The opioid crisis hits home. Mine.
Whenever I meet someone new at a social gathering, the question typically comes up within a few minutes of casual conversation: How many children do you have?
Until nine months ago, this innocent question had a simple answer. Now it triggers a rapid and painful mental calculation. I could say two. My daughter is in New York and my son is in Philadelphia.
That’s the easy answer, I suppose. But it doesn’t feel right. No, that doesn’t feel right at all.
Or I could say three. Yes, that feels better. Much better. But do I want to discomfort this person I just met? And how much do I really want to share?
Picture an NFL stadium holding a capacity crowd of 72,000.
That number, according to a preliminary estimate by the Centers for Disease Control and Prevention, is about how many Americans died last year from drug overdoses. An entire stadium full of people.
Our son Scott was one of those people. After a lengthy battle with opioid addiction, he suffered a fatal overdose Nov. 30.
It was a Thursday night. My wife, Ellen, and I were watching the Redskins-Cowboys game from our home in the suburbs of Washington, D.C.
Scott had been staying in a sober-living apartment complex in Dallas after spending time at an inpatient drug-treatment program outside the city. We hadn’t heard from him all afternoon or evening, which was unusual but not unprecedented.
I could tell that Ellen was growing concerned. Maybe Scott had scored a ticket to the big game, I said. Maybe he was somewhere in
the crowd we were watching on TV.
At halftime, my cellphone rang. An unfamiliar number from Texas. It was a psychiatrist from Scott’s treatment program.
Had I heard about Scott? Something in her voice made me suspect the worst, that this could be The Call every parent dreads. “Is he alive?” I asked. Hesitation. “No,” she replied. I shook my head sideways. Ellen screamed.
Scott was 31 years old.
No ‘magic conversation’
As a parent, your natural inclination is to fix your children’s problems or, better yet, teach them how to fix their problems themselves. And when the kids are little, you mostly can. But as they grow older, the problems get bigger and more complicated.
There’s no “magic conversation” that can keep adult children out of harm’s way or turn their lives around. There’s no bright, clear line between supportive and enabling.
I’m far from an authority on addiction. But I know the emotional and financial toll it can take on a family. Having lived through the nightmare and having talked to some of the leading experts in the field, I’ve learned a few things and formed a few opinions that might be helpful to others struggling to cope with this insidious, infuriating affliction:
No family is immune from the scourge of the opioid crisis. About 2 million people in America, from all walks of life, are addicted to opioids. The epidemic is evolving but not improving.
You can think of the epidemic as a tragedy in three acts. In the first act, drugmakers, distributors and doctors flooded the United States with prescription painkillers that were far more addictive than the manufacturers claimed. (We think Scott’s first exposure to opioids came during college when he was prescribed painkillers after an incision to remove his appendix became infected.)
In the second act, many people addicted to OxyContin and similar drugs switched to heroin, which was cheaper and gave a better high. In Act III, the pain pills and heroin were increasingly spiked with illicit fentanyls – powerful synthetic opioids manufactured mainly in China and Mexico. The lethality of these fentanyls explains why deaths involving opioids increased 16 percent last year, even as prescriptions for painkillers were going down.
Until about four decades ago, addiction was regarded as a character flaw or moral failing. The treatment for it – the AA, 12-step, Big Book model – grew up disconnected from the medical profession. Today, addiction is recognized as a chronic brain disorder marked by people losing control of their drug use and then losing control of their lives. They can’t stop using, despite the harmful consequences.
The roots of addiction can be biological (a genetic predisposition), psychological (self-medication for an underlying condition such as depression) or social (everyone around you is using). What makes addiction more pernicious than many other diseases, however, is that the patients actively conspire against, and constantly lie to, those who want to help them recover. The stigma and shame get in the way of honesty. And addicts don’t want anything or anybody to get between them and their drugs, their false best friends. If addiction is an illness, it should be treated like other illnesses. We don’t talk about letting heart patients or diabetics hit bottom before giving them treatment. Nor should we talk that way about people battling addiction. Yes, some addicts will tell you that finding themselves homeless, jobless, penniless or friendless is what prompted them to seek help or recover on their own. And yes, tough love can be necessary to get a drug abuser into treatment. The problem is, the bottom is recognizable only in hindsight. Particularly with so many fentanyl-laced drugs on the street, relapsing on opioids or dropping out of treatment needs to be regarded as a life-threatening emergency. Too often, hitting bottom means dead.
The Food and Drug Administration has approved three medications for opioid-use disorder: methadone, naltrexone and buprenorphine. Like any medical treatment, each has downsides. Heroin dealers lurk outside methadone clinics. You have to be off opioids for a week to start on naltrexone. Buprenorphine can be easily sold or diverted. But the evidence shows that MAT, combined with social support and counseling, is far more effective than talk therapy alone.
