The high cost of hidden addiction

Tammy King doesn't know exactly when it started. The long-time IT manager at Duke University recalls feeling on many days a sinking acknowledgement that she was, in fact, addicted to opioids.

"I realized I had a problem in the early 90s," King said.

We'd met her and her doctor, a Duke University physician named Larry Greenblatt (he's important to this story), at his office in Durham.

"It was after one of my bouts with shingles," King explained, "and I knew then that I had a problem. So I did the pill counting and tried to make the amount last until I got the next prescription. But it went on for 20 years."

King recounted the pains of addiction and what it took to get healthy.

"It was absolutely a living hell," she recalled. "I didn't take the pain pills to get a high. That was long gone. I took the pain pills just to feel normal; and if you didn't take the pills at a certain time, you would start having shakes, profuse sweating. I'd just feel miserable until I could get another Percocet."

"Was it always Percocet?" I wanted to know.

"Vicodin as well," she answered. "Anything that had the same effect."

King's account of her slide into "addict" sounds as if it might have come from any number of people hooked on opioids.

"At the beginning," she explained, "the prescription would say 'Take one or two.' I would take two and after an hour or so, 'If two makes me feel this good, I wonder what three will do?' And then, 'If three makes me feel this good,' later on in the day, 'I wonder how four would be?'"

When the pills would run out, King said she would usually run back to her doctor. "Usually, no questions. Because i still had the blisters in my hair from the shingles; I'd still have fractures on my feet."

"Do you feel like they over prescribed?" we asked.

"I do," King answered. "It does make me mad. Because, without the overprescribing, I don't think I would have gone through what I went through." But when she couldn't get a drugs through "official" channels, she also turned to the street. "Certain friends would say, 'Certain people are going to be at 'X-spot.'"

"It consumes your thoughts," King went on. "It consumes your whole being."

"Did anyone know?" I asked. "No. A few of my closest friends had an idea but I never said anything."

King hit rock bottom on April 12, 2016.

"I was very low. And I didn't know what I was going to do. I got down on my hands and knees and prayed. And as soon as I got up, there was my laptop. Duke has an electronic medical record where everything about you is stored confidentially and so I went into the electronic medical record and sent a note to my primary care doctor and said, 'I'm addicted. I need help. I'll call your office tomorrow. And by doing that, it couldn't be erased. It couldn't be, 'Oh, that didn't happen. I made sure it was there so she would read it."

Today, King looks back on 4/12/16 as a second birthday of sorts. "The next morning I called. She said, 'How fast can you be here?' I said, '25 minutes.'"

"The wonderful thing that I had going for me," King said, "I had tremendous support from the doctors at Duke. I also had tremendous, tremendous support from my senior leaders at Duke. The CEO of our group would send me handwritten letters. He'd send me text messages just making sure I was OK."

But it wasn't just a robust support group. King credits her recovery in large part to a relatively new drug called Suboxone.

"Suboxone has just been a life saver. I didn't have any withdrawal symptoms, no sweating, no shaking. The Suboxone worked marvelously for me," she said.

That's where Dr. Larry Greenblatt came in. A general internist and Medical Director for Northern Piedmont Community Care, Greenblatt is part of a group of doctors at Duke University who've taken up the charge of determining best practices when it comes to treating patients with opioids, including the use of Suboxone.

"Suboxone can be a highly effective treatment for people with opioid abuse disorder," Greenblatt explained. "It's about as effective as methadone, which has to be prescribed in a specialized clinic. Suboxone is made available in many office settings. There is some oversight from the DEA but it's much more straightforward to implement. It's a much safer drug than methadone but it's not right for everyone."

Greenblatt said Suboxone is one of many improving treatment options for opioid addicts but pointed out they're often not distributed evenly around the state.

"There are many counties where opioids are prescribed in a manner that is less safe and often in much greater quantities and to more individuals. And in those counties there's a strong correlation between the amount of opioids prescribed and the risk for overdose death. And it pretty much goes lock-step. When there's three times the rate of prescribing, you'll see three times the rate of deaths and in those same communities there's a lot of people who are battling addiction and opioid abuse disorder. There needs to be a standard that applies everywhere. It can't just be in the more urban counties or the places that have academic centers. This needs to be a statewide standard and, really, a national standard," he explained.

And Tammy King couldn't be a bigger supporter of Greenblatt's ideas for treatment.

"Getting people involved with his program and with other programs where Suboxone is an option will be key in the state's and the nation's recovery from this," she said.
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