Inside one woman's near-fatal overdose, struggle with addiction
Editor's note: In late 2016, Trib journalists Megan Guza and Andrew Russell set out to chronicle the opioid crisis in Pennsylvania. To help them understand the impact of the epidemic, Washington County-based Ambulance & Chair granted them permission to ride along with paramedics on one of the many overdose calls they attend to every week. About 7:40 p.m. Dec. 2, Guza and Russell watched as paramedics revived a woman who had just used three stamp bags of heroin. The woman, a former nursing assistant, later recounted her addiction to prescription painkillers and heroin in face-to-face meetings. She requested that her name not be used to protect her and her family from the stigma attached to addiction. Here is her story.
She knew the signs of addiction: She was a nursing assistant for years.
She knew about the shakes, the constant swings of hot and cold. She knew painkillers could become a gateway to illegal drug use, namely heroin.
She knew heroin could kill, but she also knew that addicts don't think about that. They think only about their next fix.
She didn't know she was overdosing.
She didn't realize heroin nearly killed her until paramedics revived her with the overdose-reversal drug Narcan.
A month later, she is almost sheepish when she says she was scared that night, when paramedics rushed to the Washington County mobile home park where she lives.
She ducks her head and raises her eyes.
A Washington County woman lays on the floor of her bedroom after overdosing on heroin in late 2016. EMS workers with Washington Ambulance and Chair administered Narcan within minutes, saving her life. Photo by Andrew Russell
"Forty-three-year-old female. Possible overdose."
The warped voice through the dispatch radio crackled through the relative silence of the Washington Ambulance & Chair garage on Braden Street in Washington.
Medics Evan Vogel and Levi Graham headed for the ambulance, as the dispatcher relayed that the woman was barely breathing.
"I was on the phone asking if she wanted pizza, then she stopped talking," cried her daughter, who lives five minutes away. Fearing the worst, her daughter rushed over.
The chaos was contained to outside the mobile home. Inside the woman's bedroom, it was calm and methodical.
Vogel and Graham found a pulse. They administered a nasal spray dosage of the overdose-reversal drug Narcan. It works faster than an injection, they said, because the nasal passages allow quicker access for the drug to begin working.
An uncapped syringe and a spoon sat on the nightstand. Buddy, the woman's beagle, kept trying to barge into the bedroom where she lay on the floor.
Eventually, she awoke.
"What's going on? Who are all these people?" she thought.
When she realized they were paramedics, she said she knew what happened.
The Narcan made her nauseous — she vomited more than once in the ambulance on the way to the hospital. She didn't want to go, and she made the medics wait while she changed out of her clothes that were damp after friends used ice to try to revive her.
A month later, she explained that she normally would shoot six or seven stamp bags. She had taken three to be safe. It didn't matter.
"You don't know what's in it," she said. "But three bags, and I was out."
A syringe used to inject heroin sits on a bedside table as EMS workers with Washington Ambulance and Chair revive a Washington County woman on her bedroom floor after overdosing. Photo by Andrew Russell
She started taking the pills innocently enough. Torn muscles and ligaments in her back, neck and shoulder from struggling to catch a falling patient caused immense pain that over-the-counter medication couldn't quell.
Her fibromyalgia — a condition marked by full-body muscle pain — amplified everything. Narcotics often are prescribed for pain brought on by the condition or such extensive injuries.
What started as a way to control the pain became an addiction and led to the unending fight to stave off the even worse pain of dope-sickness — withdrawal from the opioids.
Doctors don't start you on the "strong stuff," she said. She started taking painkillers such as Percocet and Vicodin and eventually moved up to Opana, the brand name for oxymorphone. Single doses generally range from 10 to 20 mgs every four to six hours. She was taking up to 140 mg at a time.
From there, her addiction spiraled.
"If I didn't have them, I knew something was wrong," she said. "I knew it was withdrawal. I'd sit here and shake. I'd be hot, cold, hot, cold."
Starting "a couple years ago," she would take too many pills and run out, leaving her searching for a fix until she could refill her prescription. That's when she would turn to heroin. She said she knew it was a slippery slope.
"I knew I was already an addict. What was I going to do?" she said.
Her path to heroin is well-worn.
On average, more than 650,000 opioid prescriptions are written each day across the country, and nearly 4,000 people start taking them recreationally daily, according to the U.S. Department of Health and Human Services.
Nearly half of all adults who use heroin reported they first abused prescription painkillers, according to a National Institute on Drug Abuse survey. Some reported switching to heroin because it's easier: easier to find, buy and afford.
