Heroin was absolutely depraved, and heroin addicts were the lowest of the low, the sad junkies at the bottom of the totem pole who were hopeless, desperate, barely even human. Intravenous drug use was something you couldn't even imagine yourself doing. You hated needles; you passed out when donating blood. The thought of sticking a needle into your arm, on your own, and pushing an unknown substance into your veins was too much to even consider.
Things changed when the government started cracking down on the pill mills, the pain clinics run by the unscrupulous prescribing doctors flooding the country with the little white pills ruining lives. These greedy doctors were the foot soldiers of the pain industry, the minions of Purdue Pharma, a private pharmaceutical company that sent an army of sales reps into regions with high disability rates to promote the idea that pain was vastly undertreated. They relentlessly pushed OxyContin (a pill that contains oxycodone, a drug molecularly akin to heroin) as a safe pain management drug, blatantly lying to the public and making billions of dollars in the process. OxyContin was ideal because it was a pharmaceutically produced pill with a legal medical use, and it created addicts out of people who wanted nothing more than pain relief.
Public officials touted the routing of pain management clinics as a huge victory. The media portrayed it like all of mankind’s problems had been solved with one swift administrative action. Nobody seemed to understand just how rampant opioid use was in small town America. Anyone receiving a monthly disability check could doctor-shop for OxyContin prescriptions. The pills could be had for next to nothing through Medicaid and then resold on the black market for $1 a milligram. Indeed, the drug was so pervasive that it essentially became a currency traded for everything from groceries to diapers. OxyContin was the new coin of the realm.
But government intervention led to a sharp decrease in the supply of pharmaceutical opioids, which led to a scarcity of pills on the streets. Demand remained constant, however, and the price of OxyContin inflated. Overnight, the drug that had been a mainstay for millions of budding addicts was now all but impossible to afford; pill habits couldn’t be sustained due to the financial impositions innate to basic economics.
Mexican cartels saw the sudden vacuum in the American drug market. They seized the opportunity, flooding the country with heroin, a cheaper and far more potent alternative to pills. A single dose packet of premium black tar heroin could be purchased for $10. It was simple math. While the era of pills had featured addicts selling to other addicts on mostly local levels, the logistics of heroin called for a much more complex distribution network. Heroin was moved, controlled, and sold by people who had never used a drug in their entire lives. Cartel families and drug cells ran incredibly sophisticated operations, and they were virtually invisible to law enforcement. These people were smart and business savvy. They studied the U.S. and predetermined the parts of the country where the heroin market would thrive. It took them less than a few months to build an empire.
An estimated 81% of heroin users started with prescription opioids.
You’ve learned firsthand that addiction is not well understood. Indeed, most people see the specter of heroin addiction as so otherworldly that they dismiss it; something like that — something as unpleasant as an ultra-ugly fairy tale like heroin addiction — could never happen to them, people who subscribe to a reality that’s mainly televisual, people who prefer to remain comfortably within the confines of their own experiences, never troubling to wonder how it would feel to live a life other than their own or what it might be like to grow up under different circumstances. The notion that addicts are inherently bad, immoral people eager to sacrifice the future to the present is little more than a self-fulfilling paralysis, a lie just believable enough to cling to. There's often a tacitly understood agreement within communities to condemn and even demonize addicts. The word "addict" itself has become synonymous with weak-willed and ethically inept. Addicts are but fleeting caricatures of a morbid curiosity, and addiction is the result of some restless attraction to the inexplicable, a weird fetish for sadness and loss and death and fear and the kinds of thoughts that come pounding on the mind’s door in the middle of the night without warning. They’re like stray dogs lingering on the fringes of a community, all of them sharing the same unknown endings. They’re like the books that readers leave unfinished, collectively unworthy of further attention.
Our social norms lead us to hide our vulnerabilities and airbrush our flaws; we construct elaborate facades for no other reason than to perform for others, and because of this we remain remote and unknowable. It’s now tough to truly understand the essence of a person without stripping away one’s exterior, which means it’s hard for people to tell when someone is suffering, and it’s becoming increasingly difficult to relate to the pains of others. We are all so consumed with ourselves and so convinced that we’re the center of the universe that trying to imagine what life is like from the perspective of another human being is all but impossible. Today’s society promotes cultural dichotomies, tribal loyalties, groupthink. It’s contagious. And it’s dangerous.
You wish you could talk to people so that they might understand. Not everyone is so lucky to have comfort imposed upon them throughout life, to be born into good fortune. Pain is among the greatest of equalizers, unfailingly democratic, indifferent to status and background and title and ethnicity. The presumption that certain people are somehow inoculated from life's vicissitudes for any reason is comically false. We all hurt the same, but some of us have more reasons to hurt than others.
