As a lifelong fan of the theater, the show Glee excited me because it brought a Broadway renaissance to today’s youth. It showed them a beautiful world they otherwise wouldn’t have known and painted it with a “cool factor.” For a baby boomer like myself, this was familiar and a nice validation of the music that moved me as a young man. Add to that, my husband Scott is a Tony Award-winning producer of musical theater, and Glee wasn’t just a show, it was a guilty pleasure.
On Sunday, I heard Cory Monteith had died alone in a hotel room. As the coroner confirmed the cause was a deadly overdose of heroin and alcohol, I reflected that the archetypical killer street narcotic of my youth is also experiencing a terrifying renaissance. And like the show tunes re-popularized on Glee, a generation that otherwise would have never even heard of heroin are being bombarded with the drug that scared me and many others back in the day.
As an interventionist, I have worked with hundreds of families where the loved one in crisis revealed the depth of their addiction included heroin or equivalent opiates (oxycodone, oxycontin, morphine, etc.). There is always one person in the room, usually more, with a look of utter shock on their face. Their shock is understandable – heroin has iconic status as an illicit substance dating back to the Civil War and the opium dens of Victorian China.
Heroin and opiates have been around so long that their existence formed our understanding of addiction pathology – their strength and popularity gave doctors ample subjects to observe and treat, while their collateral side effects of societal crime and broken families made them the subject of scrutiny by the temperate advocacy.
Basically, we know a lot about heroin and its deadly properties, yet its scourge flourishes. Why is this the case?
When the world loses a beloved figure like Cory Monteith, it’s important to find a teachable moment in the event to help make sense of the tragedy. I would offer that the takeaway here is twofold: First, heroin is cheap and extraordinarily easy to get, and second a person can be living with a full blown heroin addiction and reveal no obvious signs to those around them. These are important revelations. Time, attention and reflection will help parents and anyone with someone in their life struggling with a drug addiction, especially one that includes pain medication. Here are some points to consider:
1) Relapse is part of addiction, its dangerous and deadly, and lifelong vigilance is required to prevent devastating, possibly even deadly, setbacks. Cory Monteith had been to rehab more than once, and his family and loved ones reportedly supported him in his aftercare and sobriety. Unfortunately, that doesn’t guarantee someone won’t succumb to their disease. Addiction is a lot like cancer – while treatable it can recur at anytime. Accountability and prevention are essential. For the addict that means an open and transparent lifestyle that facilitates recovery and cooperation and support from loved ones. This includes random drug testing and actively participating in his or her recovery plan. This gives the recovering addict better odds at health and happiness, but like cancer, there is never a guarantee.
2) Heroin is popular, cheap and as available as cigarettes. I grew up in a time where people’s idea of heroin addiction junkies and hippies and some Jimmy Hendrix madness thrown in. Heroin was the king of all street drugs, it was terrifying and to get it you had to do business with some pretty unsavory characters. I smoked it once, but it scared the dickens out of me, and I never touched it again. Things are drastically different now – I can’t tell you many families I have worked with who are financially well off and whose kids have every advantage someone could want or need, yet wind up addicted to heroin. They don’t buy it from shady gangsters in back alleys, they place orders on their mobile phones to high-end bike delivery services, they meet popular students in their high school who sell them drugs, they join chat groups on the internet and meet well-to-do professionals that also indulge in heroin. The list of unconventional circumstances is endless. Basically, throw out everything you thought you knew about heroin in our society, as it no longer applies. Any stigma is long gone, and securing drugs is not as disruptive or dangerous to the life of the addict as it was in the past. The marginal is now mainstream, and it should terrify us.
3) Prescription pain killers are at the root of the problem. Treatment for prescription drug dependency has skyrocketed 430% in the last decade according to SAMSHA. The active substance in oxycodone, morphine, fentanyl, vicodin, codeine and many other popular prescriptions is a related derivative of street heroin. This class of drugs – opiates – effect the opiate receptors in the brain the exact same way, and are one of the oldest and best understood metabolic pathways of physical addiction. While painkillers can serve a critical medical purpose to manage pain, they are sometimes prescribed too quickly, without a proper addiction assessment and without cross-referencing whether a patient has multiple prescriptions from multiple doctors. This allows an opiate tolerance to build in a person who otherwise would never have sought out an opiate high. Once the prescriptions are harder to get or a person feels withdrawal symptoms, the easiest and most effective substitute is street heroin. It is also the most dangerous. The vast majority of heroin addicts I encounter started with a history of prescription opiate abuse and never “intended” to be using street heroin. Because a physician is involved in the initial prescription of an opiate painkiller, people are desensitized to the danger and powerful nature of these drugs.
The most tragic fact of all about Cory Monteith’s death is that it will not be the last time we lose a young talented person in the prime of their life to addiction. That’s simply how the disease works. Every day, the active addict world loses some of its own … our own.
However, there is hope. Committing to a lifestyle of prevention and openness gives a person an enormously better prognosis. Invitational intervention works, as does good treatment and 12 Step help.
A solid support circle is essential. In Cory’s case it’s being reported that it came as a surprise that he was still struggling with relapse and had no idea that he was using drugs. When an addict is attempting recovery, it’s normal to regret the past and shut the door on it, which can drive them to silence about slips and regression. Only the most compassionate approach with love and trust can transcend that insidious nature of addictive behavior.
The death of Cory Monteith offers us a typical case study in the cunning, baffling and powerful reality of the disease of addiction. We can celebrate his life by understanding and exposing its lessons.