Addiction and the Danger of Isolation

What if treating addiction as if it's a moral shortcoming is as lethal as the drugs themselves?

Photo by Myriam Zilles on Unsplash

The doctors told Cleve the Fentanyl would keep him alive. “One patch kills the pain. Two patches will kill you,” they said.

Cleve, my husband, had been struggling with opioid addiction for years, so this was promising. At least, now, he couldn’t abuse his prescribed medication so long as he wasn’t interested in dying. Which he wasn’t. He’d been fighting for his life ever since being blown up by an IED in Iraq three years before. He’d lost his left leg and had been in hospitals ever since. All he wanted was to get better, medically retire, and move back to Alabama, where he grew up. But he was in so much pain. Taking him off of pain medications would be inhumane, or so the doctors said, so they scrambled to find a solution.

That was in 2009, before Fentanyl was famous. I’d never heard of it before. I didn’t know how addictive or lethal it was. All I knew was that it was sometimes used on cancer and hospice patients. We were willing to try anything. Pills weren’t working for him, so maybe patches would. We trusted our doctors.

Did you know the drugs on Fentanyl patches can be scraped off and smoked? We didn’t either until Cleve went to rehab for addiction, and one of the patients there told him about it. When he told me about it, it crossed my mind that he might be tempted to try it himself. I wanted to believe he wouldn’t go to such lengths to get high. But I was naive. I didn’t yet understand how powerful addiction is.

A year later, in 2010, while at a different rehab facility—this time for PTSD—Cleve was found dead in his hotel room across the street from the hospital where he was receiving care. Beside his body was a homemade aluminum foil pipe with a black tar-like substance in it. After an autopsy was done, it was confirmed to be Fentanyl.

17,656 Americans like Cleve died of opioid overdoses that same year. A year later, in 2011, the CDC declared prescription opioid deaths an epidemic. Suddenly, it was all over the news. Cleve had been a part of something much bigger than us, and we hadn’t even known it.

I wish I could say the United States has gotten a handle on this crisis since my husband’s death fourteen years ago, but it hasn’t. It was only getting started. Since then, it has gotten significantly worse.

More than 2.1 million Americans are suffering from opioid use disorder today. In 2022, 77,603 Americans died from opioid overdoses. 70,891 of those were from Fentanyl. More recent statistics are considered preliminary because toxicology reports can take a long time, but they do not look good. This is a persistent problem in the United States (and worldwide) that we are nowhere near solving.

Some of you reading this might think immigrants are to blame for the influx of illegal drugs in the United States, but that isn’t true. In 2022, 89% of Fentanyl traffickers were U.S. citizens, 93% of Fentanyl seizures happened at legal crossing points and interior checkpoints, and 99% of illegal drug smuggling was funded by US citizens. Meanwhile, only .009% of those arrested for crossing the border illegally had any Fentanyl on them at all, and the amount found on those individuals averaged half of what was found on people arrested at ports of entry.

Immigrants are not to blame for the opioid epidemic. In fact, focusing on immigration as a means to solving the opioid crisis is absurd. It’s part of the problem. It distracts us from looking into real solutions. We’re wasting precious time and resources and, as a result lives.

There are a handful of factors at the root of the opioid crisis, all of which fed each other to create the perfect conditions for an epidemic. It started in 1995 when the FDA approved Purdue Pharmaceutical’s Oxycontin. Then, in 1996, the American Pain Society introduced the “Pain as the 5th Vital Sign campaign,” which aimed to “make pain assessment and measurement as important a measure of patient wellbeing as the existing four vital signs.”

This is when we started to see the numeric rating scale for pain. Due to pressure to take patients’ pain more seriously, doctors began overprescribing opioids.

Purdue saw the liberalization of opioid prescribing as an opportunity and launched an unprecedented ad campaign for Oxycontin. Hundreds of millions of dollars were pumped into aggressive ad campaigns that severely downplayed Oxycontin’s risk of addiction. They included things like coupons for free prescriptions and monetary incentives to prescribing doctors, targeting physicians known to be the highest opioid prescribers.

The campaign worked, and Purdue became the “leading supplier of prescription opioids to patients.” Between 1996 and 2002, over 14 million Oxycontin prescriptions were given out, resulting in sales that rose from $44 million to $3 billion. This also led to a decades-long, steady rise in opioid-related deaths. Some areas of the United States, such as southwest Virginia, saw them rise as much as 830%. In the past two decades, Oxycontin has killed around 450,000 people. It’s estimated that half of those who became addicted to opioids started with a prescription from a doctor.

“In April 2010, Purdue Pharma introduced a reformulated version of OxyContin designed to make the drug more difficult to abuse.” The following August, Purdue discontinued the original formula. It was “one of the largest reductions in the supply of abusable prescription opioids to date.” Many speculate that this led to an increase in the use of illicit opioids by those who were addicted to oxycontin. Following Oxycontin’s reformulation, heroin-related deaths increased dramatically. Three years after that, in 2013, Fentanyl-related deaths skyrocketed. And now, here we are.

