When Jack O'Connor was 19, he was so desperate to beat his addictions to alcohol and opioids that he took a really rash step. He joined the Marines.
"This will fix me," O'Connor thought as he went to boot camp. "It better fix me or I'm screwed."
After 13 weeks of sobriety and exercise and discipline, O'Connor completed basic training, but he started using again immediately.
"Same thing," he says. "Percocet, like, off the street. Pills."
Percocet is the brand name for acetaminophen and oxycodone. Oxycodone is a powerful opioid. It's one of the most commonly prescribed painkillers, and is a key factor in one of the country's most pressing public health problems — an opioid addiction epidemic. It is a crisis that started, in part, from the overprescription of painkillers like Percocet, and then shifted to heroin as people addicted to prescription drugs looked for a cheaper high.
O'Connor is one of an estimated 2.5 million Americans addicted to opioids and heroin, according to the National Institute on Drug Abuse. Over three years, he detoxed from prescription painkillers — and heroin — more than 20 times. Each time, he started using again. So why is it so hard for opioid addicts to quit? You can boil it down to two crucial bits of science: the powerful nature of opioids and the neuroscience behind how addiction hijacks the brain.
"The first recording of opioid use was 5,000 years ago," says Dr. Seddon Savage, an addiction and pain specialist at Dartmouth College. It was "a picture of the opium poppy and the words 'the joy plant.' "
'It Ruined Me That Time. But I Loved It'
Jack O'Connor says he ended his freshman year of college as an alcoholic. He went home that summer desperate to replace alcohol with something else. And it was not hard to do. In 2012, 259 million opioid pain medication prescriptions were written — that's enough painkillers for every American to have a bottle of the pills. O'Connor got his hands on some 30-milligram Percocet.
"I ended up sniffing a whole one, and I blacked out, puking everywhere," says O'Connor. "I don't remember anything. It ruined me that time. But I loved it."
Opioids got him higher faster than any drug he had tried. And even though different drugs produce different highs, they all involve the same pathway in the brain.
They trigger the release of dopamine, which is a neurotransmitter that causes intense pleasure in parts of the brain that include the limbic system, according to Savage. It links brain areas that control and regulate emotions such as the pleasures of eating, drinking and sex. "This is a very ancient part of the human brain that's necessary for survival," says Savage. "All drugs that people use to get high tickle this part of the brain."
People can become psychologically and physically dependent on opioids very quickly. Breaking the physical dependence involves a several-day nightmare called detox, when the body gets used to being without the drug.
"It is an amazing thing to see someone basically vibrating in their chair, feeling nauseated, looking like hell," says Jeffrey Ferguson, a detox specialist at Serenity Place in Manchester, N.H.
Jack O'Connor put himself through detox 20 times, but that didn't stop his addiction. O'Connor's limbic reward system had hijacked other systems in his brain — systems that drive judgment, planning and organization — driving them all to seek that pleasure of getting high. This process can go on during years of sobriety, according to Savage.
"Addiction recruits memory systems, motivational systems, impairs inhibitory systems and continues to stimulate the drive to use," she says.
O'Connor says all his decisions began to serve his addiction. When he was using, everything was about getting the next drink or drug.
Over his years of addiction, O'Connor lied to his family and stole from his job — all while also trying to get sober. A little over a year ago, he put himself through a five-day detox clinic and managed to get through five more days in the real world sober. Then he couldn't take it. One day he started obsessively searching his credit cards for drug residue. He found a bag of heroin in his wallet.
"Somebody's telling me I need to get high," he thought at the time.
And that's what he did.
'I Don't Need It Anymore'
Feelings like joy and shame also play a role in drug dependence, and make it hard to quit. Practical issues are a challenge, too. "Finding the job, saving money, finding a place to live," says Ferguson. "Maybe they have some felony convictions. It's a lot."
And the country is facing a shortage of addiction treatment facilities and specialists; the shortage ranges wildly from one state to another. Treatment for opioid addiction includes a variety of services: medication, talk therapy, job support, all stretched out over years. Detox isn't enough.
"For people who don't get intensive treatment, people who are just detoxified [from opioids]," says Savage, "relapse rates can be above 90 percent."
O'Connor is now 23 and he's finally sober — Jan. 11 is his one-year sobriety date. In that time he's been in a nonmedical residential treatment program in Dover, N.H., where he lives and works. He has support — a girlfriend, his family, the Marines. And in the same way that he once replaced his coping skills with drugs, he has rebuilt his coping skills around quitting drugs.
"I don't need it anymore," he says. "I literally, physically and emotionally don't need it." And as much as O'Connor loved the feeling of getting high on heroin, now there is something he loves more: "I love the way I feel sober," he says.
DAVID GREENE, HOST:
Addiction to painkillers, opioids, has become one of the country's most pressing public health problems. But no matter how Congress, health care providers and families approach this problem, recovery will not come easy. I'm joined on the line by New Hampshire Public Radio's Jack Rodolico to talk about why quitting is so difficult. And, Jack, welcome to the program.
JACK RODOLICO, BYLINE: Thanks, David.
GREENE: So two and half million Americans are addicted to opioids. And you sat down with one of them.
RODOLICO: That's right. His name is Jack O'Connor. He's at a recovery center here in New Hampshire. And O'Connor is an opioid addict and an alcoholic. And four years ago, he was just so desperate to beat his addictions that he took a really rash step. He joined the Marine Corps. And this is what he was thinking as he went to boot camp.
JACK O'CONNOR: This will fix me. I'm going to get cured by doing this - 13 weeks. It better fix me or I'm screwed.
GREENE: My god, he joined the Marines to try and get off alcohol and opioids. Did it work?
