They are working heroin addicts – people who do jobs, pay the bills and fool their families.
For some, addiction is genetically determined; You are so wired. For others, chronic pain and lack of legal opioids ended up here. Or experiments made them addicted and changed everything.
According to experts, what addicts have in common is a disease that has more to do with their brains than with the substances they use. For example, approximately 85% of people can take a pain pill and never long for it again.
This is a story about the others who are taking the dangerous path of functional addiction. According to experts, what works for them now can be derailed easily and fatally.
Hanging in the balance are people you may never imagine: peers, co-workers and neighbors. Dear, bosses and teachers. Respected members of your community who want to be heard for the full understanding.
After CNN gave a voice to addicts on Skid Row last fall, I set about telling this overlooked part of the heroin story.
To be a functioning addict depends on heroin use remaining silent. That is why we agreed to change the names of those who are ready to open up.
& # 39; All smiles and happiness at work & # 39;
Loving and successful parents, good schools, a great upbringing in the Midwest: Todd can't point out anything that drove him to drugs. He was a typical local student dealing with grass. Then, at 15, he popped a percocet that his mother left lying around while she was recovering from the surgery.
"The feeling in my head was: & # 39; I want to feel that way for the rest of my life," "says Todd. "It was the perfect drug for me."
The eleven years since then have been a dance with opioid addiction, even when he graduated from college and started a successful career in business management. The 26-year-old has traveled distances where he was sober, but the train is strong and keeps pulling it back.
He's been drinking heroin for some time and says it's "fantastic", but shooting is not his style. Provided he can find them, he prefers to buy more expensive opioids. OxyContin has long been his favorite drug. Now he prefers Opana and, if he can't, Subutex.
He makes good money, which means he can afford his habit of $ 350 to $ 600 a week.
He found out how much he had to take so that he didn't feel the pain of retreating, which is now his goal – instead of reaching a full-on high. His sweet spot: 60 milligrams of opana.
"I don't know how to describe withdrawal. It's like the worst flu you've ever had in your life – and then multiply it by 1,000," he says. "It scratches in your brain. You are ready to do anything to feel better."
To avoid this hell, Todd often lives a lie. He is "all smiles and happiness at work," he says, and he tells stories to keep his secret. He could say he's in one city when he's really in another. This short trip he makes to McDonald & # 39; s could be to meet his dealer at Burger King. When he uses heroin, he explains the bruises on his arm by telling people that he has diabetes or an infectious disease. He once told a pharmacist that he was a science teacher who needed syringes for experiments. He invented the death of family members to take days off.
But death is a reality in his life.
His last serious girlfriend also took drugs and died of an overdose. In the past six years he has lost seven people who are dear to him through addiction.
He wants to find love, build a relationship, and have a family, but says, "It would be dishonest and I never want to hurt anyone. That is the biggest problem."
He knows he has a lot to live for, but he often forgets that and struggles to imagine a future. And because he can't be far from his dealer, a dream he has will remain on ice indefinitely.
"I've always wanted to see the world," he says. "I've never been outside the country because I can't go. I'm tied up where I am. It's a damn prison."
The Sign of an Addict
The sensation Todd first had when he popped a Percocet was the giveaway he wanted to hold onto for the rest of his life . Like 10% or 15% of people, he has an addiction, explains Dr. Stuart Gitlow, former president of the American Society of Addiction Medicine.
What doesn't offer a high for most people or even make them feel uncomfortable has become Todd's goal. And part of the problem, says Gitlow, is that "you don't know in advance who you will be."
Todd may be working now, but Gitlow warns that tolerances and doses change frequently. As the addiction progresses, it is also influenced by life events and stress factors. What happens if one day Todd loses his job or cannot afford his favorite pills?
"They all start to work," he says. "Most of the people who take heroin probably work. Only in the final stages do they nod off in an alley and have a pretty good chance of dying."
What Todd needs, says Gitlow, is the help of a doctor who is certified in addiction medicine and can treat his illness. The vast majority, or 80%, of those seeking appropriate treatment and following their treatment recommendations are doing well, he says.
No Unique Story
It Didn't Start with a pill for Lisa. Her first addiction started at 12 when she started cutting herself.
When she carves into her flesh, dopamine is released in her brain, which gives her a high, she says. When she did it for the first time, she never expected a rush. She was emotionally overwhelmed and just played out. But cutting became her way to self-medication because it provided comfort and relieved the emotional pain of living in a screaming household.
Now, at the age of 23, Lisa decides to use heroin. And because of that and other opioids she used: "I hurt myself a lot less."
The difference now is that, like Todd, she is no longer looking for a high. When she shoots up every morning, she insists "I'm doing just enough to stay healthy" and I don't feel any physical pain.
