Sitting outside her ranch-style house in Florida, enjoying a warm day and cloudless blue sky, Melissa recalls when she was first introduced to opioids: She was 18 and had had gastric bypass surgery for obesity the summer after her freshman year at the University of Tampa. Her doctor gave her a morphine drip and later prescribed an opioid painkiller for the post-surgical pain.
She lost 130 pounds that summer but sank into an identity crisis. “I was so used to being overweight. I thought I was supposed to be happy,” she says, “but I was still miserable.” In contrast, the opioid painkillers she was given to ease her recovery made her feel good.
The vivacious 31-year-old, who asked that her real name and hometown not be disclosed to protect her privacy, was raised on Long Island by a loving, Conservative-affiliated Jewish family. After the surgery, in order to be closer to home and her support network, she transferred to Hunter College in Manhattan. She moved in with her older sister in the city and, after being prescribed another opioid painkiller after oral surgery that year, began “dabbling” with more opioids, she says, such as oxycodone and hydrocodone. She also took whatever she could get her hands on, including friends’ ADHD medication as well as anti-anxiety benzodiazepines, including Xanax and Klonopin.
At Hunter, Melissa recalls struggling both academically and socially. “I wasn’t living up to the stereotypicalJewish-girl American dream,” she says, noting the pressure to date, get engaged and marry—all by the age of 25. “I should have been at a certain place in my life. When I wasn’t, I felt there was something wrong with me.”
By the start of her junior year, Melissa had a $200- to $300-a-day drug habit. Unable to manage her coursework, she left Hunter midyear—which she concealed from her family. The academic fiasco only spurred her addiction. “I was afraid to tell my parents I’d flunked out, so I used more drugs to cope with those feelings,” she says.
Only when her mother requested a college transcript after Melissa had supposedly graduated did her parents discover the truth: The transcript didn’t exist, and their daughter was an addict.
“We were clueless,” says her mother, Ava, 62, who also asked to use a pseudonym. “It was not within the realm of our thought processes that this could be Melissa from Long Island whose mother is a lawyer. So much has changed. Now there are many Melissas in the world.”
The national public health crisis of opioid addiction is no longer breaking news—but it remains heartbreaking. According to figures from the Centers for Disease Control and Prevention, there were 70,237 deaths from drug overdoses in the United States in 2017, 68 percent of them from opioids.
Opioid addiction affects Americans of all genders, ages and socioeconomic levels. While a large majority of deaths from opioid overdose are men, women have fallen victim disproportionately in several ways. Between 1999 and 2015, prescription opioid overdose deaths among women increased 471 percent, more than double the rate among men, according to the United States Department of Health and Human Services’ Office on Women’s Health.
The CDC also notes that women become dependent more quickly than men and are more likely to engage in “doctor shopping” to obtain prescriptions from multiple physicians. At the same time, the differences in the impact of opioid use on women and men are often not well understood. The presumption is that because women suffer more than men from chronic pain, they are more often prescribed painkillers and given higher doses.
In addition, women aged 25 to 54 are more likely than other age groups of women to go to the emergency room from prescription painkiller abuse and women aged 45 to 54 are the highest risk group for dying from a prescription painkiller overdose. Moreover, the quick progression from prescription opioids such as oxycodone and hydrocodone to heroin, an illegal opioid made from morphine that delivers a comparable high for much less money, results in more deaths. Indeed, 80 percent of heroin users today first became addicted to prescription opioids.
“Opioids are not an easy topic in the pain community,” says Dr. Tanya Weissman, 40, a physical medicine and rehabilitation doctor and pain management specialist in East Brunswick, N.J. “We see the benefits, but realize the epidemic and potential for abuse.”
The first stumble into opioid addiction often begins with a short-term prescription after dental work or a procedure like a C-section, Dr. Weissman says. “Any small amount can be abused,” she explains. “People who are predisposed to addiction have cravings on more than a physical level. There is a psychological component.”
As the problem has grown, she says, physician education has helped decrease the number of irresponsible prescriptions. Medical practices also have started to screen more as states tighten regulations, including creating registries of opioid prescriptions. Dr. Weissman, for example, both screens all her patients and asks them to sign a contract stipulating that they will not get opioid medications from more than one doctor and will not share their own or others’ medications, among other rules. Doctors can enforce a contract by checking a state’s registry for other prescriptions and discharging the patient from the practice if there is a violation. Yet patients who go for root canal often aren’t screened, she notes, and screening varies from doctor to doctor and screening laws vary by state. Addicts can travel across state lines to fill a prescription that doesn’t comply with their own state’s rules.
A 2018 survey that explored issues around American women and the opioid epidemic noted how much further the medical community has to go. The study, commissioned by Shatterproof, a nonprofit dedicated to battling addiction, found that only one in five women reported being screened for a substance abuse disorder before receiving an opioid prescription and few were offered non-opioid alternatives. Seventy-eight percent said there is shame or stigma associated with a substance abuse disorder; fear of what other people might think is a major obstacle to seeking treatment.
Melissa hid her opioid addiction from her parents for over five years. “I was sneaking around behind my parents’ backs, yet I was still on their health insurance,” she says. When she was unable to find doctors to write her a prescription, she began looking for other ways to get a fix. “I knew people sold drugs on the street—it’s just something you know—and I found a dealer through a friend.”
Instead of going to classes, each day she left Manhattan’s Penn Station for the hourlong trip on the Long Island Railroad to meet her dealer, who supplied her with 15 to 20 oxycodone pills as well as several Xanax bars. “I wanted to get high, so I was excited to get the pills,” she says of those days.
Sometimes she would meet the dealer at his house, or in parking lots in Long Island. When she visited her parents, he would leave pills in her parents’ mailbox at night after they had gone to bed. When the allowance her parents gave her was not enough to cover her habit, she stole their debit cards and jewelry. In total, she stole $15,000 from her parents and grandmothers; she even duped an employer into giving her $2,500, which she said was for cancer treatment.
Melissa’s speech became slurred and she suffered seizures from the drugs. “No one diagnosed these as the consequences of addiction and withdrawal,” says her mother, who currently works as a public school teacher.