Five years ago, fueled by heroin addiction, Kasandra Quednau pursued drugs the way a CEO chases a high-stakes business deal. The adrenaline flowed, and the thrill of the hunt had an aura of consequence and glamour to it. “As much as the drug itself, you also crave the lifestyle,” says Quednau, 26. “It’s fast, it’s fun. You’re getting in the car and going down to the city. You’re always getting phone calls, there’s action, there’s money. And you’re high, so you feel great.” In moments like these, a healthy, normal life seemed boring, hardly something to aspire to. Yet other moments were far less glamorous—the broke and evicted moments, the vomiting-all-over moments, the crushed-by-despair moments. “When it was good it was good, but when it was bad it was just so so so bad,” she intones. “The bad starts overshadowing the good.” Quednau always suspected that with heroin she’d end up either dead or in jail. Lucky for her, it was the latter. After 18 months of incarceration, six of them in a military prison boot camp, she knew she’d never go back to the lifestyle, or the drug. “If it wasn’t for that time in jail,” she says, “I might never have shaken it.”
White Picket Fences and Opioids
The fast pace of addict culture matches the breakneck speed at which opiate use is growing in this country. In 2014, more than 47,000 Americans died from drug overdoses, a 14 percent leap from the previous year. With the nation in the grip of a heroin epidemic imported mainly from the poppy fields of Afghanistan and shuttled through cartels in Mexico, we now have more deaths from overdoses than from car accidents. “Over the last five to 10 years we’ve seen a dramatic rise in the abuse of opiates,” says Dean Scher, PhD, executive director at Catholic Charities Community Services of Orange County. Catholic Charities has eight locations, ranging from community residences with crisis units for detox to day rehab services and residences for people in recovery. In the past, Catholic Charities has mainly served urban areas such as Newburgh affected by heroin addiction; these days, the scourge is more widespread. “We’re seeing it in all locations now,” says Kristin Jensen, director of communications and development for Catholic Charities. “People used to see [heroin] as an inner-city problem, but it’s not anymore. It’s a very middle-class and suburban problem now. It’s even in rural areas.”
Communities locally and across the country are scrambling to catch up and get a handle on the crisis. They’re tackling it from all sides as if fighting Godzilla, with a growing number of interventions—from urgent police task forces and community coalitions to support groups and prevention councils. Some states are putting a cap on the number of painkiller pills that doctors can prescribe. The Centers for Disease Control and Prevention issued tough new guidelines last month on the use of prescription opiates such as OxyContin, Vicodin, and Percocet, advising doctors to try nonnarcotic options for their patients’ chronic pain. It’s an important move, because heroin addiction often begins with a dependence on painkillers that can lead to their abuse, says Paul Arteta, the police lieutenant in charge of Orange County’s drug task force. “A lot of people we’ve spoken to, most of them that had been arrested [on heroin-related charges], stated that they’d had a sports injury or car accident, or they went to a party and someone who’d had one of these injuries or accidents provided them with a pill. And it filled some kind of hole, something missing in their life.”
Whatever the hole is, a feeling of euphoria fills it up instantly when the drugs are snorted or injected, and opiate molecules flood the brain in a chemical reaction that mimics endorphin, the feel-good hormone naturally produced by the body. With long-term use, tolerance builds and users require larger doses or more frequent injections to achieve the same results. In extreme cases Arteta has encountered addicts who shoot up heroin 100 times a day, spending $1,000 daily on the drug. “We’re seeing a lot of research being done that shows people can be fully functional; they’re using heroin and going to work,” he says. For many hard-core users the euphoria begins to fade or vanishes completely. Yet they continue to take the drug to feel “normal” and avoid the onslaught of nausea, vomiting, shaking, and flu-like symptoms that are the hallmarks of the addict’s worst nightmare: withdrawal.
Thinking Outside the 28-Day Detox Box
It’s hardly simple to kick a heroin habit (indeed, the phrase “kick the habit” likely originated as a reference to the jerky, involuntary movements of the legs and feet that happen during opiate withdrawal). The traditional 28-day rehab model doesn’t work for everyone, and many insurance companies balk on covering it. “Detox is the main thing that addicts are doing these days,” says Quednau, who is now a certified alcohol and substance abuse counselor and does community outreach through Rt. 212 Coalition, which she cofounded with partner Shayna Micucci. “They’re scared about getting sick, and they know they can get their methadone or Suboxone to help taper them down.” Many addicts check themselves into a local hospital’s detox unit if they can; often, there aren’t enough beds, and the hospitals have stipulations requiring patients to be in active withdrawal. “Sometimes the person will go for a few days and then sign themselves out; they feel better and think they’re fine,” says Quednau. “Then it becomes a cycle; they might do it four or five times before they realize they have to stay in.”