She works hard, always has. She excelled in college at her private school, where she was described as "gifted and talented," she says. She takes her job as branch manager seriously and enjoys a supportive marriage. No one at work knows that their day begins with a call to their dealer. If there are traces, a simple long-sleeved shirt hides the evidence.
How she found heroin is not unique.
Lisa was long plagued by tendinitis in the knees and two herniated discs in the back and tried everything. Steroid injections gave her migraines and her stomach could not handle anti-inflammatories. Physical and aquatic therapies offered little relief, as did the deep tissue massage. Finally, a doctor wrote a prescription for pain relievers four years ago.
She found consolation in these legal opioids. But then came the crackdown on opioid prescriptions, she says, and effectively ended her rightful pain treatment.
When her pills were used up, she bought them on the street. However, they were difficult to find and the cost became prohibitive. An old friend, a heroin user, suggested that she try his drug.
"I can't find any pills, I'm in pain and it's really cheap," she recalls. "What happened to me is what happened to thousands and thousands of people."
Where she lives in Texas near the Mexican border, the price of heroin is unbeatable. A pill may cost her $ 50, but she can get half a gram of heroin, which is far more effective, for $ 20. The same product, she says, would cost up to five times as much in other parts of the country.
"If I moved somewhere where it was $ 100," she says, "I would stop."
Her husband does not use drugs. He hardly drinks. And even though he would prefer her to give up the habit altogether, he is determined to be by her side – so much so that he has Narcan, the overdose antidote, at home and watched training videos to help him learn how to administer overdoses in case.
"He loves me enough that he is ready to stay with me," says Lisa. "It's a key component to keep me from leaving the deep end."
Lisa says a small handful of friends know that she uses heroin. Everyone else, including her family, thinks she loves "just pills". That way it's easier. Pills and other vices don't have the same judgment.
"People drink and we don't think about it. They make heroin and you are the scum of the earth," she says. "People will cut you out of their lives."
Heroin users were not always "the scum of the earth". In the late 19th century, it was a brand name for an over-the-counter drug from Bayer.
Today there is a policy behind which drugs are demonized and which are not, and much of it is due to racism, says Dr. Michael Miller, who preceded Gitlow as President of the American Society of Addiction Medicine.
White celebrities sniffing cocaine in an Aspen ski hut are forgiven, while downtown blacks who smoke crack – just another form of cocaine – are slandered and locked away, Miller explains. Heroin was romanticized when musicians used it, he says, but after black kids in coastal towns seized it, perception changed and got stuck.
Well, with the explosion of the opioid epidemic and the emergence of heroin as a cheaper alternative, it has become a problem for everyone – white or black, rich or poor, on the coasts or in Central America, whether you're in live in a city, suburb, or rural community.
So Lisa was harnessed and learned to keep a secret.
She admits that the management of her addiction largely depends on her husband being by her side. But what if he leaves? What if life throws you a different kind of idiot? How much heroin would she need to relieve her pain?
"She has no coping skills. She is right on the edge," says Gitlow. "What if your dealer gets arrested and your new dealer interferes with Fentanyl? Boom. She's dead."
& # 39; How to drink a beer & # 39;
Not everyone I spoke to considers themselves addicted. Matthew enters.
As long as Matthew can remember, he has been fighting anxiety and depression. Aside from recipes like Xanax or Valium, he started treating himself with marijuana and LSD at the age of 19, he says.
An arrest for possession of the Pot and LSD with a view to distributing them brought him to probation. In regular drug tests, where cannabis was detected, he turned to harder drugs that didn't stay in the urine that long. So Matthew, 28, first tried Oxycodon.
Later, a doctor prescribed opioids for chronic stomach pain, a disease he had had for six years.
It is the kind of pain, he says, that drove him into the bathroom so often that he couldn't keep a job. Several GI doctors have tried to help him. Only prescribed opioids and marijuana have brought relief.
Growing up in the eastern United States, he now lives in rural Northern California and works as a consultant in the cannabis industry. He does not hide his marijuana use or addiction to painkillers.
It is the powdered heroin that he buys in the dark net, the stuff that he snorts in the bathroom a few times a day and that he keeps to himself. He says he only uses it when his prescriptions or insurance cover expire.
He never used heroin intravenously. After going back and forth between drugs and illegal deliveries, he says he can use a milligram scale to carefully measure how much powder to ingest.
"It resembles a dose of Percocet." he says. "The effect would be like drinking a beer or a cocktail."
He doesn't consume much and says he only snorts about $ 5 a day of heroin. He stopped in batches and wrote down pros and cons lists to see if he could go on. The professionals keep winning.
"I just don't find it sober that I'm the best," he says.
Having a secret can be isolating, he says, but otherwise heroin hasn't hindered his life. Rather, Matthew says, "It changed my life for the better."
