When Michelle Frizzell broke her foot in 2000, her doctor prescribed the powerful narcotic Vicodin. It was Frizzell’s first introduction to any kind of opioid pain killer.
“I really liked the way it made me feel—the buzz it gave me,” says the 44-year-old mother of two. “I felt this euphoria.”
At the time, Frizzell had no idea how highly addictive opioids were, nor that her personal background put her at even higher risk for addiction.
Two years later, after delivering her first child, Rory, via cesarean section, her doctor prescribed Percocet—another opioid—to deal with the pain during recovery.
“I knew I’d have to be on it only a short time, but once I was, I didn’t want to stop,” she says.
When her prescription ran out, Frizzell began stealing OxyContin from her mother, who was already abusing opioids, alcohol and cocaine.
As Frizzell’s tolerance increased and her need grew out of control, she turned to the illicit market.
— Michelle Frizzell
By the time she became pregnant with her second child in 2008, the black-market price of OxyContin had grown to about $55 a pill. Needing a cheaper alternative, she turned to heroin, which she used heavily throughout her pregnancy.
In December 2008, her son, Kody, was born addicted.
“I remember crying while using because I was so disgusted that I couldn’t stop, and I didn’t understand why,” says Frizzell, now a clinical supervisor at Grand Ronde Recovery in La Grande, Oregon. “But when you’re addicted, drugs are the only thing important to you—more than your bills, your job, your kids. All that matters is your next fix.”
Clean for seven years now, Frizzell is one of countless Americans swept up in a national opioid epidemic.
From 1999 to 2017, the number of Americans killed by opioid overdoses increased nearly 600 percent, from 8,048 deaths annually to 47,600, according to the National Institute on Drug Abuse. In 2017, opioid overdoses accounted for 67 percent of all deaths from drug overdoses of any kind in the U.S. That year, for the first time, opioids killed more Americans than car accidents.
As a certified drug and alcohol counselor and certified recovery mentor, Frizzell is one of the thousands of counselors and other health professionals battling a national epidemic and helping victims navigate the road to recovery.
While no area of the U.S. has gone untouched by the opioid crisis, “the impact on small towns and rural places has been particularly significant,” according to the U.S. Department of Agriculture’s website.
Dr. Joel Rice, psychiatrist at Grand Ronde Recovery, says rural Americans are especially vulnerable to the risk factors that lead to opioid abuse. Rural communities tend to have a lot of working-class people who suffer injuries at work or in their personal lives, and many suffer with depression from lack of economic opportunities.
“The greater your number of social stresses, the more likely you are to get addicted,” Rice says. “Things like poverty, level of education, abuse history, current abuse, etc., greatly increase the risk of developing opioid use disorder and other addictions.”
Housing and food insecurity, financial difficulties, unemployment, emotional problems, and lack of or limited health insurance all increase a person’s risk of addiction. So can a family history of addiction, a traumatic childhood and being around addicts.
Both of Frizzell’s grandfathers were alcoholics. Her mother and father were both addicts.
Larry Howell, a certified recovery mentor in Roseburg, Oregon, also came from a family of addicts. When his parents divorced, he and his mother bounced from place to place.
Eventually, he fell into a familiar pattern, using drugs like cocaine and methamphetamine.
After a motorcycle accident 17 years ago, Howell’s doctor put him on opioids. Like so many others, he quickly became addicted and eventually turned to morphine and heroin.
Now 50 and clean and sober for six years, Howell works as a peer recovery specialist at The Alliance in Roseburg, which serves patients with HIV/AIDS in 13 Oregon counties.
He runs weekly support groups for Self-Management And Recovery Training, or SMART. Unlike 12-step programs’ focus on a higher power, SMART is built on science, stresses self-reliance and helps people with all types of addictions manage their emotions, thoughts and behaviors.
“It’s not because you’re weak, lack willpower, or are morally defective that you become addicted, but because the drug reprograms your brain,” Howell says. “Drug addiction is a disease.”