"Of the last 2,000 new users I've talked to in Western Pennsylvania, I'd say about 90 percent tell me they started with prescription pills," said Dr. Neil A. Capretto, medical director at Beaver County-based Gateway Rehab.
Many start on opioid painkillers for legitimate reasons.
"Some come off it, but some get trapped on it, find they need more and get addicted," he said.
Alternative: Their supply runs out, they can't get a prescription, they can't afford to buy them on the street. Withdrawal grips them, and they turn to the alternative —heroin — to stave it off.
Seventy-three people died because of overdoses in Washington County in 2015, the most recent year for which data were available. That was a 103 percent increase over the total in 2014. In Allegheny County in 2015, 422 people died from overdoses — 37 percent more than the previous year.
Statewide, medical examiners and coroners reported more than 3,500 overdose deaths in 2015. Though 2016 data are not finalized, experts have predicted the state will experience another increase.
"People are dying in record numbers," Capretto said. "Opioid pain pills are what caused this problem to literally explode."
A Washington County woman is treated by Washington Ambulance and Chair EMS workers, Levi Graham (left) and Evan Vogel, after she overdosed on heroin. Photo by Andrew Russell
The calls never cease, said Zachary Seery, shift supervisor at Washington Ambulance & Chair.
"Ten years ago in EMS, it was chest pain," said Seery, 30. "You always knew you were going to get a call for chest pain. Now you know you're going to get an overdose. It's second nature."
"It's just another call at this point," said Joshua Lane, 24, an EMT. "It's kind of an annoyance, really, because it happens all the time."
Washington Ambulance & Chair serves 27 municipalities, from Amwell and Canton to South Franklin and West Middletown. The medics and EMTs there said they try to have sympathy for the addicts they treat. But it can be hard, most said.
"On the weekends, you see the same people," said EMT Patsy Capo. "I say, 'I come get you every weekend. Why is that?' We call them frequent flyers."
Capo blamed inefficient rehab programs but admitted he doesn't know the solution.
"Rehab programs aren't what they need to be," he said. "They take you in for a month and then turn out."
He shook his head.
"You try not to get hard to people," said Rene Riggs, 39. She's studying to become a nurse — several of the paramedics at Ambulance & Chair are, she said, because it's easy to burn out working in EMS. "I feel bad for them. Nobody says, 'I'm going to be an addict.'"
A Washington County woman shows the scars that are the result of 17 years of opioid addiction at her home in January. In December, the woman overdosed on heroin but emergency medical personnel used Narcan to save her life. Photo by Andrew Russell
"I know I'm an addict, and I'll take it," the woman said, back home about a month after her overdose. "I'm not a heroin addict. I'm addicted to pain pills."
Despite having a legitimate prescription for painkillers, she said she doesn't keep them in her home anymore. She wants to stop taking them.
Since her overdose, she said she gradually has reduced the number of pills she takes. Her daughter keeps the pills at her house.
"If I need one, I take it, but I don't want it to be every day," the woman said. "Addiction is a disease. It's a terrible thing to go through. A lot of people don't make it."
"I'm ashamed I got to that point," she added. "It didn't have to go that far."
In her next breath, however, she describes addiction taking over her entire thought process.
"Your mind's not clear," she said. "You think, 'I'm not going to go through the sickness,' and you think, 'I'll just take another pain pill.'"
She had gone four days without a pill.
"I don't want to be taking more than prescribed. I don't even want to take as many as I'm even prescribed," she said. "I've been sick a few days, and now I'm hot and cold. My body has to deal with it. To get off them, you have to go through it. I'm trying to kick it myself — cold turkey."
She almost certainly will relapse, Capretto said.
"It's physically very, very painful," he said. "Dope sickness — it's a horrible one."
He said addicts describe withdrawal as the worst flu imaginable, with their head feeling as though it is in multiple vices and their stomach being stabbed by knives. Days of that can be followed by secondary withdrawal: low energy and depressed feelings.
"There's a high, high relapse rate," Capretto said. He pegged the failure rate for those trying to kick it cold-turkey at 95 percent.
The woman's words, though, sound like those of conviction. It was more than just the overdose scare, she said, that has pushed her to quit.
Her father died suddenly in August, leaving a void in the family. When she talked to her mother after the overdose, "She told me, 'If you died, I'd have to die, too. I just lost your father. I can't lose you, too.' That kind of woke me up," she said.
Her family has dealt with her addiction for too long, she said.
"They've seen me doped out of my mind. They've known what's been going on for a long time," she said. "I'm doing this for me and my kids. I deserve better."