Not infrequently, I get emails from readers of my blog—dedicated to medical horror stories—describing their own encounters. The stories they tell are often uncomfortable, ones they’re too shy to discuss with their own doctors. As a trauma surgeon who maintains anonymity, I seem to have become a safe harbor for unconventional medical anxieties.
Most of the questions I get are fairly routine, “What’s this lump on my ass?” kind of thing. But every now and then I get one that throws me for a loop. Enter Candace. I received an email from Candace (not her real name) last week and was immediately struck by her story.
While the particulars of her narrative are unique, the circumstances surrounding it are not. America is in the midst of an unprecedented opioid epidemic. The National Institute on Drug Abuse estimates that anywhere from 26 million to 36 million people are abusing the drug (either pain pills or heroin) worldwide.
Not the first drug epidemic to sweep the nation, this one is decidedly different. The nearly 3 million people addicted to opioids don’t fit the “junkie” trope society perpetuates. They are not living in poverty or committing criminal acts. They are white-collar Americans with high-power jobs, picket fences, and clean records. They’re coworkers, neighbors, and friends who—unbeknownst to most among them—are living with a dark secret.
Candace is one of them. Here is her story.
“I must admit that even as I type, I'm not entirely sure if I will, in fact, send this,” her email begins. “I'm just a wee bit intimidated, and I'm truly afraid after I ask you my question that I will find myself on the receiving end of, well, basically a response fitting to that of a complete and utter f***ing moron.”
Candace’s opening filled my mind with tragic scenarios: Did she drive while drunk and hurt someone? Did she jump off a roof? But after identifying herself as a single mother of two young boys and full-time caretaker for an ailing grandmother, she hit me with it:
“In your opinion, what is the best way to ask a doctor for help with a heroin addiction?”
Candace’s relationship with opioids dates back seven years. After a serious car accident left her temporarily paralyzed with a broken neck, doctors prescribed OxyContin. The powerful and (pricy) long-acting narcotic helped with the pain, but as time went on and her neck healed, the pain never fully dissipated.
Eventually she needed higher and higher doses just to make the pain bearable. Like so many people she found herself hooked, still needing the medicine just to get through her day. Unfortunately, about two years ago, she lost her health insurance. In an instant she could no longer afford the expensive medication. She managed to buy some OxyContin illegally, but the pills were much too expensive.
That's when a “friend” suggested she try heroin as a cheaper alternative.
Candace started by snorting it just a few times a week, never considering the possibility of addiction. As her addiction deepened, it became daily use and—after a few months—she found herself injecting it IV. Through all of it she managed to maintain her household, care for her sons and her grandmother, and hold down a job, all the while hiding her secret.
To this day, her sons, grandmother, neighbors, friends, and coworkers remain completely unaware of the heroin addict living among them.
If this surprises you, it shouldn’t. According to an article in JAMA Psychiatry in May 2014, 50 years ago the typical heroin addict was a poor young teenaged boy in the inner city who started using heroin to escape the real world. Nowadays, Candace fits the profile of a heroin addict perfectly: Over 75 percent are middle-class, young, suburban twentysomethings who started their excursion into drugs with legally prescribed narcotics before turning to heroin as a cheaper alternative. And while the number of prescriptions for these powerful narcotics like OxyContin, Vicodin, and Percocet have tripled over the past decade, the number of overdoses on them has predictably also tripled.
Candace has officially turned from an accident victim into a statistic.
The biggest problems that people like Candace face are the shame and humiliation at slipping into their condition and the fear that they are powerless to escape it. Heroin abusers become very adept at hiding their addiction, blending seamlessly into the workforce, going to book clubs, and participating in PTA meetings.
But at the same time, they feel worthless, impotent, and may contemplate suicide (substance abusers are six times more likely to commit suicide than the general public). Once they’ve put themselves into this predicament, it can easily spiral out of control.
Candace’s desperation grew stronger as the email continued. “I don’t know where to go for help or how to even begin. I want to stop though, but I know I can’t do it on my own because I’ve tried,” she wrote. “I’m honestly just tired of waking up, feeling like a giant piece of shit, and believing wholeheartedly that maybe, just maybe, my two boys would have a better life in a different situation, possibly if it were one in which I wasn’t in it.”
As a trauma surgeon I find myself in life and death situations regularly, but this one was far outside the norm for me. I gave Candace the best advice I could offer—get in touch with an addiction medicine specialist (I gave her a link to search for one in her area), and try to find a support group. Her answer was heartening: "I must say, with just your response, I feel like there’s hope for me. I know I need to also seek help for my depression issues as well as my addiction,” she wrote. “I will always be in your debt for pointing me in the right direction to get help and finally be free of this. I am so grateful."
The isolation that Candace described, one that others in her situation have described similarly, seems directly related to the deep stigmatization of drug addiction—specifically heroin. “I don’t know if all addicts feel this way, or if I am alone in this, but it just sucks,” she wrote toward the end of the email. “I don’t want to disappoint anyone else, and I don’t want my family to think of me how I think of me: just a worthless junkie who shouldn’t have put herself in this position.”
I am cautiously optimistic that Candace will seek assistance and get the help she desperately needs. Unfortunately, Candace is far from alone—there are innumerable people all over the world forced to live a similar lie. If anyone else reading this finds that Candace’s story hits close to home, I hope you can use this as the wakeup call you need as well.