Guilt. When my brother died, I was shell-shocked. I felt a strong sense that I had failed him. Pat was 10 years younger than me, and our dad was sick with cancer for most of Pat’s life (he died when I was 19 and Pat was nine), so I spent a lot of time babysitting Pat when we were younger, and there was a maternal aspect to our relationship. But I also tried to foster openness and honesty between us, which is why I didn’t understand the secrecy of his addiction. Hiding is a part of addiction; no one wants those who love them to know the depths of their darkness. I didn’t know that at the time, so I felt that Pat was either making stupid choices or actively trying to hurt me—sometimes both. And because of that misperception, I was angry with him. I had no experience with addiction and I certainly didn’t know about the link between painkillers and heroin. I ended up saying things to him like “just stop doing drugs,” as if it were something he was doing for fun. He wasn’t. His downfall was hard and fast, and shocking in the context of our family. Of course we’d had tragedy with the loss of our dad, we weren’t perfect, but we loved each other and lived in a great community where this type of thing didn’t happen.
After Pat died, I needed to understand what had happened to him even though it was too late—it was my way of processing the fact that he was gone, and trying to learn from my mistakes. My discoveries hurt me, but I needed to be hurt—these are hurtful facts. I learned that Pat’s darkness had consumed him, and realized all the ways that I could have supported him more compassionately, if I had only known more about his struggle and about addiction in general. And I also learned that what happened to Pat wasn’t an anomaly. I felt like I was hearing our family’s story over and over again, and it was so disturbing. I decided I had a responsibility to share these stories with the world, because this is the reality of what’s happening to a whole generation of kids, and it needs to be talked about.
What gave you hope?
Sometimes along the way, someone would thank me. I’d get a random call or email from an addict’s loved one, saying how they’d experienced the same thing and how it was comforting to know they weren’t alone. Each time I communicated with someone like that, I felt more strongly that I had to go on. I hate that I had to lose my brother, but I became a journalist to tell the stories that need to be told. This one needs to be told.
My first interviews with family members who’d lost addicts were extremely difficult, but in a strange way they gave me hope too, or at least the sense that I was doing the right thing. I often struggled not to lose control as they told me their stories of loss. It was bizarre how often these stories mirrored my own. That motivated me to keep going, because I saw the common thread of disbelief, the sense that we as a society don’t know how to deal with addiction when it happens to those we love.
I also came into contact with many kids who’d gone down the same path as Pat and survived. I learned so much from them, and while it made me sad to realize that knowledge was lost in terms of me being able to be more supportive towards Pat, I also felt hopeful that if I could share their perspective, more people might gain from the knowledge I’d wish I’d had when Pat was still alive. Addiction is horrible and pervasive and dark. But it isn’t the whole person. The person is still the person: Pat was still Pat, and we all loved him. My hope is that the stories in my book can help show the complexities of addiction.
If there are a few takeaway messages from your book, what would they be?
Second, because addiction is a disease, it shouldn’t be stigmatized in the same way we don’t stigmatize someone who has cancer or diabetes. It’s so easy to write off an addict as lazy or weak-willed, because their behavior—using—is a symptom of their disease. What’s less understood is that using isn’t “fun” for true addicts—it’s what they need, on a bodily level, to feel normal, be at baseline—to NOT be sick. This is the hardest thing to understand, because every relapse feels like a personal betrayal. It’s not. It is so much more than that, both physically and emotionally, and there needs to be more compassion and understanding as to why this happens.
And third, because my book is about opiate addiction: naloxone. I am a huge proponent of harm reduction strategies, so you can stop reading now if that’s not your thing. A few months into my research, I learned that there is literally an antidote to an opiate overdose called naloxone (marketed under the brand name Narcan). It’s easy to use and has no abuse potential, and it’s saved over 10,000 lives since 1996. The White House has expressed support for broadening access to naloxone, and many states are actually in the process of enacting legislation to do so. It’s the first thing I tell families and friends of addicts: find a naloxone distribution program near you. It could change the conversation you have around your loved one’s addiction; you’re letting them know that you don’t want them to do drugs, but more than that, you don’t want them to die. It could also save their life.
What topics do you as a writer enjoy delving into, and why?
