A pill bottle sits on a medicine cabinet shelf. The prescription pain pills inside are leftover from a family member’s dental procedure.
Slowly, a couple Vicodin pills disappear.
No one questions what happened to the bottle or the pills inside. The painkillers were shelved away, forgotten about.
“I was probably 15 and from there it just blew up,” Alex Waxman, said.
For Waxman, those couple Vicodin pills in his family medicine cabinet opened the door to years of prescription drug abuse, and eventually a life as a recovering heroin addict.
In a national survey, the number of people who admitted to using heroin in the past year nearly doubled between 2005 and 2012, from 380,000 to 670,000, according to Dr. Nora Volkow, director of the National Institute on Drug Abuse.
“You get that one miracle drug and you are off to the races,” Waxman, now 23-years-old said. He grew up in the San Fernando Valley in Southern California, just outside of Los Angeles.
From the time he was 15 until about a year ago, Waxman found himself in a cycle of drug abuse. It began with prescription painkillers, popping them with friends at parties to alter his reality, so he “didn’t have to think about life.”
Around the time he was entering adulthood, he added drug dealer to his resume.
“It got bad once the crooked doctors started coming into play. The pain management doctors were all over the place, they would write you prescriptions for whatever you want,” Waxman said.
He used to meet his doctor in a Target parking lot. Waxman would spend $300 for three prescriptions of 90 pills each. Selling pain pills went from being a lucrative business to something to help fuel his addiction.
“It went from, ‘I will only take one or two pills’ then ‘I will only take half the prescription,’ to ‘this is my prescription,’” Waxman said.
For Waxman, the pain pills quickly progressed to heroin.
“Heroin was ten-fold cheaper, no comparison,” Waxman said. “I could spend a quarter of what I was and get twice as high. I could get twice as high and it lasted longer.”
“Heroin provides a similar high as prescription opioids,” said Nathaniel Rickles, an associate professor of Pharmacy Practice and Administration at the Northeastern University School of Pharmacy. “They are central nervous system depressants, deadening what you are feeling, so you are in a drugged-out state. You don’t worry about anything, so things feel a lot better to you.”
Rickles said states are adding challenges for people who are illegally trying to obtain prescription pain medication. Many states have monitoring systems, tracking where and how often prescriptions are filled. If someone is going to different pharmacies, trying to not be noticed, states flag the individual as a potential abuser and add them to a state monitoring program.
“The fact that the states are getting more involved and checking is putting more pressure on the access to these medications,” Rickles said. The increase in heroin abuse could be related to the difficulties that exist in obtaining prescription pain pills.
“People in the field have talked about drug diversion: greater restrictions to some drugs leads to greater use of other drugs,” Rickles said.
Data from the National Survey on Drug Use and Health shows the heroin use rate was 19 times higher among those who reported prior nonmedical pain reliever use than among those who did not. The study has been conducted annually from 2002 through 2011.
A former drug dealer tells his story of addiction in the video below.
This week the U.S. Senate Caucus on International Narcotics Control is conducting a hearing to discuss prescription drug abuse and the role it plays in the recent increase of heroin abuse in America.
Caucus Co-Chairman Senator Chuck Grassley (R-Iowa) said the increased demand for opioids is alarming.
“Unfortunately, after becoming addicted to prescription opioids, people increasingly are turning to heroin in search of a cheaper high,” he said. “Policies have to balance the needs of chronically ill patients to get necessary medicine with the realities that opioid addiction is a serious, dangerous epidemic.”
In the beginning, Waxman only smoked heroin once or twice and didn’t enjoy it, he said. But, that quickly changed.
“It became something I hated so much,” Waxman said. “Then it became like a warm blanket, it made me feel like a warm blanket was wrapped around me. It was comforting.”
Waxman’s high from heroin soon went from being comforting to a necessity. It eventually became too much for him to handle on his own.
“He said, ‘I am a heroin addict and I need help and I am scared,’” Jody Waxman recalls the phone call her son made to her a little over a year ago. “I had never had to deal with someone who was a drug addict, and heroin of all things. I remember thinking, he is a nice Jewish boy, we are a nice Jewish family, that just doesn’t happen to people like us, but boy was I mistaken.”
Dennis Poncher, founder of Because I Love You, Parent & Youth Support Groups, has been surveying teenagers across the greater Los Angeles area for years, asking them about access to drugs and drug abuse among their peers.
Because I Love You is an organization that has been helping parents deal with child behavioral issues, like truancy, drug and/or alcohol abuse and running away since 1982.
