Generation Rx

James is about to begin treatment for addiction to opiates—prescription drugs he’s obtained both legally and illegally. With sunken eyes, he looks older than his 25 years. Tall and rail thin, he sprawls in a chair, all arms and legs. His subdued mother sits next to him, lips pursed, and says she’s felt “horrible and helpless” during her son’s many years of addiction.

“I want it to stop,” he says.

“A kid on drugs is a car wreck. A kid addicted to prescription drugs is a disabling or fatal car wreck,” said Alex Stalcup, medical director for the New Leaf Treatment Center, an alcohol and drug facility in Lafayette, Calif., and frequent presenter on addiction locally as a consultant paid by a Butte County grant.

“We’re in the midst of a medical catastrophe here, a public-health crisis. Eventually these kids can’t support their [prescription drug] habit, and they’re driven to using heroin by needle—the most fatal addiction known.”

There’s an uptick in heroin use in Butte County, Stalcup said, and along with an uptick in heroin use comes an uptick in other public-health problems, such as HIV and hepatitis C.

Stalcup knows a thing or two about addiction. When he was a medical student at UC San Francisco in 1967, he was one of the group of medical, nursing and pharmacy students who joined with Dr. David Smith to found the Haight-Ashbury Free Clinic, which became the predominant place for addicts to get treatment in San Francisco.

After a crack addict murdered a close friend and research fellow, he made the decision to re-train in addiction medicine. He gave up a faculty appointment at Columbia University Hospital in New York City and returned to San Francisco, becoming medical director of the Haight-Ashbury Free Clinic in 1985.

He and wife, Janice, also a doctor, opened the New Leaf Treatment Center and now do outpatient treatment for drug addicts and alcoholics, pain patients, mentally ill drug addicts, and an onrushing wave of kids with prescription-drug addictions.

“I have seen a lot of drugs come and go in my 25 years of this practice, but the prescription-drug epidemic among young people is the most heart-breaking, lethal and preventable,” he said, speaking over the phone in a warm voice tinged with frustration and sadness.

Although methamphetamine addicts still top the list numbers-wise in this area, Stalcup said the “new” addiction includes drugs such as Oxycontin and Vicodin (opiates); tranquilizers such as Xanax and Klonopin (benzodiazopines); and stimulants used to treat attention-deficit disorder such as Ritalin and Adderall.

How do kids obtain these drugs? There are three primary ways: Some raid medicine cabinets. Prescription drugs abound in American households, and many people don’t keep track of them. Kids diagnosed with ADD are often put in charge of their own medications—and nobody knows some are selling them at school rather than taking them.

When the household wells run dry, kids turn to the streets, where they can readily purchase Oxycontin, Vicodin, Xanax (“alcohol in a pill”)—just about any prescription drug of their choosing.

Finally, many young people obtain legitimate prescriptions from doctors—some of whom are far too liberal with prescribing—often lying about physical problems to obtain the scripts.

Stalcup said kids love the euphoria they experience with opiates, the reduction in anxiety they encounter with tranquilizers, or the increase in confidence and alertness they have with stimulants. But soon they become addicted to these highly potent drugs.

“Once they’re addicted, they realize that if they don’t take the drug, they start to go through withdrawal,” he explained. Withdrawal from opiates in particular is so horrific, he said, that almost no human being willingly chooses to go through it. It almost always involves severe vomiting and diarrhea, extreme panic attacks, and agonizing physical pain.

Addicts will do anything to keep from going through withdrawal—including prostituting themselves, stealing and burglarizing. If they can’t obtain the drug, they develop symptoms of withdrawal that can include convulsions or even delirium tremens—the DTs.

“Young people can die if they come off prescription drugs too quickly,” Stalcup emphasized. “They need medical management to get safely off these drugs.”

Jeff Smith, commander for the Butte Interagency Narcotics Task Force, said abuse of prescription drugs—especially opiate painkillers—has exploded in Butte County over the past few years. People easily obtain drugs and sell them on the street.

“One 80 mg Oxycontin pill can be sold for 50, 60, 70 dollars,” he explained, while a single Vicodin pill is typically sold for five to seven dollars. Smith said some doctors truly believe what they’re doing is proper and that their patients are using the drugs as prescribed—but increasingly patients lie to doctors about physical problems so they can obtain the drugs and sell them.

Ultimately, he said, it comes down to dollars and cents—“There’s money to be made in seeing a lot of patients.” Pharmacies and drug companies are making money, too. Prescription drug addiction is the dirty little secret that nobody wants to talk about because everybody is making money off it.

