heroin addiction

>>announcer: there once was a time when wewere truly free -- free of worry... free of fear... far from doubt. that is strength. that is power. that is fearless. "second opinion “is funded by blue crossblue shield. which is committed to improving health careaccessibility and supporting more affordable community clinics where care is limited. blue cross blue shield live fearless.

>>announcer: "second opinion" is producedin association with the university of rochester medical center, rochester, new york. >>dr. peter salgo: this is "second opinion,“and i'm your host. peter salgo. today we're joined by special guest, cynthiascudo. cynthia is here to share her personal story,a story that may shock you. >>cynthia scudo: i was taught how to smokei.e. could convince myself that if i didn't inject it, i was not really a heroin addict. >> dr. peter salgo: did you keep working?

>>cynthia scudo: i did. >>dr. peter salgo: you continued to work. you raised your family. >> cynthia scudo: yep. >> dr. peter salgo: how long did you smokeheroin? >>cynthia scudo: about nine years. >>dr. peter salgo: nine years of heroin addiction. >>dr. peter salgo: thank you so much for beinghere today with us, cynthia. i know that what you're gonna share with ustoday is somewhat difficult to discuss, and

i’m really grateful that you’ve joinedus. what i'd like to do is introduce you to our"second opinion “panel of experts. they’re going to be hearing your story forthe first time. they are dr. anne marie mckenzie-brown fromemory pain center. “second opinion" primary care physicianfrom the university of rochester medical center. lou papa, and lou or louis baxter from theprofessional assistance program of new jersey. now, cynthia, let's get righto work. i want to know a little bit about you. i understand you've got, what, eight children?

>>cynthia scudo: eight children and i justhad my 20th grandchild last month. >> dr. peter salgo: congratulations. >> cynthia scudo: thank you. >> dr. peter salgo: and you live in denver. >> cynthia scudo: i do, yes. >>dr. peter salgo: and tell me about whatyou do. what is your job? >> cynthia scudo: i am an executive assistantto svp of sales fora credit-card company, and i also kind of manage the denver office.

>> dr. peter salgo: you started to experiencesome pain when you were about 44 years old. tell me about that. >> cynthia scudo: i started developing somehip pain, and i went to the doctor. they did an mri, which they said at that timewas inconclusive. i did a round of physical therapy for approximatelysix weeks and tried some over-the-counter medication with no relief, so my next stepwas a pain-management doctor. >>dr. peter salgo: well, let me be very clear. did they ever make a diagnosis as to why youwere in pain? >>cynthia scudo: no.

>>dr. peter salgo: lou, does that bother you? >>dr. lou papa: no. i mean, there's lots of times that we havepatients that have, you know, pain that we can't find the obvious cause for it. we have things that may suggest it, but whetherthere’s a smoking gun, sometimes we don't have that. >>dr. peter salgo: all right, but what happenednext, cynthia? that’s important. >>cynthia scudo: so, my first appointmentwith the pain-management specialist, i walked

out with two 40-milligram oxycontin -- >>dr. peter salgo: let me back you up, becauseyou jumped right to a pain-management specialist. you went to a doctor who took a look, couldn'tfind what was wrong and sent you right to a pain-management specialist. >>cynthia scudo: correct. >>dr. peter salgo: and that pain-managementspecialist did what? >>cynthia scudo: prescribed oxycontin my firstvisit. >> dr. peter salgo: oxycontin is a narcotic. >> cynthia scudo: yes, it is.

>>dr. peter salgo: all right. let’s go right to the panel. does this sound like a good idea? to you? >> dr. anne marie mckenzie-brown: it doesnot. it does not. opioids are generally not the first line oftherapy for a pain that you've been having for the very first visit, and there are othermedications that can be used for pain that are non-opioid that might have been helpfulfor you.

