#Those two bottles of vicodin would have been gone and so would have house

[purrassicjet]

OHOHO I JUST FINISHED SEASON 6 AND IT IS QUITE THE SEASON!! I CAN'T WAIT TO START SEASON 7!! I'M GIDDY THAT WAS A GOOD EPIOSDE

[things-arent-what-they-seem66]

Guardian Angel Au @fanofstuff02

First Meeting

Trigger Warnings For Drug and Alcohol Addiction, Depression and Anxiety.

Adam laid with his head back on his couch, one hand playing with the string of his hoodie the other grasping a cold bottle of Jack Daniels. It wasn't even noon yet but who gives a shit, it's five o'clock somewhere in the world.

Looking at his nightstand, Adam got up and grabbed his medicine. He needed it badly today, he didn't feel well.

He never felt well.

Adam dumped out two Vicodin and three Xanax into his hand and popped them in his mouth, washing them down with some Jack. He'd need more in about an hour or two.

He sat back down and turned on his tv, ignoring the messy state that his apartment was in. Adam just stopped caring what it looked like in here. No one came to visit him.

Well, his cousin Alastor did but that was only every three months. So does that really count?

No lights were on, only the light from the tv playing some trashy reality show illustrated his apartment. Did he thank Al for the light blocking curtains? Adam couldn't remember.

There was a knock at his door. Who the fuck could that be? Wouldn't be Alastor, he's not due to show up for another month. No one visits him. Maybe they had the wrong apartment number.

More knocking told Adam that no, they wanted him. Fuck. Adam got up to his door and unlocked it, he only opened it a crack.

Some short blonde guy was standing there with pancakes looking so cheery. It kinda grated on Adams nerves, why were people so happy?

"The fuck do you want?" Adam asked sharply, his eyes narrowed distrustfully at the man on his doorstep.

"Hi there! My name is Lucifer. Lucifer Morningstar, I'm your new neighbor across the hall and wanted to meet you! I brought pancakes." Lucifer said in an upbeat manner, smiling brightly and as friendly as he could.

Adam was confused. New neighbor? No one has lived across the hall from him since Rosie died two years back. He misses her.....

Weren't the new neighbors supposed to be the ones to receive a house warming gift not the other way around? Whatever, Adam didn't give a shit, he could feel his pills kicking in. "You and your pancakes can fuck off." He slammed the door in Lucifer's face.

Lucifer sighed, he knew it wouldn't be that easy. He had read Adams file up in heaven, he was amazed that Adam even talked to him at all.

He stepped back and placed the plate of pancakes in front of Adams door, using his magic to keep them warm just in case.

Lucifer went back to his apartment to set it up as if he were a normal human who lived here.

Adam looked over at his door when he heard the door across the hall open and close. He went over and opened his, to make sure the guy was gone. A sweet smell wafted up into Adams nose and he looked down to see the pancakes that that Lucifer guy brought him.

He really wanted him to have those huh?

Adam picked them up and brought them inside. They smell so good.....

He didn't even bother with a fork and just used his hands to eat them, Adam didn't care about the syrup or butter that dripped from his fingers. He just nibbled at them as he watched his show.

Adam was surprised when his hand met an empty plate. Huh? Guess he ate them all. He set the plate down and washed his hands.

Adam didn't want to explain syrup stains to Al when he came by.

Those pancakes had been very good, nice and fluffy, not too chewy, the right amount of syrup to butter ratio...... Just how Adam liked it.

Just a coincidence, he told himself. He wasn't the only one to like pancakes like that.

He picked up the plate and put it back outside his door. It was time for more medicine and the rest of his Jack.

Lucifer heard Adams door open and close. He quietly opened his and smiled at the empty plate. Lucifer walked over and took it back to be cleaned.

Slowly, he would get through to Adam slowly.

Food was a good start.

[dogueteeth-fhr]

FOr the WIP ask. Two in particular make me curious. Please tell something about "5 Camels and 10 White Horses" and "vice & vicodin".👀 I am looking forward to all parts of "capsaicin", but I will be patient and let myself be surprised.🙂

Ooh so glad you asked!!! (Also dw you won't have to wait long for most capsaicin bits >:3)

5 Camels and 10 White Horses

Tiny morsel snippet that works as a synopsis teaser:

" he doesn't have the same urges in Ace's body as he does in his own. doesn't feel the needy twitch in his left hand as it fumbles in his pockets for a cigarette, doesn't feel the oncoming headache that grows when he can't find any. it reminds him of darker times, fumbling blind through alleyways, the taste of grime and motor oil burning away behind a plume of smoke. "

This one is a one-shot between Dr. Mortum and Constantine!! I think this is my first fic for Constantine beside a capsaicin WIP between the two. It's a puppetstuck!ending that explores Constantine and his past, and it sheds some insight to him about how he could be different if he decided to change his ways. This fic is a reminder to him that he's not alone anymore. The title is a bit odd so I feel I should explain it— "Camel" and "White Horse" are the names of two cigarette brands! Not many people know of White Horse anymore but it's Constantine's favourite.

vice & vicodin

Long Snippet (WARNING TWs: Mentions of self-harm and drug abuse);

" But she's been bed-bound for weeks and only recently gotten the clear from Mortum's doctor-friend to whirl around in a wheelchair. She's not keen to rebreak her legs before they've even gotten a chance to heal, but it's been hell, trying to keep herself occupied. She feels like one of those ex-military dogs, retired and told to play house. Pent up and out of place. A lion put in a cart, pacing across straw and ten-by-fifteen wooden boards as the circus music plays. Lightning in a bottle.

She's already gone through pile after pile of evidence, cleaned up the lair, and repaired her armor. Downed some Vicodin after hitting her leg against the wall and organized more plans and files. Took another blunt, researched Carter's info, stared at the ceiling and wished it would fall on her, went through evidence piles again, avoided and failed staring at the knives and did it all over again. Twice. Took a bit more Vicodin than she probably should have. That's going to be awkward to explain to Dr. Halabi.

Did it all over again, thrice. Multiple times with more variations. Some involving more blood and bandages. Those ones were often spent reassuring the Rat King that she's okay afterwards. She's not going to die. Not yet. It's just blood. It's just more wounds that will heal. Horizontal. Not vertical. She promises the Rat King she'll give it a break. For now.

Rat King.

Now there's something that she can do. Something to occupy her mind with. "

Oh boy, vice & vicodin is the first part of a new series I have planned called "it's called "freefall" about Isa post-guilty crash, set after Retribution and crossing into Revelations; kind of like my own little continuation of Retri since we don't know what Revelations will be like yet!

Writing-wise, I feel very odd about this series, as I plan to kind of go at it with whatever my mind tosses at me. I have some POVs of other characters (Daniel and Ortega mostly) planned for the series that I will go through my usual process of writing for, but most of it will be from Isa's POV and what I'm trying to accomplish with that is the pacing and sentence structure that you can see a bit of in this snippet.

Her thought process is a bit everywhere, not sure if that reflects in my writing here in comparison to my other works, but it feels starkly different in tone to me at least. Not sure if it makes for a good read, so I do look forward to future feedback on that and deciding if I want to keep this style for this work or if I should comb through it to make it easier to read. But, then again, this series is not planned to be an easy, lighthearted read beyond syntax and grammar, but content-wise as well.

[josy1986]

Period Pains

Beca Mitchel suffers from heavy cramps during terror week.

Beca never was the extremely girly type like most of the other Bellas but during that special time of the month, she surely hated being a woman.

The DJ laid curled up on her bed, wishing to god she had been born a man instead of an incubator on legs.

Fuck sake, why the hell do we need this kind of reminder we’re not knocked up?! She groaned, holding the pillow against her body even tighter. Her periods had surprised her this morning and had cursed like a sailor during her bathroom visit. The bloody mess wasn’t even the worst, the cramps she had to endure were horrible and her small bottle of vicodin was empty. Normal painkillers didn’t work for her and her doctor had given her a prescription for heavier ones that did. Unfortunately for her, she had run out last month and she was in no state to get a refill.

However, she had sent a text to Jesse, asking if he could do it for her. He was currently on his way to the Bellas house to pick up the prescription and go out to get Beca’s refill. She hoped to god he would hurry.

Chloe had gone out to a small grocery shop on campus, came to the realization that she forgot her wallet on her way there and turned back around. She arrived back at the house right when Jesse did. She watched the young approach and gave him a polite smile. “Morning.” She said, taking out the key to open the door.

“Hey, I’m here for Beca.” He stated and Chloe rolled her eyes, her back towards him as she finally opened the door and walked in.

Well duh, captain obvious… “She should be in her room. Which I’m sure you’ll be able to find.” She said, it was a bit more snarky than she probably had intended.

While he went upstairs, she kicked off her shoes, walked into the kitchen and took a bottle of cold water from the fridge. She settled on the couch in the living room while drinking, checking her phone to browse her social media before she would look for her lost wallet. 

It was only a few minutes later that she suddenly heard voices coming from upstairs. She couldn’t quite make out what was being said, but she could clearly hear Beca yelling and she sounded angry. Several seconds later, a door opened, Jesse came rushing down the stairs and hurried out the front door. Chloe frowned and after putting her water and phone down, she got back on her feet.

Slowly but surely, she walked up the stairs and headed to Beca’s room. “Beca..?” Her voice was soft and filled with worry. She wasn’t sure what happened but Beca didn’t usually yell at anyone. Unless you touched her music equipment and computer. If she caught you touching it you’d be flying out the window.

The door to Beca’s room was open slightly and after Chloe called for the DJ, she heard a soft but clearly painful groan. “Chlo..?” A pained whimper followed. “Oh god…”

Chloe pushed against the door to find her friend curled onto her bed with a clear pained expression on her features. “Oh my god, Beca, what happened..? What’s the matter?” Chloe was next to the brunette before Beca could even blink, worry seeped into her voice.

Beca just buried her face into her pillow in shame. “Periods…” She mumbled but Chloe heard it nonetheless. She felt for her friend, she herself suffered from really bad cramps too during her periods.

“Is there something I can do?” She asked, carefully placing a hand on Beca’s shoulder who didn’t pull away from the touch. “Did you take anything for the pain yet?” Chloe wasn’t sure if her friend heard her questions but Beca eventually reacted with a soft whimper at first. Her body cramping up around the pillow, the action pulled the pillow away from Beca’s face and revealed how much pain the brunette really was in. It broke Chloe’s heart seeing her crush in such a state and not being able to help.

“I’m… out of pain medication.” She whispered, her voice cracked and she let out a soft sob.

“Let me see if I have some left.” When Chloe was about to get up, she was stopped by Beca’s hand around her wrist. The DJ was shaking her head.

“Normal pills… they don’t work.” Chloe put her hand on Beca’s when she felt the other woman squeeze, Beca took slow and deep breaths to ease herself through the pain. It didn’t really work but there was nothing else she could do. “I take vicodin… the stuff you can… just buy in stores, it simply doesn’t work.” Beca swallowed loudly, her eyes screwed shut when another horrible cramp hit her full force. “Oh god… Chloe…” Beca whimpered in pain and the redhead wrapped her arms quickly around her friend, holding her close to offer some sort of comfort. The fact that Beca allowed her told her all she needed to know. The brunette wasn’t the touchy feely type, displays of affection among friends was something she never did.

“I got some heavy pills too. I should have a few left.” Chloe whispered although she didn’t want to leave Beca, not even for the few short minutes she would have to leave, go to her own room and come back.

Beca nodded and reluctantly let go of Chloe’s clothes so the redhead could leave. She watched her friend leave, feeling like it took half a day before she eventually returned. Right when another massive cramp hit her and took away her ability to breathe for a few short seconds. “Chloe…!” She cried right when the woman in question reentered the room.

“I’m here! I’m here Becs.” She assured the brunette who was holding out her hand for Chloe to take. Which the older Bella did while squatting down next to Beca’s bed. “I’m here, I got two pills for you. Here.” She held the pills in her free hand while the other was still occupied with holding Beca’s.

The DJ took a few seconds to compose herself, pushing herself up after letting go of Chloe’s hand, afraid she might crush it otherwise. Once she was sitting with her back against the wall for support, she took the offered pills along with some water that Chloe brought with her. Once the pills were down, she let out a deep sigh. “Thanks…” And offered Chloe a shy, pained smile.