Smith and his staff direct some resources toward educating doctors about the prescription-drug-abuse problem, and some doctors, he said, have cut back on how many pills they issue at a time. Some doctors have even called the task force, he noted, to report patients they suspect of selling prescription drugs.

“It’s a double-edged sword,” Smith said. “Some people have legitimate problems—others just like it [getting high on prescription drugs]. It’s a very fine line. But a lot of these pills are being sold on the street—it’s a burgeoning industry.” It’s difficult to make arrests, he said, as often people have legitimate prescriptions for the drugs that are found in home and vehicle searches.

Lately a relatively new drug for treating addiction, Suboxone, has emerged, Stalcup said. It’s highly effective in stopping withdrawal symptoms—within an hour—by taking away the cravings. Not many doctors in Butte County are certified to use it, however, even though a four-hour online class is all that’s required for certification. Stalcup said most doctors just don’t want to deal with addicts.

The Suboxone treatment is so easy to do, he said. “We need to broaden our treatment availability—it can be done on an outpatient basis. We need to expand the number of trained doctors who do this work. The whole system for treatment is not presently in place, but addiction is more treatable than it’s ever been in human history.”

Most Northern California rural counties have little to nothing in place to cope with this growing drug-abuse problem, Stalcup said. “We have a medical emergency going on here right now, the first opiate epidemic since the 1960s, and Butte County is painfully lacking in treatment.”

Stalcup keeps working to get people to understand the pervasive tragedy in their communities. “What would happen if an outbreak of smallpox occurred? People would be up in arms! These are our children—they deserve help.”

By all appearances, John—a Pleasant Valley High graduate —is a nice young man from a good family. His parents are hard workers who own a successful business in Chico, and John and his sisters had many of the advantages of a well-educated, middle-class family.

Why, then, is John now behind bars for a spate of car thefts he committed over the past couple years? What went wrong?

Early in adolescence, John started getting in trouble—trouble that took him to juvenile hall. By his late teens, it was clear he had a drugs-and-alcohol problem. After many other attempts to get help for their son, John’s parents signed him into a highly recommended residential rehabilitation program, where he spent several months. He did well in the program and began to thrive for the first time in his life.

Following discharge, John completed a vocational program, worked for a while at a respectable job, and had a girlfriend. Then things started to fall apart. He was arrested on a drug charge and put on Prop 36, which allows for a drug charge to be expunged from a person’s record if all reform criteria are met. For a while, John met the criteria, and he landed another job. Then, when his employer found out about his legal problems, he lost the job.

John moved in with his parents for a while, and he went through a succession of brief jobs. He moved into an apartment with some other young people, and nobody in the family saw him much. Then his father learned John was seeing a Chico doctor who had prescribed Oxycontin for an ostensible shoulder condition. Concerned, the father called the doctor and informed him John had a history of drug addiction. Later, he found out the doctor was still prescribing the drug to John—in spite of the information he had provided.

In January, John was arrested on numerous counts of car theft in Chico. While he quickly took responsibility for his bad choices, his history of addiction was raised during his judicial process; regardless, he received a state prison sentence of several years.

Addicts who end up in the judicial system do not fare well, Stalcup said. After being supported by the taxpayers for several years, learning more about crime, becoming sexual victims, and perhaps still using, they come out “worse criminals,” and 90 percent will resume using drugs within three years after their release from prison.

“Prison does not help addiction,” he emphasized. As the pill problem increases, stats rise for theft and burglary. But Stalcup cited new research papers showing that if opiate addicts start on Suboxone while incarcerated, fewer than 25 percent will relapse—if they also are assisted in transitioning back into the community. This approach lowers the crime rate, too.

“The reason to offer this treatment is because it’s humane—people should not have to suffer. I can’t see why we send them to prison.”

Stalcup said we are only in the “building phase” of the epidemic—it’s going to get worse. He sees a new kid or two every day addicted to prescription drugs of one sort or another, and he has to work hard not to cry.

“I get overwhelmed with what I am seeing.”

Local professionals involved with youth who confirm that use of prescription drugs is indeed a problem include John Siebal, prevention and intervention specialist and youth counselor at Pleasant Valley High School; Sue Baber, who fills the same roles at Chico High School; Fred Porter, the Chico Police Department Youth Services supervisor in charge of the gang unit and school resource officers; and Paula Felipe, Butte County Sheriff’s Office crime prevention coordinator.

