Written by Wanda Curtis
When Worcester County resident Andrea Smith was 18 years old, her physician prescribed her Vicodin – an opiate pain pill – for fibromyalgia. Andrea said that no one offered her any education or warned her that the drug could be addictive.
“If I had known that, it would have been in the forefront of my mind,” said Andrea, who chose to use a different name for this story to protect her and her family’s privacy.
According to Andrea, she used Vicodin intermittently for the first two years. However, she said that by the third year, she was using it on a regular basis.
“My physician continued to prescribe it for five years with no questions asked,” Andrea said.
It wasn’t until she was laid off from her job that Andrea realized how much she was dependent on Vicodin, which she couldn’t afford to purchase.
“I got laid off from my job and lost my health insurance,” said Andrea. “I couldn’t afford the doctor’s visits and pay for the prescription out of my own pocket.”
Prescription Pain Pills Replaced by Heroin
About that time, Andrea became friends with a man who had dabbled in pills and heroin. She was divorced from her husband and had a 3-year-old son who lived with her.
“I started using heroin,” said Andrea.
When she tried to stop using heroin on her own, Andrea experienced severe withdrawal symptoms. Andrea was also taking muscle relaxers, which had been prescribed for her fibromyalgia, she said.
“I was experiencing withdrawal and decided to take some extra muscle relaxers to help me sleep,” said Andrea. “I ended up overdosing on the muscle relaxers.”
Andrea said she was transported to the hospital in Springfield, where she remained in a coma for about 24 hours.
“About an hour after I came out of the coma, the Department of Human Services began to interrogate me about my drug use and how I took care of my 3-year-old son,” said Andrea. “Then they told me that they were taking him away.”
Across the U.S., a wave of unchecked prescribing of opiates for pain has led to a nationwide epidemic. Hundreds of thousands of people have become accidentally addicted to prescription pain pills – Vicodin, Percocet, and Oxycontin, among others. When patients can no longer afford pain pills, many switch to street heroin, which has led to an alarming increase in fatal overdoses nationwide.
Director of the National Institute on Drug Abuse, Dr. Nora Volkow, testified at a U.S. Senate hearing earlier this year that 80 percent of recent heroin addicts started out using opioid pain pills.
“The emergence of chemical tolerance toward prescribed opioids, perhaps combined in a smaller number of cases with an increasing difficulty in obtaining these medications illegally, may in some instances explain the transition to abuse of heroin, which is cheaper and in some communities easier to obtain than prescription opioids,” Volkow testified on April 29, 2014.
Fox News published a June 20, 2014, opinion piece, “The accidental addict: soccer moms, painkillers, and addiction,” in which a New York addictions specialist, Dr. Nicholas Kardaras, Ph.D., LCSW wrote about a new class of heroin addicts who he referred to as “accidental addicts.” He defined an “accidental addict” as “a person who trips down the rabbit hole of addiction after being prescribed pain or anxiety medications by a well-intentioned doctor.”
Kardaras shared the story of a 45-year-old soccer mom named “Peggy” with three children who accidentally became addicted while taking Vicodin after surgery and Xanax for anxiety. He said her physician failed to warn her of the addictive nature of her medication. Then she later turned to heroin when she developed a tolerance to the prescription medications.
Kardaras wrote, “Peggy defies the stereotype of addiction: syringes, tattoos, the poor and uneducated. But Peggy is not alone; there are hundreds of thousands of addicts like Peggy, who are upstanding family members, well-educated, successful …yet in-the-closet addicts.”
According to Kardaras, “Once the accidental addict has gotten clean and sober, educated about the addictive potential of certain medications, and learned new, healthy coping skills, they can then transition back into a healthy and fulfilled life.”
Massachusetts and National Guidelines Recommend Informed Consent
Dr. Jeffrey Baxter, MD, an addictions specialist with Spectrum Healthcare Systems, said national and Massachusetts treatment guidelines recommend that prescribers go through an informed consent process in which “patients are warned of the risks of opioids, including physical dependence, full-blown addiction, and overdose.” He said those guidelines also include a recommendation for monitoring patients “to help be sure that patients aren’t losing control over the medications.”
Baxter advised the phenomenon of becoming addicted to prescription medications is referred to as “iatrogenic addiction” and said it’s very difficult to say how often that occurs.
“Anyone who takes opioids daily for a few weeks will develop some degree of physical dependence and be at risk for some degree of withdrawal. But that physical dependence is not addiction – the same is true for other addictive chemicals, such as nicotine, alcohol, benzodiazepines, and caffeine,” said Baxter. “More severe risk comes with higher doses for longer periods of time. Even then, some people are able to stop and move on. Others either don’t or can’t stop using it and spiral out of control. Why is that? What is the difference?”
Baxter explained many factors influence whether an individual would become addicted to prescription medication.
“People with severe pain or severe withdrawal symptoms who are inadequately treated or monitored can progress to drug abuse,” said Baxter. “Some people are genetically predisposed to addiction, or have addictions to other substances, and are more prone to developing opioid addiction.”
Baxter said that many people are now surrounded by other people using opioids, which makes it easy to sample meds that are not prescribed for them.
“Opioids have become part of the experimentation subculture in this country,” he said. “In many neighborhoods, it may almost look like normal behavior.”
Baxter also added that “people with mental health issues may self-medicate mental health symptoms with drugs like opioids and have a more difficult time quitting.”
He said, “all of these factors influence the likelihood that someone who gets a prescription could progress to drug abuse and addiction. Getting the prescription itself is only one piece of the puzzle.”
Opiate Addiction Affects Families
Andrea said that after she was admitted to the hospital, she had to wait five days for a bed in the psychiatric unit. She said that once they had a bed open in that unit, she spent two days there. During that week, she missed a court hearing and lost custody of her son.