Chloe offered a warm smile in return and settled next to her friend on the bed. “You’re very welcome, glad I could help.” Chloe felt her heart skip a beat when they locked eyes for a moment. Beca swallowed hard but quickly looked away, focussing instead on the wall at the opposite of her bed.

One hand resting on her belly while the other laid on the bed, between her and Chloe. The redhead looked at the hand, biting her lower lip while considering to put her own on Beca’s. Instead of just blatantly putting her hand on the brunettes, she placed her own right next to Beca’s. Giving her friend the opportunity to initiate anything if she’d want to.

“So… why did Jesse run out the door..?” Chloe started but it had the opposite effect of what she had hoped. Beca groaned in frustration and let herself flop back down onto the mattress. 

“Cause he’s a fucking idiot… that’s why.” She muttered and let out a deep sigh of frustration, her hand now resting on the mattress next her. She waited for a few seconds before she continued. “I uh… I asked him if he could get my refill…” She said with a soft voice.

“He didn’t want to get it for you?” What an asshole.

“Oh, no he did.”

Damnit, not an asshole then.

“But uh… he asked for a blowjob as a reward.”

Nevermind, still an asshole. “Oh my god! Are you kidding me..?” She was genuinely in shock.

“Yeah, that’s what I said too.” Beca grumbled, wrapping her other arm around her lower body when a new massive cramp announced itself. It momentarily robbed her of her ability to speak and breathe. She curled up into a ball, wishing to god that her crush wasn’t there to see her in such vulnerable state.

“Is… is there something I can do…?” Chloe offered, god how she just wanted to hold the brunette and give her some kind of comfort. That’s how she usually dealt with her own monthly week of terror. Aubrey being the one that cuddled up with her and watched movies together. However, Aubrey graduated and was commanding people around somewhere in the wild. This was the first time that she found Beca in such a state, her heart ached thinking that the brunette had to go through this every month on her own.

Chloe waited for an answer, hoping that Beca wouldn’t pull those walls back up and close herself off but the brunette remained silent. “I… I’ll be out of your hair again.” Chloe said and scooted closer to the bed’s edge so she could slip off. Before she could in fact get off, a weak and surprisingly cold hand, wrapped around her wrist. Chloe looked at her wrist first before looking at Beca, who looked at her with red eyes.

“Don’t.” She whispered and the redhead could feel the DJ tremble. “Please, stay.” There was something in her voice that Chloe never heard before: desperation. “I’m sorry, I’m just…” She sniffled, gently letting go of Chloe’s wrist.

Chloe smiled softly and instead of getting off of the bed, she moved to lay next to her friend instead. “Come here.” She whispered and Beca did just that, both women moving closer to one another.

Beca slipped her arms around Chloe’s waist, her head nestled under her friend’s chin. As much as she hated feeling like this, so incredibly needy and clingy, this was really nice. Chloe’s arms around her body made her feel safe and secure. Made her feel like she wasn’t alone in the world.

“Comfy…?” Chloe asked and it broke Beca’s train of thoughts.

“Yeah… thanks.” She mumbled against Chloe’s skin, she was warm, soft and comfortable. She was the only one that Beca allowed to peek past the walls around her heart.

Chloe’s heart hammered in her chest, her arms around her favorite person, being this close to her. About an hour ago she thought this was her worst day of the week when she realized she forgot her wallet. How that turned around to this, she had no idea but boy was she grateful for it. Without realizing it, she started to gently caress Beca’s hair. It was something she personally loved being done to her, so she hoped Beca would too. A soft hum of approval followed by a sigh in relief was all and more than she could have hoped for.

“Feels nice…” Beca whispered, her eyes closed while just enjoying the moment for once. 

“Glad you like it, I love it when someone plays with my hair.” Chloe said and let out a giggle when she heard Beca yawn.

“Oh, shit, sorry about that.” She apologised sincerely. “You’re being so sweet and cute and I’m just falling asleep.”

Chloe bit her lower lip, smiling. Did she just call me cute? A faint blush on her cheeks. “That’s okay, take a nap, the medication should be working by the time you wake up.”

“Mhn… I love strawberries…” Beca mumbled, clearly dozing off to sleep, the smell of Chloe’s shampoo clear as day while she took a slow, deep breath.

Chloe just listened while Beca’s breathing slowly evened out, a clear sign for the brunette that she did indeed fall asleep. She shifted her position slightly, only enough for her to look down and watch the woman she loved sleep peacefully. The walls around Beca, even though still present, Chloe managed to finally get to the other side and see the real Beca.

Her face showed no signs of pain or discomfort anymore now that she slept and cuddled up against Chloe. The older Bella couldn’t help herself and carefully cupped Beca’s cheek and to her surprise, the DJ smiled ever so slightly at the touch. Letting out the softest ‘mhn’.

Jesus, how can someone be this cute… Chloe swallowed hard when her eyes moved to Beca’s lips. It would be the easiest thing to close the small gap between them and kiss her. No… No! I’m not Jesse, no matter how much I..- No. Her hand remained on Beca's face but she placed her head back in its former position. Her chin resting on the top of the brunette’s head while she felt that sleep would claim her soon too.

Chloe stared at the wall, her thumb gently caressing the skin of Beca’s cheek. I wish I could tell you how I truly felt about you, Beca… She let her thoughts drift to the moment she had almost kissed the brunette during aca-initiation night.

Chloe was tipsy already when she had grabbed both of Beca’s wrists and pulled her in. She cringed at the memory of her telling Beca how she knew they’d be best friends really soon. I had to say something…! She facepalmed herself internally. That memory now is full of regret and missed opportunities. 

Beca Mitchel, the woman that single handedly turned her world upside down. The woman whose smile made Chloe’s heart skip a beat. The woman who, with a single look, could make her weak in the knees. The woman who could undo her with a touch as simple as holding onto her wrist.

While she shifted her position slightly to be able to look at Beca’s face, she felt her heart break. She let her eyes flutter shut, her friends face the last thing on her mind as sleep finally claimed her too.

The woman I’m so desperately in love with, it hurts.

@chloebeale 

[cosmosogler]

hawaii part 3

hmm yes it does appear that i left writing the journal off until 11:30. that was a mistake. i got distracted. it’s easier to not think about things than to think about things. it’s... easier to think about other things too.

reading my post yesterday in order to get my bearings i realized how much i dislike the way i “sound.” no wonder everyone treats me like a man baby.

the public beach was fine. i didn’t want to stand around at the hotel and play pokemon all day so i went to a beach with bigger waves with my brother, austin, thomas, dad, and uncle mike. the neighbors came too, later. everyone except me and uncle mike was out in the waves so i just sat in the shade in the soft dirt-sand and talked to mike about cook’s pines, which we had spotted at the very north end of the island. you could see out that far from this part of the beach. we also talked about pigeons since there were a lot of them. we talked a little bit about eve and how, when pounds want to get their animals adopted, they describe the animal using the most exotic breed in the mix. wiley is a “finnish spitz mix.” (look them up they’re super cute actually.) eve is a “greyhound mix,” even though mike said she acts way more like a black lab. he said they’re always skittish like she is. 

i couldn’t really argue with that. it is more exciting to say you have a half-greyhound than a half-black lab. and eve never shuts up when mike is around. she just howls and howls and runs away and howls from the other room even a little while after he’s gone. she’s done that since she was 3. i thought she would get used to him after a year or two, but i guess once she realized he was also her vet she kept a grudge. 

wiley likes him though.

i eventually stumbled out into the waves knee-deep to laugh at the boys and their boogie boards. i probably stood out in the sun for just a little too long. i had been upset that i’d forgotten the sun hat gramma bought for me... i dunno it’s just nice to stand with your feet in the ocean even if you’re not swimming. 

i didn’t stay out for too long though. i mostly had gotten up because my legs were falling asleep sitting in the dirt, and also because i had sat down less than a foot away from an anthill and dropped my shoes on top of it. i went back in the shade and talked to sierra a little bit and played some pokemon.

i don’t remember what we did for dinner after that. it’s kind of frustrating to go to dinners with my family. gramma and sharon heavily favor restaurants we are familiar with over restaurants that are good/are easier for 25% of us to eat at. ryan has the fatal peanut oil allergy, i’m vegetarian, my sister’s got a lot of dietary restrictions and is generally picky, austin’s not allowed to touch nuts since his brother’s so allergic. gramma can’t eat red meat but we go to steak houses all the time. thomas won’t eat anything but hot dogs and sometimes pizza.

the next day was the last day on maui. my sister, claudia, uncle dave, and i broke off from the group to go to the aquarium. i didn’t realize that my family wasn’t joining everyone else for lunch so i didn’t think to say goodbye to anyone when we left the hotel. that kind of sucked. the aquarium was nice though. i sent a lot of pictures with one-liners and snarky comments to asher. i also took a ton of videos, which i forgot to show him when we hung out today.

after that (and some shopping) my sister and i had to wait in the shopping center after dave took claudia back to the hotel. we waited for like 40 minutes for our family to pick us up. we had some ice cream. the car ride over to ihop sucked. it was just the worst. my parents would yell at each other, and then demand unreasonable things from my sister (who had siri open), and then when my sister would get irritated she would get yelled at for raising her voice. my mom and dad acted like she was SO unreasonable for being frustrated with them. “i’m just such-and-such,” they would say, like “just” doing something excuses you from being a dick. “i’m just sayin.”

i hate “i’m just sayin.” it’s dad’s trump card for when he wants to “win” an argument. because if you get mad when someone is “just sayin” words, because “just” saying is so different from “actually” saying, then you are unreasonable and you lose!!!

at ihop i was too sick to eat and my sister was too sick to eat. then about halfway through the meal my brother cried out and put his hands over his eye. i was worried he had gotten hot sauce in it (i noticed the bottle next to his elbow) and suggested washing it out in the bathroom. he and dad didn’t come back for a long time. after we finished eating we dug out my sister’s eye drops and mom basically shot his eye with a jet of saline. also a guy who may or may not have been a tourist was there. he gave me conflicting stories over the span of our conversation. i wanted to focus on my brother but there wasn’t really anything i could do and the guy was very interested in talking to my family.

so then we went to the airport, and i played pokemon while waiting for the plane, which was about 40 minutes late. then we got on the plane and i watched the sun go down and listened to less than a full elo album before we landed on oahu. when we collected our bags and got the rental car my brother complained that his eye still felt like someone was jamming a needle into it and it had been seven hours.

so mom decided it was a good idea to give him one of her oxycodone pills. 

i have some feelings about this. mostly confusion, because i don’t understand why mother would have those pills in the first place. she’s always so harsh when she judges dad’s mom because she’s “addicted to pain killers” and “stole grandpa’s medication before he died” and “complains to the doctor too much so he’ll keep refilling her prescriptions.”

but you know what? 

mom stole my pain killers, my vicodin, when i had my wisdom teeth out. i had to go like five days with just tylenol when my jaw still wasn’t healed enough for me to even eat solids. when i talked to dad about it one time, years ago now i think, he seemed to imply that that was just something she does. 

i’ve met people who are addicted to oxycodone. it’s not a fun time. where the hell is mom getting such a powerful drug? who the hell is giving it to her? she has migraines. but i looked it up just now and oxy is a TERRIBLE  choice for treating migraines. and also it’s super addictive. 

and also i’m a stickler for rules i guess and i was super irritated that mom broke the rules and gave a prescribed medicine to someone who it had not been prescribed to. a powerful one! and she said this might mean she couldn’t take him to the emergency room!

at 11 after we had gotten settled into our new hotel room mom and dad took him to the emergency room anyway. i hope she got in trouble. my brother was super stoned. on the way to the hotel he was asking me stuff like what my major was and where i was going to school. he also made sammie-level bad jokes and laughed at them.

mom complained that we shouldn’t have pushed her to give him one. even though no one had told her to... even my brother was like “i don’t care just do something” at the time. 

so that night i didn’t fall asleep until 1, after my brother got back from the er. he had debris stuck in his eye and it had scratched his cornea. 

i had a dream that the monster didn’t want to kill me. it was after some equipment i had. a while into the dream i realized that not only could i teleport myself (sometimes i can do that), i could send other things away too. actually it was easier to Send Things Away than to teleport myself, which required a lot of brute-forcing my imagination into believing i had taken a huge step forward, sometimes up a wall or through one, instead of just a normal walking step.

