Ron* remembers vividly the first time he felt “the warmth of the opium embrace,” as he puts it.
“I was 23 at the time,” the now-33-year-old Norfolk resident recalls. “I’d been doing a lot of cocaine and pills but had always been afraid of heroin because I didn’t want to stick a needle in my arm. My friend, who’d offered it to me, said I didn’t have to—that I could snort it. I sort of faked it, taking a light snort, but I still got high. I felt like I’d taken some Percocets or something. So it did pique my interest.”
His curiosity notwithstanding, Ron—who was raised in an upper-middle class home in Norfolk—didn’t touch heroin again for another year. And when he finally did, it wasn’t for recreational pleasure.
“I got really sick,” he recalls. “It turned out I had pancreatitis from drinking so heavily. Pancreatitis is really painful, so they were pumping me full of Dilaudid (a strong narcotic pain reliever), and I loved it. I didn’t even want to leave the hospital. I just wanted to lie in bed all day because I felt fantastic.”
When Ron was finally released, the doctor wrote him a prescription for the drug, and he began taking more than the prescribed dose. Realizing he was headed down a slippery slope, he tried to stop, but the withdrawal made him sick. Then one night, a friend offered him a couple lines of heroin.
“I thought, what the hell, and did it. I’d been puking and sweating uncontrollably. I was so sick I barely had function in my arms and legs—but in a span of two minutes, after doing the lines, I was feeling great.”
“They’d told me in the hospital that I couldn’t drink anymore,” he adds. “At that point, I thought, I don’t need to drink—this is 50 times better.”
Stories like Ron’s have become alarmingly common in recent years. According to the National Institute on Drug Abuse, an estimated 2.1 million Americans are now abusing opioid pain relievers, and nearly half a million are addicted to heroin. Many won’t survive. According to a December 2016 report by the PBS Newshour, 300,000 Americans have died from opioid overdoses since 2000. Heroin overdoses, meanwhile, went up 20 percent in the past year and now exceed gun homicides.
While the problem in Virginia is less severe than it is in some other states, more people in the Commonwealth now die from drug overdoses than automobile accidents, according to VaAware, a website set up last November after the state’s health commissioner declared opioid addictions a public health emergency.
“Deaths from prescription drug overdoses doubled in Virginia over the past 15 years, while heroin-related deaths tripled from 2011 to 2015,” noted Gov. Terry McAuliffe in his comments on the declaration.
The growing problem—which now affects people of all races and income levels—caught a lot of people off guard. After all, a generation ago, mainstream America didn’t think much about heroin. If the middle class did think about it, they associated it with ‘junkies’ in poor, black neighborhoods, or troubled rock stars.
To understand how we got here, it’s helpful to consider the history of heroin. It’s a long one, but a few facts here will suffice. According to a 2004 report by Harvard Medical School, “Opiates are outranked only by alcohol as humanity's oldest, most widespread, and most persistent drug problem.” Indeed, there is evidence that the opium poppy was being cultivated in ancient Mesopotamia, circa 3400 B.C. and that the Sumerians referred to it as the “joy plant.”
In the West, however, it was the discovery of morphine—opium’s active ingredient—by German chemists in 1803 that piqued interest in it. By 1827, the drug giant Merck began to commercially manufacture morphine.
But an even bigger turn of events came in the 1890s when Bayer—as it was first marketing its aspirin—began to advertise liquid heroin as the best cure for a child’s bronchitis.
Even then, however, many people were becoming alarmed by the dangers of opium-related drugs—and by 1923 the U.S. Treasury Department’s Narcotics Division (the first federal drug agency) had banned all legal narcotics sales. But just as Prohibition did for alcohol, the ban opened up opportunities for illegal drug networks—sometimes aided by the U.S. Government. According to a PBS Frontline documentary called The Opium Kings, U.S. efforts to contain the spread of Communism in the 1950s resulted in alliances with drug warlords in Southeast Asia.
“In order to maintain their relationship with the warlords while continuing to fund the struggle against communism,” notes Frontline, “the U.S. and France supplied the drug warlords and their armies with ammunition, arms and air transport for the production and sale of opium.” The result was a dramatic increase in the illegal flow of heroin into the United States.
Since then, the influx and abuse of heroin has ebbed and flowed. But through the latter decades of the 20th century, it had not been perceived as a threat to families like Ron’s. That began to change around the turn of the new millennium.