My husband jokingly refers to me as “the Journalist of Doom,” and that was even before this book. It’s a bad joke, but there’s truth to it. I tend to gravitate towards the stories of people who struggle. I don’t know why; maybe it’s because I’ve had some struggles in life—but who hasn’t? I like to think of it more as being a conduit or a soundpiece for those whose truths wouldn’t otherwise be brought into the light, where it would benefit the public to know what had happened. That line became a little blurred when I was writing this book. I felt very strongly that Pat was emblematic of a larger issue: he shouldn’t just be one more young life lost to this crazy epidemic. He should have a legacy. I started writing about losing him; I started talking to others; I realized his story was one of many. It seemed natural to complete the circle, to put together something that would show all aspects and angles of what is really happening. But going public with Pat’s story has been harder than I anticipated. It’s uncomfortable to know that I am laying out this horrible chapter in our family’s life for all to see. There will inevitably be criticism and judgment, and I wish I’d considered that more fully at the beginning, because I feel fiercely protective of my family. At the same time, I’m not sure if I’d have come to a different conclusion, because I really do still feel that the only way to attack this problem is by being honest and taking a stand. This did happen to me, to my beautiful brother, to my amazing family. It can happen to you, too.
How was the grief over losing your brother aided by writing this book? Was it comforting or not to hear other addicts’ stories that were similar to your brother’s story?
Losing my brother felt obscene, in the sense that this kind of thing just shouldn’t happen to our family, to him. Writing was the only way I could move forward, and my grief went through spurts. In the beginning, it was disabling. There is a whole year after my brother died that mostly I don’t remember; I was just too shattered. But grief is a process. Much of the book was written in the early days of my grief, and at the time it was simply the only way I knew how to deal with my pain—the way I always had, through writing. It was only later, looking back over where I’d come from, that I felt a sense of catharsis.
And yes, it was comforting to hear other stories that were similar to Pat’s—but it was also disturbing. It was comforting because I talked to people who were so open and willing and raw, and they let me into their lives the way I wished I’d been able to get into Pat’s life when he was struggling. So I gained a lot of knowledge, understanding and compassion from their openness. However, it was also painful to feel like if I’d only had a better understanding of addiction, I might have been a better help to Pat in his struggle.
After your brother died, you began digging into his secret life as an addict. How has your understanding of Pat changed since writing this book? What have you discovered about your brother that you are glad to have learned?
I often wrote off my brother as just partying too much or being a dumb kid or not caring. In reality, he was at the opposite end of the spectrum from carefree and clueless. He knew how much his addiction was hurting his family, and he was tortured by it. He was a good kid battling a horrible disease, and none of us had the tools to adequately help him because it had never happened to us, we didn’t understand it, and we loved him so much that we just wanted to believe everything would get better. In retrospect we seem so naïve—and we were. But I think this is a common experience. You want to believe the best of those you love, never the worst. I think this was my greatest takeaway about my brother. It was hard to comprehend that such a great person could die so senselessly, so young, when we all loved him so much. But I came to understand him so much more after his death, which is so sad, but I hope that my journey can help others.
It sounds strange, but I’m glad I discovered how dark Pat’s life had become. It hurt so much to learn it, I just ached for him, but I think because I learned about the darkness I was able to truly see the impact his addiction had on him, how it changed him into someone I didn’t recognize. I could separate the addiction from Pat, and it ultimately helped me to be able to forgive him for all the hurt he caused. It also helped me forgive myself. I didn’t know what I was up against, and I did the best I could at the time. At the end of the day, I know Pat knew how much I loved him, and I try to remember that when I’m feeling overwhelmed by my failures towards him.
Why doesn’t your book include a discussion of the pharmaceutical industry and explore the role Big Pharma has played in contributing to the painkiller addiction epidemic?
Interestingly, I originally envisioned the book to be exactly that: an expose on Big Pharma. Throughout Pat’s addiction, we really only knew about the pills; it’s hard to recall exactly when we found out about the heroin, but what really drove it home for me was when I read Pat’s autopsy and saw it explicitly stated that heroin was the cause of his death. I remember thinking “that’s how Big Pharma will get away with this—they’ll get a whole generation addicted to painkillers and then when these kids die of heroin, their hands will be clean.” So I was very much focused on investigating the evolution of the prescription drug epidemic. Unfortunately, several publishers rejected this early incarnation of the book. They said the topic was timely, relevant, and important, but they weren’t willing to take the risk of going up against Big Pharma—it was too much liability. One publisher even used the phrase “we won’t go near this subject with a ten-foot pole.” My agent—the wonderful Penny Nelson—has worked in publishing for years, often dealing with potentially controversial topics, and even she was shocked at the strong negative response we initially received. It was really disheartening because the entire point of journalism is to uncover the truth, and I couldn’t find the support to do that. But I still felt the story needed to be told, so after lots of discussions with Penny I decided to revamp the angle and make the story more personal. I do feel that there has been a fair amount of really good investigative reporting into the pharmaceutical industry by some media outlets, but my book wasn’t the place for that—at least this time around. In the end, I was lucky to be connected up with Counterpoint Press. Everyone there has been incredibly supportive and committed to bringing this story into the open.