it’s literally the best way i’ve dealt with a monster in my dreams basically ever. anyone around me it wanted to hurt, maybe as punishment? send them away. after the machine i had? send it away. “sorry dude, better luck next time.”

there was a lot more to it but it’s hard to explain in words that make sense when put in a sentence together. i wish i dreamed less in fluid images or impressions and more in solid ones.

well, even the solid images don’t always make a lot of sense... they make sense to me, in a weird way, but i can’t figure out how to make it make sense for everyone else. and drawing them is like looking into an infinite fractal. i can never put as much detail on the paper as i saw in my head and then it looks bland and strange and not what i wanted to communicate.

the next day i woke up at like 10:30, which is the latest i ever woke up during the trip. i even turned my alarm off. i felt sick all day. my family left to get lunch and i just stayed in the room because it hurt. in the evening we went to my mom’s cousin’s anniversary house gathering party. this is the cousin my mom doesn’t even like very much, due to gay. 

i didn’t have much food. i mostly talked to my mom’s other cousin and her family, and caught up with some people i didn’t know. the meal was jewish chinese hawaiian. i liked the pasta salad.

by 9 i was too exhausted to talk to anyone any more. i found myself blinking even more owlishly at the host’s collection of mugs painted with the faces of what appeared to be american presidents. there were like 40 of them. i had laughed when i saw them the first time and said “it’s good to have a hobby.” i guess as i got more tired i wanted to say more, but had less to say. so i just looked at them a lot.

i don’t know what i did with all that time. i don’t know what i spent my evening doing. my family was watching a different movie on each tv in the hotel room. we had the two-room setup again, but my brother and i had separate beds this time. it was frustrating because my feet and ankles would get caught in the blanket tucked under the bed. it was too hard to kick the blankets loose so i felt pressed down and restricted and that made it really hard to fall asleep. i have enough trouble getting my arms and legs into comfortable positions while i’m up and about during the day. i spend all night fidgeting and adjusting my weight and yanking my pajama pants around trying to get them to sit right. this happens every night. i’m uncomfortable all the time. my legs just won’t sit right and it feels like if i just kicked or flexed them i could maybe jimmy them into better positions but it never happens. so when i sit i kick my feet around all the time. and when i sit with my hands or arms against a surface i knead at it trying to get my hands! into! the Correct! position!!!

the correct position probably doesn’t exist. i’ve never gotten there before. all i can do is try to loosen up my muscles a little bit so i stop feeling so strained and uncomfortable.

the last full day i spent laying around mostly. i went and looked at the baby seal and took pictures and sent them to asher. i found anny and sarah on the beach but my legs fell asleep while i was sitting under the umbrella with them so i got up and left. i was also getting sunburnt again. i found mom at the hotel restaurant so i got lunch with her even though i didn’t want to. i got a fancy drink with dragonfruit and mango and stuff. i told mom i wasn’t hungry at all but she talked me into a sandwich that was way too big for me to reasonably eat and also like 20 dollars. i barely managed half of it. i gave the other half to dad when he showed up.

then we went to the actual anniversary party at a fancy restaurant. i was too tired to interact with anyone so i sat with my brother and sister and tried to track down a glass of water. my brother ended up with three, mostly as a joke on my part.

this is the story as i understand it. my aunts have been together for 20 years. marriage was legalized between 3 and 4 years ago, and they got officially married a few weeks after the law passed. we were here to celebrate their “anniversary,” though it may have just been the best time of year for everyone to travel. there were a lot of cute and touching speeches. i always enjoy uncle len’s terrible, terrible poetry. it’s actually better than mine at least.

hmm, well, maybe they’re about the same quality now that i’m thinking about it.

the food was very interesting. i was told the chef said he would have something “interesting” for me since i think i was the only vegetarian. i got some kind of briny rice with like a creamy green sauce. it was topped with asparagus and some little tomato cubes. and also really spongy looking mushrooms. and a cracker made out of cheese. i think it was asiago.

it was ok. i was tolerating it pretty well until i picked up a big mushroom stump and tried to eat that. the effect was immediate. i near gagged on how spongy and salty it was. it tasted like the ocean. the last time i accidentally swallowed ocean (a few days previously) i had thrown up immediately. as had my brother. we’re cool like that.

after that i wasn’t interested in eating any more. i had some of the dessert but didn’t really enjoy it that much. i think if i was feeling better i would have liked it more.

don’t tell no one, but we had assigned seats. when i got over to the table with my brother and sister i saw that i was assigned next to dad. i swapped my name card with my second cousin’s so i could sit next to my brother instead.

there were three performing sisters supplying the party with music. they were pretty good! when they came over to our table and asked for requests i said “please god anything but over the rainbow” and they laughed. they played some songs that their mother wrote. but at the end they made us all hold hands and sway together and sing aloha oe. i was bummed about that, mostly because i didn’t want to be standing, partly because i didn’t know the words, and partly because i really didn’t want to hold hands with anyone.

i had a lot of trouble falling asleep at a reasonable hour that night. i had more dreams, and i was thinking about them the next day, but i don’t remember what they were any more. the ride to the airport was stressful. i was crammed in the back with all the suitcases and every time we made a sharp turn i’d get squashed or knocked in the face by the suitcase’s wheels. i ended up getting something like chocolate chalk on my fingers trying to buckle my seat belt and i was upset about that the whole ride.

i texted with asher for a while. i don’t think he was doing so hot but he heard me out which was nice of him. i was looking at a billboard while we were stopped at a gas station and i texted “it’s kind of surprising how little matters in life when you think about it.”

i’d been thinking about that for over a week at that point. so few things actually matter. i was trying to make a list and i could only really think of one thing. being able to see the sky matters.

i also said it was really a relief to look at something and say “screw it, i don’t care about this any more, i’m going to stop putting any effort into it.” because, like, it saves so much energy to not put effort into things you don’t care about! why waste your time on crap that doesn’t matter? 

i mean, sure, if you care about something, be tenacious as hell. but if it doesn’t matter? why am i still trying? why not try at something that does matter?

what i’m getting at here is that i don’t care about being friendly with dad any more. he never apologized or mentioned it or did anything. he barely looks at me. if being embarrassed or being the authority or whatever is more important to him than i am, then screw it! i don’t care! i don’t HAVE to care.

so that’s the hawaii lesson. you don’t have to care. you can choose to care, but you don’t have to.

on the flight back i did nothing but fish for bottle caps for basically six hours. i got up to use the restroom and i did doze for about 20 minutes at the start of the flight. 

it wasn’t really just fishing for bottle caps. i never just fish. that’s boring. i was listening to music and fishing for bottle caps on the side to keep my hands busy. i was barely even paying attention. i spent a lot of time thinking about random stuff. like animorphs, or doing a mental review of one of the comics i’m reading, or wondering about recent developments in another. i also spent actually more time than i should have wondering what the guy next to me was thinking. i mean i was playing what was clearly pokemon, but all i was doing was running back and forth and fishing up pokemon that i ran away from. 

i got nine bottle caps.

we landed around 10:30. baggage claim was normal amounts of crowded and stressful. dad missed the terminal’s curb when he drove over to pick us up and had to spent 10 minutes going all the way back around the airport to try again. it was over 100 degrees even though it was the middle of the night. the car was crammed the whole hour back. we decided to stop at carl’s jr for dinner at 11:30 and i got really sick from the grease. we got home at 12. i putzed around on the internet until 1:30, and then i took a really long time getting ready for bed because i felt disgusting and i wanted to wash off more than usual, and then i couldn’t fall asleep because my brother was screaming at the computer and stuff.

in the morning i went downstairs to go to my doctor’s appointment after sleeping for 5 and a half to 6 hours. after waiting for 10 minutes for dad to get ready to leave, i finally asked when we were heading out because i had no idea where this office was or how to get there. he leaned in real close to me and growled “i NEVER said i would take you ANYWHERE.”

the end!!!!!!!!!!!!!!!!!!!

[biofunmy]

Nearly Half A Million Americans Died From Drug Overdoses In The 2010s

Brendan Smialowski / Getty Images

Pill Man, a skeleton made from Frank Huntley’s oxycontin and methadone prescription bottles, is seen on Pennsylvania Avenue in front of the White House on Aug. 30 in Washington, DC.

Prince. Tom Petty. Philip Seymour Hoffman. Men and women, young and old, rich and poor. Maybe someone you knew or loved.

All gone, among the 467,00 drug overdose deaths in the US counted so far this decade, with another 67,000 more that will likely be added to that staggering total when this year ends. The epidemic has overtaken both car crashes and gun violence as leading causes of deaths nationwide, and it now causes far more deaths every year than AIDS did at its peak. US drug overdose deaths in this decade exceed the number of battle deaths the country suffered in World War I and World War II combined. And they played a pivotal role in the politics that made Donald Trump president.

The death toll from opioid overdoses over the past 10 years has triggered a national public health emergency and shocked addiction experts. The “war on drugs” rhetoric of the last 50 years finally ended amid all those deaths, which brought the realization that we can’t arrest away the disease of drug addiction, a change that noticeably came with a drug epidemic ravaging white, rural America.

“No one predicted the ferocity of the opioid epidemic,” American Society of Addiction Medicine President Paul Earley told BuzzFeed News.

As the death toll mounted, the epidemic shifted from painkillers to illegal drugs — first to heroin and then to synthetic fentanyl. The drastic shift pushed a relatively new approach called “harm reduction” to center stage, with the aim of limiting overdose deaths by meeting people “where they’re at,” and cutting down the ills of drug use rather than eliminating drug use itself.

The overdose-reversing drug naloxone, once hard to access, is now frequently carried by first responders and available over-the-counter in pharmacies. Needle exchanges, once held up as illegal by Republican and Democratic presidents alike, are now set up in over 300 facilities nationwide and have the approval of President Trump. And cities like Seattle, Philadelphia, and San Francisco are spearheading still-controversial efforts to create “safe injection facilities” for drug users. Billions of dollars in grants are finally flowing to states to integrate more recovery services into health care.

“No one predicted the ferocity of the opioid epidemic,” American Society of Addiction Medicine President Paul Earley told BuzzFeed News. 

“Ten years ago people did not recognize substance use disorders as a disease,” said drug policy expert Beth Connolly of the Pew Charitable Trusts, who studies public opinion about drug abuse. “A lot of people really thought of it as a moral failure.”

That shifted after the opioid epidemic. More than 85% of Americans in urban, suburban, or rural counties see drug addiction as a serious problem in their community, according to a 2018 Pew survey.

Even so, the federal money spent on the overdose crisis still amounts to less than the $8.6 billion that the Trump administration requested to build a border wall with Mexico this year. And US overdose death numbers are still unprecedented; the country’s overdose death rate increased by 76% from 2010 to 2017.

“It has been a decade of catching up,” Brendan Saloner of the Johns Hopkins Bloomberg School of Public Health told BuzzFeed News. “We are doing a lot of things better than we did a decade ago. But it is not enough.”

Spencer Platt / Getty Images

Drug reform advocates, former addicts, and family members who have lost loved ones to drugs participate in a New Orleans–style funeral march to demand action on Overdose Awareness Day on Aug. 31, 2017, in New York City.

The Painkiller Epidemic

At the start of the 2010s, drug overdose deaths were largely driven by the previous decade’s rampant overprescription of opioid painkillers, such as OxyContin, Vicodin, and Percocet. A wave of recent lawsuits have laid bare how the pharmaceutical industry, led by OxyContin manufacturer Purdue Pharma, knew the drugs were feeding the opioid crisis but still pushed to make doctors and patients alike think they were not addictive.

By 2010, more than 251 million prescriptions for opioid painkillers were being written every year. The Obama administration that year called attention to an uptick in deaths from these drugs, relying on mortality statistics from 2007, in its inaugural national drug control strategy. “Prescription drugs are now involved in more overdose deaths than heroin and cocaine combined,” the report warned. Even then, more than 10,000 people a year were dying of prescription painkiller overdoses in the US.