“Age-adjusted drug overdose death rates, by opioid category: United States, 1999–2017”

Eventually, Purdue was sued by nearly every state in the country, resulting in a controversial $8.3 billion settlement. Some, myself included, believe it isn’t enough. But I’m not going to get into that. All I know is that what started in the 90s has turned into an absolute nightmare today, and we have got to do something about it before it gets even worse.

For me, the issue of opioid addiction is personal. I had to bury my husband when I was 24 years old because of it. I know how devastating it is, and I’m tired of politicians using the issue to justify asinine ideas like building giant walls (when 93% of Fentanyl seizures happen at legal crossing points) or putting people suffering from addiction behind bars (when it has been proven that punishment doesn’t solve addiction, it just forces people to hide their drug use, making it more dangerous).

I’m angry. We’ve lost focus—or maybe we never were focused—and people are dying. And I don’t mean focus on the morality of doing drugs, either. That’s just another distraction. It isn’t relevant, not when it’s your loved one. These are friends, daughters, sons, mothers, fathers, and siblings who need real help.

When it’s your loved one, the only thing that matters is keeping them alive. That should be everyone’s focus.

So, how do we do that? I’m just a mom and writer from Alabama who has been affected by this issue. I’m not an expert and don’t have all the answers. But here’s what I do know:

• People struggling with addiction need access to quality healthcare so that they can, at the very least, get counseling and rehab.

• Isolation is often what kills people who are using drugs. Making personal drug use illegal forces people into isolation, making their drug use significantly more risky.

• The use of dangerous synthetic drugs is on the rise, and it’s contributing to a significant spike in drug-related deaths.

• The demand for synthetic drugs rises when people do not have access to the safer, original version of the drug.

• The synthetic drug market funds non-drug-related criminal operations, “perpetuating cycles of violence and instability.”

• Putting people behind bars doesn't work.

• It doesn’t make sense to punish people getting high on one drug when the most lethal drugs are legal.

• What we’re doing right now isn’t working.

A couple of months ago, I listened to an episode of This American Life called “The Call.” In it, a mom—her name is Jessie— talks about her only daughter’s addiction. “She’s the most magnificent creature I’ve ever met in my life,” she says about her daughter, almost longingly, before pausing. And then, “She’s also the raggediest bitch I’ve ever met in my life. She is magnificent. She is magnificent.”

Every time I listen to this I laugh-cry. I also have a daughter, and Jessie’s words—the way they’re seeped in love and reverence—are heartbreaking, even if the way she says them is also hilarious. It’s relatable. This idea that there is nothing Jessie’s daughter could do to make Jessie think less of her. She recognizes her daughter is flawed—she’s a raggedy bitch, even—but she will always be magnificent in Jessie’s eyes. As a mother, it spoke to the very center of my soul.

When Jessie first found out about her daughter’s addiction, she did what I think most parents would: she tried to get her to stop. But it didn’t help. It just made her daughter push her away. With time, Jessie realized getting her daughter to stop doing the drugs, while important, wasn’t the most important thing. The most important thing was Don’t die.

Jessie is also an operator for the Never Use Alone hotline. It’s a number people can call while using drugs, so they don’t have to use in isolation. If something goes wrong, Jessie or whoever is on the line with them will call 911. It helps keep people safe. It keeps people from dying.

Because of her job, Jessie knows firsthand how much more dangerous drug use is when done alone. So, when her daughter and some friends showed up at Jessie’s house with a bag of dope one night, Jessie invited them in so they could do it in the safety of her home. She knew they would do it somewhere else if they didn’t do it at her house. Don’t die was the only thing on her mind. At least if her daughter did drugs with her, she could keep her alive.

As a mom, I had to pause the episode to think. If my daughter becomes addicted to drugs, would I do the same for her? She’s only three, so I’d never considered it before. I thought about the day I gave birth to her in my living room, her giant eyes the same shade of blue as mine, the way she tells me every day that I’m her best friend. She is the most important person in my life. I’ve never loved anyone so much. Of course, my answer was yes. I would do anything—absolutely anything—to keep her alive.

That episode also made me think of my husband, Cleve. I had no idea he was smoking his Fentanyl. I didn’t even know he was still struggling with addiction. He didn’t share that with me because he was ashamed. He had been taught his entire life that people who do drugs deserve to be punished, not helped. He feared losing his military benefits and reputation as a war hero. So, he kept his addiction a secret. And that’s what killed him.

Could someone have saved Cleve had he not been alone? That question will haunt me for the rest of my life.

Cleve and me, two years before his death.