Friedrich Hayek wrote in "The Constitution of Liberty", “Law in its ideal form might be described as a ‘once-and-for-all’ command that is directed to unknown people.” While a goal worth striving for in theory, in practice many laws nevertheless fall short. The purpose of Faces of Policy is to ensure the individuals affected by those laws don’t remain unknown, in the hope that those imperfect laws will evolve toward the ideal as a result.
Faces of Policy is a docuseries produced by the American Enterprise Institute, in which our scholars listen to the individuals whose lives are most affected by the research fields they study and the policies they advocate. In the inaugural series, Dr. Sally Satel interviews former opioid addicts about the factors that led to their addiction, what steps helped them overcome it, and the tangible impact different proposed policies would have on their lives.
Prescription opioid abuse is a lot more complicated than the media and politicians make it out to be. . . . It's true that some people who get prescription opioids from their doctors do become addicted to them. But the majority of people who abuse opioid painkillers typically get them from their friends and relatives.
"All that mattered was that I had one person who believed in me. And that gave me some hope." A balanced approach to solving the opioid epidemic requires compassionate interventions that will first stabilize drug abusers and then help them find an emotionally satisfying purpose in life.
Sally Satel, MD, is a resident scholar at the American Enterprise Institute (AEI) and a practicing psychiatrist and lecturer at the Yale University School of Medicine. As a scholar at AEI, she studies mental health and domestic drug policy and political trends in medicine. The author or coauthor of several books, her most recent one, “Brainwashed: The Seductive Appeal of Mindless Neuroscience,” (Basic Books, 2015) coauthored with Scott Lilienfeld, was a 2014 finalist for the Los Angeles Times Book Prize in Science.
Taking on the scourge of opioids: Factors beyond physical pain are most responsible for making individuals vulnerable to opioid abuse. The problems start with poor job opportunities for those without college degrees. Absent employment, people come unmoored, families and communities unravel, and opioids become a salve for these societal wounds.
The myth of what's driving the opioid crisis: Contrary to popular belief, the opioid epidemic is not driven by doctors overprescribing pain patients. Overdose deaths are overwhelmingly attributable to illicit fentanyl and heroin, otherwise known as the "street opioids" that have become the engine of the opioid crisis in its current, most lethal form.
Comforting fictions and unintended consequence: What is addiction? In many ways it's not a disease, as we've become accustomed to calling it, and we should challenge the comforting fictions this belief leads many people to accept. But there is one big commonality between addiction and any other medical problem: Anyone who is suffering deserves humane and competent care.
Jay saw opiates as even better than alcohol; he got more relief from his mental illnesses without the hangover or regretful behavior. The next day, he tried heroin, and for six months he got high every day. By the time he was 18, he thought he had enough of his drug lifestyle and told his parents he needed to go to a methadone clinic. In 1998, the methadone clinic wasn't providing any sophisticated treatment, especially for his underlying mental health issues, and he just abused the drug to get high - while using cocaine and nerve pills on top of that. At that time, he didn't see a quality life without drugs because he had no other ways to cope with anxiety and depression.
In fact, he says, "I tried [every drug] I could because I wanted to die." He spent years going back and forth between opiates and alcohol, flipping between rationalizations on which one was better for him. Eventually, he was at home on probation and realized that he was going to go to prison.
He took heroin and some psych meds he was prescribed and overdosed. He was revived by Narcan. He went to jail soon after that, and jail never helped him stay clean or sober. He was using in prison and used right when he got out in 2004. After a year of using and run-ins with the law, in 2005, he went to a long-term, nonmedical detox. That was the only thing that was able to help him - following directions with discipline.
Now, even through injuries, surgeries, and his mental illness, he does not take substances. He works strictly through counseling to get him through rough patches. In sobriety, he was able to pursue his dream to be a comedian, and since 2010 he's been doing that fulltime.