In response, the government moved to limit how easily people could abuse prescriptions. The FDA approved a form of the opioid painkiller oxycodone that was resistant to being crushed and snorted. And at the center of the burgeoning epidemic, states cracked down on “pill mills,” where doctors rapidly dispensed painkillers, often for cash. At one ring of 40 Florida clinics broken up in 2011, doctors saw up to 100 patients a day and made $1 million a year. That same year, “Operation Pill Nation” saw the arrests of 60 doctors across the Sunshine State.

“We know of no other drug prescribed so frequently that kills so many patients,” said Thomas Frieden, former director of the CDC, in 2016, announcing federal guidelines that made opioid painkillers a last option for long-term pain treatment.

While states focused on painkillers as the main culprit behind the tidal wave of deaths, some public health officials started noticing an uptick in young white men checking in for heroin treatment. That became a clear sign of another emerging epidemic: a steady rise in the number of fatal heroin overdoses in the first part of the decade. In 2014, the CDC reported an increase in heroin-related deaths in 28 states, noting a split between older people dying from painkillers and younger ones dying from heroin.

”The heroin supply became more dangerous,” drug policy expert Andrew Kolodny of Brandeis University told BuzzFeed News, with Mexican criminal cartels innovating by delivering the drug to white, rural America. As described in the 2015 book Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones, the cartels pumped a steady supply of heroin into small cities like Nashville, Cincinnati, Salt Lake City, and Minneapolis, where the drug was previously rare. Suddenly parts of the country that thought they just had a painkiller problem also had a heroin problem.

It is too simple to suggest that all the people with an addiction to painkillers had simply switched to heroin as doctors cracked down on overprescribing, said Earley. An often-cited JAMA Psychiatry study in 2014 noted that, 75% of the time, the new users of hard drugs were introduced to opioids via painkillers. But many people were likely using stolen or illicit pills, not their own prescriptions. “The pills may have come from a grandmother’s medicine cabinet,” said Kolodny.

The end result was that the US had two overlapping overdose epidemics, with heroin and prescription painkillers both killing more than 13,000 people a year by 2015.

“It’s a Chronic Disease”

While officials at the National Institute on Drug Abuse had long argued that addiction should be seen as a chronic “brain disease,” the call took on more urgency by the middle of the decade, when a staggering 52,000 people a year were dying of drug overdoses.

NIDA chief Nora Volkow became the most prominent voice calling for treatment of substance use disorder as “a disease that should be treated like any other.” The move, along with calls to reform drug sentencing laws, would be a striking departure from the “Just Say No” mentality that came to define previous decades. Around the same time, Congress passed two bipartisan bills, which directed more than $1 billion in grants for states to build out their drug treatment networks.

“We had a white epidemic; we changed our tune,” Daniel Ciccarone, a medical epidemiologist with the University of California, San Francisco, told BuzzFeed News. The response to an epidemic among white opioid users in rural states stood in sharp contrast to that of the past decade, which saw blacks 10 times more likely than whites to be imprisoned for drug offenses. “I think a cultural change is coming very slowly, but it is moving,” Ciccarone added.

“We had a white epidemic; we changed our tune.”

As news reports exploded of dubious detox centers defrauding people in recovery and leaving them more likely to die of an overdose, demand increased for more medication-assisted treatment (MAT), which the Substance Abuse and Mental Health Services Administration endorsed as the gold standard for addiction treatment. For opioid use disorder, MAT is the prescription of milder opioids, such as methadone or buprenorphine, to treat addiction — or less often, the opioid-blocking drug naltrexone. From 2014 to 2018, MAT prescription rose 62%, from 2.6 million to 4.2 million people per quarter of the year, according to the IQVIA Institute, which tracks the pharmaceutical industry.

Even conservative bigwigs like Newt Gingrich have come to embrace the need for treatment, previously seen as just replacing one addiction with another in traditional abstinence-focused recovery circles exemplified by Alcoholics Anonymous. The overdose crisis and the attention paid to it by Republican lawmakers might partly explain why in the 2016 election Donald Trump received more votes in counties with the highest mortality rates from drugs, alcohol, and suicide, a factor in winning states like Pennsylvania, Wisconsin, and Michigan.

In 2017, as overdose deaths in the US peaked, killing more than 70,000 people that year, Trump declared the opioid crisis a national public health emergency. The deaths were a leading reason for the decline of US life expectancy over three consecutive years, unheard of during peacetime. This declaration has been renewed eight times since then.

All the attention from public health officials, Congress, and the White House had perhaps started to make a difference by last year, when overdose deaths began to level off nationwide to a still-horrific 68,000 victims. The Bipartisan Policy Center estimates federal agencies had spent $7.4 billion on combating the opioid crisis in 2018, nearly double the previous year’s total.

The Affordable Care Act kicking in has also made a big difference in getting more people into recovery, because under the law, addiction is no longer considered a pre-existing condition for insurance purposes. More states, like Ohio and West Virginia, accepted Medicaid expansion under Obamacare and increased the number of people receiving MAT, by around 70% in such states. The number of states putting time limits on addiction treatment length went down by more than 50%.

Police and fire departments far more frequently equip officers with naloxone, an opioid overdose-reversing drug. In 2012, President Obama ended a ban on needle exchanges, which cut rates of infectious diseases among drug users. Now those sites are supported by the Trump administration, and even conservative states like Kentucky now have 54 active sites, albeit with more needed.

“There has been real progress, real change,” Regina LaBelle, a former official with the White House Office of National Drug Control Policy, told BuzzFeed News.

DEA

From left: Lethal doses of heroin, carfentanil, and fentanyl

Game Changer

At mid-decade, as the medical establishment scrambled to address the new heroin epidemic, something even worse happened — fentanyl. An opioid 30 to 50 times more potent than heroin — with analogs such as carfentanil that are hundreds of times stronger than fentanyl itself — entered the illicit drug supply.

“Fentanyl was a game changer,” Kolodny said. In March 2015, the Drug Enforcement Administration released a nationwide alert about fentanyl, warning that the drug was widespread and “extremely dangerous.” Ohio, for example, reported 502 deaths tied to fentanyl in 2014, a 500% increase from the year before, and the state soon became infamous for its soaring rates of overdose deaths.

In March 2017, at the height of the fentanyl epidemic, the coroner in Canton, Ohio, ran out of storage space for dead bodies. Ohio police data shows that heroin seizures containing fentanyl or carfentanil increased from 3.4% in 2014 to 48.6% in 2017, a year that saw an astonishing 4,700 people in the state die from a drug overdose.

Not only was the increased potency of fentanyl dangerous, but the variability it introduced into the heroin market proved deadly, both because various analogs came in bewildering strengths, and because the difference between a safe dose and a fatal one was now only a milligram or less. “Drug dealers are not chemists,” said American Society of Addiction Medicine President Paul Earley. “There’s no quality control in illegal drugs.”

By 2017, fentanyl and its analogs had quickly emerged as the leading cause of drug overdose deaths nationwide, killing more than 28,000 people, almost as much as heroin and painkillers combined. Fentanyl deaths were concentrated in the Midwest, Appalachia, and the Northeast, where brown powder heroin was diluted with illicit fentanyl imported from China into Mexico and distributed by organized crime networks.

The Fourth Wave

Even as drug overdose deaths have started to level off, and attitudes toward drug addiction have begun to change, another shift has started that will likely extend into the next decade. Deaths from stimulant drugs, notably cocaine and meth, have suddenly started increasing.

Drug users may be shifting back to those drugs in reaction to the opioid deaths, suggested Ciccarone, a familiar swing of the pendulum between depressants and stimulants seen in past drug epidemics.

“I’m calling it a fourth wave in the epidemic. Meth is not supposed to be a deadly drug. Now we have young people dying from it.”

More of the deaths are among older heroin users, often longtime black or Latino users in cities, who favor “speedballs,” mixtures of cocaine and heroin, reports the Chicago Urban League. As well, Ciccarone and other epidemiologists are seeing more mixed stimulant and opioid use, or “goofballs,” among younger drug users, everywhere from Washington state to West Virginia.

“I’m calling it a fourth wave in the epidemic,” said Ciccarone. “Meth is not supposed to be a deadly drug. Now we have young people dying from it.”

The challenge posed by these puzzling new deaths is to build a drug treatment system that covers more than opioid addiction, said many of the experts interviewed by BuzzFeed News. The Trump administration has focused heavily on the opioid crisis: Trump himself donated his most recent $100,000 quarterly salary to “continue the ongoing fight against the opioid crisis,” and the administration announced another $1.8 billion in state grants in September. But this focus on opioids alone might miss the next phase of the epidemic.

“We don’t know what drug will be the next heroin, but there will be one,” said Ciccarone. ●

Sahred From Source link Science

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[nancygduarteus]

The Penance of Doc O

Well past seven one evening in 1988, after the nurses and the office manager had gone home, as he prepared to see the last of his patients and return some phone calls, Dr. Lou Ortenzio stopped by the cupboard where the drug samples were kept.

Ortenzio, a 35-year-old family practitioner in Clarksburg, West Virginia, reached for a box of extra-strength Vicodin. The box contained 20 pills, wrapped in foil. Each pill combined 750 milligrams of acetaminophen, the active ingredient in Tylenol, with 7.5 milligrams of hydrocodone, an opioid painkiller.

Ortenzio routinely saw patients long after normal office hours ended. Attempting to keep up with the workload on this day, he had grown weary and was suffering from a tension headache; he needed something to keep him going. He unwrapped a pill, a sample left by a drug-company sales rep, certain that no one would ever know he’d taken it. Ortenzio popped the pill in his mouth.

“It was a feeling like I’d never felt before,” he told me recently. “I’m tense and nervous, and that anxiety is crippling.” The pill took the anxiety away. The sense of well-being lasted for four hours, carrying him through the rest of the night’s work.

Back then, Ortenzio was one of Clarksburg’s most beloved physicians, the kind of doctor other doctors sent their own families to see. His patients called him “Doc O.” He made time to listen to them as they poured out the details of their lives. “To me, he wasn’t like a doctor; he was more like a big brother, somebody I could talk to when I couldn’t talk to anybody else,” says Phyllis Mills, whose family was among Ortenzio’s first patients. When Mills’s son was born with a viral brain infection and transferred to a hospital in Morgantown, 40 miles away, Ortenzio called often to check on the infant. Mills never forgot that.

As a physician in a small community with limited resources, Ortenzio did a bit of everything: He made rounds in a hospital intensive-care unit and made house calls; he provided obstetric and hospice care. Ortenzio loved his work. But it never seemed to end. He started missing dinners with his wife and children. The long hours and high stress taxed his own health. He had trouble sleeping, and gained weight. It took many years, but what began with that one Vicodin eventually grew into a crippling addiction that cost Ortenzio everything he held dear: his family, his practice, his reputation.

The United States is in the midst of the deadliest, most widespread drug epidemic in its history. Unlike epidemics of the past, this one did not start with mafias or street dealers. Some people have blamed quack doctors—profiteers running pill mills—but rogue physicians wrote no more than a fraction of the opioid prescriptions in America over the past two decades. In fact, the epidemic began because hundreds of thousands of well-meaning doctors overprescribed narcotic painkillers, thinking they were doing the right thing for suffering patients. They had been influenced by pain specialists who said it was the humane thing to do, encouraged by insurance companies that said it was the most cost-effective thing to do, and cajoled by drug companies that said it was a safe thing to do.

Opioid painkillers were promoted as a boon for doctors, a quick fix for a complicated problem. By the end of the 1990s, Ortenzio was one of his region’s leading prescribers of pain pills. It was a sign of the times that he didn’t think there was anything wrong with that.

Clarksburg sits atop rolling hills in northern West Virginia, halfway between Pittsburgh and Charleston. Lou Ortenzio came here in 1978, a recently married young resident out of the University of Maryland School of Medicine. “Small-town living seemed so much better than suburban life,” he told me as we drove around town one afternoon. “In Clarksburg, every block had something going. We had mom-and-pop grocery stores in every neighborhood. All these houses were occupied by teachers, downtown business owners, and people who worked in glass factories.”

Coal mining was the state’s dominant industry, but in Clarksburg, the glass business boomed. Glass manufacturing had arrived at the turn of the 20th century, drawn by the state’s high-quality river sand and rich fields of natural gas. Pittsburgh Plate Glass opened a factory in Clarksburg in 1915 and for years was one of the world’s leading plate-glass producers. Anchor Hocking employed 800 people making tumblers, bottles, fruit bowls. The city had family-owned factories too: Rolland Glass, Harvey Glass, and others.

