For Part 1, click here.
As his dependence on prescription drugs increased, Miami student Alex, whose name has been changed to protect patient confidentiality, found himself struggling to foot the bill of his expensive habit. The average price of pills - $1.20 per milligram - would easily break his scanty college student budget. But with his addiction nagging at the corners of his head, he asked his dealer for the next best, and cheapest, thing: heroin.
"I was heavily addicted to Xanax and heroin," Alex remembers. "At first, all I could think about was scoring dope and getting high."
Alex is not alone. The National Institute of Drug abuse estimates that in the U.S., 9 million people suffer from prescription drug addiction, while 200,000 people suffer from heroin addiction. Board certified psychiatrist at the Miami Student Counseling Services (SCS) Dr. Joshua Hersh said he treats such addictions every day.
"I have seen hundreds of people, during my career, both [at SCS] and at my private practice, with dependence," Hersh said. "About half of their addictions to prescription drugs started when a doctor prescribed them often after a minor surgery. The other half happened when people were experimenting."
While addiction may indeed be growing, recovering addict Tyler, whose name has also been changed to protect patient confidentiality, believes it lurks seemingly unknown among the student body.
"The crazy thing about prescription drugs is that your best friend or co-worker can be an addict and you will never know," Tyler said. "People I attend classes with would be shocked to find out I am a recovering painkiller and heroin addict."
While Tyler contends that drug abuse and addiction does not discriminate, Hersh argues that some are more vulnerable than others.
"Drug addiction is a disease," Hersh said. "For someone with a predisposition to addiction, you are prescribed that, there is a chance you will get an addiction to that."
Predisposition is identified after an examination of a patient's genetics and family history, Hersh said. Addiction, like many other diseases, can follow a lineage of generations. If a family member develops an addiction, his kin are more susceptible.
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But even if a user is not predisposed, once dependency or addiction occurs, the habit is hard to break. Tyler remembers the agony of his addiction and seeking to break it.
"Being addicted is torture," Tyler said. "You wake up every morning feeling ill and have to get your fix before doing anything, whether it is class or eat."
And, like Alex, Tyler often found that fix in a much more dangerous place - heroin.
"Prescription abuse is a major problem because it is very easy to spiral out of control and upgrade to heroin," Tyler said. "It takes a lot of time and resources to accept recovery once you are hooked."
A 2012 study conducted by NBC News that investigated the addiction histories of about 100 heroin users found that Tyler and Alex's instances are not uncommon. In fact, every single heroin user NBC interviewed had arrived at the drug in the same way: they started with prescription drugs, especially opiates.
Hersh said the upgrade to heroin is an easy one. Expensive prescription drugs do not look as appealing to a drug that can give a better high for a smaller price - $3 to $10 a bag.
"This is how heroin addiction starts: People are swallowing pills. Half of them are getting them from physicians initially. They build up a tolerance to that. They end up snorting the pills because that bypasses the liver, it is absorbed well," Hersh said. "Snorting the pills becomes very expensive, so they often resort to snorting heroin, which is now a lot cheaper. The next progression is injecting heroin."
While most users never imagined resorting to heroin, as soon as they become dependent on pill popping, Hersh said the progression to the illegal street drug is very likely.
"A lot of people say, 'I will never get addicted to heroin. I might mess around with a little Vicodin but I will never use heroin.' Well it doesn't start out that way. It starts out by people getting addicted to pills," Hersh said.
And once a user is hooked on heroin, without treatment, there usually is no return.
"The average lifespan of an IV heroin addict after developing the addiction is about 17 years, because of chances of overdose, Hepatitis and other complications," Hersh said.
The Ohio Department of Health reports that, in 2011, 44.7 percent of unintentional drug overdoses in Ohio resulted from heroin. Oxford is particularly familiar with these kinds of deaths.
According to the Butler County coroner's records, from 2011 to 2013, eight people died after overdosing from heroin or opiate ingestion in Butler County. Last December, 21-year-old Miami student Andy Supronas died of a heroin overdose.
Hersh stresses that prescription drug abuse, in general, can be just as deadly. Drug overdose, according to the Ohio Department of Health, is the leading cause of non-injury death in Ohio.
"60 percent of drug overdoses in Ohio can be traced back to prescription opioids or benzos," Hersh said. "But it can also be a combination of drugs. Seventy-one percent are overdosing on a combination and that usually involves alcohol."
Tyler said he remembers performing CPR on a friend who overdosed.
A Miami graduate whose name has been changed to Joe to also protect his patient confidentiality, dealt prescription drugs in the past in the Oxford area and knew several users who died.
"I personally went to six funerals of my friends who overdosed," Joe said. "But I heard of many more."
A less deadly, but still damaging side effect of drug abuse stems from the legal system. While misusing a legitimate prescription obtained by a doctor is not illegal, possession of prescription drugs without a prescription is a felony, said Oxford Police Department (OPD) Sgt. Jon Varley.
"We have seen a sharp increase in the amount of prescription medication we find on people, especially Adderall," he said. "What many students don't know is that possessing this without a prescription is a felony and could mean jail time."
According to Ohio law, the potential punishments an alleged offender can face for drug trafficking depend on the kind and amount of drug he or she possesses. Generally, i f a person is found drug trafficking in Ohio, they will receive a prison sentence from six to 18 months and/or fines up to $5,000.