Schools and public agencies are working to address the problem, Siebal and Baber said, focusing on education and conducting drug-awareness campaigns at the schools. Felipe said Butte County Superior Court Judge Tamara Mosbarger took the lead last spring in organizing a well-attended symposium on prescription drug addiction that included a strong effort to educate parents and encourage them to dispose of (at authorized drop-off locations) or lock up their unused prescription drugs.

Local police officers have seen first-hand the devastation of teens addicted to Oxycontin, Felipe said. According to a press release from the Sheriff’s Office this past July, more young people age 12-17 abuse prescription drugs than any illicit drug other than marijuana.

“Last year, there was a big problem [at Chico schools]—enough to measure,” Porter said. “There was an upswing in kids bringing prescription drugs to school and using, selling, or giving them away. Some kids got sick, and there was some overdosing.”

Could John have gotten on top of his addiction issues and avoided prison if he’d had access to Suboxone treatment in his teens? And if a money-hungry doctor hadn’t prescribed Oxycontin for a known addict?

Dr. David Altman thinks so, and he’s determined to make this kind of treatment available to anyone in Chico who wants and needs it. He sees the good in everyone, he says—all people are worth saving. He especially wants to see young prescription-drug addicts get their lives back on track before they die, are disabled, or end up in prison.

A stocky, smiling man in his middle years, Altman sits in his cluttered yet comfortable office in North Chico. He’s practiced medicine for more than 30 years; first in Sacramento, now in Chico. He looks out from under thick, bushy eyebrows as he speaks animatedly while gesturing.

He describes teenagers holding “rainbow parties” where they all bring pills they’ve taken from their parents’ medicine cabinets, toss them in a bowl, and take several—not knowing what they’re taking—until they’re “messed up.” Altman said people in Chico are dying from opiate and other prescription-drug overdoses (including methadone overdoses), but that never appears in the newspaper obituaries—overdose deaths are always listed as deaths from “natural causes.”

Altman is one of only a few doctors in Chico who are certified to use Suboxone to treat prescription-drug addiction and other addictions—and the majority of his patients are young. He treats alcoholics using a drug called Vivitrol, and he treats methamphetamine addicts with Provigil and Nuvigil.

Altman doesn’t mince words when talking about doctors in Chico and elsewhere who over-prescribe drugs. “There’s a factor of money-making involved,” he said, echoing Smith. “They’re hypocrites of the Hippocratic Oath.”

He charged one local doctor takes only cash payments from his patients and hands out Oxycontin prescriptions like order forms for candy. Patients fill their prescriptions, use half of them, and sell the rest on the street, sometimes parlaying $65 of Oxycontin into $1,200 or more in cash.

Altman believes that methadone replacement therapy, used by one clinic locally—Aegis Clinic on Rio Lindo—is a joke, methadone being a highly addictive substance itself. “How can they take pride in addicting young people to methadone?” he asked incredulously, noting that some physician’s assistants in Chico “prescribe methadone like water.”

Arron Hightower, Aegis Clinic’s director of clinical services, responded that Aegis has a high success rate with its narcotics treatment program, which includes a large percentage of case management and counseling in addition to replacement therapy.

Citing the recent death of Michael Jackson, which has now turned into a homicide case, Altman said doctors who prescribe inappropriate amounts of drugs now stand to run afoul of the law. “Michael Jackson is the best thing that could have happened to raise our awareness,” he said.

Unfortunately, the Department of Justice and the California Medical Board do not have the manpower to provide adequate oversight of the state’s doctors.

The judicial system’s “answer” to the drug problem is to put young people in jail, Altman said—and, like Stalcup, he believes this approach is antithetical to dealing with the skyrocketing problem.

Along with undergoing Suboxone treatment, his patients enter into counseling with his assistant of two years, Mary Ellen Smith, who is a certified addiction counselor and educator. Patients must address their family and peer group issues and learn how to stay away from people who want to lure them back into addiction.

Many of his patients, Altman said, have a mental-health diagnosis in addition to their substance-abuse problem, and their drug use has served as a form of self-medication. Both he and Smith give considerable time to each patient. And, Smith adds, Butte County courts have recently started sending referrals to their office, which shows the courts are accepting Suboxone treatment for addicts—it’s becoming mainstream.

Ryan is well on the road to putting his prescription-drug addiction behind him.

“Ryan is our most successful client,” Altman says. “But people have to want to get better.”