Unlike simple resource extraction, glassmaking required sustained technological investment to meet new demands from the marketplace. The mass production of plate glass made skyscrapers possible. Picture windows and sliding-glass doors made small homes look bigger and more luxurious. The industry forged a middle class in Clarksburg and even gave the city a cosmopolitan air. The glass factories attracted artisans from France and Belgium; French was commonly heard on the streets for years.

Glass manufacturing helped forge a middle class in Clarksburg, but by the mid-1980s the industry, and the city, was in decline. Clockwise from top left: Lou Ortenzio; the abandoned Anchor Hocking glass factory; glass collected from the city’s streets; downtown Clarksburg. (Jason Fulford)

Each neighborhood was a self-contained world, with its own churches, grocery stores, and school; many had a swimming pool. High-school sports rivalries were fierce, and football games drew large crowds. When Victory played Roosevelt-Wilson, or Washington Irving went up against Notre Dame, people knew to arrive early to find a seat.

By the late 1970s, Clarksburg’s older physicians were retiring. Like many small towns at the time, it had trouble attracting young professionals. Ortenzio was among the few physicians who moved there to fill the void. He and two other young doctors opened a practice in 1982. Almost immediately, Ortenzio was seeing 40 to 50 patients a day.

The people who came to see him were mostly older; many had served in World War II. They had the aches and pains to show for a lifetime of hard work in the glass factories or at the gas company, but they had retired with something approaching financial security. They owned homes and cars, had pensions and good health insurance.

Ortenzio’s patients suffered from the ailments of the old—arthritis, diabetes, hypertension—and most of them did so stoically. This was partly generational and partly an Appalachian inheritance. One man, Ortenzio remembered, came to him thin and wasted away from cancer. “The disease was advanced, but he put up with it. I said, ‘Why didn’t you come in earlier?’ He said, ‘Well, I wouldn’t want you to think I was complainy.’ That was the Appalachian line—‘I wouldn’t want you to think I was complainy.’ ”

Ortenzio grew into his adopted city. In 1992, he established a free clinic where Clarksburg’s uninsured could get medical care. The county chamber of commerce named him Citizen of the Year for that. He had been trained to treat patients holistically. Most of what a doctor needs to know to make a diagnosis, his professors had taught him, could be learned from taking time to listen to the patient. X-rays and lab tests were mostly to confirm what you gleaned from asking questions and paying attention to the answers. He’d also been trained to help his patients help themselves. Part of his job was to teach them how to take care of their bodies. Pills were a last resort. This careful approach endeared him to his patients, but it lengthened his day. “He would have office hours until 11:30 at night,” says Jim Harris, a friend and the director of the free clinic. “People waited until then because he was worth the wait.”

Drug salesmen visited him weekly. It was a stodgy profession back then. Ortenzio remembers the reps as older men who had grown up and lived locally and who cultivated long-term relationships with doctors. One of the reps for Eli Lilly was a deacon in a local Catholic church. Once a week, he would visit Ortenzio’s office in a business suit, with information about the drugs Lilly produced. Like many in his profession in those years, he avoided hard-sell tactics. Ortenzio grew to rely on the salesman’s counsel when it came to pharmaceuticals. Once, when the Food and Drug Administration removed a Lilly drug from the market, the rep dropped by Ortenzio’s office, embarrassed and apologetic.

Before long, Ortenzio and his wife saw Clarksburg as home. They found a two-story, three-bedroom house in the Stealey neighborhood, southwest of downtown and at the foot of a hill. They set off to the bank for a 30-year loan. To their surprise, they were denied. “The house won’t keep its value that long,” the banker told them. “The best we can give you is a 15-year loan.”

The banker was right. It wasn’t yet clear, amid the bustle of Main Street and Friday-night football, but the city’s prospects were fading. Newer glass technologies required large factories, which meant stretches of flat land rare in West Virginia. Mexico and Japan emerged as competition in glass manufacturing, and plastic and aluminum emerged as alternatives to glass. Pittsburgh Plate Glass had closed in 1974. Anchor Hocking left in 1987. Its hulking concrete plant is slated for demolition, but for now it remains, just off Highway 50.

By the mid-1980s, the city was in decline. Glasswork was replaced by telemarketing. Downtown, locally owned stores began to disappear. Homeowners yielded to renters, many relying on Section 8 assistance from the government. The city eventually had to destroy dozens of abandoned homes, leaving streets with toothless gaps. The swimming pools, too, slowly closed; resident associations lacked the money to maintain them.

Ortenzio drove me by the massive Robert C. Byrd High School, home of the Eagles. It was built in 1995 to consolidate two smaller high schools in Clarksburg, whose population had receded. Replacing neighborhood schools with one centralized school allowed for better course offerings. But Byrd is far from any student’s home. School consolidation extinguished the sports rivalries that had brought people together each week. Without local schools, neighborhoods lost their social centers.

When glassmaking departed Clarksburg, locally owned stores began to disappear as well. The city eventually had to destroy dozens of abandoned homes, leaving streets with toothless gaps. (Jason Fulford)

Lou Ortenzio began to see people in economic as well as physical pain. Many were depressed, worn out by work or the fruitless search for it. Obesity became a more common problem. Some patients began to ask whether he could get them on workers’ compensation or disability. Others left to seek job opportunities in New York, North Carolina, Florida. “I was always calling people out of state telling them how sick their parents or grandparents were,” he said.

When Ortenzio had opened his practice, he’d tended to see young people only for pregnancies or the occasional broken leg. By the mid-1980s, younger people were showing up in larger numbers. They were coming in with ailments that their parents and grandparents had borne in silence—headaches, backaches, the common cold. “The new generation that came in the 1980s, those kids began to have the expectation that life should be pain-free,” Ortenzio said. “If you went to your physician and you didn’t come away with a prescription, you did not have a successful visit.”

The shift was not peculiar to Clarksburg. Americans young and old were becoming accustomed to medical miracles that allowed them to avoid the consequences of unhealthy behavior—statins for high cholesterol, beta-blockers and ACE inhibitors for hypertension and heart failure, a variety of new treatments for diabetes. Fewer patients showed up for annual physicals or wanted to hear what they could do to improve their wellness. They wanted to be cured of whatever was ailing them and sent on their way. Usually that involved pills.

The medical establishment, to a large degree, abetted this shift. In the 1980s, a new cadre of pain specialists began to argue that narcotic pain pills, derived from the opium poppy, ought to be used more aggressively. Many had watched terminal cancer patients die in agony because doctors feared giving them regular doses of addictive narcotics. To them, it was inhumane not to use opioid painkillers.

The specialists began to push the idea that the pills were nonaddictive when used to treat pain. Opioids, they said, could be prescribed in large quantities for long periods—not just to terminal patients, but to almost anyone in pain. This idea had no scientific support. One author of an influential paper later acknowledged that the literature pain advocates relied on to make their case lacked real evidence. “Because the primary goal was to destigmatize, we often left evidence behind,” he said.

Nevertheless, an alliance of specialists who saw their medical mission as eradicating pain was soon joined by the pharmaceutical companies that manufactured opioids. Medical institutions—the Department of Veterans Affairs, the Joint Commission on Accreditation of Healthcare Organizations, hospitals and medical schools across the country—bought into this approach as well.

By the late 1990s, medical schools, when they taught pain management at all, focused on narcotics. By the early 2000s, doctors were being urged to prescribe the drugs after almost any routine surgery: appendectomy, ACL repair, wisdom-tooth extraction. They also prescribed them for chronic conditions such as arthritis and back pain. Chronic pain had once been treated with a combination of strategies that only sometimes involved narcotics; now it was treated using opioids almost exclusively, as insurance companies cut back on reimbursing patients for long-term pain therapies that did not call on the drugs.

The U.S. drug industry, meanwhile, was investing heavily in marketing, hiring legions of young salespeople to convince doctors of their drugs’ various miracles. Nationwide, the number of pharmaceutical sales reps ballooned from 38,000 in 1995 to 100,000 a decade later. The old style of drug rep, grounded in medicine or pharmacy, largely passed from the scene.

“It went from a dozen [salesmen] a week to a dozen a day,” Ortenzio remembered. “If you wrote a lot of scrips, you were high on their call list. You would be marketed to several times a day by the same company with different reps.”

Most drug companies in America adopted the new sales approach. Among them was Purdue Pharma, which came out with a timed-release opioid painkiller, OxyContin, in 1996. Purdue paid legendary bonuses—up to $100,000 a quarter, eight times what other companies were paying. To improve their sales numbers, drug reps offered doctors mugs, fishing hats, luggage tags, all-expenses-paid junkets at desirable resorts. They brought lunch for doctors’ staff, knowing that with the staff on their side, the doctors were easier to influence. Once they had the doctor’s ear, reps relied on specious and misinterpreted data to sell their product. Purdue salespeople promoted the claim that their pill was effectively nonaddictive because it gradually released an opioid, oxycodone, into the body and thus did not create the extreme highs and lows that led to addiction.

[From April 2006: The drug pushers]

The reps were selling more than pills. They were selling time-saving solutions for harried doctors who had been told that an epidemic of pain was afoot but who had little time, or training, to address it. For a while, Ortenzio still suggested exercise, a balanced diet, and quitting smoking, all of which can alleviate chronic pain. But his patients, by and large, didn’t want to hear any of this, and he was busy. So he, too, gradually embraced pain pills. Nothing ended an appointment quicker than pulling out a prescription pad.

The number of people on pain pills grew from a tiny fraction of Ortenzio’s practice to well over half of his patients by the end of the 1990s. The shift was gradual enough at first that he didn’t recognize what was happening. Patients with medical problems unrelated to pain migrated to other doctors. Still, Ortenzio was working 16-hour days, seeing patients who had been scheduled for the afternoon at 9 p.m.

The more drugs Ortenzio prescribed, the more he was sought out by patients. Many would use up a month’s supply before the month was out; in need of more pills, they were insistent, wheedling, aggressive. Many lied. Some would curse and scream when Ortenzio told them that he couldn’t write them a new prescription yet, or that he wanted to lower their dosage.

The pills were soon on the streets of Clarksburg as well. They replaced beer and pot at many high-school parties. Phyllis Mills, Ortenzio’s longtime patient, had two daughters who abused the pills. Theirs did not come from Ortenzio, at least not directly, but the supply of pills was exploding, due in large part to doctors like him who were overprescribing them.

Ortenzio should have noticed what the pills were doing, to his patients and his community, but he was less and less himself. After his late-night encounter with Vicodin in 1988, he had begun his own slide into addiction. By the late 1990s, he was using 20 to 30 pills a day, depleting even the plentiful supply of free samples from the ubiquitous sales reps.

Desperate to get his hands on more pills, he found a friend he could trust, a middle-aged accountant and a patient of his. “I’m in some trouble,” Ortenzio told him. “If I write you this prescription, can I ask you to fill it and bring it back to me?”

“Sure thing,” the man said, without asking for an explanation. “If you gotta have it, you gotta have it. You’re the doc.”

Soon a dozen or so trusted patients were helping Ortenzio. He knew he was out of control and needed help—even the amount of acetaminophen he was consuming was toxic—but he feared that seeking treatment for his addiction might cost him his medical license. Around 1999, he found a new way to get his fix. He began writing prescriptions in his children’s names.

Ortenzio could plainly see that the claim that these pills were nonaddictive was untrue. He would try to quit and feel the symptoms of withdrawal. “I couldn’t be away from my supply,” he said. His patients, too, were terrified of going without. One, a nurse at a local hospital suffering from chronic pain as well as depression and anxiety, would approach him in his office parking lot, often bearing gifts of quilts or canned goods, insisting that she needed her pills that morning, that she couldn’t wait for her monthly appointment.

Ortenzio saw no way to break the cycle the pills had created for the people in his care. He never found a way to get his patients down to lower doses of narcotics. They rebelled when he suggested tapering; just cutting people off made them sick. The area didn’t have enough pain clinics or addiction specialists to refer them to, and insurance companies wouldn’t reimburse for many pain treatments that did not involve pills. Without good alternatives for his patients, he kept on writing prescriptions.