Joe, the former Oxford dealer, believes OPD and the Miami University Police Department (MUPD) are oblivious to the immense underground web of dealers and buyers at Miami.
"I really don't know how to help law enforcement. I would up my order from my supplier every time and I had them sold in the blink of an eye," Joe said. "The demand here is just too high and the minute they touch this campus they disappear and are ingested by the student base quicker than the police will ever catch on."
For months, Alex was nursing an addiction that was spiraling out of control. What began as recreational pill popping led to reliance on heroin.
The pills he once turned to for happiness, tranquility, an escape from the grueling pressures of college and adulthood eventually provided anything but.
Now he is fighting back.
"No one plans on getting addicted," Alex said. "You try something once, like it, do it again and again and again and again and then you're addicted. But once you're addicted, it's a really hard journey to treat the disease."
But he has to try.
Currently at the SCS, Hersh treats patients with an ongoing prescription drug addiction. Hersh said SCS offers a variety of treatment options for users seeking help, depending on the kind of drug they abuse.
Treatment at SCS begins with a series of assessments, which determine the kind of treatment a patient needs. From there, SCS offer group therapy, individual counseling, medication-assisted treatment and if problem is serious enough, referrals to off-campus rehabilitation centers.
For Tyler, rehab was a necessity.
"I went to rehab this past summer," Tyler said. "Rehab saved my life, however I will always be in recovery because addiction never sleeps."
Now both Tyler and Alex benefit well from the medication-assisted treatment. For opiate users, medication like Vivitrol halts the effects of certain drugs once ingested, thus the user will not experience a high.
"Vivitrol is a shot administered once a month," Hersh said. "It stays in your system a month. It blocks the receptors in your brain so that drugs like Percocet won't have any effect. It helps with cravings as well."
Hersh notes that currently there are no substantial medication-assisted treatments for prescription stimulant and sedative addicts. However, group therapy meetings and organizations like Narcotics Anonymous (NA), which are offered within the city of Oxford, can help provide the support addicts need to get clean.
The biggest obstacle for both addicts and the SCS is that addiction is never completely cured. It is a danger addicts carry for the rest of their lives.
"No one recovers from an addiction," Hersh said. "Even if you are sober and haven't relapsed for years, you will never be rid of this disease and you will always be in recovery."
And for Alex and Tyler, recovery starts simply with admitting they need help.
"If you are an addict, don't be embarrassed," Tyler said. "Forgive yourself and seek help. It is nearly impossible to do it alone. You have to build a network of support to stay clean."
Lowering in the Dose
Given his work, Hersh is fully cognizant of the growing prescription drug epidemic, and maintains that the nation, as a whole, could better address the issue and improve drug education.
At Miami, the Office of Student Wellness, situated at Student Health Services, works to draw attention to drug and alcohol abuse. In partnership with Health Advocates for Wellness Knowledge and Skills (HAWKS), the Office of Student Wellness "serves to enhance the community by providing educational resources and services that promote the health and wellness of Miami students," according to its official website. Each year they host AlcoholEdu and tobacco prevention programs.
Rebecca Baudry, assistant director of the Office of Student Wellness, said students can request material about safe prescription drug use from the undergraduate HAWKS mentors, who also host information sessions about prescription drugs to student organizations and residence halls. In addition, AlcoholEdu facilitates education about prescription drug abuse through its program for first-year students.
Baudry said the Office of Student Wellness concentrates, for the most part, on advising students to look out for one another.
"We, as well as the Student Counseling Services, with the new I Am Miami Campaign, we are trying to focus on how we should take care of each other, how we should look out for each other and how we should be accountable for one another," Baudry said.
The Office of Student Wellness also presents different topics during the first Wednesday of every month, called "Wellness Wednesdays." In October, the topic for Wellness Wednesday was prescription drug abuse.
Even with these efforts, Hersh believes, at Miami, too much focus is on alcohol.
"We talk a lot about alcohol on Miami's campus. We talk about medical amnesty, but we talk about that in terms of alcohol," Hersh said. "1,500 deaths occur in the country each year as a result of alcohol poisoning. But last year, over 40,000 deaths occurred each year due to prescription drugs and opiates. My question is, why do we focus so much on alcohol and not more on prescription drugs, which are leading to a lot of deaths?"
Hersh argues the key to combating prescription drug abuse is to educate first-years as soon as they enter Miami's doors.
"I absolutely think Miami could do a better job at educating students about this issue," Hersh said. "I would love to see Miami integrate some of this education into the orientation experience and to the first-year student experience."
Baudry noted that Miami does address prescription drug abuse to a certain degree at orientation, primarily during the student safety and community expectations program with students and families.
However, Joe asserts that Miami could do more to inform first-year students about the dangers of prescription drugs.
"The university needs to educate freshmen about how common drugs are on this campus and the dangers," Joe said. "I had no idea how addictive these drugs were the first time I touched them. Students need to be made aware of it."
Facing addiction issues for the rest of his life, Alex knows the road ahead may be long and obstacle ridden. Not long ago, he used prescription medication to get high, to float away from world and to focus on school. Now he uses prescr iption drugs to stay clean.
A paradox, maybe. But Alex says he is happy.
"I couldn't be happier with the treatment and care I am receiving for this disease," Alex said.
And even after a prolonged, brutal struggle to get where they are now, the three - Alex, Tyler and Joe - know everything has just begun.
"Getting clean is the easy part," Tyler said. "Now comes life."