At Catholic Charities, the model is set up to try to avoid the revolving door; patients have access to holistic, individualized, and longer-term programs depending on their level of severity and need. “Someone could be in our crisis unit for detox for anywhere from five to 15 days, then they can be moved to our community residence for up to 60 days,” says Scher. “During that time they’d be receiving fairly extensive individual therapy, family and group therapy, and medication-assisted treatment. Those people who have severe addictions, they’re allowed to stay in our residences up to six months. Then we have community-based apartments that provide additional structure. We try to use as many of the evidence-based tools that are available to the field as we can.” Scher notes that 75 to 80 percent of Catholic Charities’ patients are mandated to treatment by the courts or social services; these are like “additional parents” that help the person try to stay in treatment. “In the populations we serve, we see the impact of factors like poverty, generational marginalization, and adverse childhood experiences—all these factors can play a role in addiction,” he says.
A complex problem, addiction requires a complex set of solutions, and recovery can be a long-haul process. Many former addicts say it takes being drug-free for six months or more before the craving for opiates subsides. “With medication-assisted treatments, the protocol is generally nine to 12 months before your brain normalizes with respect to the neurophysiology and pleasure-seeking,” says Scher. The medications available to help taper off addiction, whether it’s Suboxone, methadone, Vivitrol, or tranquilizers, are tools for therapists as well as patients. “Essentially, we’re asking someone with addiction to put their attention on the very things they have spent a lifetime not attending to, like adverse childhood experiences, painful feelings. The medications can help reduce the size of the emotional tidal waves. This gives an opportunity for talk therapy, and also reduces the probability of relapse,” Scher explains.
Medication-assisted treatment is not without controversy; many people question the logic of treating heroin addiction with yet another addictive drug. “When you can’t get heroin, you freak out. And you get just as sick when you can’t get Suboxone,” says Quednau. “It’s a slippery slope because it can be beneficial. But is it really recovery? It’s supposed to be for tapering off, but I’ve seen people on Suboxone for years.”
After trying “everything,” what finally did it for Quednau, who is now three years in recovery, was being physically removed from the entire world of her addiction—not just the drug itself, but all the people, places, and things that went with it. One goal of Rt. 212 Coalition is to establish in Woodstock a program called PAARI, the Police Assisted Addiction Recovery Initiative, which links up local addicts with detox and rehab facilities in other states or even across the country. Quednau would also like to see Ulster County set up a job position for a full-time, dedicated detox aftercare coordinator—someone who can make sure that outpatients stay on track, counseling them not to go back to the boyfriend who uses or back to their parents’ house if drug use is part of the family system. “It’s about getting out of your context,” says Quednau. “It’s extremely difficult for people who go to detox for three days and then come back to the same environment. It’s almost impossible to stay clean.”
Nipping It in the (Poppy) Bud
Sometimes addicts will hit bottom and ask for help, but just as often they will retreat deeper into the carefully insulated world of their addiction. “We know how hard it is to actually reach the addict directly,” says Quednau. “It’s extremely difficult unless they want to be reached or want help.” That’s why Rt. 212 Coalition puts the emphasis mainly on prevention and education. Quednau has started visiting local schools to tell her story and participate on panels with other experts, feeding her community’s need to understand and tackle the crisis.
Parents need to know what to look for and how to keep their children safe; one way is to increase awareness about the evolving ways in which drug use—both prescription drugs and recreational drugs—are a part of modern teen culture. In some communities, teens participate in “pharming” or “bowling” parties in which they gather and trade prescription pills gathered from their families’ medicine cabinets. Discarding unused pills, or keeping them locked away, should become habitual. Curiosity, along with boredom and peer pressure, can lure kids down a path that’s a lot more dangerous than they imagine. To counter it, parents need to talk with their kids, denormalize drug use, and give them escape routes, suggesting ways they can decline drugs without sounding uncool (“No thanks, I’m not into it” or “Not today”). And schools need to host assemblies featuring from-the-trenches tales that put another angle on the subject.
Quednau’s story, with its soaring highs and crashing lows, is deeply cautionary but also hopeful. “People say, ‘Once an addict, you’re always an addict.’ For me, I don’t think so,” she says. “I don’t miss it, I don’t want it. I’m over it. Recovery is possible. Once you start setting a foundation for yourself, and that foundation starts giving you a little more self-confidence and a better self-image and some responsibility, then you start gaining things that are too valuable to lose.”
This is the second in a two-part series about the opioid epidemic. This story originally appeared in Chronogram magazine.
Catholic Charities Community Services
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