Top: A resident of the Mission, a shelter that opened in 1969 with a few beds, for alcoholics and homeless veterans. Today, many of its 120 beds are occupied by opiate addicts. Bottom: A set of house rules. (Jason Fulford)

Addiction and overwork had estranged Ortenzio from his wife and children. As Clarksburg declined, his wife moved the kids to Pittsburgh to find better schools. In 2004, after more than a decade of living in different cities, they divorced. Raised Catholic but without much feeling for the Church, Ortenzio joined a Protestant congregation. Ultimately, he found Jesus in his exam room. During an appointment one day, he and a patient, a Baptist, talked of his search for redemption. The patient knelt with Ortenzio on the linoleum floor and prayed for the doctor. Ortenzio marks that moment as his new beginning. He had advantages many addicts don’t have: a home and a car, financial resources, generous friends and colleagues, and, later, the support of a second wife. He managed to taper off the drugs. A couple of months later, he was baptized in a deep section of Elk Creek, where baptisms have taken place since the early 1800s.

Not long after that, federal agents raided his office. They interrogated his staff and confiscated hundreds of patient records. The investigation dragged on for nearly two years. His children had to testify before a grand jury that they knew nothing about the prescriptions their father had written in their names.

In October 2005, prosecutors charged Ortenzio with health-care fraud and fraudulent prescribing. That year, 314 West Virginians died from opioid overdoses, more than double the number of people five years earlier. By 2006, according to the Centers for Disease Control and Prevention, physicians were writing 130 opioid prescriptions for every 100 West Virginians.

In March 2006, Ortenzio pleaded guilty. His sentencing occurred shortly after a 2005 Supreme Court decision made federal sentencing guidelines nonmandatory and individual sentences up to judges’ discretion. Despite what he’d done, Ortenzio was still beloved in Clarksburg. More than 100 people wrote to the judge on his behalf. He received five years of supervised release plus 1,000 hours of community service, and was ordered to pay $200,000 in restitution. He would serve no prison time, but he did lose his medical license.

At 53, Ortenzio was unemployed. A temp agency offered him a landscaping job at the Stonewall Resort, where, as a doctor, he had taken his family for Sunday brunch. He’d never worked outdoors in his life, but he took the job. It paid $6.50 an hour.

He worked at the resort for a couple of months, then as the janitor at a local community center before returning to Stonewall as a full-time groundskeeper. He also found a night job.

Tom Dyer is one of northern West Virginia’s leading defense attorneys; Ortenzio had been his client. One night in 2006, Dyer ordered a pizza from Fox’s Pizza Den in Bridgeport, a town near Clarksburg. When the doorbell rang, he opened the door and there stood Lou Ortenzio, holding a pie. It took a minute before Dyer realized: Doc O was now a pizza-delivery guy. “I was just speechless,” Dyer told me.

“I made pizza deliveries where I used to make house calls,” Ortenzio said. “I delivered pizzas to people who were former patients. They felt very uncomfortable, felt sorry for me.” But, he said, “it didn’t bother me. I was in a much better place.”

Ortenzio eventually left pizza delivery. But the way he told me the story, the job was an important step in his recovery: Every pie he delivered liberated him. He was free of the lies he’d told his colleagues, his family, and himself to hide his addiction. He liked hearing kids screaming “The pizza guy’s here!” when he knocked on the door. “You make people happy,” he said. “That was what I liked about being a doctor.”

Today, Ortenzio spends his days trying to atone. He does this through constant work. There are places in and around Clarksburg where addicts can get help, and Ortenzio can be found at most of them.

The Mission opened in 1969, in Clarksburg’s Glen Elk neighborhood, at the time a small red-light district with bars and backroom gambling. The shelter started with a few beds, intended for alcoholics and homeless veterans. A neon-blue jesus saves sign outside has remained illuminated for all the years since, as the shelter has expanded. Today, many of its 120 beds are occupied by opioid addicts.

One afternoon, I met Ortenzio in a small, windowless office at the Mission. Now 66, he is thin, gray-haired, and bespectacled; he dresses in a hoodie, blue jeans, and sneakers. He does a bit of everything at the Mission, from helping the addicted find treatment to helping them find a coat, or shoes for their children, or a ride to the probation department. He is a volunteer adviser there, too, and at the county’s drug court, where he guides addicts through the criminal-justice system.

Ortenzio is also involved with two newer initiatives, which suggest the challenges of repairing the damage done by opioids. A wood-beamed downtown church is home to Celebrate Recovery, a Christian ministry founded in Orange County, California. Celebrate Recovery has grown nationwide due in large part to the opioid epidemic. On the cold Tuesday night I visited, the service featured an electric band singing the kind of fervid new gospel music that is common to nondenominational Christianity: “You are perfect in all of your ways …”

Ortenzio is Celebrate Recovery’s lay pastor in Clarksburg, running its weekly services. The flock is about 100 or so strong. One evening, a young mother named Sarah stood before the congregation to give her testimony. Sarah’s story started with parents who married too young and divorced before she was 3. It featured father figures who were coal miners and truck drivers and a stepfather who molested her repeatedly, beginning when she was 8. Then a life of illicit drugs, marriage, divorce, and addiction to prescription pain pills.

Clarksburg’s traditional congregations have dwindled along with the city’s population; many rely on support from former residents who commute in from elsewhere on Sundays. The place these churches once held in this community has been taken by new churches proclaiming a gospel of prosperity, insisting that God wants us all to be rich. And by ministries such as Celebrate Recovery.

A regular devotional service held in the Mission’s cafeteria (Jason Fulford)

Ortenzio coordinates the training of recovery coaches at the church, people who can help addicts as they try to wean themselves from narcotics. Addiction, however, seems as present as ever in Clarksburg. At the Mission one day, I met a group of recovering young drug users. Several of them had started out on heroin but then turned to meth. In Clarksburg and many other parts of the country, meth is coming on strong, poised to be the fourth stage in an epidemic that began with prescribed pills, then moved to heroin, and then to fentanyl. Meth seems to reduce the symptoms of withdrawal from opioids, or maybe it’s just a way to get high when anything will do. Whatever the case, like the various forms of opioids before it, meth is now in plentiful supply in Clarksburg.

A couple of years ago, Ortenzio decided to open a sober-living house downtown, where recovering addicts could spend six months or more stabilizing their lives. He said God had instructed him to undertake the project, and had told him, in fact, where to do it—in a house right around the corner from the duplex where Clarksburg’s first resident overdosed on fentanyl. In 2017, more than two West Virginians a day were being claimed by opioids. Recovering addicts needed places where they could maintain sobriety. “We thought, This is going to be great. They’ll throw a parade for us,” says Ben Randolph, a businessman whom Ortenzio helped recover from pill addiction.

Instead, the idea of a sober-living house outraged many in town. The principals of two local schools were concerned that the house was too close to their campuses. Owners of local businesses worried that the house might further tarnish the city’s image. “The property value of the homes around it are going to plummet. You’re going to have both drug dealers and recovering addicts in one area, so they’ll have a captive market,” one resident told The Exponent Telegram.

But Ortenzio persisted, and a bank eventually granted him a mortgage. Since July 2017, he has run a six-bed home for men, with daily supervision and no problems—no spike in crime nearby, no complaints of loitering—reported so far. A similar home for women opened last May. Nevertheless, the episode showed where the city, perhaps even the country, was when it came to addiction: afflicted mightily and wanting it to go away, but not knowing how to make that happen.

Lou Ortenzio was the first Clarksburg doctor prosecuted for improperly prescribing pain pills. He was the first person most residents I talked with recall as putting a different face on addiction. He was the first to show that this was a new kind of drug plague, and the first to puncture the idea that the supply came from street dealers. He was also the first to publicly work at his own recovery without shame.

He was not, however, alone. In 2005, another local doctor, Brad Hall, gathered with members of the West Virginia State Medical Association concerned about addiction among physicians in a state that cannot afford to lose them. They started the Physician Health Program, which has helped some 230 West Virginia doctors with substance-abuse problems get confidential treatment and retain their license to practice. Many are overworked, as Ortenzio had been. Some were self-treating emotional and physical problems. About a quarter abused opioids.

Left: Lou Ortenzio beside one of Clarksburg’s abandoned neighborhood pools. Ortenzio managed to overcome his own addiction to narcotic painkillers and today spends his time helping other addicts recover, at the Mission (right) and elsewhere. (Jason Fulford)

Ortenzio managed to escape drugs, but he’s still living with the effects of his addiction. He is working to repair his relationship with his youngest son; Ortenzio didn’t attend his wedding and has yet to meet a young grandson. He leans on his faith to keep him going. Many of his encounters with addicts prompt sudden, public prayers, Ortenzio bowing his head as he clasps the person’s shoulder. His faith has humbled him, relieving him of a sense of hubris that got him into trouble as a doctor: the idea that he could heal an entire community, if he just kept the office open a few hours longer.

Doc O will never practice medicine again. Yet his work at the Mission doesn’t seem so different from his routine as a family physician, tending to the needs of one person after another. One morning, he took a resident to a clinic, then talked on the phone with an addicted doctor living in a halfway house. A pastor from the coalfields of southern West Virginia called to ask how to set up a Celebrate Recovery ministry in his large but dying church. A 24-year-old mother of four from a West Virginia mountain town was looking for $225 to pay the utilities for an apartment she was trying to rent. Ortenzio promised to reach out to the Mission’s supporters for a donation.

As the morning wore on, a gaunt 26-year-old man from North Carolina, a construction worker addicted to heroin and meth, showed up to report that he’d had five of his teeth pulled. The dentist had prescribed a dozen hydrocodone pills. The construction worker couldn’t fill the scrip without proper ID, which he didn’t possess. Ortenzio sat and listened as the young man, slumped beneath a baseball cap, stared at the floor and insisted on his need for the painkiller.

The dentist had probably figured that the fellow had lost a lot of teeth, that a dozen pills weren’t many. If that were the case, it would mark a change. Not that long ago, the dentist might have prescribed 20 to 40 pills.

Ortenzio offered the construction worker a prayer. The man clearly still wanted the drugs. Ortenzio, who as a doctor had prescribed pills by the hundreds each day, could only give him packets of ibuprofen.

“You want to stay away from hydrocodone,” he said.

This article appears in the May 2019 print edition with the headline “The Penance of Doc O.”

from Health News And Updates https://www.theatlantic.com/magazine/archive/2019/05/opioid-epidemic-west-virginia-doctor/586036/?utm_source=feed

[ionecoffman]

The Penance of Doc O

Well past seven one evening in 1988, after the nurses and the office manager had gone home, as he prepared to see the last of his patients and return some phone calls, Dr. Lou Ortenzio stopped by the cupboard where the drug samples were kept.

Ortenzio, a 35-year-old family practitioner in Clarksburg, West Virginia, reached for a box of extra-strength Vicodin. The box contained 20 pills, wrapped in foil. Each pill combined 750 milligrams of acetaminophen, the active ingredient in Tylenol, with 7.5 milligrams of hydrocodone, an opioid painkiller.

Ortenzio routinely saw patients long after normal office hours ended. Attempting to keep up with the workload on this day, he had grown weary and was suffering from a tension headache; he needed something to keep him going. He unwrapped a pill, a sample left by a drug-company sales rep, certain that no one would ever know he’d taken it. Ortenzio popped the pill in his mouth.

“It was a feeling like I’d never felt before,” he told me recently. “I’m tense and nervous, and that anxiety is crippling.” The pill took the anxiety away. The sense of well-being lasted for four hours, carrying him through the rest of the night’s work.

Back then, Ortenzio was one of Clarksburg’s most beloved physicians, the kind of doctor other doctors sent their own families to see. His patients called him “Doc O.” He made time to listen to them as they poured out the details of their lives. “To me, he wasn’t like a doctor; he was more like a big brother, somebody I could talk to when I couldn’t talk to anybody else,” says Phyllis Mills, whose family was among Ortenzio’s first patients. When Mills’s son was born with a viral brain infection and transferred to a hospital in Morgantown, 40 miles away, Ortenzio called often to check on the infant. Mills never forgot that.

