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Brain surgery launches descent to heroin addiction

Free Lance-Star (Fredericksburg, VA) - 7/17/2016

July 17--She had been in trouble with the law only once before--a speeding ticket when she was 20.

Fourteen years later, she found herself nearly naked in a frigid, overly bright concrete cell. She huddled on a dark blanket.

Clad in a mesh vest, she shivered from cold, fear and the first pangs of opiate withdrawal.

The room had a thin mattress, a blanket and a small hole in the floor. The stay-at-home mom was horrified to learn the hole would be her toilet.

She spent three days in the suicide prevention cell, in pain from a rare brain condition and suffering from the nausea, diarrhea and nerve pain that accompany opiate withdrawal.

At times, she begged for relief in the form of the prescription painkillers in her purse.

But the corrections officers had heard similar stories many times before. People in the throes of opiate withdrawal will say and do anything for relief.

Those days spent isolated in a cold, empty cell marked a turning point in her life. She said that was the moment she transformed from a brain-surgery survivor into a heroin addict.

As the nation struggles with a growing epidemic of opiate addiction, this woman's story shows an all-too-common slide from drug dependency to addiction and a disturbing lack of safeguards available to stop the descent.

The woman--who doesn't want to be named to protect her young daughter--is rebuilding her life and plans to go back to college in the fall to earn the credentials needed to be a certified addiction counselor.

Some days, her thoughts drift a few years back, to a time when she was a graduate student and the wife of a diplomat, to dreams derailed by a rare medical condition and an addiction to painkillers.

"All of my peers from grad school are psychologists now," she said. "I was supposed to be a doctor by now and I can't get a job at Aldi or Food Lion. It's one of the most bitter parts of this whole experience."

DIAGNOSIS, THEN DESCENT

Her world went black in the middle of Walmart.

The headaches started when the woman was living in the Middle East, raising a toddler and studying psychology in graduate school. Stress seemed the likely culprit.

Pain spread throughout her body. She was always exhausted.

Some days, she couldn't get out of bed. She dropped out of school and moved back to the United States when international doctors couldn't find out what was wrong.

She still couldn't get a diagnosis.

She lost her vision while shopping at Walmart. Her daughter, then a preschooler, led her to the pharmacy for help.

The woman went to the hospital, where a spinal tap showed doctors that she had a rare, chronic condition known as pseudotumor cerebri.

Doctors at Johns Hopkins performed an experimental brain surgery to reduce pressure. Her vision returned, but she was still plagued by headaches.

Her medical journey had taken a toll on her marriage, and her husband filed for divorce while she was in the hospital.

She was sent home with dilaudid, a narcotic painkiller. She could sleep, but the pain didn't subside.

She tried to rebuild her life following the surgery and divorce, but her head and back hurt constantly. Turned down for disability, she received welfare and Medicaid. She couldn't find a pain management specialist who accepted Medicaid, so she put her medical bills on her credit card.

Her treatment included massage therapy, exercise and heavy narcotics.

"I didn't think I was doing anything wrong, I was in legitimate pain," she said.

She soon built up a tolerance to the opioids. The doctor increased the doses until she was taking 24 miligrams a day of dilaudid and 100 micrograms of fentanyl, plus heavy sedatives.

The pain never fully abated, and she struggled to support herself and her daughter. Despondent, she attempted suicide by overdosing on her medications.

She woke up groggy, confused and under a temporary detention order. She wanted to go home, fought a police officer and was charged with assault and battery.

NO RELIEF IN SIGHT

She was placed in one of the Rappahannock Regional Jail's suicide prevention cells--bare rooms void of anything an inmate could use to end their life.

"I hate that we have these," said Capt. Kevin Hudson, director of community corrections and programs for the jail. "But we need to keep people safe."

Such cells are known as dry cells, and psychiatric protocol recommends that no one is placed in one for more than eight hours, said Lindsay M. Hayes, project director for the National Center on Institutions and Alternatives.

"Subjecting a suicidal inmate to these conditions only exacerbates their suicidal thoughts and mental illness," he said.

Hayes, a national prison-suicide expert, was called in to evaluate the Rappahannock Regional Jail after a rash of suicides in 2002. He called for more mental health services at the jail, and some changes were implemented.

He would not have suggested dry cells, he said in a recent email interview.

"The vast majority of jails throughout the country utilize 'suicide resistant' cells that have ... sinks, toilets and beds," he said.

More than three years after being released, the woman can't stop thinking about that concrete room.

She got out on bond and entered an Alford plea to the charges, meaning she didn't admit guilt but acknowleged there was enough evidence for conviction. She served the rest of her time under house arrest.

"There was a part of me that thought, 'I might as well be a drug addict if they're going to treat me like one,' " she said. "Why was I fighting so hard for my dignity?"

The headaches and back pain continued to plague her.

"I just had so much despair," she said. "Everything in my life I had worked for was gone. I was a welfare mom, dependent on narcotics, my marriage was gone."

She turned to YouTube and learned how to inject dilaudid into her bloodstream. She put on latex gloves, prepped her skin with alcohol and used a clean needle to inject the narcotic.

"I really believed I could do this carefully and control my pain," she said. "And for a while, I did."

THE SYSTEM TAKES A TURN

When she used a month's worth of pills in less than two weeks, her pain management practice cut her loose, she said.

She left with pages printed from a Google search: a list of pain management doctors and a substance abuse resources.

