Highway to Heroin 

Long before heroin overtook him, Josh Graham swallowed a single, legally prescribed Lortab pill. It was meant to kill his pain after a wisdom-tooth extraction, and it worked. During the next year, Graham, 23, says he “abused Lortab casually. I took it to get drunk easier at high school parties.”

A friend soon talked him into trying oxycodone, better known by its trade name, OxyContin. “I was drunk at the time. But it was the most euphoric feeling I could ever have. The high was unbelievable. I didn’t have a care in the world. All my problems went away,” Graham says, who asked his real name not be used because he fears revealing his identity could harm his ability to keep his job.

Back then, Graham’s outward life seemed to be carefree. He had completed half of the classes for his bachelor’s degree at a Utah university and held a job at a big corporation. Through the friend who first introduced him to OxyContin, he started buying a 40-milligram pill to split with another friend on weekends. “I never thought I’d get addicted,” he says, “because I thought I was smart about it.” He started using OxyContin once during the week, and then several times a week. Finding a way to get the drug legally was impossible. Graham had made fake ID cards in the past, so it wasn’t too far a jump to the next side project: He would get Oxy by forging his own prescriptions. “I knew a pharmacist who wouldn’t question it,” he says. “Once I had a lot of them in my possession, my goal was to sell them for a dollar a milligram–$40 for a 40-milligram pill.”He conned himself into thinking everything was fine. The word “addiction” wasn’t in his vocabulary. “Every day, as soon as I woke up, I’d have some. I figured everything was OK, as long as I used before work and school. I was using at night and again in the morning.” Graham says the “the money was going well and school was something I was good at.” He tried to forge as few prescriptions as possible, he says, because it was stressful, and he didn’t want to get in trouble. Soon enough, none of that mattered. Graham’s story is playing out routinely all over the state. Eventually, like so many others addicted to painkillers, Graham couldn’t get enough pills to keep up with his own relentless demand. His highest intake was eight pills of 80 milligrams each—more than 640 milligrams of oxycodone–in a single day.

Just 18 months after his foray into painkillers, when scrounging for prescriptions was too much effort, Graham began snorting and smoking heroin. He could find it easily on the streets, it required no prescription—forged or not—and its supply was endless. “[Heroin] was so much cheaper, and no one ever ran out of heroin,” he recalls.

In the past decade, admissions for heroin-addiction treatment have climbed 8 percent in Salt Lake County, Eric Schmidt says, associate director of Salt Lake City’s Odyssey House, a private nonprofit rehab center for substance abusers. State-funded treatment facilities admitted 1,232 heroin addicts last year; 224 were admitted for treatment with other opiate addictions (primarily oral painkillers).

Because the statistics do not include admissions to private treatment centers, experts in Utah’s treatment community believe the numbers of opiate addicts are much higher, and that only 20 percent of those who need treatment are getting it. Drug counselors estimate up to 6,000 people in Salt Lake County are addicted to opiates but haven’t sought help.

“They don’t think they’ll have the money or don’t have access or feel they are not ready yet,” Schmidt says. “Maybe they haven’t gotten in trouble about drugs or don’t have anyone coercing them into treatment.” Because they are both opiates, oxycodone and heroin share similarities in the high they create. But its cheaper cost and wide availability make heroin an easy second-choice for people who can’t keep up the struggle to forge prescriptions or dream up other ways to get their hands on oxycodone. Long-term painkiller addiction also requires bigger doses to achieve the same high, which means more expense and logistical maneuvering.

Increasingly, they turn to heroin.

Feeding a Habit
It isn’t exactly a reasoned choice oxycodone addicts make in switching to heroin. As is typical, Graham developed a tolerance to OxyContin and had to keep upping his dosage to get the same effect. Because the addict has to continually up his dosage to get the same effect, the addiction can be life-consuming, Lewis Galway says, licensed professional counselor with Intermountain Healthcare system. He has counseled substance abusers for 20 years.

Heroin offers a much more rapid delivery system for addicts, Galway says. While in his work he meets people who grind up and snort the opiate-based pills, the needle system or smoking of heroin is preferred.

At one point, Graham tried to quit OxyContin by illegally buying suboxone, a synthetic substance used in treatment. Galway explains that suboxone blocks the opiate at the brain synapse receptor site and stops both the craving and the subsequent withdrawal. “It is the method of choice for maintenance treatment for opiate addiction for many facilities and outpatient clinics,” Galway says.

