Jennifer estimated she drained more than $7,000 in one year from her and her husband’s joint bank account — all to buy opioid pain pills from a “street” dealer. That was before she started snorting heroin; before her overdose; before she was state-ordered away from her grandchildren.
The 53-year-old former nurse’s aide — whose name has been changed to protect her identity — told the Star Beacon she always knew she “liked” pain pills, but never took them regularly, even though she feels she has an “addictive personality.”
Then in 2008, she tore her rotator cuff while lifting a patient, and underwent shoulder surgery two years later. Her doctor prescribed up to four 7.5-milligram Vicodins a day, as needed. But about a year later the post-surgery treatment ended — and so did the pills.
Jennifer said she still found what she felt she needed easily enough outside the doctor’s office. She was eventually put in touch with a street dealer — someone who only dealt in pain pills; someone she otherwise never learned much about.
For the next year, she fudged bill payments and lied to her husband about them — withdrawing $150 to pay a $50 bill — to keep the Vicodins and Percocets coming, she said. At the time, she and her husband pulled down more than $80,000 a year, and “money was no issue,” she said.
“I stole a lot of our money out of the bank account for them. I’m so sorry for it to this day. ... I stole thousands,” Jennifer told the Star Beacon. “My husband caught the guy calling me to say he had pills for sale. I got caught.
“I looked at my husband; I said, ‘I need help.’”
Overdose deaths up, Rx down
A recent Raycom Media investigation into doctors who over-prescribe opioid pain medication and their so-called “pill mills” suggests that, for at least half of the nation’s heroin users, addiction started with a legal prescription for painkillers. Medicare provider data from 2015 shows 128 general practice health care providers wrote more prescriptions for opioids than all other drugs combined.
Statewide, overdose deaths — for all drugs, not just opioids, which can be the most lethal — shot up 39 percent from more than 3,700 in the 12 months ending in July 2016 to the more than 5,200 for the year ending in July 2017, according to the Centers for Disease Control. Ashtabula County saw a nearly 500 percent increase in unintentional overdose deaths from 2004 to 2016, according to county officials.
But opioid prescriptions in Ohio dropped for the fifth straight year in 2017, according to a report released this month by the State Board of Pharmacy’s Ohio Automated Rx Reporting System, or OARRS, which was established in 2006 to monitor outpatient prescriptions.
Statewide, patients were prescribed 225 million fewer opioid doses between 2012 and 2017 — an about 28 percent decrease, the report shows. It also found instances of Ohio patients “doctor shopping” — where patients visit multiple doctors illegally to receive prescriptions — have also decreased 88 percent since 2012.
“It is widely accepted that prescription opioid abuse often progresses to the use of heroin and other illicit drugs,” Tracy Plouck, director of the Ohio Department of Mental Health and Addiction Services, is quoted in a release. “That is why Ohio’s efforts to reduce exposure to prescription opioids are essential to combatting this public health crisis.”
In Ashtabula County, patients were dispensed more than 7.8 million doses of opioid medication in 2010 — that’s 77 doses for each person living in the county that year and an average 301 doses per patient, according to OARRS. The number of doses has been on the decline since peaking in 2012 at more than 8 million doses, however. County patients were dispensed just under 4.5 million doses in 2017, averaging about 240 doses per patient.
State steps in
Ohio’s Pharmacy and Medical board maintain licenses for the state’s health care providers and drug distributors and enforce the Pharmacy Practice Act and the Dangerous Drug Distribution Act. The Pharmacy Board’s online drug distributor licensing records show only one Ashtabula County distributor whose license was revoked, suspended or surrendered.
Dr. Bruce Piszel, who owned Piszel Pain Management Systems LLC along Main Street in Geneva, permanently surrendered his license to legally operate a pain management clinic in May 2015, after the Pharmacy Board filed disciplinary charges in 2013 relating to those drug laws, according to online records.
A surrender is similar to a legal settlement, in which a defendant neither admits nor denies wrongdoing, said board spokesman Cameron McNamee.
The board’s records, however, do not provide context for Piszel’s disciplinary action. The board’s records of disciplinary actions often include “Finding of Fact” documents regarding a distributor’s actions, but no such findings could be located in Piszel’s case.