"None of the addiction places would see me because they saw me as a pain management patient, and none of the pain management places would take me because they saw me as an addict," she said.

Increasingly, chronic pain patients have been stuck in the same quagmire as efforts to stem the rising tide of heroin overdoses have spotlighted prescription narcotic abuse.

For decades, narcotics were reserved for terminal cancer patients, said Dr. Alan Wynn, an internist with Sentara Healthcare in Woodbridge. In the late '90s, pain became the fifth vital sign and the pain scale was introduced. Patients were routinely asked to rate their pain, and physicians were encouraged to treat it as they would high blood pressure or a fever.

"There was a lot of push to relieve pain," Wynn said.

In the early 21st century, two movements in the medical world had doctors scribbling furiously on their prescription pads. Medicare added patient satisfaction as a measurement of physician performance, and patients in pain are less likely to give their doctors high marks, Wynn said.

At the same time, pharmaceutical companies developed new narcotics, touting them as safer and less addictive.

"Pain management experts said they could give these narcotics safely and effectively, but there were no long-term studies on people with non-cancer pain," Wynn said.

The issue was compounded by the fact that most doctors receive little training in pain management and less in addiction.

Narcotics were handed out for back pain, headaches and other conditions that were chronic but not life-threatening. Many patients grew dependent on narcotics. Prescription painkiller abuse was treated as a minor issue, troubling but not alarming.

And then heroin addictions rose. People started dying of overdoses. Heroin, long seen as an inner-city drug, moved to the suburbs as desperate patients dependent on opioids discovered that street drugs were cheaper and easier to obtain.

Emergency rooms and morgues became crowded from overdoses. Health care officials, politicians and law enforcement officers took note and started enacting policies aimed at curbing opioid abuse.

But those efforts to squash abuse also impacted patients seeking pain relief. A local nurse practitioner who specializes in pain management recently saw doctors hesitate to prescribe narcotics to a woman who had only weeks to live.

"The many bad apples have ruined it for the people who legitimately have pain," Judy Albert said.

She partners with Dr. Ronald Gaertner, a psychiatrist and medical director for the Family Counseling Center for Recovery, the Fredericksburg area's only methadone clinic.

The Family Counseling Center for Recovery gets calls regularly from patients who've been cut loose from their pain management regimens, Director Chuck Adcock said.

"You see doctors kicking people out at the first sign of abuse," Adcock said. "With all the focus on addiction, they're getting scared."

Pain management specialists should instead try to work with patients who've become dependent, Wynn said.

"You should continue the care, continue the pain medicines rather than discharge them," he said. "If you just discharge them, this patient finds street drugs."

That's what happened to the Stafford County mom.

She called the methadone clinic for help, hoping to get on the maintenance drug that mitigates withdrawal symptoms and diminishes cravings for opiates. Methadone is a narcotic and also addictive, Adcock said.

He agrees with critics who say that methadone is replacing one addiction with another, but the maintenance drug allows people who are addicted to opiates to lead somewhat normal lives. Combined with intensive counseling, methadone can help people break addictions, Adcock said.

But the clinic does not accept pain management patients.

The Drug Enforcement Agency has specific protocols for treating pain, Gaertner said, and the clinic isn't prepared to offer that sort of care.

"It's a tough decision with each intake," Adcock said. "They're clearly dependent on the medication and they're clearly in a lot of pain. And we don't want to get inundated with people we can't help."

FROM HEROIN TO HELP

The woman tried other substance abuse treatment but couldn't find relief.

"You are always led to believe that asking for help is the hardest part," she said. "That is the biggest bull--. Here I was screaming for help and I was turned away."

Unable to get on methadone, she turned to a drug easier to obtain: heroin.

She found the constant pain unbearable and withdrawal was hitting her hard with nausea, vomiting and diarrhea. She could barely pick up her daughter from school.

She mentioned her situation to an acquaintance who connected her with a heroin dealer.

"It was a huge letdown," she said. "I had been injecting my dilaudid and it was nothing compared to that. I thought to myself, 'Wow, this is it? This is what everyone is going crazy about?' "

It helped with withdrawal but offered little pain relief.

"I was disappointed. I couldn't believe this was supposed to be the Holy Grail, but it became a necessity because I was in withdrawal. I wasn't trying to get high, I was just trying to not be sick," she said.

She sold her jewelry, her laptop, her camera, a guitar she'd had since her teenage years, all to buy heroin. Her daughter spent the summer with her father, and the woman used heroin during that time. But she knew she couldn't continue.

"I had battled infertility, my daughter was a miracle," she said. "I couldn't let her suffer anymore. I wasn't going to allow my life to continue to spiral downward."

She went back to the Family Counseling Center for Recovery, and was accepted as a patient last fall. With help from her family, she pays $14 a day for methadone. She also receives counseling and other substance abuse treatment through the center.

"They really saved my life, and I feel like the Family Counseling Center is responsible for hundreds of people still being alive in this area," she said. "They offer everything a person needs to get better."

She said she hasn't used heroin since Oct. 30, and she is trying to piece her life back together. She looks forward to going back to school in the fall and hopes to find a job soon, although her arrest makes that challenging. She still lives with chronic pain, which she tries to manage with biofeedback, relaxation techniques, massage therapy and exercise.

"It's just something I'm going to have to live with, because the alternative is dying for pain control," she said.

Amy Flowers Umble: 540/735-1973

aumble@freelancestar.com

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