>>dr. peter salgo: and let's stop right there. we’re talking about a word that some ofour viewers may not have heard -- "opioid. “they come from opium. they are narcotics. they’re powerful pain relievers. would you jump to that right off the bat? >>dr. louis baxter: absolutely not, and i'malso very concerned that there wasn’t more done in terms of trying to find out what thecause of the pain. when we find patients that have painful conditions,one of the primary things should be to find

out what is causing the pain. >>dr. peter salgo: well, that's a good idea,but here you are now. you’ve been given oxycontin, a narcotic,and did you take it as prescribed? >>cynthia scudo: i did for about the firsttwo weeks. >> dr. peter salgo: and then what? >>cynthia scudo: and then i realized throughan inadvertent double-dosing that the euphoric feeling was amazing if i added a little bitmore. >> dr. peter salgo: so it made you feel good,not just took your pain away. >> cynthia scudo: oh, the pain was gone, and--

>>dr. peter salgo: even now looking at yourface. >>cynthia scudo: i can remember. i can still remember that feeling. >> dr. peter salgo: so, what did you do? i mean, that's something that drives a lotof people to take these drugs. what did you do? >> cynthia scudo: i started taking them notas prescribed. i took -- i chewed them, i crushed them, ismoked them, i...my second appointment, i was increased to 80-milligram oxycontin.

>> dr. peter salgo: so here we are with opioids. i think people are somewhat aware that thenarcotics can make you feel good. they also block pain. how do they work? >>dr. anne marie mckenzie-brown: well, theybind opioid receptors, and they can dull the sensation that comes along with pain, butthere are many other side effects along with it. i'm curious. had you ever taken any other opioid beforethis?

because starting out 40 milligrams of oxycontinseems like a large dose. did it make you sleepy? >> cynthia scudo: no. i'm a very functioning person on opioids. >>dr. louis baxter: and the first-time experienceof euphoria for her is a big herald signal for those of us that treat people with addiction. >>dr. peter salgo: okay, so the fact thatsomeone is becoming euphoric on an oral dose of opioids --and you mentioned opioid receptors. those are spots in your body where these drugsbind.

>>dr. anne marie mckenzie-brown: yes. >>dr. peter salgo: and when they bind to thesesites, they get rid of your pain, but they do other things, like cause euphoria in somepeople. is there a checklist that you might go through,you say, "uh-oh. this is a person who is not gonna be the bestcandidate’ cause they are at risk for becoming addicted or getting the euphoria"? >>dr. anne marie mckenzie-brown: so, yes. in our practice, we do what’s called -- andthere are many forms of assessment that you do, but there is basic assessment that canbe done.

one that we use is called opioid risk tool,where we ask questions about your background, about your family history, history of substanceabuse, history of family history of substance abuse --various different things, treatmentfor various different psychological conditions --ocd, depression -- things like that thatmay give us a clue as to whether or not you’re particularly susceptible to having difficultieswith opioids. >> dr. peter salgo: now, you had taken anopioid before in your life, right? >> cynthia scudo: i have had c-sections, andi was given percocet at that time. >>dr. peter salgo: and you didn't get addicted? >>dr. peter salgo: but there is a family historyof addiction.

>> cynthia scudo: my mother's a recoveringalcoholic of 25 years. >> dr. peter salgo: would that have been redflag for you? >>dr. anne marie mckenzie-brown: absolutely. >>dr. peter salgo: and would that have absolutelyruled out narcotics? >>dr. anne marie mckenzie-brown: no, but itwould have given pause, and going back to the original scenario where the very firstdrug being opioids, it just does not seem like an appropriate first step. >>dr. peter salgo: all right, so you're onnarcotics, and you're going up in the dose, and you told me now you’re crushing, you'resmoking them.

right away, this is trouble. did your family know you were in trouble? >> dr. peter salgo: okay. you hid it. >> cynthia scudo: i was very good at hidingit. >>dr. peter salgo: then what happened withyour doctor? >>cynthia scudo: so, my doctor ended up notpracticing long in the state of colorado, and a new doctor came in and took over hispractice, and she took a look at my dosages and the types of medication that i was beinggiven, and she said, "you are taking enough

for three grown men, and i am not comfortablewith prescribing that, and i am cutting you back." >>dr. peter salgo: and your response to thatwas? >>cynthia scudo: "i'm sorry. that’s not going to work for me." >>dr. peter salgo: why not? what was it that terrified you about cuttingback? >>cynthia scudo: i was already getting dopesick at that time. >>dr. peter salgo: and that's a term of art.