Says Graham: “It worked so well the first time, I figured I could use again.” But soon he was trading pills for suboxone, simply repeating the cycle of quitting and relapsing back into his habit.

Eventually, he was arrested for identity fraud and forced to detox in jail. He left jail clean, but Graham started using again while on probation. He tried to cheat his court-ordered drug tests by quitting a couple of days before the tests and “cleansing” his body with a drink addicts believe will trick the system.

Kristin Howell, 19, first took two of her stepfather’s Lortabs, then used them occasionally. Eventually, it was OxyContin. “A good high,” she says, “but very expensive.”

She first paid $35 for an 80-milligram pill. Then the price rose to $55. She was 16 when she overdosed on OxyContin. “I was really sick. I threw up everywhere,” Howell says. “I told my parents I quit, but I never did.”

Instead, she discovered that heroin was stronger, easier to get and cheaper at $10 a balloon—one hit. Economics count, Galway says, who cites one case of OxyContin addiction that set back the user $30,000 a year.

“People don’t take Lortab or Oxy thinking they will eventually shoot up heroin,” Galway says. “It’s a pill; somebody has a prescription. It’s legal, it’s clean. A buddy gives them one, and they take it. They take one more and like it, and the next thing you know, they are addicted.” Odyssey House’s Schmidt agrees. “We are a pill society, and there isn’t a stigma related to a pill. The misconception is that this is a prescription medication and is therefore safe. People are more willing to cross that bridge.”

But again, financing the habit becomes crucial. One client of Odyssey House told Schmidt he could sell 80 milligrams of OxyContin for $60, while $18 to $25 could buy a balloon of heroin, which gets into the bloodstream faster and lasts all day.

Still, “some folks work very hard to stay with pills,” Schmidt says. “They aren’t willing to go as far as using heroin because they feel it carries a stigma. They will pay a lot of money, doctor shop, steal a prescription pad. And they are scared. They think, ‘If I smoke or shoot heroin, I really am a junkie.’”

The self-deception continues, up until pharmacies will no longer fill an addict’s prescriptions. “They know that if they run out of ideas and have hard time getting the pills, they can always get heroin,” Schmidt says.

Needle and the Damage Done
Treating addictions to oral painkillers and heroin is essentially the same, Joel Millard says, executive director of Project Reality, a nonprofit drug treatment and prevention agency in Salt Lake City. “They are all opiates and the same receptor site [in the brain] is involved,” he explains.

It’s when addicts run out of their “easy supply” of pills and start suffering from withdrawal that heroin becomes a seemingly logical option, Galway says.

Buying heroin is strictly dangerous business. “You call a number where the guy gives you a name, but you don’t know if it’s real,” Graham says. “You say how much you want. He names a place and tells you what kind of car to look for. You park in the parking lot and wait. When the car gets there, you follow it, and they drive around for a little bit to make sure you are the one who called. They’ll pull over and ask how much you want. They throw the stuff into your car, and you throw the money into their car, and they drive off.”

Drug counselors say buying heroin is often an addict’s first criminal activity. “Though it’s hard to say which came first—criminal thinking or addiction—a lot of them don’t have criminal histories prior to their addiction,” Schmidt says.

Howell was initially arrested for stealing money from her place of work. Graham’s first arrest was for identity theft. Both broke the law to buy drugs. Along with being inexperienced at criminal behavior, many addicts are students or have jobs.

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IHC Counselor Lewis Galway	Odyssey House assoc. director Eric Schmidt

Usually, after an addiction has progressed from opiate pills to heroin, the addict’s life implodes as he becomes increasingly dependent on the drug, Schmidt says. “He spends more time getting the drug, getting the money to pay for the drug and more of his time high. Once the addiction reaches its low, the addict is not functional and not able to hold down a job.”

John Rogers says he held a job and lived in an upscale Salt Lake City neighborhood while feeding a heroin addiction. Rogers, who asked that his real name not be used, started with Lortab abuse, stealing pills from his relatives’ medicine cabinets. Once he found heroin, nothing else compared. “Shooting heroin is like taking an elevator from the 100th floor to the first floor in two seconds. Swallowing a pill and waiting 20 minutes doesn’t come close,” he says.

Rogers, 43, never had trouble finding the drug. “Sometimes, you can score immediately. At the most, It takes 20 minutes to find heroin,” he says, recalling buying it in downtown’s Pioneer Park.

