Doctor talks about prescribing opioids
(This is the second of an occasional series on the opioid crisis in Illinois.)
When Jack Evans drove into the pole, he instinctively put up his arms.
It had been snowing lightly. He was traveling from Herrin to Marion, just 10 miles, in an old Chevy Chevette. He and his wife had bought two of them from the Post Office, which used them to deliver mail. His was white.
Evans had been drinking a little, and he wasn’t wearing a seat belt. He was going about 35 mph when he came to the intersection near the airport. He braked but couldn’t stop and slid right through. When he tried holding himself in place, his left arm punched through the window, and when he drew back, the glass caught his flesh and tore through several nerves that required surgery in St. Louis.
“From that time on, I was in constant pain,” said the 6-foot-3 retiree from Marion. “It wasn’t a pain you could just take away with ibuprofen.”
Evans agreed to use his full name for this story but declined to be photographed for his privacy.
A doctor started Evans on hydrocodone, the most popular opioid in Illinois by far, and for the duration of the treatment, Evans said, he was a “stickler” about taking them at the right time. He can’t remember now exactly what the prescription was — whether he had 5- or 10-mg pills — but he estimated he received 90 of them, and took them three times a day for 30 days.
The St. Louis doctor wouldn’t refill the prescription and sent Evans to his regular physician, who prescribed 10-mg hydrocodone pills. But even that wasn’t enough to relieve Evans’s pain, and after a couple of months, his doctor sent him to a pain-management clinic, which started him on a stronger regimen with hydromorphone, another type of opioid.
Evans took the pill and started feeling a little woozy. He was high.
“That is when my addiction started,” he said. “That’s when I started abusing.”
The first phase
The first time Evans tried to find pills on the street, he was terrified — not necessarily of getting caught, but of losing his stash of opioids.
He didn’t know the dealer well.
“I found him through a friend of a friend of a friend of a friend,” Evans said.
The dealer was scared that Evans was a cop wearing a wire, and Evans was scared that the man would rat him out to his doctor. He discovered they shared the same one. “That made me nervous,” but when you’re sick or in pain, you overlook a lot of things, he said.
Evans can’t even remember how many pills he bought.
“It would have been anything he had and as much money as I could come up with,” he said.
Evans went to the man’s house, bought some painkillers, and neither of their worries came true. In fact, the men eventually became good friends, and Evans was introduced to other sources for pills. That was important. You needed to know a lot of people to buy from because not everyone will always have something to sell, he said.
For Evans, one hydromorphone tablet was supposed to last eight hours, but it didn’t, so he’d have to find them elsewhere, or he would take it with a hydrocodone, his opioid of choice. They weren’t as strong as hydromorphone, but he felt they lasted longer, and they were more plentiful, too. On the street, he could get 10 hydrocodones for just one hydromorphone.
After a year, someone showed Evans how to inject the stronger drug, which gave him a heroin-like high.
“At first, I was real scared,” he said. “At first, I had a lot of shame, a lot of guilt.” After the injection, though, “all that just melted away.” He didn’t care about the pain in his arm or the pain of the guilt anymore.
At first, I was real scared. At first, I had a lot of shame, a lot of guilt. After the injection, though, all that just melted away.
Jack Evans, of Marion
Evans would get a 90-day supply on a Monday, and by Friday they would be gone, he said. He would take maybe 60 pills, and the other 30 would go toward bartering. He started trading for morphine, which came in even stronger 60-mg tablets, and shot up more.
Then, at some point, he got a call from the doctor at the pain clinic. He wanted to do a pill check, but Evans was short.
He scrambled to buy some pills that looked like the ones the doctor prescribed, put them in the bottle, and took them in. He had prepared for a urinalysis, too, laying off the hydromorphone and taking a dose of methadone, commonly used to treat heroin addiction, to tide him over a few days before he went in.
Evans had heard the clinic didn’t check for methadone, but it did, and after he showed up positive, the doctor stopped seeing him. Evans had never been screened before, and he blamed his wife for calling the clinic. They fought a lot about his addiction, but it would be years before she finally left him.
After the clinic stopped serving him, Evans went back to his regular doctor. It had been three or four years since the car accident. By now, Evans’ tolerance had increased, and he couldn’t get by on what the doctor was comfortable prescribing. Worried about Evans’ health, the doctor limited his supply to just hydrocodones, and he wanted routine urinalyses, too. Evans didn’t like that, so he left him and went back to the street.