Medicare prescriber data from 2013 shows Piszel distributed more than 3,400 30-day fills or refills for opioid medications — mostly to patients younger than 65 — and distributed the most Oxycodone among all Ashtabula, Geneva and Conneaut doctors that year. The total cost for the opioids Piszel prescribed that year was more than $280,000.
State Medical Board records show Piszel’s state medical doctor license — first issued in 2004 — is still active, and set to expire in 2020.
Piszel could not be located to confirm the nature of the Pharmacy Board discipline.
The state boards investigate and may present illegal pharmaceutical activity to county prosecutors, but county Prosecutor Nicholas Iarocci said his office has not seen any such opioid overprescription cases in recent years.
“At least we know the physicians — but more importantly the pill mills — are being much more closely monitored and supervised,” he said last week. “The ability for them to distribute these opiates in such a careless way — as they have in the past — has diminished quite a bit.”
Ashtabula County, however, has joined several other municipalities across the country in filing fraud or racketeering lawsuits against opioid manufacturers and distributors. In December, a Cleveland law firm filed a more than 250-page complaint in Ashtabula County Common Pleas Court against 23 national pharmaceutical companies and individual physicians whom officials said directly contributed to the county’s opioid crisis.
“This case is about one thing — it’s about corporate greed,” Iarocci said during a press conference about the litigation.
The complaint alleges opioid makers and distributors intentionally misled the public on the dangers of long-term opioid use and dependency, and pushed to normalize opioid painkiller prescription “in order to expand the market for opioids and realize blockbuster profits,” Iarocci said.
Since the case’s introduction, a judicial panel placed it and more than 400 other similar cases from across the country at the feet of Cleveland’s Northern District of Ohio Judge Dan Aaron Polster, according to the New York Times. Polster has experience hearing similarly consolidated cases from multiple districts, the Times reported.
Polster is now pushing attorneys from both sides toward a swift settlement, eschewing a traditional jury trial, according to the Times.
“We’re pleased it’s more local,” Iarocci said last week. “It’s in Cleveland, as opposed to some federal district court across the country.
“(Polster is) really taking an aggressive stand on trying to get everything resolved.”
‘Addiction is right by my side’
By 2012, Jennifer had quit her nursing job — her shoulder ached too much, she said. She stopped taking opioid pain pills, and her doctor prescribed a new medication for her opiate withdrawal symptoms. She said she stayed clean for the next two years — until someone offered painkillers to her again.
She started bartering for them, this time from coworkers who had extra or through family members with connections — “I didn’t know where they were coming from,” she said.
But one day, Jennifer’s sources “dried up.” And in 2015, she snorted heroin for the first time. It didn’t seem as dangerously seductive, she said — she only felt she needed to go back to it once every couple days.
The unexpected death of her grandson the following year caused her to spiral — or at least that was her excuse at the time, she said.
“I got as much heroin as I could,” she said. “I remember a little bit of my grandson’s funeral. I don’t even know (who) showed up there. ... That’s how high I was.
“I did overdose one time and after that — you’d think that’d scare you. It didn’t.”
Jennifer’s drug habit eventually caught the attention of the county Children Services Board, who threatened to remove her five grandchildren from the home, she said. They offered diversionary drug programs for her and others in her home who were also using — but none of them participated, she said. Their drug screens kept coming back dirty.
She ultimately offered to remove herself so the children could return, and the board agreed, she said. For the next three months, she stayed in a motel room paid by her husband of almost 35 years — a man who was always “afraid to take an aspirin”; a man who stuck with her through her battle with addiction, she said.
“He kept on telling me, ‘You can do this,’ ‘We’ll get you through this,’” she said.
Jennifer dropped heroin cold turkey, she said. She sought therapy and treatment through Community Counseling Center and joined a relapse program that teaches recoverers about the triggers that could lead them to use again. After three months, the board let her return to the home for visits. Eight months to the day, she’s moved back in and still clean, she said.
But her time with the drug has irrevocably changed her, she said.
It was “hard,” Jennifer said. “I wouldn’t wish that on my worst enemy. ... There wasn’t a day that’d gone by for those three months that I didn’t think about going out and getting some more. It’s such a powerful drug. It’s in your mind all the time.
“Right now, my addiction is by my side. I know it’s there,” she said. “My addiction reminds me, ‘don’t do that.’ But it’s here. It’s always going to be at my side.”