what does "dope sick" mean? >> cynthia scudo: "dope sick" means that ihave extended the time that was to take the opiate, and i was having physical reactionsnow. >>dr. peter salgo: you were withdrawing. >>cynthia scudo: i was withdrawing. >> dr. peter salgo: i take it -- let me seeif i understand it -- that the euphoric effect was wearing off, and you were getting physicalsymptoms of withdrawal. what were those symptoms like? >>cynthia scudo: it was like somebody washitting my lower back with a sledgehammer.

it was intense pain down my back, my thighs. it was -- it was miserable. >>dr. peter salgo: now -- i'm sorry. go ahead. >> dr. louis baxter: peter, by this time,the euphoric feeling has long gone. she hasn't felt euphoria for many, many months,if not years, and even when they are continuing to take opiate medication, if it's not atthe dose that their body requires, they are actually dope sick while they're actuallytaking medication. >>dr. peter salgo: there's a medical phrase--tachyphylactic.

it's an awful word. it means that you need more to get the sameeffect. you’re getting used to the drug. lou, do you prescribe narcotics for your patients? >>dr. lou papa: very limited. >>dr. peter salgo: and do you watch for signsor symptoms that she’s describing? >> dr. lou papa: yeah. i mean, usually what happens, for myself,i've never prescribed a lot of narcotics just because of the risks that are associated withthem.

i don't consider myself clairvoyant, i justalways felt that way, but usually we use a fixed amount of medications. i let them know what the concerns. at a minimum, if i have to have somebody who'sgonna need to be on narcotics to control that pain, as long as it's not cancer pain, i geta specialist involved, and usually they sign a drug contract, they have urine testing. there’s a lot more involved. >>dr. peter salgo: a drug contract means iagree with you this is what i'm gonna do with this drug.

did you ever have one of those? >> cynthia scudo: i did not. >>dr. peter salgo: would it have helped? >>cynthia scudo: um...you know, that's a goodquestion, and i don't know the answer to that. >> dr. lou papa: i think what it does is ithelps set up parameters that --narcotics are a lot like antibiotics. you know, you got to use them appropriately. they're not used in all situations, and youbetter make sure you're using the right one in the right place, and i think it sets upthe condition that this is how it's gonna

work. if it's somebody who is drug-seeking, it letsthem know it’s not going to fly here, that you’re going to follow what’s appropriatemedical care, and you agree to that. and we have people say, "okay." >>dr. peter salgo: and we're going to breakin a moment. is it fair to say before we go to our breakthat the opiates are not, a priori, bad drugs, evil drugs, but that there are people forwhom they have problems? >>dr. louis baxter: yes. >> dr. peter salgo is that fair?

>> dr. anne marie mckenzie-brown: that’sa fair statement. >>dr. peter salgo: so what'd i like you todo --i know you've got more to your story. so i'd like you to stay here with us if youwould. we got a lot more ground to cover, but, first,here's this week’s "myth or medicine." >> announcer: according to the world healthorganization, opioids are responsible fora high proportion of fatal drug overdoses aroundthe world, and when someone dies, it‘s often thought they die quickly and alone. is this true? do people die immediately when they take anopioid overdose?

is this myth or medicine? >> dr. gloria baciewicz: people dies immediatelywhen they take an opioid overdose. that is a myth, and i will tell you why. i’m dr. gloria baciewicz, addiction psychiatrydivision chief at the university of rochester medical center. we often think that when people take an opioidoverdose, they die immediately, even instantly, and this can, theoretically, happen, but oftenyou have minutes to hours before respiratory depression becomes severe enough to stop theperson's breathing and lead to death. those few minutes or hours present the windowof opportunity for family or friends to assist

the person --to call 911 or use a naloxoneor narcan kit to reverse the opioid overdose or to do basic first-aid measures. and that's medicine. >>announcer: not sure if it's myth or medicine? connect with us online. we’ll get to work and get you second opinion. >> dr. peter salgo: and we're back with cynthiascudo. she is a mother of eight, grandmother of 20.howyou survived eight kids and 20 grandchildren. congratulations.