“I missed the hearing and lost custody of my son because they found heroin in my body,” she said.
Losing custody of her son was extremely painful for both Andrea and her son and was one of the factors which motivated her to seek treatment. Andrea said her ex-husband was given custody of her son, but she didn’t see him for about a month. She said that was extremely traumatic for both of them.
“It was hard for a 3-year-old to understand what was going on,” said Andrea. “I would tell him that mommy’s sick and trying to get better, so it was best for him to stay with daddy for right now. I used to call him on the phone to sing him to sleep at night. He told me that he hoped I got better … He always asked me when I was coming home.”
The author of the online article Chasing the Heroin Resurgence reported that the number of children removed from parents’ custody in Butler County, Ohio (home of U.S. House Speaker John Boehner) doubled between 2010 and 2012, with heroin accounting for more than half of that county’s child removal cases in 2012.
Andrea said it took four to five months for her ex-husband to get full legal custody of their son through the courts. She said after the first month, she was allowed to see her son for supervised visits once every other week, during which time she would visit with him and a DHS worker at a public place like the park or a restaurant.
“[My son] used to cry when it was time to leave,” said Andrea. “I tried to hold back my tears because I didn’t want to make it harder on him.”
Andrea said no one ever told her what steps she needed to take to regain custody of her child. She said she had no previous history of involvement with DHS.
“They had no interest in reuniting him with me,” said Andrea. “No matter how well I was doing or what I did to better myself.”
Andrea made up her mind to enter a treatment program because she wanted to get better for herself and her son. She decided to enroll at Spectrum Healthcare System’s methadone clinic in Worcester. She said she chose the program because it offered not only methadone but also counseling and support groups. She said she started out going to the clinic once a day but now goes only once a week.
“I knew that I needed that level of support to get better,” said Andrea.
Many Addicted Women were Molested as Children
Another factor that Andrea believes predisposed her to drug addiction was that she was molested as a child by a male babysitter. She said she’d been treated for panic attacks and post-traumatic stress disorder since she was 14 years old.
“You don’t feel like you’re worth anything or like you deserve anything good,” Andrea said.
Studies show that many women who are addicted to drugs were molested as children. According to the National Institute on Drug Abuse, as many as two-thirds of all people enrolled in treatment for drug abuse reported being abused or neglected as children.
The counseling and support that Andrea has received through Spectrum Healthcare Systems’ methadone program have helped her a lot, she said.
“I’ve been [free of opiate use] for four years,” she said. “I’ve had to work hard to build my life up and realize that I deserve a good life and good relationships and a stable environment around me.”
Andrea said she’s glad her drug use was not as long-term as it has been for some people and that she never went down the roads that some have traveled.
“I was fortunate that my drug use didn’t go on for that long. I count myself lucky that my use of heroin lasted less than one year. So I didn’t bottom out like a lot of people…I never burned all of my bridges with my friends and family…I never stole from my family.”
Andrea said the methadone clinic provides Narcan (medication that can sometimes reverse heroin overdoses) for people who are enrolled in the methadone program. She said they also offer classes instructing them how to use it.
In an article titled “Another Day, Another Chance Can Lead to Path of Recovery,” Spectrum Inpatient Division Clinical Director Kendra Marien writes, “Spectrum provides counseling and education on overdose prevention,” and, she continues, “staff from Edward M. Kennedy Health Center come weekly to train clients and staff as Narcan responders. When someone leaves treatment abruptly, we provide even more overdose prevention education and do our best to send them on their way with Narcan.”
Another Child on the Way
Several months after entering the methadone program, Andrea discovered that she was expecting her second child. She said her healthcare providers at UMass Memorial Medical Center’s Women’s Health Center were very supportive.
“They’re really great with methadone and pregnancies,” said Andrea. “They have an understanding of how methadone and pregnancy go together. They’re not judgmental and are willing to work with you and support you with any needs.”
Andrea said she was concerned during the pregnancy whether her baby would be born addicted to methadone. However, she knew that risk was still better than what the baby could experience if she wasn’t taking the methadone and was still using illicit drugs, including the risk of overdose, which could result in the death of both her and the baby.
Andrea’s second child was delivered six weeks early at UMass Memorial Medical Center, where she said the doctors observed him to see if he displayed symptoms of neonatal abstinence syndrome (NAS) — restlessness, tremors, exaggerated startle reflex, high-pitched crying, diarrhea, vomiting, poor feeding, skin breakdown, or seizures.
“They observed him for a week,” said Andrea. “I was fortunate that he didn’t have any [withdrawal] symptoms.”
The staff at UMass Memorial, Andrea said, were very supportive while her baby was being observed and never condemned her because she was enrolled in the methadone program. She said one of the nurses there befriended her, and they had a good conversation.
Andrea was eventually reunited with her ex-husband, who she said has been very supportive. Their oldest son is now in elementary school. She said when the family was first reunited, her son couldn’t believe that she was really there.
“He’s 8 years old now, and I still sing him to sleep every night,” Andrea said.
Just a few months ago, Andrea’s third son was born. She was pleased he, too, didn’t experience any symptoms of NAS as a result of her taking methadone during the pregnancy. The doctors observed him in the hospital for a week to check for any withdrawal symptoms.
Andrea encourages other mothers to seek help for their addiction for their own sake and for the good of their children. She encourages mothers to get out of the area where they used drugs and away from the people with whom they used drugs.
“You need to build a whole new life and get away from the place where you used drugs and the people that you used them with so that they’re not in your face all the time,” said Andrea.
She added that it’s important for mothers to focus on themselves while trying to get better.
“If you do it for other reasons besides yourself, it won’t stick,” said Andrea.
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