'Chasing the Dragon'
Oxycontin misuse on Maui, with an inside glimpse of one man's battle
January 18, 2007
It was my first Christmas party of the year and everyone was dressed to the nines. We all mingled, exchanging the familiar merrymaking pleasantries. Our attire and surroundings were festive, but the occasional strained conversation made it apparent that the holidays were an uncomfortable time for some.
As the night rolled on, the mixture of champagne and Christmas lights seemed to make things livelier. But despite the jovial turn, I couldn't help noticing my friend Jack. He appeared more restless than usual.
At one point, Jack—not his real name—grabbed my hand. "Dance with me!" he said. "Tomorrow is never promised." He turned up the music, twirled me around and closed his eyes while dancing like a mad man. I watched as Jack swayed back and forth, trying to immerse himself deeply in the music, reaching for a place only he knew. It wasn't until later that I understood the depth of what he was struggling with.
Later Jack disappeared. Walking around the party, I noticed a strange smell coming from one room. Entering, I saw Jack holding a lighter under a piece of tin foil while sucking in smoke from a small cylinder. "This is what we call chasing the dragon, girl," he said.
I watched as his eyelids got heavy and his speech slowed. "It's OxyContin," he said. "Some people would kill for this shit."
The U.S. Drug Enforcement Agency (DEA) considers OxyContin one of the most abused pharmaceutical drugs in Hawai`i. Rising demand has considerably hiked its street price. A single 80 mg pill can cost up to $20. Here on the islands it is reported that individuals usually get it through illegal sales from healthcare professionals and workers. "Doctor shopping"—obtaining a few different prescriptions from different doctors—is also popular.
"People often try to self-medicate," said Barbara Ann Keller, Maui Drug Court administrator. "People seem to be diagnosing themselves and then prescribing the medicine they think they need, making ourselves our own pharmacists. We can see these drugs on the television or in a magazine and then we can go to our doctor and tell him that we want it. We are actually telling our physicians now our own diagnosis. This is somewhat of the norm now; it is actually wild when you think about it."
Chief Tom Phillips of the Maui Police Department agreed that there is a problem here on Maui. "This has been around for awhile," he said. "We see that it is sometimes connected to other things such as meth, cocaine or alcohol. We also see a lot of heroin addicts using it. People are trying to change their prescriptions from five to 50 but in one way or another they are reported or getting caught."
According to Captain Gerald Matsunaga of the Maui PD's Vice Division, "It's not as big of a problem as our Ice epidemic but we do see the Ice heads using it as a downer or to sleep."
OxyContin is a strong narcotic similar to morphine. Sometimes it's referred to as Hillbilly heroin, OC's, Oxycoffins or Killers. Friends have told me they've snorted it, becoming dependent on its opiates. What's more, I had also lost an old crony to it last spring. He had injured his back on the job, overdosed and died in his sleep.
OxyContin is the trade name for the drug oxycodone hydrochloride, which is manufactured by Purdue Pharma. It was created to treat the chronic pain associated with serious back injuries as well as cancer. It's a controlled-release tablet known to provide symptomatic relief for up to 12 hours.
Because of this controlled-release formula, the drug was initially never considered a threat for abuse. Purdue Pharma designed it to be taken orally and swallowed whole, not snorted, injected or smoked. But once the controlled release mechanism is tampered with, lethal doses of oxycodone are released immediately causing a rush similar to heroin.
"The safety of the drug is based on taking the drug exactly as intended," says Deborah Leiderman, M.D., the director of the Food and Drug Administration's (FDA) controlled substance staff.
Today, the DEA classifies oxycodone as a Schedule II controlled substance. This "schedule" is based on the drug's potential for abuse. Once it acquires such a label, the drug enters a formal system requiring the manufacturer to provide security at the factory as well as regular reports to the DEA.
The U.S. Food and Drug Administration (FDA) now considers OxyContin to have a high probability of abuse. Other drugs with similar potential for abuse include morphine, codeine, Vicodin and Demerol. The FDA says long-term use of OxyContin can lead to addiction and that a large single dose can cause respiratory failure or a fatal drug overdose.
Last year the medical journal Pain Physician evaluated OxyContin misuse. In the review, titled "Prescription Drug Abuse: What is being done to address this New Drug Epidemic?" author Laxmaiah Manchikanti, MD found disconcerting results. From 1997 to 2004, according to Manchikanti, there was a 6,390 percent increase in sales of oxycodone, a 568 percent increase in the non-medical use of OxyContin and a 129 percent increase in opioid-related deaths not connected to heroin.
It gets worse. According to the White House Office of National Drug Control Policy, within the past year, 5.5 percent of high school sophomores reported using OxyContin. In addition, the office says most abusers tend to be over 30 years old, while young adult users aged 18-30 are a growing problem. The U.S. Substance Abuse & Mental Health Services Administration supports that claim, saying that "young adults aged 18-25 tended to have the highest rate of non-medical use in the past year."
Prescription drug addiction has also reached into the world of high-profile personalities. In 2003 talk-radio leviathan Rush Limbaugh famously admitted to being addicted to pain medication. His former housekeeper told the press that she would supply him with OxyContin, Lorcet and hydrocodone. "You know how this stuff works," he said in an email quoted in the New York Daily News, "the more you get used to it, the more it takes."
When I asked my pal Jack how he obtained his OxyContin supply, he said simply, "Oh, you know. A friend of a friend of a friend." He explained how one of his acquaintances would find a physician that would prescribe pills for various ailments such as "back problems, cramps, or anxiety" and that he would get his drugs from him.
"When I'm in a total void of despair and I can feel the weight of the world, it's like a warm hug from your mother that makes everything melt away," Jack said. "I don't have to keep crying inside. I know this is all delusional but somehow it helps me through it."
He told me that he had social anxieties and neurosis, "like everyone else," and that he used it to self-medicate.
I asked Jack to tell me what he normally felt like after coming down. "You pay for it the next day," he said. "I usually feel like I've been punched all over my whole body.
"It can eat at you, it can rob you," he continued. "It will rob you of your bankroll and relationships, of moments. You could be watching the most beautiful sunset in the world and all you can think about is getting your fix. It definitely imprisons you."
I watched my friend as he talked to me about this socially acceptable and easily accessible drug. I wondered whether he would make it through as I listened to his justifications.
"You know it's all geographical, I didn't use this until I moved here," he finally said. "I'm leaving and I'll stop. I'm just trying to feel comfortable about being alive. But then again, these are all just crack-head ways of rationalizing my choices." MTW
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