RODOLICO: Well, he was sober through boot camp. But as soon as he left, he started using again.
O'CONNOR: Same thing - Percocets, like, off-the-street pills.
RODOLICO: Over three years, he detoxed more than 20 times.
GREENE: So is it any different for, say, a cocaine addict than for someone addicted to opioids?
RODOLICO: Yes and no. Experts describe addiction - and that's all addiction - as hijacking the brain. But with these prescription painkillers and heroine, the hijacking can be particularly aggressive. And as I really dug into O'Connor's story, I talked with Dr. Seddon Savage, an addiction specialist at Dartmouth.
SEDDON SAVAGE: The first recording of opioid use was 5,000 years ago. And ironically it was two words - a picture of the opium poppy and the words the joy plant.
RODOLICO: So, David, let's return to Jack O'Connor's story now because he discovered that joy. He was an alcoholic during his freshman year of college. And he went home that summer desperate to replace alcohol with something else. And that was easy to do. In 2012, prescribers handed out enough painkillers for every American to have a bottle of opioids. O'Connor got his hands on some 30-milligram Percocet pills.
O'CONNOR: And I ended up sniffing a whole one. And I, like, blacked out, puking everywhere. I don't remember anything. It ruined me that time. But I loved it.
RODOLICO: Opioids got him higher faster than any drug he'd tried. And even though different drugs produce different highs, all drugs have the same pathway in the brain, says Dr. Savage.
SAVAGE: Ultimately, the released dopamine, which causes intense pleasure in a part of the brain that's called the limbic reward system. This is a very ancient part of the human brain that's necessary for survival.
RODOLICO: The intense pleasure of eating, drinking, sex - that's all driven by the limbic reward system.
SAVAGE: So all drugs that people use to get high tickle this part of the brain.
RODOLICO: But opioids are so addictive you become physically dependent on them very quickly. And breaking that physical dependence, that's called detox. Jeffrey Ferguson is a detox specialist at Serenity Place in Manchester, N.H.
JEFFREY FERGUSON: It is an amazing thing to see someone basically vibrating in their chair, feeling nauseated, looking like hell.
RODOLICO: This is the thing Jack O'Connor put himself through 20 times. It's a five-day physical nightmare. But when detox is over, addiction is still there. Dr. Savage says that's because in the addicted brain, the limbic reward system - that drive for pleasure - has hijacked other brain systems.
SAVAGE: Memory systems, motivational systems, judgment.
RODOLICO: The more Percocet O'Connor sniffed, the more getting high became his only coping skill in life. Everything drove him to get high - his stress, his joy, his shame.
O'CONNOR: Mentally somewhat it kind of straightens out my head - or spiritually I guess would be the better word for that 'cause, like, everything was about me until I get that next drink or drug.
RODOLICO: O'Connor switched from pills to heroin to get higher cheaper. In fact, 75 percent of prescription opioid addicts shift to heroin. Jeffrey Ferguson says that's because the addicted hijacked brain is singularly focused on getting high at all costs. [POST-BROADCAST CORRECTION: In the audio of this story, we incorrectly say that 75 percent of people addicted to prescription opioids switch to heroin. Actually, 75 percent of heroin users started out abusing prescription opioids.]
O'CONNOR: My morals, my standards, my ethics may start out like I would never steal money from my mom's purse. All of a sudden, click, that bar goes down. I'll never rob a store - click, click, click. I'll never be homeless. I'll never sell my body for drugs.
RODOLICO: Jack O'Connor lied to his family and stole from his job all while trying to get sober. In late 2013, he put himself through a five-day detox clinic. Then he managed to get through five more days in the real world sober. And then he found a bag of heroin in his wallet.
O'CONNOR: Somebody's telling me, like, I need to get high - cool. So I get high, go to a Christmas party, like, really ashamed of myself that I did that.
RODOLICO: Giving into his heroin craving was his addiction tipping point. At the Christmas party with his family, high on heroin, O'Connor got drunk - really drunk - wine then beer then whiskey.
O'CONNOR: It, like, sets off this thing where it's like, cool, I'm good now. But I could be better. Let's have some more.
GREENE: All right. That report coming to us from Jack Rodolico from New Hampshire Public Radio. And he's still on the line with us. And just listening to that voice there, clearly opioids are different. But this is not some big scientific discovery that people who are addicted are driven to use again and again. I mean, does it really involve a change in approach in some way?
RODOLICO: Well, it does in that what has changed is that tens of thousands of new people from all walks of life are now hooked on opioids. That's the change. We've got more people addicted to these drugs. And we don't have enough addiction specialists in the country to help those people. And detox isn't enough. For people who only detox from opioid dependence, relapse rates can be above 90 percent.
GREENE: OK, so where does this all leave this man you spent so much time with, Jack O'Connor?
RODOLICO: Well, so far, he's actually in the minority. Today is his one-year sobriety anniversary. He's been in rehab for that entire year. He has a job and a supportive family - all things that help people stay sober in the long-term. And in the same way he once replaced his coping skills with drugs, he has now rebuilt those coping skills by quitting drugs.
O'CONNOR: I don't need it anymore because what it essentially is is like, I like the way I feel when I put drugs or alcohol in my system. Now sober, I love the way I feel sober. I literally physically and, like, emotionally don't need it.
RODOLICO: O'Connor is optimistic for himself but not for everyone. Every hour two Americans die of an opioid overdose.
GREENE: Wow, that's a stunning number. We'll certainly be rooting for O'Connor. Jack Rodolico is a reporter for New Hampshire Public Radio. Jack, thanks a lot.
RODOLICO: Thank you, David. Transcript provided by NPR, Copyright NPR.