involved one would want to be with the person described — is often based on personal negative experiences with “alcoholics” or “addicts.”  Family members, friends, co-workers have experienced pain and suffering from their connection to persons with alcohol or substance use disorders and a resistance to not just “calling them what they are” may be understandable.

      But, the researchers said, over time, adopting what they call person-first language (referring to a person with a heroin addiction rather than a heroin addict) — especially by public officials and the media — could help reduce the negative bias and stigma that keeps people from seeking and getting help for their disease.

       In 2017, prior to this study, the Associated Press, which publishes a style guide used by most news organizations, adopted a new policy on reporting on addiction. It recommends that news organizations avoid terms such as “addict” and “alcoholic” in favor of person-first language — someone with an alcohol or substance use disorder or someone who was using opioids addictively, rather than a substance abuser or former addict. Someone in recovery, rather than someone who is “clean.” Shift the blame from the person to the disease.

     This doesn’t excuse or absolve the person who is addicted from any damage he or she may have done, and it may be considerable. But it does provide an identity beyond the addiction and makes the road to recovery more navigable.

     Earlier this year, the Philadelphia Inquirer and Daily News adopted a policy similar to AP’s.

      The concept is simple: A person should not be defined solely by his or her disease. When mental health professionals stopped referring to patients as schizophrenics, society started referring to people with schizophrenia. Similarly, there are people with diabetes today who once were labeled diabetics. It is often argued that alcoholism or addiction are different from other diseases because the person chooses to use the substance. But experience tells us no one chooses to become addicted and the nature of the disease is being unable to stop — or at least feeling that stopping is not possible. Negative labels can’t help.

       Government agencies have begun using the new language, referring to persons with alcohol use or substance use disorders rather then alcoholics or addicts. Some who have managed to face their addiction and overcome it have abandoned the anonymity of 12-step programs and identify themselves publicly as persons in recovery. The opioid crisis has spawned a program called Hope Not Handcuffs, which steers the person who is addicted to treatment rather than incarceration.

       An exception to the change in language is recognized for those who are in 12-Step programs who identify themselves as alcoholics or addicts at their meetings. These are people who don’t see the terms as negatives, but rather as an honest admission of a fact in their lives. Members of Alcoholics Anonymous have been saying, “My name is xxxx, and I’m an alcoholic” at meetings for nearly 84 years. It’s tradition. There’s no stigma attached, but rather a common bond that holds out the hope there is something beyond being labeled a “drunken bum” or “hopeless addict.”

      The groups recommending the language change say this is not merely “political correctness,” as some have said. Lives are obviously still being ravaged by addiction. If something has to change in approaching the disease, there is a growing feeling that how we talk about it might be a good place to start.

Bob Gaydos is a freelance writer.

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.