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A Bitter Pill to Swallow

Since 1999, prescription opioid sales have nearly quadrupled, as have opioid and prescription drug overdose deaths. Prescription drug abuse, especially of opioids, is sweeping the nation, and Iowa is no exception.

Photo by Sofie Lie, Illustration by Nova Meurice

Photo by Sofie Lie, Illustration by Nova Meurice

Sofie Lie and Nova Meurice, Iowa City High School

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Imagine an opioid user. Do you have a clear picture in your head?

Now, meet Abe*. He’s an honors student, and an athlete. He is white, his parents are affluent. Abe also regularly uses prescription drugs.

For several years, he’s smoked marijuana routinely, but more recently, he was introduced to lean, a drink that mixes soda with prescription cough syrup that contains codeine or other opiates. From there, he also began to experiment with prescription opioids like oxycodone as well as prescribed stimulants like Xanax or Adderall.

“I love [oxies],” Abe said. “It was probably a couple months ago that I first did it, I’m not going to lie, it doesn’t come around that often, but if I get my hands on it, I’ll definitely get it, because it’s like the lean, it’s just even better.”

When it comes to using—especially for the first time—Abe is calculated: he makes sure that he has nothing going on later that day; he researches dosages beforehand; and he prefers to be in a controlled environment—with a few close friends or by himself, rather than at a party.
“My main principle is that I get my stuff done during the day—I don’t need drugs for that at school—and then at the end of the day when I have free time, that’s when I like to do the other stuff, the oxy or whatever, if I have it,” Abe said.

After all, he says, he doesn’t want his high school legacy to be that of what he calls a “druggie” which he defines as someone who delves into a myriad of drugs, and who will stop at nothing to get them. Rather, he characterizes himself as unassuming, his drug use “a low-key thing,” and his tendencies controllable.
“I’m not going to say that I’m probably slightly a druggie, if you use [my] definition,” Abe said.“But I really like to not think of myself as that, because I’m not an addict and shit. I have a good time but I can still handle my shit. [I’m not] the type of druggie that will do anything for drugs. I’m able to control it, but I still do drugs.”

While Abe enjoys using prescription opioids like oxycodone, he is careful to avoid other stronger opiates such as heroin. With heroin, he fears, the threat of overdose and addiction looms greater. Indeed, heroin-related overdose deaths have tripled in the past decade, and heroin addiction has doubled, according to the CDC.

“It’d be awesome [to do heroin]; it’s the best one… that’s what it’s all hyped up to be, it’s the top thing,” he said. “But I would never go down that route.”

To avoid dependence, Abe tries to space out his usage. Sometimes his spacing is unavoidable as his access to prescription drugs is spotty; people who deal him marijuana often avoid prescription medications, he says. Instead, they usually come from friends with prescriptions or from a vast, tenuous network of people who know people with access to painkillers or anxiety medications.

Abe feels that these connections are sometimes ethically dubious. Once, for instance, he got prescription opiates “through a friend, through another friend,” who he knew somewhat. That last friend, the source, had access to opiates because his mother was dying of cancer.

“You get them from whoever you can get them from anyone. It could be the kid with ADHD, it could be somebody that knows somebody that has cancer and has these crazy painkillers or something,” he said. “But it’s kind of messed up in that way if you’re looking for them and getting them from those kind of people. It’s a shady thing.”

Increasingly, Abe is a typical opioid user. The stereotypical image of a young, black, inner-city dwelling male heroin user, fueled by media portrayals and our collective imagination, is in fact, largely a relic of the 1960s. Indeed, according a 2014 study in the Journal of the American Medical Association, in the 60s, 82.8 percent of opioid users were male, 60 percent were nonwhite, and their mean age was 16.5. In the past several decades, however, the demographics of opioid users have shifted to an older, whiter and more affluent audience. According to that same study, 90.3 percent of opioid users are white, men and women use at about equal rates, and their average age has increased to 22.9. Where opioid usage was once concentrated on the coasts, it has now spread to middle America. The spread, according to the CDC, has been correlated with an increase in prescriptions for painkillers. Between 1999 and 2014, the number of prescriptions written for oxycodone and hydrocodone, two types of opioid painkillers, have increased from 76 million to 207 million, making the United States one of the largest consumers of these painkillers in the world. Largely, like Abe, they don’t initiate opioid use through heroin; rather, the overwhelming majority get their drugs from friends or relatives for free or from their own prescription, according to the National Survey on Drug use and Health.

Abe is, however, somewhat atypical in his usage patterns; often, users start with prescription drugs, become addicted, and move on to heroin because it’s cheaper and gives a more powerful high. Both prescription painkillers and heroin, contrary to Abe’s belief, carry high risk of overdose and addiction. Especially if snorted or injected, both drugs can be very potent and put users at risk of contracting diseases such as Hepatitis C or HIV. With the increased prevalence of such drugs in the past few decades has come a rise in overdose deaths; between 2000 and last year, the number of opioid overdose deaths tripled.

While Abe has never worried about overdosing, the possibility remains a reality for many prescription drug users. Meet George*. He, like Abe, is a thoughtful person, a good student, and a drug user, but from there, their stories diverge.

Read the rest of the story here.

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