By the age of 21, Justin had begun using harder drugs. He progressed from weed and alcohol in his younger years to using OxyContin illegally. That was a gateway to other opiates, including heroin. He also abused Xanax, which he was prescribed by a doctor to treat his anxiety. During his nine-year period of hard drug use, he was in and out of jail several times. He eventually was selling large amounts of heroin and trafficking heroin from Maryland to West Virginia.
In 2005, he overdosed and was revived by Narcan. In the same year, he was prescribed Suboxone, but it was not effectively treating his addiction. Instead, he abused and sold the Suboxone while continuing to use other drugs. It wasn't until 2013 when he checked into a psychiatric ward for suicidal thoughts and then went into a AA program that he started his journey into recovery. He finally addressed his issues with his depression, anxiety, and self-esteem. While he still wishes he had a better relationship with his mother, or had a father at all, he is able to deal with that stress without using drugs.
After his success with staying sober, Justin decided he wanted to help others. In 2013, with no education and only one change of clothes, he started developing the Newness of Life Program. Now, Newness of Life is a halfway house program with nine properties, where Justin leads many people on their path to recovery. He is a business owner and property owner, with a family, a home, and a 6-month-old daughter. With so much to lose, Justin is driven to stay clean so that he can continue his work helping others.
Matt's first interaction with drugs was when he was prescribed Vicodin in seventh grade after an accident where he was hit by a church van. His drug abuse started a year or so later at the age of 13, when he started doing drugs socially with his friends. They taught him everything about drugs, including teaching him how to snort the Vicodin he was prescribed again when he got his wisdom teeth taken out. By the age of 16, he was regularly using cocaine and illegally sourced opioids at parties. He became so addicted he went through withdrawal symptoms every time he didn't use drugs.
He had learned how to lie to doctors to get more prescriptions. The doctor never gave him enough pills to satiate his addiction, so he had to supplement with illegal use. Eventually, knowing he needed help, he decided to tell his parents the truth. Not knowing treatment options, they took him to a doctor who asked questions about his mental health and admitted him into a psych ward for five days. Instead of facing his mental health issues, he spent his time trying to convince everyone how wrong they were for putting him in the psych ward. Even though he promised his parents he would never use after his release, that same day, he called his drug dealer.
Between the ages of 23 and 24, he was at his lowest point in his life. He was addicted to pain medication (primarily OxyContin). One day, his dealer could not get him oxy anymore and introduced him to heroin. That's when his steep downward spiral started. His parents court-ordered his treatment, but he left the next day. The withdrawal was so horrible that he didn't want to go through it.
To escape treatment, he stole his parent's car and went on the run for two months. He slept in the car and continued abusing drugs. Matt knew the cops would find him one day, so he devised a plan: He stole a bottle of sleeping pills from a grocery store, wrote a goodbye letter to his parents, and kept the pills on his person at all times. When the cops came for him, he would take every sleeping pill and kill himself. Upon his eventual capture by the police, he followed through with his plan.
However, Matt woke up days later, thinking he was in the hospital. Instead, he was in jail on suicide watch. He stayed in jail for a month and then went back to rehab after that. When he got out of rehab, he was bombarded with stressful circumstances; His grandfather died, his son had an open-heart surgery, and he was back in his old environment. He didn't know how to deal with these issues, and he relapsed. He used again for a year, until he was arrested again. This time around, he stuck with his program. Now, he has so much more to live for — his kids and his family. He also has a purpose: helping others in a suboxone clinic.
Amy Monahan-Curtis spent 15 years searching for the correct diagnosis for her intense pain, spasms, and shaking. During this time she went through what felt like every treatment in the book — such as massage, chiropractic therapy, relaxation techniques, acupuncture, and even Reiki healing. Nothing worked. Finally, she was properly diagnosed with cervical dystonia, a Parkinson's-like disease that wracks her neck and arms in painful muscle spasms that lock her head to the side. With this diagnosis, she finally took her first opioids for pain management after her doctor carefully described the risks of addiction and found the medication gave her the best results of any treatment she'd tried thus far.