Medication-assisted treatment isn’t just substituting one drug for another. Without meds, people addicted to opioids have an 80 percent to 90 percent relapse rate a month after detox, according to Dr. Marc Fishman, medical director at Maryland Treatment Centers in Baltimore.
With meds, the relapse rate is more like 50 percent to 60 percent at six months. Long-acting injectables, available for naltrexone and buprenorphine, appear to hold considerable promise, because they don’t rely on the addicted person taking a pill or film each day. Unfortunately, in many places it’s still easier to get heroin than it is to get medication-assisted treatment. Only about one-quarter to one-third of treatment centers even offer MAT.
When Scott overdosed the first time and ended up in an emergency room in Austin, Texas, we were handed a piece of paper with the names and phone numbers of about three dozen detox and treatment centers. Reliable information about specific drug treatment programs and providers is hard to come by, but several useful guides can help families understand addiction, ask the right questions and find reputable treatment: The Partnership for Drug-Free Kids offers overviews of treatment options, how to find a provider and getting treatment for your child. (drugfree.org) The National Institute on Drug Abuse provides a research-based guide to treatment principles, with answers to frequently asked questions. (drugabuse.gov)
A free booklet for families, “What is Substance Abuse Treatment?”, is available from the Substance Abuse and Mental Health Services Administration. (samhsa. gov/find-help/national-helpline) The Hazelden Betty Ford Foundation lists “12 Questions to Ask Every Addiction Treatment Provider.” (hazelden.org)
The American Board of Preventive Medicine provides a physician look-up site, and the American Society of Addiction Medicine offers information about boardcertified addiction specialists and how to find one. (theapbm.org) No indication of which were any good. No indication of which were still in business or accepting new opioid patients. No indication of which took Scott’s insurance. No indication of which offered medication-assisted treatment. As a journalist, I’m trained to find credible information in a hurry. But I was overwhelmed.
The fact is, addiction treatment in the USA is in many ways the Wild West. There are some decent guides on how to pick a treatment center and what questions to ask. But there are no easy ways for people to navigate the system and get reliable, consumer-friendly information about specific programs and providers.
When you dig behind the flashy websites and implausibly high claims of success, you discover that some treatment programs are essentially scams set up to harvest the 30 days of treatment that many insurance policies cover. (Never mind that it takes at least several months to heal the addicted brain.) Some programs are run by recovering addicts who are well-meaning and have credibility with the patients but are unqualified to dispense medical advice. (Does being a cancer survivor qualify you to treat or cure cancer?)
Sometimes, an “accredited” program means little more than that the fire alarms work.
And sometimes, as we discovered, even the top treatment centers – those staffed by board-certified medical professionals who can prescribe medication and deploy other state-of-the-art techniques – are no guarantees of success.
A hole in our hearts
Two months before he died, Scott came home for the weekend. Sunday was a beautiful autumn day. Scott went to visit his grandmother in the nursing home and spent quality time with Duncan, the aging cockapoo he loved like a brother. We bought a laptop computer to celebrate his five months of sobriety and to help him find a better job.
That afternoon, Scott and I played golf. He drove the ball long and straight. He beat me by a stroke on the last hole and I lost $5 to him, and I was fine with that. We went to dinner at one of his favorite restaurants, with one of his best friends from growing up. Then we came home and watched the season premiere of "Curb Your Enthusiasm" and we all laughed together.
On that perfect day, we dared to imagine a happy ending to Scott’s troubles. But it was not to be. Addiction is cruel. As one therapist put it to us, it hijacks your brain. The longer you are clean, the more your tolerance changes. If you relapse, a dose you used to be able to handle can be fatal.
Scott’s death left a hole in our hearts and a void in our lives. Our family will never be the same. The stages of grief aren’t a linear progression, and we’re still going through a sort of parental PTSD.
Last month, instead of celebrating with Scott on his birthday (Aug. 8), we participated in International Overdose Awareness Day (Aug. 31). Later this month, we’ll be back at the cemetery, unveiling his headstone.
How many children do we have? The answer is three. We’ll always have three. One of them is no longer with us.
Bill Sternberg is the editor of the USA TODAY editorial page. Follow him on Twitter: @bsternbe Editor's note: USA TODAY Editorial Page Editor Bill Sternberg wrote this powerful column as a grieving father and as a journalist who wants to serve the community. The story is very much worth telling in Tennessee because the Volunteer State has the second highest rate of painkiller prescriptions per capita of any state in the nation. Drug overdoses killed 1,776 Tennesseans in 2017, an increase of nearly 9 percent from the previous year. However, deaths from prescription painkiller overdoses decreased slightly in the state for the first time in five years. I saw Bill at a conference of news editors in Austin this past week. He told me he has received dozens of emails from people who were moved by the column and shared their stories with him. If you wish to share a message with him, send me an email to dplazas@tennessean.com and I will pass it along to him. – David Plazas, opinion and engagement editor, The Tennessean