The drug’s accessibility contributes to the struggle toward recovery, he says. “Knowing that you can feel better in 20 minutes, it’s hard to face six months of hell from cravings and withdrawal.” Graham and Howell tried to keep up with school while using, but it was impossible. They missed classes; they lied to teachers. Howell says she withdrew from heroin three separate times.

“I couldn’t eat or drink. I thought I was dying,” she says. Eventually, after serving five months in jail for theft, Howell voluntarily transferred to Odyssey House for treatment. “I just didn’t want to be in jail anymore,” she says.

Howell is using her real name for this story. Both Graham and Rogers chose to use pseudonyms because they feel that revealing their addictions could threaten their ability to earn a living.

More than 80 percent of Odyssey House clients are referred from the courts after criminal behavior—typically on charges of drug possession, distribution, theft or prostitution.

The life experiences and support system for an addict can help or hinder treatment, Schmidt says. “While some addicts still have a conventional home life and can approach recovery with 15 or more hours of outpatient treatment a week, some lack a stable recovery environment.” That means they have lost their homes, alienated families and are couch surfing from place to place.Before she went to Odyssey House, Howell’s parents had kicked her out. She was living in her car and was in and out of jail. Rogers’ wife discovered his double life when he suffered a bad drug reaction and had to go to the emergency room.

Rogers has been through treatment at 12 rehab centers. He has been sober now for six months. His track record is spotty, but he is feeling hopeful, and his wife has allowed him to move home.

Along with both inpatient and outpatient treatment, Rogers attends meetings of Narcotics Anonymous and Alcoholics Anonymous. Rehabilitation is a tenuous process, and the possibility of relapsing is always present.

Howell and Graham have each completed programs at Odyssey House. Howell has been sober for six months—her longest recovery ever. Graham worked his way through an Odyssey House program and has been sober for 21 months. He enjoys simple pleasures—going to a football game, eating a good restaurant meal. But the thought of relapsing haunts him.

“I’m an all or nothing type guy. One pill here or there, and I’d be back to everyday use. It’s such a slippery slope that it’s not even an option.”

A Winding Road to Recovery
Mark Van Wagoner accidentally swallowed Drano as an 18-months-old toddler – his first “issue” with chronic pain. In his 20s, a doctor regularly prescribed him 20 Lortabs a month.

“I held to that 20 pills a month for years,” says the 55-year-old Van Wagoner, who hosted the morning slot at KSL-AM radio for years before a new management team replaced him and several others in 1998.

“I felt so lost,” says Van Wagoner. “That’s when I started using heavy.”

Van Wagoner went from 20 to 50 Lortabs a month. He discovered a fellow addict in a dentist who had bought advertising time on local television. “He would write two prescriptions. I kept one and gave the other to him. My prescriptions never ran out. I knew every pharmacist from St. George to Pocatello. I made sure I didn’t go to the same one twice.”Van Wagoner’s supply of prescriptions kept coming, and he never felt the urge to move to heroin. But his drug connection eventually grew tenuous.

Van Wagoner is certain the U.S. Drug Enforcement Administration was tracking him by the time he checked himself into drug rehab in Arizona. Like so many others, he relapsed after doing a media job in Atlanta and finding his way to pain pills. He was drinking, too—a deadly combination. “My body was about ready to give out. My wife told me to get ready to die,” he says.

He decided to embrace a line credited to actor Tim Robbins: “Get busy living or get busy dying.” Van Wagoner found Discovery House, a Salt Lake City outpatient clinic. He began methadone treatment, under medical supervision. “People who use methadone as a recovery tool must abide by very strict standards; constant urinalysis and weekly sessions with a licensed counselor to get even a single does of methadone,” he says. It doesn’t work for everyone and, like pills or heroin, can be abused. Strict supervision and regular drug testing are essential to methadone treatment, he says.

“Methadone doesn’t give you a rush. It just takes the edge off and makes it so you are not sick. You can work. You can drive. It doesn’t affect your balance or your vision—it just makes you OK.”Van Wagoner says he is alive because of Discovery House. “I am here to pay taxes, tuition, house payments and provide for a family because of the program. My wife and best friend of many years is still my wife and best friend, not a widow, because of my methadone program.”He has his own radio show on KDYL-AM, writes a column for Utah Spirit magazine and volunteers in the LDS Church Family Services Substance Recovery Mission. “There is hope and health out there, if you are willing to work for your sobriety. It’s nice to walk past a pharmacy and not get chills.”