Several things contributed to this shift, according to Nora D. Volkow, M.D., in her 2014 presentation to the Senate Caucus on International Narcotics Control. “They include,” she wrote, “drastic increases in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies.”
Today, in other words, the problem is personified not so much by the ghetto junkie looking for a fix, or the Hollywood celebrity using heroin to escape the pressures of fame, as it is by the young suburbanite who gets hooked on prescription pills—sometimes under a doctor’s care, sometimes not—likes them a little too much, then seeks heroin as an alternative because it’s a lot cheaper.
It’s also readily available. “I could have it for you this evening,” a Norfolk waitress—whom I call Isabel—told me recently after I asked her during an early afternoon chat how easily it can be obtained. Isabel says she was exposed peripherally to heroin culture while she was still attending Maury High School in Norfolk, from 1998 to 2002. “There was this elite crowd of people who just had this wildness in them—and this darkness,” she recalls. “It was as if there were this hole that always needed to be filled.”
Six years after graduating, while working at a local restaurant, she confronted it more directly when a fellow Maury grad started working there as a cook. “I watched him spiral into the abyss three or four times,” she says. “But he was one of those archetypes of the rich, white boy with parents who have an infinite well of money to throw at problems, so nothing he ever did had truly lasting consequences. I watched him become the worst kind of human, admitting to stealing money from his mom. Eventually he ended up going to jail after holding up a 7-Eleven at gunpoint.”
Isabel believes her former coworker and classmate represents a certain type of addict who seeks hard drugs because of simple “boredom” and slips easily into the lifestyle because the drugs are easy to obtain. “These are kids who are home alone a lot of the time, with extra income from allowance or whatever—and they’re drawn to the idea of something dangerous because it makes them feel alive.”
Isabel recognizes that there’s another type of addict, though—people who seek it because they’re trying to escape pain of one kind or another.
A case in point is Joe Porfert, another Maury grad, who went into the bathroom of a local bar one night in May 2015, stuck a needle in his arm, and overdosed. A short time later he was pronounced dead. His story is chronicled in a book published last fall called—ironically—I’ll Be All Right. The book contains selections of Porfert’s own poetry and journal writings, interspersed with biographical narratives written by Virginia-Beach-based author Joe Jackson.
“Joe was a mystery to his friends,” Jackson writes. “On the surface, he seemed smart and easygoing, with an odd sense of humor.” But there was another side of him—a side, according Porfert’s childhood friend Wes Mason, that could be “dark and self-deprecating, almost to the point of self-loathing.”
Porfert’s struggle to maintain his mental health, in other words, appears to have pre-dated his first experiments with heroin and other opioids. And that is not uncommon.
“When opioid addiction occurs, it is rarely someone’s only mental health problem,” writes journalist Maia Szalavitz in a well-documented article on FiveThirtyEight. “The majority of people with opioid addictions have a pre-existing mental illness or personality disorder … Common conditions include depression, anxiety disorders and attention deficit/hyperactivity disorder, among others. Some studies find rates of these pre-existing problems among people with heroin addiction as high as 93 percent.”
Melissa*, a 28-year-old Virginia Beach resident and recovering addict, says this dovetails with her experience. “The majority of people I see in Narcotics Anonymous have dual diagnoses: substance abuse disorder and something else, like depression or severe anxiety.”
Melissa counts herself among them. “I was never diagnosed with anything as a child,” she says. “But I was constantly depressed and anxious. Before I started drinking and doing drugs, I was really bulimic and also cutting myself. I always used outside things to feel differently. So, I guess you could say was an addict before I was an addict.”
When she was just 13, however, she took the first steps toward full-fledged addiction, drinking and taking pills in an effort to escape her emotional problems. By the time she entered college at James Madison University, she was partying hard, virtually every night. One night, the party cocktail included an Oxycontin that someone had given her.
“I could kind of take it or leave it for a while,” she recalls. “But the more I took them the more I liked them. Pretty soon my drinking and use of other drugs fell by the wayside, and I was on this strict path of just doing [opioid] pills.”
When Melissa graduated in 2010, she moved back home to live with her mother. “I remember one night I was driving around trying to find pills, but I couldn’t. The guy I was with said he knew where to get heroin, and I was like, ‘OK.’” Melissa didn’t shoot up that first time; she smoked it. But that was enough to tighten the grip of addiction and amp up her risky behavior. “I was working as a nanny at the time,” she says. “I’d go off to my job, taking care of someone else’s kids, do what I had to do, then go in the bathroom and smoke a little bit.”