—Dr. Joel Rice
Opioids trigger a user’s brain to release high amounts of the feel-good chemical dopamine. Over time, the brain adapts to the drug, and users develop a tolerance to it, needing more of it—and more often.
“If you reintroduce the drug over and over, you begin to get physically dependent on it,” Frizzell says.
A recent poll sponsored by the American Farm Bureau Federation and National Farmers Union says the opioid crisis has struck farm and ranch families much harder than the rest of rural America. While nearly half (46%) of rural Americans said they have been directly impacted by opioid abuse, 74% of farmers and farmworkers said they had been directly impacted by the crisis.
Origins of the opioid epidemic have been traced to 1996 when Purdue Pharma introduced OxyContin and aggressively marketed it to doctors, claiming the drug posed minimal risk of addiction and could safely be prescribed for non-cancer-related pain.
Purdue’s sales grew from $48 million in 1996 to nearly $1.1 billion by 2000. By 2002, doctors had written more than 14 million prescriptions for OxyContin.
Drug users quickly figured out they could crush the tablet and swallow, snort or inject the powder to get even higher.
By 2004, OxyContin had become one of most-abused drugs in the U.S.
In May 2007, Purdue Pharma’s parent company and three company executives pleaded guilty in federal court to misleading regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused. The company paid $600 million in fines, and Purdue President Michael Friedman, Howard R. Udell, the company’s top lawyer at the time, and Dr. Paul D. Goldenheim, the company’s former medical director, agreed to pay $34.5 million in fines.
Meanwhile, doctors kept writing prescriptions, and the death toll kept rising.
Eventually, as the worsening crisis drew greater media attention and public awareness, doctors became increasingly concerned about prescribing opioids.
In 2016, the CDC stepped in with guidelines for prescribing opioids for chronic pain. The move resulted in fewer prescribed opioids and pushed many abusers toward the illicit market’s more potent and cheaper alternatives, such as heroin and the powerful synthetic opioid fentanyl.
Fentanyl—the drug that killed Prince and Tom Petty—is 50 to 100 times more potent than morphine. It is typically prescribed to treat patients with severe pain, especially cancer patients, according to the U.S. Drug Enforcement Administration’s website. Fentanyl is often added to heroin to increase its potency or is disguised as highly potent heroin. Users often believe they are buying heroin instead of fentanyl, which often results in overdose deaths.
In 2010, fentanyl was involved in 14.3% of opioid-related deaths. By 2017, that number had risen to 59%.
Since Purdue’s plea deal in federal criminal court in 2007, 1,600 lawsuits alleging culpability in the nation’s opioid epidemic have been filed by cities, counties, states and Native American tribes against Purdue Pharma and dozens of other drug companies.
In March, Purdue agreed to a $270 million settlement with the state of Oklahoma. The agreement requires Purdue to contribute $102.5 million to establish a foundation for addiction and treatment research at Oklahoma State University. Purdue will also provide the state $20 million worth of treatment drugs, such as Naloxone and Buprenorphine (also known as Suboxone).
Naloxone is an opioid antagonist that can reverse and block the effects of opioids and quickly restore normal respiration to a person whose breathing has slowed or stopped due to opioid overdose. Police and paramedics often carry it and can administer it by injection or nasally.
Buprenorphine is an FDA-approved opioid doctors and clinicians often prescribe to control withdrawal symptoms by blocking certain receptors in the brain.
Frizzell says Buprenorphine was a crucial factor in her recovery because the pain from opioid withdrawals is overwhelming.
“Your muscles ache and your skin hurts,” she says. “You’re vomiting and feel hot and then cold. It’s like the worst emotional pain, the worst physical pain and the worst anxiety you’ve ever had at the same time.”
Photo by Ethan E. Rocke
Frizzell and her husband, Brent, who used heavily together for 10 years, got clean through medication-assisted treatment, which combines Buprenorphine doses with counseling and behavioral therapy, such as 12-step and other recovery programs.