Not only does it help with the pain, he says it clogs him and enables him to leave the bathroom and leave the house.
"I am addicted," he says. "But I wouldn't necessarily call myself an addict."
The Paralyzing Truth
Matthew makes fun of it, experts say.
"Denial is a debilitating component of addiction," said Gitlow. "Here we have a well-documented illustration of this deadly component."
From 19 years of age, there were signs that Matthew turned to drugs rather than "conventional coping mechanisms," explains Gitlow. Someone without addiction might have tried these drugs for temporary relief, but then found that they weren't worth the long-term risk.
Matthew's belief that he has no problem is no different from a man with high blood pressure or diabetes who pretends that there is nothing wrong with him, according to Gitlow.
The use of heroin and other opioids also changes brain chemistry, says Siobhan Morse, director of clinical services for the Foundations Recovery Network.
The natural way a body deals with pain or stress is, according to Morse, to produce endorphins.
"If you give him the artificial substance," she explains, the brain believes that this is not the case. I don't have to do the real thing. "So if you take away the artificial substance, everything is so painful."
And for people like Matthew who have psychological problems like anxiety or depression at the same time, self-medication with opioids can make this situation worse, Morse adds. She describes the combination as a "moving target".
Finally, she and other experts say Matthew's drug use will catch up with him.
"I have never met anyone who is held indefinitely. It is a heroin addict," Morse says.
The Fall of the & # 39; Superfrau & # 39;
Rebecca has been used for more than three decades – longer than Matthew, Todd and Lisa together. She is surprised to be still alive.
She grew up in an upper middle-class household in a suburb of Tony in the south, where she was raised more by the housekeeper than by her parents. Her mother was checked out; Her father had lovers and traveled often.
"I had no limits," says Rebecca, 59. "I could do what I wanted, which was a recipe for disaster."
From 12 she tried every narcotic she could find. When she was 15, the man who was her drug dealer and friend introduced her to heroin.
"I was in love," she says of the drug. "It became the love of my life."
One day she slept on the couch in her family's house when an older sister held her, rolled up one of her sleeves and called her tracks.
"Mom didn't open her eyes," Rebecca recalls. Instead, she shrugged and said, "Jewish people are not addicts."
When he was around, her father was more of a friend than a parent. He celebrated with Rebecca and gave her quaaludes, she says.
Rebecca finally married the drug dealer friend and they had a daughter. But the marriage was short-lived.
Divorced and 24 years old, Rebecca went to treatment after her daughter turned 3. Rebecca knew she was unable to be parents and feared that she would lose her daughter forever. It was the first of about 20 times she looked for help in a treatment facility.
On the way, she remarried; Husband # 2 died of a heroin overdose.
Rebecca met her third husband in treatment and remained sober for eight years. They had two other children and a comfortable lifestyle. They enjoyed the privileges that they knew as adults. But when this marriage fell apart, it did.
"It was then that I started to turn down," says Rebecca. "As soon as I started using it, it was instant … it was like I never stopped using it."
Even when Rebecca returned to heroin and spent $ 100 or more a day, she built a career in traveling companies, working for well-known companies.
"As long as I didn't go out [of heroin] and got sick, I was like a super woman," she says of her job performance. "If I had come in and said I was addicted to heroin, people would have laughed."
Years of use caught up with her. The lunchtime is running to see that their dealer got longer and became lies about flat tires or broken cars. She jumped between five and six companies and took longer sheets to be treated or detoxified at home. She continued to overdose. She fired a $ 30,000 mistake at work.
"People kept saying: & # 39; you will die & # 39;" says Rebecca. "The problem with me was not that I would die, but that I would live."
Most of their children were raised by other family members and knew them worst. They would see her after overdoses and visit her in the "bad places" she called at home. "It was just awful," says Rebecca, who is still working to fix the relationships she's frayed.
Today Rebecca has been sober for three years.
The last time she went to treatment, she said: "Something clicked and I remember thinking: & # 39; I can't do this anymore. & # 39;" "
She was "sick and tired, being sick and tired," she says. "I didn't have the heart left to keep doing what it took to stay high."
Rebecca is not the only member of her family who has problems. One relative is an alcoholic, another is addicted to heroin, and a third – who doesn't use heroin because of Rebecca – is addicted to painkillers.
"It's in the genes," says Rebecca. "No doubt."
She has seven grandchildren and is determined to be a better grandmother than she was a parent. She lives in an apartment with a friend and works part-time for a sober flat share.
"If there is regret, I missed decades," says Rebecca. "I just thought I wasn't going to live, so I never worried about getting old."
She struggles to make the rest of her life important while, based on decades of experience, knows how easily she can slip again.
A time-lapse, a moment of weakness or subconsciousness that she can handle it, and everything Rebecca builds up could collapse and possibly bury her.