Before long, she was doing it every day, along with regular doses of Adderall. Still, she wanted more.
“I knew people through mutual friends who were shooting up, and that’s what I really wanted to do. One night I was hanging out with them and asked them if they would shoot me up, and they said, ‘No, you don’t want to do that.’ But later that night, this guy was like, ‘If you want me to shoot you up I will.’ It was the best feeling in the world. You don’t get the rush from smoking it that you do from shooting it. You still get the same high but not the initial rush. So I started shooting up from there.”
A couple weeks later, a diabetic friend gave her a bunch of extra needles he had, and she attempted for the first time to shoot up herself. “I remember that I’d just woken up, and I had all this heroin. I tried unsuccessfully a few times and was covered in blood, but eventually I found a vein. After that, I started getting high every day by myself.” Within a few weeks, she’d moved in with a guy she’d met—a fellow drug user—who was living in a house with several other addicts. They didn’t even have running water. But they did whatever it took to maintain their supply of heroin. “I started selling my body,” Melissa says.
When Melissa’s mother learned of her daughter’s addiction, she got her into the Farley Center, a drug treatment facility in Williamsburg. But that didn’t last long. “I ended up getting kicked out for sneaking drugs,” she says. “The first thing I did after that was go to the motel directly across the street and ask the first person I saw if he knew where I could get some heroin. He said he did and told me to wait in his motel room with his wife and kids while he went to get it.”
Over the next few months Melissa bounced back and forth between Norfolk and Richmond, preferring the latter because the heroin there was of higher quality, cheaper and easier to get. By this point, she was in a vicious cycle: getting high for weeks at a time, getting sick, going to detox, getting treatment, failing, and starting all over again.
“I tried Suboxone (a common treatment drug for heroin addicts), but that, too, was short-lived. In my experience, drug replacement just doesn’t work. These drugs just keep your addiction alive. They’re like Band-Aids. You’re not solving any problems. Before long, I was selling my Suboxone to get heroin.”
In 2012, she moved back to Coastal Virginia once again and soon thereafter got arrested for heroin possession after nodding off in a convenience store restroom. Even that, however, didn’t stop her. When a friend came to bail her out, he was carrying heroin, and they got high again that night. “Back then, I thought that’s what a good friend was,” she says.
Four months later—in March of 2013—she decided she’d finally had enough. But rehab had no appeal. “I tried to kill myself,” she recalls. “I took a bunch of pills and shot up.”
Fortunately, a friend had been trying to get hold of her and had grown worried. By sheer luck or good instinct, her friend found her at her mom’s place, unconscious, not breathing and blue.”
“When I woke up in the hospital, I was pissed,” Melissa says. “I didn’t want to be alive because I didn’t want to suffer the consequences of getting clean. I’d been doing a lot of screwed up things. I owed a lot of people money, I had stolen from a lot of people, and I didn’t want to deal with the chaos I had caused. I just wanted everybody to leave me alone with my drugs.”
At long last, however, something clicked. After detoxing yet again, she moved into an Oxford House (see sidebar) and started going to Narcotics Anonymous meetings. She has now been clean for four years. “I’m not sure why I managed to stay clean after that last detox,” she says. “I guess I was just sick and tired of being sick and tired.”
While living at Oxford House, she met a guy, eventually moved in with him, got married and had a child, who is now 2 years old. In spite of her success, Melissa says she’s still tempted at times to shoot up again. “I know it’s readily available, and now I’m in a financial position to do it for a really long run without getting caught. But then, I think, I don’t want to do that to my daughter.”
For Ron, family is a motivator as well—although he’s quick to add that for an addict that’s not always enough. Two years ago, while he was managing to stay clean, he met a woman, fell in love and got married. Subsequently, they had a baby. But within months of her birth, he relapsed, and his wife filed for divorce.
Alone and broke, he detoxed yet again and began going to Narcotics Anonymous meetings, where he found a sponsor who’s been clean for 27 years and has helped a number of addicts. Ron has now been clean himself for about a year and a half. “You have to work the program,” Ron says. “That includes using the workbook, in which, among other things, you write down every bad thing you’ve done as an addict. There’s something about writing it down,” he says. “You see it, and you’re like, damn, I did all this? It’s very uncomfortable. But it’s effective.”
He also credits the support he gets as an Oxford House resident—and an herb called Kratom (see Saving Lives), which helps him resist opioids. Still, he’s under no delusions. “I’ll always be an addict,” he says. “You’re always recovering. You’re never recovered. Once you think you are, you’re screwed.”