As a physician in a small community with limited resources, Ortenzio did a bit of everything: He made rounds in a hospital intensive-care unit and made house calls; he provided obstetric and hospice care. Ortenzio loved his work. But it never seemed to end. He started missing dinners with his wife and children. The long hours and high stress taxed his own health. He had trouble sleeping, and gained weight. It took many years, but what began with that one Vicodin eventually grew into a crippling addiction that cost Ortenzio everything he held dear: his family, his practice, his reputation.

The United States is in the midst of the deadliest, most widespread drug epidemic in its history. Unlike epidemics of the past, this one did not start with mafias or street dealers. Some people have blamed quack doctors—profiteers running pill mills—but rogue physicians wrote no more than a fraction of the opioid prescriptions in America over the past two decades. In fact, the epidemic began because hundreds of thousands of well-meaning doctors overprescribed narcotic painkillers, thinking they were doing the right thing for suffering patients. They had been influenced by pain specialists who said it was the humane thing to do, encouraged by insurance companies that said it was the most cost-effective thing to do, and cajoled by drug companies that said it was a safe thing to do.

Opioid painkillers were promoted as a boon for doctors, a quick fix for a complicated problem. By the end of the 1990s, Ortenzio was one of his region’s leading prescribers of pain pills. It was a sign of the times that he didn’t think there was anything wrong with that.

Clarksburg sits atop rolling hills in northern West Virginia, halfway between Pittsburgh and Charleston. Lou Ortenzio came here in 1978, a recently married young resident out of the University of Maryland School of Medicine. “Small-town living seemed so much better than suburban life,” he told me as we drove around town one afternoon. “In Clarksburg, every block had something going. We had mom-and-pop grocery stores in every neighborhood. All these houses were occupied by teachers, downtown business owners, and people who worked in glass factories.”

Coal mining was the state’s dominant industry, but in Clarksburg, the glass business boomed. Glass manufacturing had arrived at the turn of the 20th century, drawn by the state’s high-quality river sand and rich fields of natural gas. Pittsburgh Plate Glass opened a factory in Clarksburg in 1915 and for years was one of the world’s leading plate-glass producers. Anchor Hocking employed 800 people making tumblers, bottles, fruit bowls. The city had family-owned factories too: Rolland Glass, Harvey Glass, and others.

Unlike simple resource extraction, glassmaking required sustained technological investment to meet new demands from the marketplace. The mass production of plate glass made skyscrapers possible. Picture windows and sliding-glass doors made small homes look bigger and more luxurious. The industry forged a middle class in Clarksburg and even gave the city a cosmopolitan air. The glass factories attracted artisans from France and Belgium; French was commonly heard on the streets for years.

Glass manufacturing helped forge a middle class in Clarksburg, but by the mid-1980s the industry, and the city, was in decline. Clockwise from top left: Lou Ortenzio; the abandoned Anchor Hocking glass factory; glass collected from the city’s streets; downtown Clarksburg. (Jason Fulford)

Each neighborhood was a self-contained world, with its own churches, grocery stores, and school; many had a swimming pool. High-school sports rivalries were fierce, and football games drew large crowds. When Victory played Roosevelt-Wilson, or Washington Irving went up against Notre Dame, people knew to arrive early to find a seat.

By the late 1970s, Clarksburg’s older physicians were retiring. Like many small towns at the time, it had trouble attracting young professionals. Ortenzio was among the few physicians who moved there to fill the void. He and two other young doctors opened a practice in 1982. Almost immediately, Ortenzio was seeing 40 to 50 patients a day.

The people who came to see him were mostly older; many had served in World War II. They had the aches and pains to show for a lifetime of hard work in the glass factories or at the gas company, but they had retired with something approaching financial security. They owned homes and cars, had pensions and good health insurance.

Ortenzio’s patients suffered from the ailments of the old—arthritis, diabetes, hypertension—and most of them did so stoically. This was partly generational and partly an Appalachian inheritance. One man, Ortenzio remembered, came to him thin and wasted away from cancer. “The disease was advanced, but he put up with it. I said, ‘Why didn’t you come in earlier?’ He said, ‘Well, I wouldn’t want you to think I was complainy.’ That was the Appalachian line—‘I wouldn’t want you to think I was complainy.’ ”

Ortenzio grew into his adopted city. In 1992, he established a free clinic where Clarksburg’s uninsured could get medical care. The county chamber of commerce named him Citizen of the Year for that. He had been trained to treat patients holistically. Most of what a doctor needs to know to make a diagnosis, his professors had taught him, could be learned from taking time to listen to the patient. X-rays and lab tests were mostly to confirm what you gleaned from asking questions and paying attention to the answers. He’d also been trained to help his patients help themselves. Part of his job was to teach them how to take care of their bodies. Pills were a last resort. This careful approach endeared him to his patients, but it lengthened his day. “He would have office hours until 11:30 at night,” says Jim Harris, a friend and the director of the free clinic. “People waited until then because he was worth the wait.”

Drug salesmen visited him weekly. It was a stodgy profession back then. Ortenzio remembers the reps as older men who had grown up and lived locally and who cultivated long-term relationships with doctors. One of the reps for Eli Lilly was a deacon in a local Catholic church. Once a week, he would visit Ortenzio’s office in a business suit, with information about the drugs Lilly produced. Like many in his profession in those years, he avoided hard-sell tactics. Ortenzio grew to rely on the salesman’s counsel when it came to pharmaceuticals. Once, when the Food and Drug Administration removed a Lilly drug from the market, the rep dropped by Ortenzio’s office, embarrassed and apologetic.

Before long, Ortenzio and his wife saw Clarksburg as home. They found a two-story, three-bedroom house in the Stealey neighborhood, southwest of downtown and at the foot of a hill. They set off to the bank for a 30-year loan. To their surprise, they were denied. “The house won’t keep its value that long,” the banker told them. “The best we can give you is a 15-year loan.”

The banker was right. It wasn’t yet clear, amid the bustle of Main Street and Friday-night football, but the city’s prospects were fading. Newer glass technologies required large factories, which meant stretches of flat land rare in West Virginia. Mexico and Japan emerged as competition in glass manufacturing, and plastic and aluminum emerged as alternatives to glass. Pittsburgh Plate Glass had closed in 1974. Anchor Hocking left in 1987. Its hulking concrete plant is slated for demolition, but for now it remains, just off Highway 50.

By the mid-1980s, the city was in decline. Glasswork was replaced by telemarketing. Downtown, locally owned stores began to disappear. Homeowners yielded to renters, many relying on Section 8 assistance from the government. The city eventually had to destroy dozens of abandoned homes, leaving streets with toothless gaps. The swimming pools, too, slowly closed; resident associations lacked the money to maintain them.

Ortenzio drove me by the massive Robert C. Byrd High School, home of the Eagles. It was built in 1995 to consolidate two smaller high schools in Clarksburg, whose population had receded. Replacing neighborhood schools with one centralized school allowed for better course offerings. But Byrd is far from any student’s home. School consolidation extinguished the sports rivalries that had brought people together each week. Without local schools, neighborhoods lost their social centers.

When glassmaking departed Clarksburg, locally owned stores began to disappear as well. The city eventually had to destroy dozens of abandoned homes, leaving streets with toothless gaps. (Jason Fulford)

Lou Ortenzio began to see people in economic as well as physical pain. Many were depressed, worn out by work or the fruitless search for it. Obesity became a more common problem. Some patients began to ask whether he could get them on workers’ compensation or disability. Others left to seek job opportunities in New York, North Carolina, Florida. “I was always calling people out of state telling them how sick their parents or grandparents were,” he said.

When Ortenzio had opened his practice, he’d tended to see young people only for pregnancies or the occasional broken leg. By the mid-1980s, younger people were showing up in larger numbers. They were coming in with ailments that their parents and grandparents had borne in silence—headaches, backaches, the common cold. “The new generation that came in the 1980s, those kids began to have the expectation that life should be pain-free,” Ortenzio said. “If you went to your physician and you didn’t come away with a prescription, you did not have a successful visit.”

The shift was not peculiar to Clarksburg. Americans young and old were becoming accustomed to medical miracles that allowed them to avoid the consequences of unhealthy behavior—statins for high cholesterol, beta-blockers and ACE inhibitors for hypertension and heart failure, a variety of new treatments for diabetes. Fewer patients showed up for annual physicals or wanted to hear what they could do to improve their wellness. They wanted to be cured of whatever was ailing them and sent on their way. Usually that involved pills.

The medical establishment, to a large degree, abetted this shift. In the 1980s, a new cadre of pain specialists began to argue that narcotic pain pills, derived from the opium poppy, ought to be used more aggressively. Many had watched terminal cancer patients die in agony because doctors feared giving them regular doses of addictive narcotics. To them, it was inhumane not to use opioid painkillers.

The specialists began to push the idea that the pills were nonaddictive when used to treat pain. Opioids, they said, could be prescribed in large quantities for long periods—not just to terminal patients, but to almost anyone in pain. This idea had no scientific support. One author of an influential paper later acknowledged that the literature pain advocates relied on to make their case lacked real evidence. “Because the primary goal was to destigmatize, we often left evidence behind,” he said.

Nevertheless, an alliance of specialists who saw their medical mission as eradicating pain was soon joined by the pharmaceutical companies that manufactured opioids. Medical institutions—the Department of Veterans Affairs, the Joint Commission on Accreditation of Healthcare Organizations, hospitals and medical schools across the country—bought into this approach as well.

By the late 1990s, medical schools, when they taught pain management at all, focused on narcotics. By the early 2000s, doctors were being urged to prescribe the drugs after almost any routine surgery: appendectomy, ACL repair, wisdom-tooth extraction. They also prescribed them for chronic conditions such as arthritis and back pain. Chronic pain had once been treated with a combination of strategies that only sometimes involved narcotics; now it was treated using opioids almost exclusively, as insurance companies cut back on reimbursing patients for long-term pain therapies that did not call on the drugs.

The U.S. drug industry, meanwhile, was investing heavily in marketing, hiring legions of young salespeople to convince doctors of their drugs’ various miracles. Nationwide, the number of pharmaceutical sales reps ballooned from 38,000 in 1995 to 100,000 a decade later. The old style of drug rep, grounded in medicine or pharmacy, largely passed from the scene.

“It went from a dozen [salesmen] a week to a dozen a day,” Ortenzio remembered. “If you wrote a lot of scrips, you were high on their call list. You would be marketed to several times a day by the same company with different reps.”

Most drug companies in America adopted the new sales approach. Among them was Purdue Pharma, which came out with a timed-release opioid painkiller, OxyContin, in 1996. Purdue paid legendary bonuses—up to $100,000 a quarter, eight times what other companies were paying. To improve their sales numbers, drug reps offered doctors mugs, fishing hats, luggage tags, all-expenses-paid junkets at desirable resorts. They brought lunch for doctors’ staff, knowing that with the staff on their side, the doctors were easier to influence. Once they had the doctor’s ear, reps relied on specious and misinterpreted data to sell their product. Purdue salespeople promoted the claim that their pill was effectively nonaddictive because it gradually released an opioid, oxycodone, into the body and thus did not create the extreme highs and lows that led to addiction.

[From April 2006: The drug pushers]

The reps were selling more than pills. They were selling time-saving solutions for harried doctors who had been told that an epidemic of pain was afoot but who had little time, or training, to address it. For a while, Ortenzio still suggested exercise, a balanced diet, and quitting smoking, all of which can alleviate chronic pain. But his patients, by and large, didn’t want to hear any of this, and he was busy. So he, too, gradually embraced pain pills. Nothing ended an appointment quicker than pulling out a prescription pad.

The number of people on pain pills grew from a tiny fraction of Ortenzio’s practice to well over half of his patients by the end of the 1990s. The shift was gradual enough at first that he didn’t recognize what was happening. Patients with medical problems unrelated to pain migrated to other doctors. Still, Ortenzio was working 16-hour days, seeing patients who had been scheduled for the afternoon at 9 p.m.

The more drugs Ortenzio prescribed, the more he was sought out by patients. Many would use up a month’s supply before the month was out; in need of more pills, they were insistent, wheedling, aggressive. Many lied. Some would curse and scream when Ortenzio told them that he couldn’t write them a new prescription yet, or that he wanted to lower their dosage.