Why do you think opiate addiction has become such a growing problem? What, if anything, do you think can be done to stem the tide?
Opiates have been around for a long time, but what is new is the ready availability of powerful prescription painkillers that are essentially heroin in a pill. One thing that really drove these medications’ popularity was the rise of direct-to-consumer marketing; the pharmaceutical industry also heavily promoted the use of these drugs to medical professionals without being honest about their potential for addiction and abuse.
I’m conflicted about what strategies will work best to stem the tide. Some pharmaceutical companies have changed their pills to tamper-resistant forms, but there are still ways to abuse them, and there’s always another new powerful painkiller hitting the market—the most recent one being Zohydro, which some critics fear is the next OxyContin. Taking individual doctors to task for over-prescribing is a good thing, in my opinion, and it’s been heartening to see some recent court cases holding drug dealers accountable when their actions resulted in overdose deaths, which could have a deterrent effect. I do think that stricter regulations in terms of doctors’ ability to prescribe massive amounts of painkillers is a good thing, and many states are working to improve their prescription monitoring databases. But the unintended effect of these efforts is that more people are turning to heroin. When the market was flooded with painkillers, scores of people became addicted, and now they need treatment. Where are the funds for that going to come from?
So I’ve decided that the best solution I can offer is advocating for education and awareness. People need to know what’s happening. They need to educate themselves about what they’re being prescribed, and learn about the risks involved with painkillers and how abuse of these medications can put anyone on the path to heroin.
How long have you been working on this project?
Five years. My brother died in February 2009, and I started my blog, www.oxywatchdog.com, a few months later, followed by the research, interviews, and personal writing that led to my book.
Why did it take so long?
It took me quite a while to build the necessary trust with my sources. I think it was probably easier for people to trust me because they knew I’d been personally affected by this issue, but as common as addiction is, it’s still really hard to get people to talk about it. And I understand that. Though the portions of my book that relate to Pat are extremely intimate, I still feel a little bit guarded when it comes to talking about my brother in real life. It’s almost like I channeled all of my emotions about Pat into the book, into a little package where it’s contained and safe and I’ve made peace with his loss. But I still feel that punch to the gut when I’m doing something mundane, like washing the dishes or taking out the trash, and for some reason it will hit me that Pat died of an overdose, and he’s gone. I still see him everywhere; I’m constantly doing double-takes because I see someone who looks just like him. And especially when good things happen, I wish he was here to be a part of that experience. Grief is weirdly persistent that way. When I think about how much I miss him, and how I’ll never see him again—there’s no eloquent way to say it, it just sucks.
Was there a point at which a label got slapped on you that you felt was disparaging or inaccurate?
I have had some people contact me through my blog who say they’re chronic pain patients, and they feel that I’m trying to deprive them of their medication. I’ve never said anything of the sort. I watched my father die of cancer; I don’t want anyone to be in prolonged, disabling pain. There’s a legitimate medical purpose for opioids. I’ve tried to stay out of the boxing ring when it comes to the politics of prescription drugs, because I feel that my most important contribution to the conversation is simply telling the stories of those who’ve been affected by the painkiller addiction epidemic. That doesn’t mean I haven’t formed my own opinions as to what should be happening, but people who think I want to abolish these medications have completely missed the mark.
I’ve also had people label my brother as a worthless. Several people have written to me asking why they should have to suffer without their medications because addicts like Pat were irresponsible and couldn’t control themselves. Natural selection has also been mentioned, as if drug addicts deserve to die. I don’t respond to vitriol. If these people can’t gain a more compassionate viewpoint towards addicts after reading the stories on my blog and in my book, we’re never going to see eye to eye, and I’m not interested in engaging with them.
The book is divided into five sections mirroring the five stages of grief. Why did you decide to structure it this way?