As he struggles to stay clean, he, too, thinks of his daughter. “I want to be a good father and take care of relationships with other people in my life,” he says. “You can’t do that when you’re strung out—you just can’t. No matter how good your intentions are. It takes all of your energy. It takes all of your love. It will suck your soul out, man.”
Last November, in response to the growing opioid epidemic, Gov. Terry McAuliffe issued a “standing order,” authorizing pharmacists to dispense Naloxone, or Narcan, a drug that can revive someone who has suffered an overdose. No prescription is necessary. The idea is that people who know that a loved one is an addict can have it available. Emergency-service personnel also carry it, but when someone overdoses, mere minutes can make a difference between life and death.
Saving a life, of course, doesn’t solve the long-term problem. Families dealing with a loved one who is an addict often feel at a loss for what to do next. There is no sure-fire approach, but Melissa, a recovering addict, (see main story) shared some thoughts. “I have thought about this so many times,” she says. “Just recently a friend called me after finding out that his 22-year-old son was using heroin and asked what he should do. I told him I would want my kid to know that I was there for her. I would try to get her into detox, rehab and an Oxford house (see Finding Hope at Oxford House).
“That said, it’s important to know that until she’s ready to stop she’s not going to stop. For some people, it takes getting into trouble and going to jail—for others that has no effect at all. The same goes for overdoses. It really varies from person to person.
“The most important point I can make is that you don’t turn your back on them completely. You can’t be co-dependent and let them run your life, giving them all your money and letting them stay in your house and do whatever they want. But you have to let them know that somebody’s on their side.” Melissa credits Narcotics Anonymous—a so-called 12-step program, similar to Alcoholics Anonymous—with helping her stay clean. But 12-step programs aren’t for everyone. Some resist the notion—central to the program—that you must surrender to a “higher power.” Others find such programs too authoritarian.
One alternative is called Smart Recovery, which takes a more democratic approach and is based on members sharing whatever has worked for them. But recovering addicts face another dilemma as well: whether to use replacement drugs to help them stay away from heroin and/or abuse of opioid pills. Two common drugs are methadone and Suboxone. The addicts we talked with, however, found them to be ineffective. One addict, Ron (see main story) uses a natural herb instead. It’s called Kratom and is available for purchase online. “It’s tremendously helpful,” Ron says. “It greatly reduces anxiety. It was actually a doctor in a rehab unit who told me about. I’ve used all these different shrink drugs—I’ve been on the Prozacs, I’ve been on the Lexapros—and the anxiety didn’t get any better.”
Not everyone is on board. Last year, in fact, the DEA threatened to outlaw the herb on the premise that more research is needed to ensure that it’s safe. Under pressure from Kratom advocates, the agency eventually backed off, kicking the issue back to the FDA. It remains to be seen whether the herb will stay legal. Some opponents—or skeptics, at any rate—insist that it can have a number of negative side effects (see, for example, Narconon).
Users we talked with, however, recommend it for both management of pain and control of anxiety. “Since I started taking Kratom, I don’t even think about getting high,” Ron says. “I work every day and feel pretty good.”
Nevertheless, the bottom line is this: Whether we’re talking about the decision to use Kratom or Suboxone, a 12-step program or an alternative, it’s clear that there is no one-size-fits-all remedy for heroin and opioid addiction. And the fact is most addicts will relapse one or more times before they manage to stay clean for good. It seems that the only path to recovery is for an addict to try and try again until they find some combination of things that work.
Finding Hope At Oxford House
Many addicts have found the motivation they need to stay clean by taking up residence in an Oxford House—a national organization that provides democratically run, self-supporting and drug-free group residences across the country. There are more than two dozen in Coastal Virginia alone, according to the Oxford House website.
The number of residents in a house ranges from six to 15, and there are houses for both men and women, though none that are co-ed. They work, say advocates, because the rules are strict. Residents must be employed, must participate in household management, are required to attend both house meetings and recovery meetings—and, of course, they must be clean. If a resident is caught using drugs, he or she is out. Follow the rules, however, and you can stay as long as you want—or move on when you’re ready.
“I think I’m going to be looking for my own place soon,” says Ron. “But it was a huge stepping stone. I don’t think I would have stayed clean without it.”
* The names in this article have been changed to preserve anonymity. While addiction is regarded as a disease, there is still a stigma associated it, and the addicts we spoke with expressed concern that they might be fired or suffer other repercussions if we used their real names.