“Had I not been on Suboxone—something to really manage the pain and discomfort that I would experience—there’s no way I would have stayed in treatment,” Frizzell says. “I would have left within 24 hours.”
Last year, Congress passed legislation to allow nurse practitioners and physician assistants—often the only primary care providers in rural communities—to prescribe Buprenorphine.
“In treatment, I learned coping skills, and I discovered I was worth it,” Frizzell says. “Learning that addiction had altered my brain wiring took the shame and guilt out of it.”
Frizzell says shame and guilt are among the biggest reasons people don’t seek help.
She remembers vividly the moment her life turned a corner in early 2012 after she walked into a pharmacy to buy more syringes in Eastern Oregon.
“I was so tired, and I felt such shame and guilt,” she says. “I didn’t want to be high anymore, but I couldn’t stop either.”
Seeing that Frizzell was in bad shape, the pharmacist handed her the syringes she came for along with a piece of paper with a note: “Dr. Joel Rice—this man can help you.”
That simple gesture was the starting point on Frizzell’s road to recovery.
“I came to La Grande with hopes of having someone help me because I couldn’t stop,” she says. “The withdrawal symptoms were so painful, and I would do anything to avoid withdrawal. It didn’t matter what it was, I would do it.”
In La Grande, Dr. Rice referred Frizzell to an inpatient treatment facility, where she stayed for six months.
“I went to a mommy-and-me program, and I was able to take my son with me,” she says. “I ended up tapering off Suboxone within about 60 days.”
Frizzell says family support was another important factor in her recovery.
“My family visited me while I was in treatment, and they were always loving, saying, ‘We believe in you.’ They were scared and nervous, but they truly believed I could do it,” she says.
—Larry Howell
Howell agrees that family is important to recovery. He says his responsibility as a parent motivated him.
“I didn’t want my kids to have that father that was a junkie who died,” he says. “I wanted them to remember me as other than an addict.”
Howell says he became a counselor because his personal road to recovery was a rocky one that “was not handled well by a lot of people.”
“I wanted the people behind me to be treated better,” he says. “I wanted to help change the recovery culture and do something that was greater than myself.”
Providing for people’s most basic needs is one of the first and most important steps toward recovery. That’s where nonprofits such as the Northeast Oregon Network and the Northeast Oregon Housing Authority in La Grande come in. The network serves five counties, connecting addicts seeking recovery to community health providers and social services. The housing authority finds subsidized housing and works with programs in the area to fund it.
“The first goal is to stabilize,” says Kate Gekeler, family self-sufficiency coordinator at the housing authority. “It’s hard to stay clean if you don’t have a place to sleep or the income to support it. You want to have permanent, affordable housing as quickly as possible, then connect to support in the community so you retain that housing. Otherwise, everything else in life is incredibly difficult.”
After years of suffering with addiction, Frizzell turned her life around after one person cared enough to offer help instead of judge her. Like Howell, she found her calling in helping others realize they don’t have to suffer alone.
Her message to anyone suffering with addiction is simple: “Ask for help. You can absolutely recover with hard work and determination.”
“Now, recovery is my medicine,” she says. “It keeps me healthy. The longer I’m clean, the more grateful I am for each breath, because it could’ve been so much different. Every day I wake up and don’t want to use. It’s a gift.”
Where To Find Help
- Grand Ronde Recovery: bluemtassociates.com
- SMART Recovery: www.smartrecovery.org
- Narcotics Anonymous: www.na.org
- Oregon Health Authority Addiction Services: oregon.gov/oha/HSD/AMH/Pages/Addictions.aspx
- Northeast Oregon Housing Authority: neoha.org
- Northeast Oregon Network (NEON): neonoregon.org
- Nar-Anon: www.nar-anon.org
About the Series: This Ruralite-produced initiative spotlights health challenges in rural communities, efforts to address them and the unsung heroes behind the work. The series receives support from the M.J. Murdock Charitable Trust, which funds projects and programs in Alaska and the Northwest. We welcome story ideas at healthnews@ruralite.org.