And there's so much pain in this world. A lot more pain than anyone seems to understand. The pain of being a single-mother or father. The pain of working a dead-end job that barely pays enough for food on the table and running water. The pain of watching your parents go through a divorce, a feud that turns your whole world upside down. The pain of self-doubt. The pain of being gay in a society that ostracizes you for being different. The pain of an abusive relationship, of being sexually assaulted. The pain of watching a family member die in front of you, slowly, so that every day feels like a lifetime, and every waking hour is spent wondering why you didn’t do things right, why you acted the way you did, why you never said the things you wanted to say. The pain that keeps you awake at night because of guilt and shame and remorse, a pain still with you come morning. The pain of being stuck in a life that revolves around nothing but surviving and getting by and regrets and longing for what others have that you don’t and what could have been and what might have turned out differently had things been better growing up in a small town or a big city where nobody is anybody and everybody is nobody. There is so much pain.
Each person we come across on any given day is someone who has lived an entire life up to that point in time, someone who has been forged by an infinite number of experiential particulars. Think about that. Think about all the things that have taken place in your own life, regardless of your age. Whether you realize it or not, these events have shaped who you are and influence how you see the world. Just like you, every stranger out there has followed a unique continuum of events and dealt with the kinds of issues and problems that have an impact on one’s development.
For you, it was the cumulative pain of underlying issues that went unaddressed for too long. It was the worthlessness you felt after being sexually assaulted and raped, the snowball effect of anxiety, depression, and trauma. It’s impossible to emerge unscathed from a youth characterized by such toxic burdens. How were you supposed to handle the baggage, the psychic wounds bleeding into your everyday thoughts? Sure, you were taught the same things as everyone else growing up; you knew drugs were bad, that self-medicating was a slippery slope. But what are you supposed to do if you’re drowning? What if you feel like you can’t go on anymore, like being alive is like being slowly suffocated? Drugs gave you a life preserver. They anesthetized a reality that was too painful to endure, helped you forget the things you didn't want to remember and escape the feelings of worthlessness and shame and rage and the sense of being somehow inferior and damaged relative to others. You knew that you were paying a very high price for a very low quality of life, that you were fighting a battle that was impossible to win. But you were drowning.
You were fired from the Pink Horse.
A nice man, a new customer nobody had ever seen before, came to the club and took a liking to you.
He bought you lunch.
You flirted with him.
He gave you some money.
You flirted some more.
He bought you drinks.
You demurred.
He insisted.
You acquiesced.
He gave you some more money.
You started to relax and opened up to him.
He reciprocated.
You mentioned you’re a heroin addict, but that you're trying to get clean. It was a mistake.
He excused himself to the bathroom.
A few minutes later, the floor manager asked to speak with you in private. And a few minutes after that, you were sitting outside on the curb with the contents of your locker in a black garbage bag.
Dancing was the only thing in your life that gave you structure, and the money was good. But now it’s gone, which means you have no way of feeding the habit that often drains you of $700 week to week. Having to acknowledge this causes you unbearable anxiety and you self-destruct, spending your last $100 on heroin.
You ask your parents if you can come back home for a while, just until you’re able to figure something out. You remind them it’s been a long time since you last saw Sarah. You beg them.
They ignore your messages.
You don’t know what to do. Any job you might apply for—any job that’ll hire you—isn’t going to pay enough. You know it’s only a matter of time before you do something drastic. You will do anything to get your fix.
You don’t know what to believe and what not to. You’ve been told that a lot of the stories are rife with hyperbole and omission, and that you should take everything you hear with a grain of salt. And yet, others have attested to the opposite; others have said that the stories are true and the girls in them real, that there are men out there looking to take advantage of you, men who use the power of hope and wield it like a weapon, luring in desperate girls with exploitative assurances and then trapping them like caged animals.
Like the young woman who was permanently damaged by the brutal phallic intrusion of three men who promised not to hurt her. The 14-year-old who was locked in a shed and used as a sex slave and was missing for weeks before she was finally able to break free and flag down a motorist. And then there’s the story that was in the paper last week: A local 19-year-old girl was raped, beaten unconscious, and then burned alive in a remote ditch. She'd been prom queen last year. Even had a scholarship to play volleyball at UGA.
But the potential payoff is enough to convince you to try it.
“You can make more in thirty minutes than you would the entire week at the Pink Horse,” you’re told. And if you’re lucky, you’ll end up finding a sugar daddy, a guy you don’t mind being around who will give you a weekly or monthly allowance in exchange for regular sex and the occasional date night.
You decide to get in touch with Zoe, an old friend who has experience as an escort. She highly recommends it, says she met a man months ago who has been taking care of her; he gives her $2000 a month, along with frequent gifts and the opportunity to travel. You ask Zoe if she’ll help you get started. You explain how nervous you are, how worried you are about being alone with a stranger.