Even while on opioids, Amy has undergone significant surgeries and treatments to help mitigate her symptoms, including epidurals, breast reduction, and thoracic outlet surgery. None of these treatments have had the impact that consistent opioid use has.
On treatment, she was able to work for 12 years as a journalist and complete her master's degree. Unfortunately, her disease is degenerative, and she had to leave her position due to the amount of time off she was taking. The track of her condition also means that she has had to increase her use of opiates throughout her treatment. Currently, she relies on four pain pills a day to maintain her quality of life.
Amy has not had her medication tapered, but she fears it's coming soon. She again is trying any alternative treatment in preparation for a cutoff, but nothing works as well as her current medication. She realizes that once she's off opioids, she won't be able to do normal daily tasks, such as showering, driving, and cooking dinner. She also has hobbies, such as bible study, that she would not be able to participate in. She battles with depression and knows that without pain medication her mental health would also decline.
Anne Fuqua has primary generalized dystonia, which causes her painful muscle spasms and involuntary movements, much like Parkinson's disease. She has tried many different medications to treat this disease; however, opioids are the only medication that control her muscle spasms and pain. Before her diagnosis, she was a nurse in Alabama. She was a coach for the youth football team and baseball teams. While she was on opioids, she played wheelchair soccer and looked for an ideal job.
For many years, she was treated by a doctor who she had a great relationship with and who managed her pain in a way that helped her quality of life. Then the regulations came in, and her doctor was forced to taper her medication beyond effectiveness. In seeing her regression, he brought her back up to her full dose, even though he had to go through tons of red tape to do it. However, this did not last. Unfortunately, this doctor resigned from pain management because the pressure he felt from regulation was too much; he felt he could no longer provide for his patients. He gave Anne one final full script, but she realized she needed to make it last for as long as it would take for her to go through the complicated process of finding a new doctor.
For weeks, she made this prescription last. During this time, she was actively looking for a new doctor. No one would take her on. Meanwhile, her life was unraveling. She was no longer able to drive, she started losing her memory, and she had a horrible fall that knocked out some of her teeth. (She's unable to get implants because of her condition.) These instances caused her to lose hope. She started making plans to commit suicide by ceasing to eat or drink and created an advanced directive stating her wish to refuse medical care. Right when she was about to send her cat to a new home to start the process of her advanced directive, she got an email from a doctor who said he would take her on as a patient in California. This saved her life.
Kelvin Young was raised in a very strict household with four older brothers. He had low self-esteem and did not have emotional support. Many people in his family were affected by the war on drugs and the crack epidemic. Through these issues, he was often validated by his brothers, who got him hanging out with the wrong crowds. To feel more important, he began selling drugs and drinking at a young age. In fact, his first arrest was at age 14. A few years after that, he dropped out of high school and spent much of his teenage years and early adulthood selling drugs, abusing drugs, and going in and out of prison.
Prison itself was a traumatizing experience for him. There was a lot of abuse and anger, and it affected his personality and self-image. In this environment, Kelvin became an angry, abusive person who was violent. He felt that at this period of his life, he could not express his feelings or handle emotions properly.
In this cycle of abuse, he was filling voids within himself with drugs and alcohol. At 26, he was hooked on heroin. Then, he tried OxyContin for the first time, illegally. He never went to a doctor for a prescription and only ever got the medication from friends on the street. To him, the prescription medication was better than heroin. He also felt that it was safer and that he couldn't overdose on it because it was a real medication prescribed by doctors. At first, these opioids were helping him hide from the mess he'd made of his life. Then, he had to take opioids so he didn't feel sick from withdrawal symptoms.
Finally, prison made a difference in his life. He was mandated to take a drug treatment program, where he was introduced to meditation, yoga, poetry, and journaling. These are practices that he would have never considered before this program, but they opened his eyes to find the root causes of his suffering. Through these practices he's learned how to take better care of his mental health, which has helped him realize that he cannot mask the pain he feels, but rather needs to address toxic stress in a healthy way.
Now he's been sober since 2009 and looks to help others with his own meditation, yoga, and sound therapy practice.