The pills were soon on the streets of Clarksburg as well. They replaced beer and pot at many high-school parties. Phyllis Mills, Ortenzio’s longtime patient, had two daughters who abused the pills. Theirs did not come from Ortenzio, at least not directly, but the supply of pills was exploding, due in large part to doctors like him who were overprescribing them.

Ortenzio should have noticed what the pills were doing, to his patients and his community, but he was less and less himself. After his late-night encounter with Vicodin in 1988, he had begun his own slide into addiction. By the late 1990s, he was using 20 to 30 pills a day, depleting even the plentiful supply of free samples from the ubiquitous sales reps.

Desperate to get his hands on more pills, he found a friend he could trust, a middle-aged accountant and a patient of his. “I’m in some trouble,” Ortenzio told him. “If I write you this prescription, can I ask you to fill it and bring it back to me?”

“Sure thing,” the man said, without asking for an explanation. “If you gotta have it, you gotta have it. You’re the doc.”

Soon a dozen or so trusted patients were helping Ortenzio. He knew he was out of control and needed help—even the amount of acetaminophen he was consuming was toxic—but he feared that seeking treatment for his addiction might cost him his medical license. Around 1999, he found a new way to get his fix. He began writing prescriptions in his children’s names.

Ortenzio could plainly see that the claim that these pills were nonaddictive was untrue. He would try to quit and feel the symptoms of withdrawal. “I couldn’t be away from my supply,” he said. His patients, too, were terrified of going without. One, a nurse at a local hospital suffering from chronic pain as well as depression and anxiety, would approach him in his office parking lot, often bearing gifts of quilts or canned goods, insisting that she needed her pills that morning, that she couldn’t wait for her monthly appointment.

Ortenzio saw no way to break the cycle the pills had created for the people in his care. He never found a way to get his patients down to lower doses of narcotics. They rebelled when he suggested tapering; just cutting people off made them sick. The area didn’t have enough pain clinics or addiction specialists to refer them to, and insurance companies wouldn’t reimburse for many pain treatments that did not involve pills. Without good alternatives for his patients, he kept on writing prescriptions.

Top: A resident of the Mission, a shelter that opened in 1969 with a few beds, for alcoholics and homeless veterans. Today, many of its 120 beds are occupied by opiate addicts. Bottom: A set of house rules. (Jason Fulford)

Addiction and overwork had estranged Ortenzio from his wife and children. As Clarksburg declined, his wife moved the kids to Pittsburgh to find better schools. In 2004, after more than a decade of living in different cities, they divorced. Raised Catholic but without much feeling for the Church, Ortenzio joined a Protestant congregation. Ultimately, he found Jesus in his exam room. During an appointment one day, he and a patient, a Baptist, talked of his search for redemption. The patient knelt with Ortenzio on the linoleum floor and prayed for the doctor. Ortenzio marks that moment as his new beginning. He had advantages many addicts don’t have: a home and a car, financial resources, generous friends and colleagues, and, later, the support of a second wife. He managed to taper off the drugs. A couple of months later, he was baptized in a deep section of Elk Creek, where baptisms have taken place since the early 1800s.

Not long after that, federal agents raided his office. They interrogated his staff and confiscated hundreds of patient records. The investigation dragged on for nearly two years. His children had to testify before a grand jury that they knew nothing about the prescriptions their father had written in their names.

In October 2005, prosecutors charged Ortenzio with health-care fraud and fraudulent prescribing. That year, 314 West Virginians died from opioid overdoses, more than double the number of people five years earlier. By 2006, according to the Centers for Disease Control and Prevention, physicians were writing 130 opioid prescriptions for every 100 West Virginians.

In March 2006, Ortenzio pleaded guilty. His sentencing occurred shortly after a 2005 Supreme Court decision made federal sentencing guidelines nonmandatory and individual sentences up to judges’ discretion. Despite what he’d done, Ortenzio was still beloved in Clarksburg. More than 100 people wrote to the judge on his behalf. He received five years of supervised release plus 1,000 hours of community service, and was ordered to pay $200,000 in restitution. He would serve no prison time, but he did lose his medical license.

At 53, Ortenzio was unemployed. A temp agency offered him a landscaping job at the Stonewall Resort, where, as a doctor, he had taken his family for Sunday brunch. He’d never worked outdoors in his life, but he took the job. It paid $6.50 an hour.

He worked at the resort for a couple of months, then as the janitor at a local community center before returning to Stonewall as a full-time groundskeeper. He also found a night job.

Tom Dyer is one of northern West Virginia’s leading defense attorneys; Ortenzio had been his client. One night in 2006, Dyer ordered a pizza from Fox’s Pizza Den in Bridgeport, a town near Clarksburg. When the doorbell rang, he opened the door and there stood Lou Ortenzio, holding a pie. It took a minute before Dyer realized: Doc O was now a pizza-delivery guy. “I was just speechless,” Dyer told me.

“I made pizza deliveries where I used to make house calls,” Ortenzio said. “I delivered pizzas to people who were former patients. They felt very uncomfortable, felt sorry for me.” But, he said, “it didn’t bother me. I was in a much better place.”

Ortenzio eventually left pizza delivery. But the way he told me the story, the job was an important step in his recovery: Every pie he delivered liberated him. He was free of the lies he’d told his colleagues, his family, and himself to hide his addiction. He liked hearing kids screaming “The pizza guy’s here!” when he knocked on the door. “You make people happy,” he said. “That was what I liked about being a doctor.”

Today, Ortenzio spends his days trying to atone. He does this through constant work. There are places in and around Clarksburg where addicts can get help, and Ortenzio can be found at most of them.

The Mission opened in 1969, in Clarksburg’s Glen Elk neighborhood, at the time a small red-light district with bars and backroom gambling. The shelter started with a few beds, intended for alcoholics and homeless veterans. A neon-blue jesus saves sign outside has remained illuminated for all the years since, as the shelter has expanded. Today, many of its 120 beds are occupied by opioid addicts.

One afternoon, I met Ortenzio in a small, windowless office at the Mission. Now 66, he is thin, gray-haired, and bespectacled; he dresses in a hoodie, blue jeans, and sneakers. He does a bit of everything at the Mission, from helping the addicted find treatment to helping them find a coat, or shoes for their children, or a ride to the probation department. He is a volunteer adviser there, too, and at the county’s drug court, where he guides addicts through the criminal-justice system.

Ortenzio is also involved with two newer initiatives, which suggest the challenges of repairing the damage done by opioids. A wood-beamed downtown church is home to Celebrate Recovery, a Christian ministry founded in Orange County, California. Celebrate Recovery has grown nationwide due in large part to the opioid epidemic. On the cold Tuesday night I visited, the service featured an electric band singing the kind of fervid new gospel music that is common to nondenominational Christianity: “You are perfect in all of your ways …”

Ortenzio is Celebrate Recovery’s lay pastor in Clarksburg, running its weekly services. The flock is about 100 or so strong. One evening, a young mother named Sarah stood before the congregation to give her testimony. Sarah’s story started with parents who married too young and divorced before she was 3. It featured father figures who were coal miners and truck drivers and a stepfather who molested her repeatedly, beginning when she was 8. Then a life of illicit drugs, marriage, divorce, and addiction to prescription pain pills.

Clarksburg’s traditional congregations have dwindled along with the city’s population; many rely on support from former residents who commute in from elsewhere on Sundays. The place these churches once held in this community has been taken by new churches proclaiming a gospel of prosperity, insisting that God wants us all to be rich. And by ministries such as Celebrate Recovery.

A regular devotional service held in the Mission’s cafeteria (Jason Fulford)

Ortenzio coordinates the training of recovery coaches at the church, people who can help addicts as they try to wean themselves from narcotics. Addiction, however, seems as present as ever in Clarksburg. At the Mission one day, I met a group of recovering young drug users. Several of them had started out on heroin but then turned to meth. In Clarksburg and many other parts of the country, meth is coming on strong, poised to be the fourth stage in an epidemic that began with prescribed pills, then moved to heroin, and then to fentanyl. Meth seems to reduce the symptoms of withdrawal from opioids, or maybe it’s just a way to get high when anything will do. Whatever the case, like the various forms of opioids before it, meth is now in plentiful supply in Clarksburg.

A couple of years ago, Ortenzio decided to open a sober-living house downtown, where recovering addicts could spend six months or more stabilizing their lives. He said God had instructed him to undertake the project, and had told him, in fact, where to do it—in a house right around the corner from the duplex where Clarksburg’s first resident overdosed on fentanyl. In 2017, more than two West Virginians a day were being claimed by opioids. Recovering addicts needed places where they could maintain sobriety. “We thought, This is going to be great. They’ll throw a parade for us,” says Ben Randolph, a businessman whom Ortenzio helped recover from pill addiction.

Instead, the idea of a sober-living house outraged many in town. The principals of two local schools were concerned that the house was too close to their campuses. Owners of local businesses worried that the house might further tarnish the city’s image. “The property value of the homes around it are going to plummet. You’re going to have both drug dealers and recovering addicts in one area, so they’ll have a captive market,” one resident told The Exponent Telegram.

But Ortenzio persisted, and a bank eventually granted him a mortgage. Since July 2017, he has run a six-bed home for men, with daily supervision and no problems—no spike in crime nearby, no complaints of loitering—reported so far. A similar home for women opened last May. Nevertheless, the episode showed where the city, perhaps even the country, was when it came to addiction: afflicted mightily and wanting it to go away, but not knowing how to make that happen.

Lou Ortenzio was the first Clarksburg doctor prosecuted for improperly prescribing pain pills. He was the first person most residents I talked with recall as putting a different face on addiction. He was the first to show that this was a new kind of drug plague, and the first to puncture the idea that the supply came from street dealers. He was also the first to publicly work at his own recovery without shame.

He was not, however, alone. In 2005, another local doctor, Brad Hall, gathered with members of the West Virginia State Medical Association concerned about addiction among physicians in a state that cannot afford to lose them. They started the Physician Health Program, which has helped some 230 West Virginia doctors with substance-abuse problems get confidential treatment and retain their license to practice. Many are overworked, as Ortenzio had been. Some were self-treating emotional and physical problems. About a quarter abused opioids.

Left: Lou Ortenzio beside one of Clarksburg’s abandoned neighborhood pools. Ortenzio managed to overcome his own addiction to narcotic painkillers and today spends his time helping other addicts recover, at the Mission (right) and elsewhere. (Jason Fulford)

Ortenzio managed to escape drugs, but he’s still living with the effects of his addiction. He is working to repair his relationship with his youngest son; Ortenzio didn’t attend his wedding and has yet to meet a young grandson. He leans on his faith to keep him going. Many of his encounters with addicts prompt sudden, public prayers, Ortenzio bowing his head as he clasps the person’s shoulder. His faith has humbled him, relieving him of a sense of hubris that got him into trouble as a doctor: the idea that he could heal an entire community, if he just kept the office open a few hours longer.

Doc O will never practice medicine again. Yet his work at the Mission doesn’t seem so different from his routine as a family physician, tending to the needs of one person after another. One morning, he took a resident to a clinic, then talked on the phone with an addicted doctor living in a halfway house. A pastor from the coalfields of southern West Virginia called to ask how to set up a Celebrate Recovery ministry in his large but dying church. A 24-year-old mother of four from a West Virginia mountain town was looking for $225 to pay the utilities for an apartment she was trying to rent. Ortenzio promised to reach out to the Mission’s supporters for a donation.

As the morning wore on, a gaunt 26-year-old man from North Carolina, a construction worker addicted to heroin and meth, showed up to report that he’d had five of his teeth pulled. The dentist had prescribed a dozen hydrocodone pills. The construction worker couldn’t fill the scrip without proper ID, which he didn’t possess. Ortenzio sat and listened as the young man, slumped beneath a baseball cap, stared at the floor and insisted on his need for the painkiller.

The dentist had probably figured that the fellow had lost a lot of teeth, that a dozen pills weren’t many. If that were the case, it would mark a change. Not that long ago, the dentist might have prescribed 20 to 40 pills.

Ortenzio offered the construction worker a prayer. The man clearly still wanted the drugs. Ortenzio, who as a doctor had prescribed pills by the hundreds each day, could only give him packets of ibuprofen.

“You want to stay away from hydrocodone,” he said.

This article appears in the May 2019 print edition with the headline “The Penance of Doc O.”

Article source here:The Atlantic