“We could team up, if you want,” Zoe says.
“What do you mean?”
“Like, work together. Like, either both of us get paid by the same dude, or if they don’t want a duo then one of us can just hide in the bathroom in case something happens. Like a security guard.”
“But you think that’ll work? Guys’ll wanna be with two girls at once?”
“Oh, hell yes. I used to do the same thing with my girlfriend back home. Tons of dudes would call us up. It’s like a big fantasy thing for a lot of them, having two of us together. Trust me.”
But you still have reservations. You tell her you’ll think about it.
“Jenny, come on, trust me. It’s not that bad and the money is unbeatable."
“Still.”
"Hey, you do Hero, right?”
“Yeah.”
“Sick! Well, then we can do a shot together before the appointment. That way, like, we’ll both be relaxed and playful and everything. I’ve got some on me now. Come over, I’ll let you bum some and you can just pay me back later. And then maybe we’ll post an ad together.”
You’re at Zoe’s place within a half hour.
You do a shot and immediately feel amazing; you don’t even care about being fired from the Pink Horse anymore, it’s old news. Now it’s time to make some real money.
Zoe sets up a camera and takes some pictures of the two of you together so that they can be posted in the ad online. She’s excited; it’s been a while since she last partnered up with another girl, and it’s always seemed to work well.
“Trust me, we’re gonna do good. I’ve always done good with another girl.”
You’re sitting on a bare mattress in her bedroom, watching as Zoe makes the post. You’re not nervous anymore, you’re excited. Eager to get started. Ready to make some money.
“You think we’ll get guys responding tonight?”
“Hells yeah we’ll get responses tonight! I'm saying at least three within a half hour of posting this. Bet. This kinda stuff is like catnip for lonely horny dudes.”
“Wow.”
“Yeah. Hang tight, I’m almost done. You cool with putting your cell number down? My phone blows, half the time it doesn’t even work.”
“Okay…do you think people are gonna be calling a lot?”
“Just depends. Probably, ‘cause of it being Friday and everything. But we don’t gotta keep the ad up forever, we can just delete it whenever. That way you won’t get calls no more.”
Zoe finishes the ad. The two of you recline on the mattress, talking, smoking. Not even ten minutes pass before your phone buzzes. It’s an unknown number.
“Answer it,” says Zoe.
“Me?”
“Yeah, you gotta learn sometime. Just relax, act like you know what you’re doing. They like when you take control. Put it on speaker if you want. Oh, and don’t give your real name. Use your dancing name or something, like a fake one.”
“I think he hung up.”
“Ugh. Hate that. He’s scared. Call him back.”
“Call him back?”
“Yeah, screw it. He called you first. Just ask him if he meant to call you or whatever, get him talking and he’ll relax.”
“Okay.”
You call the number back.
He answers.
Zoe smiles and nods her head, encouraging you to keep talking. He sounds young. There’s an endearing nervousness to his voice and he’s easy to talk to. Zoe whispers what to say next. Two minutes later, you’re set to meet him at a hotel in a few hours.
“Ha! Yes!” Zoe throws both arms up and falls back onto the mattress. “Told you!”
Brad, I have read about twenty of the first few lines, but I have to complicate the story of big pharma and Purdue Pharma as the big bad guys! There were other players in official roles,such as, if I’m not mistaken the Joint Commission on the Accreditation of Hospitals, who introduced a pain scale for patient reporting. As a consequence of fearing themselves or their institutions being downgraded, physicians prescribed freely. I do agree that Purdue put an unconscionably heavy hand on the scales with their scantily supported claim that their powerful painkiller was miraculously non-addictive.
To me, the greater scandal is that somehow we abandoned our brothers and sisters from productive work to the need for such pain relief.
There are other conditions that mimic addiction; chief among those are eating disorders. They are as difficult to shake as drug addiction, and multiple rounds of therapy/rehab are typically required.
A complication of rehabilitation is monitoring of individual physicians' prescriptions by DEA. Every month is assumed to have thirty days except February, which is recognized as having 28. All other months are counted as thirty days each, and prescriptions are written on a 'months' basis. This leaves the patient with the problem of prescriptions expiring on weekends with no authority to refill a needed prescription.
Opiates and opioids have other uses, especially in controlling liquid output from the GI tract. A year ago I contacted my daughter's pain management physician to sort out how to get her through a long weekend without access to tincture of opium, which is primarily used to control diarrhea. My daughter had an ileostomy and would lose electrolytes and face the danger of dehydration. We worked out a formula to take a ten percent reduction in each dose of the opium and compensate with a few mg of an oxycodone prescription I had left over. No one made a record of the discussion, which was illegal.