After Pat died it took me a few months to start being able to express my thoughts on paper, but once I was able to write, it became almost a compulsion. I wrote things down all the time, little thoughts and big ones, in my journals, on my computer, on random scraps of paper. When I sat down to organize all these notes, I tried to take a step back and see the narrative as it unfolded. I had been thinking a lot about the five stages of grief—denial, anger, bargaining, depression, and acceptance—and while I hadn’t noticed my progression through these stages on a day-to-day basis, it became clear that I’d gone through them.
I then tried to think about the stages as broader themes that play out in other areas of our lives, especially in terms of addiction. And it was interesting because when I interviewed my sources, I usually found that one of the five emotions was most dominant at that time for that person. That’s how I ended up deciding how to structure the chapters and create a storyline where the characters weren’t always linked to one another.
Are there any narratives you are especially proud of? Or narratives that you thought would never work, but that came together in the end?
One of the hardest stories to get was from Luke, the young man in Chapter 2. I was working alongside the photographer Daniel Anderson for a piece on painkiller and heroin addiction for the Center for Investigative Reporting, and up until the last minute we weren’t even sure Luke would agree to meet up with us, let alone allow us to record and photograph him. It was deeply disturbing to watch Luke shoot up, to be that close to the process of the thing that killed my brother. He kept nodding out during our interview, and I was terrified that he would overdose. I had never been around someone that high before. It was very emotionally intense for me. Luke had such a sweetness to him, which made it even more heart wrenching, because he reminded me a lot of Pat.
What happened to the addicts you interviewed—have they been able to remain sober?
Almost all of them have relapsed. Relapse is unfortunately often a part of the process of recovery. Some have managed to get clean again, and have stayed in touch with me. A few have disappeared, and because I haven’t been able to reach them, I worry they’re not in a good place. The ones who were sober when I interviewed them and have remained sober since are in the minority—but it does happen.
How did your own legal background influence the way you approached these difficult stories?
Because I was familiar with some of the early litigation involving pharmaceutical companies, I felt even more compelled to put a human face on this epidemic. I was very frustrated with the outcome of the litigation against Purdue Pharma; in 2007, the company and three of its top executives plead guilty to misleading doctors and consumers about the abuse potential of OxyContin. The company paid a $634.5 million fine, which seems like a lot until you realize that Oxy was pulling in more than $1 billion per year in sales at that time. And Purdue continued to manufacture Oxy for three more years—it didn’t reformulate the drug to make it tamper-resistant until 2010. It was irresponsible corporate greed, and the punishment was vastly inferior to the crime. Many of the people I interviewed had a lot of anger towards the pharmaceutical industry and the FDA for allowing a public health crisis of this scope to unfurl. I think sometimes anger obscures the message, though, so I tried to focus on the real-life implications of this epidemic on their lives. I think their stories speak for themselves.
How does your family feel about your book?
My family is amazingly supportive. They understand that my goal is to use Pat’s story to help others. But not everyone will be reading the book, and I understand that. The book is about Pat, but it’s very much my take on what happened. My other brother and sister did collaborate with me on the manuscript in places where I was unsure if I’d gotten the story right. Memory is a tricky thing, so we tried to piece together our best understanding of how things went down based on our collective experiences. The fact is that we’ll never know the whole truth about what happened to Pat, because we can’t ask him. But I feel the book is probably the closest we’ll get to the truth about his story. That said, it is still my version of the story, my retelling of the events, and much of it is very raw. Not everyone in my family wants or needs to go through the process of reliving the pain of losing Pat, and that is completely understandable.
What’s next for you?
A part of me wants to close the door on this chapter of my life—it’s been a rough road, and I’m pretty emotionally exhausted. Though writing the book was cathartic, it was also very heavy to witness the widespread pain and heartache this epidemic is causing. But I also feel a responsibility to continue to talk about my brother and about this issue. For now, I plan to continue blogging and to share my book with as many people as I can. I want to keep the conversation going.
ERIN MARIE DALY was a senior reporter for Law360, a New York City-based legal newswire where she covered the pharmaceutical industry and product liability litigation for the past five years. In 2007, she was nominated for a GLAAD Media Award for Outstanding Digital Journalism. Daly has also reported in countries such as India, Bosnia, and Russia. She holds an MA in cultural reporting and criticism from New York University. Her feature writing has appeared in a myriad of publications. She is the author of Generation Rx: A Story of Dope, Death, and America’s Opiate Crisis, published this month by Counterpoint.