That was the first phase of his addiction.
By the time he left his doctor, Evans had entered his 40s. The pain in his arm from his car accident was still throbbing, and now arthritis had settled in his lower back.
Evans was already a veteran of the black market, but doctors had provided an important source of his opioids. Strapped for a medical supply, he entered the second phase of his addiction: doctor-shopping.
In the doctor’s office, Evans would cry, acting like he couldn’t stand the pain, and that hydrocodones weren’t working well.
“Basically, you’ve given all your pride away,” he said.
At one point, he was going to Florida every month to scam 100-mg morphine pills. The doctor didn’t care about insurance, Evans said. All that mattered was that he came with $160 cash.
Evans went to a variety of doctors in Illinois, but eventually they caught on. He would go in for an appointment, but someone might check his past prescriptions. Then their mood would change, and they would send Evans away empty-handed.
He had been a doctor-shopper for about five years before his luck ran out.
Then “there came a point when I had no doctor,” he said, and that’s when he entered the third phase of his addiction.
In those years, Evans was banished to the street again, and, eventually, he started dealing — $3 dollars for a 5-mg pill, $4 dollars for 7.5 mg, $5 dollars for a 10.
He started taking oxycodone, and his addiction grew worse.
Basically, you’ve given all your pride away.
Finally, after years of struggle, it wasn’t even about getting high anymore. He didn’t think it was illegal, either. He was just dealing with what his body needed.
Evans had track marks all over his arms, and his home life grew worse. A lot of his memories from that time are hazy, but many of them are of his couch, where he would be high as his wife maintained their family life.
Toward the end of his addiction, all he wanted to do was avoid getting sick. He began looking for anti-addiction medication — buprenorphine fetched high prices on the street — to stabilize his cravings so he could function like he used to.
Eventually, he decided to take care of his addiction once and for all, and went to a clinic to be evaluated for addiction treatment. It had been a couple of days since he’d gotten high. He had a yellow complexion from contracting Hepatitis C, and he was in the throes of withdrawal.
The clinician told him to go straight to an opioid-addiction treatment provider in Carbondale.
“He took me as a patient right then, and I never looked back from there,” Evans said.
It wasn’t the first time Evans had sought help to end his misery.
He’d wanted to start treatment earlier, but the first time he was evaluated, he was put “on the bottom of a very, very long waiting list.” In his attempts to quit opioids on his own, he wouldn’t make it more than a day or two “before the sickness would be too much.”
In 2012, however, his condition was so bad that it catapulted him to the top of the list when he hobbled over to the doctor’s office.
The doctor sent Evans to an infection-disease doctor, who treated him for Hepatitis C, and then Evans started taking Subutex, a brand-name anti-addiction medicine like buprenorphine, which is commonly known as Suboxone. Since then, Evans said he hasn’t relapsed one time. In fact, after decades of smoking two packs of cigarettes a day, he quit that, too.
Evans has been clean for about four years now, and separated from his wife for eight. They’re friends now, but it’s been difficult for him to fill the gap in his life where his friends and family once were.
Him, God and Subutex saved my life.
When he was an addict, all his friends were addicts, too. He estimated he lost 15 friends to overdose over the past 10 years, and when he got clean, he shed the rest to make it easier to recover.
As useful as anti-addiction medication has been, Subutex is cold comfort, giving Evans a new life only to make him realize how much he lost to his old one.
“(I’m) 58 years old — I don’t know how to go out and make friends,” he said.
Loneliness has taken the place in his life where addiction once was. It’s shaped by fear, and it has changed the way he sees the world. Long after he had a reason to be concerned about the Drug Enforcement Agency, he’s still afraid that people he doesn’t know are enforcement agents.
Evans pushes people away out of worry of making friends with someone hiding an addiction, but he isn’t entirely without a support network. Still, animals have taken the places where people might otherwise be. Until recently, he had five dogs running around, but he had to put one down on New Year’s Eve day.
He appreciates the friends and family members who helped him, and now he’s busy making up for lost time. In the spring, he went down to Memphis to see his grandchildren and take them swimming. The younger one is 8, and the older one is 11.
Evans takes an anti-depressant to help with anxiety, and he continues with counseling, only just beginning to process the past. It’s the psychological fallout from addiction that trips him up now, much more than the physical addiction, he said.
Evans also still takes anti-addiction medication, and he’s still thankful to his doctor for taking him in.
“Him, God and Subutex saved my life.”