you have my undying respect. >>dr. peter salgo: but you became addictedto opioids because you were prescribed them for your hip pain, and then you got a newdoctor who cut back your dose. >> cynthia scudo: correct. >>dr. peter salgo: and you left your doctor’soffice and did what? >>cynthia scudo: i drove right to a youngman’shouse that i knew dealt heroin. how did you -- i think our viewers right nowhave stopped, and they've said, “wait a minute. “you are a middle-class person living indenver.

how on earth do you know somebody who's aheroin dealer? >>cynthia scudo: eight children. stands to reason one of them was going tobe hooked up with some people in high school that, at that time, i didn’t approve of,and yet that’s the first person who i thought of. >>dr. peter salgo: so you go to a heroin dealer. why heroin? why not try to get more oxycontin? that's the drug you were on.

>>cynthia scudo: yes. oxycontin’s very expensive. >>cynthia scudo: an 80-milligram pill is $80-- a dollar for a gram. i could sell one pill, which wasn’t evenone dose for me, and get enough heroins for two and a half days. >>dr. peter salgo: all right, what i'm hearinghere -- and i do want to move on -- but i think it's really important for our audience. i heard not only that you were going fromoxycontin to heroin, but that you were selling oxycontin.

>>dr. peter salgo: i mean, this is a two-for. you’re dealing and you're using. >>cynthia scudo: exactly. >> dr. peter salgo: and so, did you go throughwith it? you went to the heroin dealer? i did. >>dr. peter salgo: what did you do? how did you use it? >>cynthia scudo: i was taught how to smokeit.

i could convince myself that if i didn't injectit, i was not really a heroin addict. >>dr. peter salgo: is that fair? >> dr. louis baxter: yes, it's very common,and that is probably the biggest problem that we have with heroin today is that it is sopure that people do not have to inject it. they can; in fact, smoke it, and it does nothave to inject it makes it easier for a person to transition. >> dr. peter salgo: that's awful, if you will. >>dr. louis baxter: it’s terrible. >> dr. peter salgo: i mean, it doesn't matterif you're smoking it, injecting it, snorting

it, its heroin, right? its narcotics. >>dr. anne marie mckenzie-brown: that's correct. what i'm not hearing about so much now isyour pain. where did the pain come into the picture? or is the pain now becoming the backgroundand now the sensation that you get from the drug is more in the forefront? is that what we're hearing? >> cynthia scudo: exactly.

the pain at this point was a footnote, somethingthat i didn't even think about anymore. >>dr. anne marie mckenzie-brown: hmm. >> dr. peter salgo: now, is she the face ofheroin in america today? i mean, look. when i grew up, heroin was a street drug. it was people down and out, being used ininner cities, if you will, and now we’re talking to a woman who's got a job. did you keep working? >> dr. peter salgo: she continued to work.

you raised your family? >>cynthia scudo: yep. >>dr. peter salgo: how long did you smokeheroin? >> cynthia scudo: about nine years. and she moved there from a prescription drug. is this the new model? is this the new heroin addict? >> dr. louis baxter: yes, this is what i see,and this is what i treating my addiction medicine practice.

>> dr. peter salgo: wow. >> dr. lou papa: that's what i see in my practice,the people that come in. >>dr. peter salgo: when i told our audiencethey might be shocked, this is where i thought we’d wind up. this is shocking, i think. >>dr. lou papa: it's the boy, girl next door. >>dr. peter salgo: it's the boy, the girl,the mom, the grandma next door. what about your family? did they know you were smoking?

>>cynthia scudo: they did not. >>dr. peter salgo: how did you keep that fromthem? you’re smoking heroin. >>cynthia scudo: i would make sure to smokeit either in my car in parking lots off the property or --i could not get through a nightwithout having to smoke, so i would wake up like clockwork, 2 o'clock in the morning,and i would creep downstairs to the basement, and i would stand on top of the toilet withthe vent on and smoke so i could get back to sleep. >>dr. peter salgo: but what about while you’reat work?