“The availability is so much more vast than it was years ago,” Poncher said. “You ask any students that I have interviewed on various campuses and they say, ‘it’s a phone call away.’”
‘I was sick’
“I couldn’t live without it,” Alex Waxman said. “I woke up very sick and until I got the fix, I was sick.”
Jody Waxman remembers spoons going missing from her kitchen. She said, “I remember thinking, ‘they (my children) must be throwing them away.’ Then foil was missing on a regular basis. I knew nothing about heroin, I knew about marijuana, but nothing about heroin. I had no idea my son was abusing heroin.”
The National Institute on Drug Abuse estimates 23 percent of individuals who use heroin become dependent on it.
“It becomes a necessity,” Alex Waxman said. “Just so you can feel well and normal, you have to use. It could be a rock on the ground and if it looks like it (heroin) you are going to buy it.”
In an April congressional oversight hearing, federal officials note that about four times as many Americans are addicted to prescription opioids than heroin, and that the transition to cheaper and more accessible heroin from those drugs is still relatively rare, at about four percent.
However, seven in 10 people who said they had used heroin in the past year also said they had used non-medical opioids, according to a Center for Disease Control report.
Opioids are the most highly scheduled prescription medications with federal and state laws requiring a lot of careful documentation and only allowing a certain number of pills to be dispensed at a time, Rickles said.
“The idea that we are taking a handle over drug abuse is an invalid statement,” said Quinlan Strong, a program director for a women’s addiction recovery center in California. “I believe it is much more readily available and it is becoming so accessible to our young population.”
Strong is a recovering addict herself.
“I was addicted to everything; anything that would make me feel better,” she said. It started with marijuana and escalated to crack, cocaine and prescription pain pills.
Working in a recovery center, Strong said heroin addiction can be different for each person. Quinlan said some of her patients would rather be homeless on the streets with the option of access to heroin instead of being in a rehab facility.
Recent high-profile heroin overdoses have brought national attention to the abuse of the drug in the U.S., including the deaths of actors Corey Monteith and Philip Seymour Hoffman.
“Corey’s death was a big eye opener,” Poncher said. “Teenagers could relate to it. They couldn’t relate to Seymour Hoffman, but Corey’s death kind of opened their eyes.”
While it may have opened up their eyes, it hasn’t stopped young people from using heroin, Poncher said.
“I hear from the kids, ‘we know how to handle it. We just do it for recreation,’” Poncher said. “What we need to be asking these kids is ‘Why?’ Why do these kids need this high? What are they trying to cover? Why do these kids have to go to this extreme?”
Jody Waxman and Strong agree: more education is needed. They believe the education is just as important for parents and for school leaders as it is for teenagers and heroin abusers.
The new user
Along with heroin, only marijuana and hallucinogens such as ecstasy have slightly increased or held steady among new users over the last decade, according to the SAMHSA 2012 National Survey on Drug Use and Health.
Heroin can be injected, inhaled by snorting or sniffing, or smoked. All three deliver the drug to the brain very rapidly, contributing to its health risks and to its high risk for addiction.
“If you chop it up and snort it, you can function much better,” Strong said. “I have seen doctors, nurses who have been able to function and complete their tasks.”
Addiction experts believe the multiple options for using heroin are contributing to the increase and more widespread abuse of the drug.
“The heroin addict today is your jock on the football field and your cheerleader in the grandstand,” Poncher said. “It is middle and upper-middle class kids doing this -- so far changed from when I first heard of heroin. Then it was looking at track marks on a user's arms, now it is easier to hide.”
Alex Waxman agrees. He said it is a lot harder to spot a heroin addict than it used to be.
“A lot of parents second-guess it,” he said. “Parents just think they are stoned or drunk, but it can get anybody.”
Like anyone struggling with an addiction, Alex Waxman has had setbacks. He has been attempting total sobriety for around a year, and for the last three months has been able to stay completely clean. He said he owes his sobriety to AA meetings.
Treatments for heroin range from behavioral therapies and medications used to help abusers to stop using heroin and return to stable lives. Medications include buprenorphine and methadone, which work by binding to the same cell receptors as heroin but more weakly, helping a person wean off the drug and reduce craving, according to the National Institute on Drug Abuse.
For addicts such as Alex Waxman, it is all about taking that first step and admitting there is a problem.
“People have to start saying, ‘we have a drug problem.’ It’s time to raise the white flag and say ‘I’ll give (drugs) up, I need help.’”