did you need to use it periodically duringthe day? >>cynthia scudo: oh, all day. i would drive off two blocks away from mywork and sit in my car and smoke and go back. >> dr. lou papa: so, what did that do to yourwork performance? what did that do to your family? they must have noticed a change in you. >> cynthia scudo: no, they attributed anychanges to the oxycontin, which i was still taking, along with oxycodone and valium andsoma and flexeril. >>dr. peter salgo: so let me get some datanow.

if we've identified this new group of heroinusers, you know the numbers. what percent of people who’ve moved to heroindid so off of prescription drugs? >>dr. louis baxter: more than 60% to date. >>dr. peter salgo: more than half? >> dr. baxter that's right. >> dr. peter salgo: they start off with somethinglike oxycontin, and the next thing you know, they're using heroin. and is the use of heroin going up, down? what’s happening here?

>> dr. anne marie mckenzie-brown: it seemsto be going up. >>dr. peter salgo: why? why? >> dr. louis baxter: because it is cheaper,and itis pure. in the old days -- and when i say "old days,"i'm talking about the 1970s and 1980s; the heroin was sort of trashy, if you will, interms of purity. but today it is very, very pure, and peoplefind it an easy transition to go from pain-prescription meds to heroin. go ahead, lou.

>>dr. lou papa: plus there's been a clampdownon physicians, that we have to --it's much more difficult to prescribe narcotics. we’ve been educated and re-educated andre-educated to reduce our use of narcotics. there’s been a lot of effort to go afterthe pill-mill docs, so access -- not only is the price good, it's perfect if you'rea drug lord. the price -- you know, they drop their price,and plus the access to your competition is disappearing. >> dr. anne marie mckenzie-brown: well, nowthere’s a prescription-monitoring program where we now have access to opioid prescribingand going to various different doctors to

get prescriptions from different pharmacies,and so that avenue is getting more difficult now, which is making it easier when you gooff the grid. >> dr. peter salgo: i mean, that's sort ofthe doctorate of unintended consequences. as lou pointed out, people are going afterpill mills and doctors overprescribing narcotics and one of the unintended consequences isthey're driving people toward heroin. now, did your family ever suspect, did theyever confront you on this? >> cynthia scudo: nope. >> dr. peter salgo: nothing? >> cynthia scudo: nothing.

>> dr. peter salgo: so, you got help. what finally drove you to get help? >>cynthia scudo: i got out of the shower andpassed a full-length mirror and actually stopped and took a look at myself, and i was weighingin at about 93 pounds, and my skin had a green tint to it, and although i had been prayingfor death for the last few years, something hit at that moment, and i realized i was actuallydying. >>dr. peter salgo: who did you tell? what did you decide to do? >> cynthia scudo: funny.

i didn't tell anybody. my mother -- i think a recovering addict hasthis radar, and she knocked on my door that same day that i had looked in the mirror,and looked at me, and she says -- she knew. she says, "have you had enough?" >>dr. peter salgo: so she did know. >> cynthia scudo: she did. she knew. intuitively, she knew. >>dr. peter salgo: how did she know?

mom radar? >> cynthia scudo: she's a mom. she’s a recovering alcoholic. >> dr. peter salgo: so, you decided to detox. how did you do that? >>cynthia scudo: i went to a recovery facilitywhere they helped me with the suboxone detox from the heroin. >>dr. peter salgo: let's stop right there. what’s suboxone detox?

>>dr. anne marie mckenzie-brown: buprenorphineand naloxone combined. >>dr. peter salgo: those are another wordsalad. what is that stuff? >> dr. anne marie mckenzie-brown: so, it'sa combination of an opioid and an antagonist to be able to decrease the amount of narcoticthat you take without having the reactions of coming off the opioids. >>dr. peter salgo: so it's supposed to giveyou a softer landing? >> dr. louis baxter: yes. these are a group of fda-approved medicationsfor the treatment of substance-use disorders.

we have them for alcohol. we have them also for opiates. >> dr. peter salgo: so, you took these drugs. you had a great time in detox, no? >>cynthia scudo: yeah -- no. >>dr. peter salgo: no. the softer-landing part was not my experience. it was a crash landing. it was six days of throwing up every 15 minutes.

i lost nine pounds in six days detoxing, anda great memory. >>dr. peter salgo: louis, is this common? >> dr. louis baxter: no, not at all. actually, detoxification can be a well medicallymanaged process, and i feel very sorry that you had to go through that process. that was common years ago. >> dr. peter salgo: but no more? >>dr. louis baxter: but no more today. >>dr. peter salgo: and they combine psychotherapywith all of this?

>>cynthia scudo: they -- yes. we started learning coping skills, because,obviously, if the drugs were the solution to my problem, i had to figure out what myproblem was. >>dr. anne marie mckenzie-brown: yeah, but,you know, kudos to you for sticking through, because it sounds like it was a very unpleasantprocess for you, and you could just as easily had said, "you know what? i'm done with this. i'm going back to what i know." but that speaks to --that's a testament toyou and your will to get better.

>>dr. louis baxter: and that is the absoluteproblem with many people that go in to seek help. if they are not treated with state-of-theart protocols and medications, opioid withdrawal is very difficult to withstand. but there are protocols and there are medicationsthat are developed now that can make that process less onerous. >>dr. peter salgo: does the chemical detox,just stopping the drugs, does that work unless there's also a support psychotherapy and allkinds of other support? >> dr. louis baxter: no, it does not, andthat's what the problem is, is that many folks

do not recognize that a full treatment experiencehas three steps. one is detoxification --getting the medicationor the drug out of the system. the second is rehabilitation counseling, whereyou learn about the disease, learn how to cope with problems so that you don't haveto pick up the next drink, drug, or fix, and then the third is ongoing maintenance, whichincludes medication-assisted therapy in some instances, but certainly ongoing counselingand follow-up with twelve-step recoveries. >>dr. peter salgo: one quick question. could this all have been averted if her doctordid something differently right at the very beginning?

>>dr. lou papa: well, i mean, i think what'sgonna be important is this was years ago, and we all have to remember that the drugswere very heavily marketed, that the way that we looked at pain, we had a much lower painthreshold. in fact, we were told we were being bad doctorsif we didn’t prescribe narcotics for any pain, and that the myth of “addiction" wasoverblown. i remember that early in my practice, so,in many respects, there was this different mind-set way back then. >> dr. peter salgo: cynthia, how long nowhave you been off heroin? >> cynthia scudo: this last april, i celebratedfive years.

>>dr. peter salgo: your fifth anniversary. i think we can all do this. it’s hard, and i am so, so pleased you choseto share your story with us, and, of course, with our viewers and with our panel. thank you so much for being with us today. so, to end our show, here’s this week's"second opinion 5." >>patrick: hello. i’m patrick seche, and i am here to tellyou five early signs of an opioid use disorder. the first sign is taking an opioid medicationfor anything other than for which it was prescribed.

if you have severe acute pain from an injuryor accident, the opioid medication is intended only for the pain from that event. you must discontinue use of that medicationonce the pain is at a level you can tolerate and dispose of the unused medication in anappropriate manner. next, is using a larger amount of the medicationthan indicated on the prescription. if the amount prescribed does not seem tobe sufficient for your level of pain, you must return to your healthcare provider forfurther assessment. third is taking other people’s opioid medication. opioids are very potent medications and shouldonly be taken under the direction of a prescribing

healthcare provider. you should never take pain medication thatwas not prescribed to you. another early sign of an opioid use disorderis taking opioids for recreational purposes. the risk of becoming addicted to opioids whenyou use the to feel good or to relieve stress is extremely high. and the fifth early sign of an opioid usedisorder is combining opioids with other medications or substances. also, taking an opioid with alcohol or medicationssuch as benzodiazepines will put you at extremely high risk for an overdose, and it is importantto note, death can occur from an opioid overdose.

and that's your “second opinion 5." >> dr. peter salgo: well, thank you so muchfor watching. and remember, you can get more second opinionsand patient stories at our website at secondopinion-tv.org. you can continue the conversation on facebookand twitter. we are live every day with health news. i’m dr. peter salgo, and i’ll see younext time for another “second opinion." >> announcer: there once was a time when wewere truly free --free of worry...free of fear...far from doubt. >>announcer: "second opinion" is producedin conjunction with u.r.

medicine, part of university of rochestermedical center, rochester, new york.