‘This makes me feel better.’ A daughter’s story

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Rachel Delaney* loved life. It’s not that she always had it easy. As the oldest of eight kids, Rachel had a tough childhood with a lot of responsibility.

My grandmother, she drank a lot,” said Rachel’s youngest child, Beth. “I was told she was a pretty angry person—just negative and mean.” Beth’s grandfather was also an alcoholic and abusive.

When Beth talks about her own childhood memories, though, her voice softens.

“She was a great mom,” Beth said about Rachel, full of life and love. Beth’s favorite memory is a simple one.

“She would have the window open,” she said. “You could hear county music playing. She would have dinner cooking.”

Rachel’s life took an unexpected downturn when she was in her mid-30s. That’s when doctors told Rachel she had rheumatoid arthritis. Unlike osteoarthritis, which is caused by normal wear and tear on our joints, RA is an autoimmune disorder, one of a large group of conditions where the immune system attacks the body’s own tissues and organs.

“It was just really painful,” Beth said. “She was always in pain. … She ended up getting really depressed.”

A hand crippled by rheumatoid arthritis. Photo by Doc James – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=40957636

The National Institutes of Health says that depression is a common result of Rachel’s condition. With rheumatoid arthritis, the immune system triggers abnormal inflammation in the membranes that line the joints (the synovium). When the synovium is inflamed, it causes pain, swelling and stiffness of the joint. In severe cases, the inflammation also affects the bone, cartilage and other tissues within the joint, causing more serious damage. The disease can also affect other parts of the body including the eyes, lungs and blood vessels. RA can lead to severe joint damage, limiting movement, and causing significant disability.

Doctors prescribed a cocktail of powerful drugs for Rachel’s pain and depression: Lorcet, a narcotic (aka an opioid) for pain, plus Ativan and Xanax for anxiety and depression.

“Once she started (taking the drugs), she was like, ‘Oh, this makes me feel better,’ and she just spiraled,” Beth said.

It wasn’t long before Rachel, once meticulous about her house and her appearance, began to let everything go. “It got really bad when I was around 13,” Beth said.

Rachel stopped cleaning the house. She stopped getting her hair and nails done. “She really just stopped caring,” Beth said.

A ‘road map’ to the opioid epidemic

In 2003, Rachel’s doctors started prescribing oxycodone, a more powerful opioid, for her pain. A 2019 study about the use of opioids for RA found that “up to 40% of patients with RA are regular users of opioids.” The study found, however, that the longer an RA patient uses opioids, the less effective they are for pain relief and the more likely the patients will become addicted or worse.

At the same time Rachel was using oxycodone for her pain, a newer, time-release version of the drug, OxyContin, was quickly gaining popularity among doctors. Its manufacturer, Purdue Pharma, promoted OxyContin as a non-addictive substitute for other opioids, one patients were less likely to abuse.

Photo from the National Institutes of Health

“A consistent feature in the promotion and marketing of OxyContin was a systematic effort to minimize the risk of addiction in the use of opioids for the treatment of chronic non–cancer-related pain,” wrote Dr. Art Van Zee, in his 2009 paper “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy.”

“Purdue pursued an ‘aggressive’ campaign to promote the use of opioids in general and OxyContin in particular,” Zee wrote. “In 2001 alone, the company spent $200 million in an array of approaches to market and promote OxyContin.” Perdue trained its reps to tell doctors that the risk of OxyContin addiction was less than 1 percent.

Between doubling its sales force within the first few years of marketing the drug, to offering their reps lucrative annual bonuses of up to $240,000 and targeting primary care physicians instead of pain specialists, Purdue made a financial killing. From 1997 through 1001, Purdue increased annual prescriptions from about 670 000 and sales of about $44 million to about 6.2 million prescriptions and nearly $3 billion.

“By 2001 it had become the most frequently prescribed brand-name opioid in the United States for treating moderate to severe pain,” Zee wrote. “…and it became the most prevalent abused prescription opioid by 2004.”

Recently, The Washington Post waged a year-long legal battle for access to the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System, known as ARCOS, which the government and the drug industry had sought to keep secret. The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, gained access to the database as the result of a court order.

“It was disclosed as part of a civil action brought by nearly 2,000 cities, towns and counties alleging nearly two dozen drug companies conspired to saturate the nation with opioids,” The Post writes.

The database “tracks the path of every single pain pill sold in the United States — from manufacturers and distributors to pharmacies in every town and city … [and] is a virtual road map to the epidemic.”

Among the Post’s findings:

• Between 2006 and 2012 as the nation’s deadliest drug epidemic spun out of control, America’s largest drug companies distributed 76 billion oxycodone and hydrocodone pain pills across the country. Just six companies distributed 75 percent of the pills during this period. Purdue Pharma, which has been successfully sued for sparking the epidemic in the 1990s with its introduction of OxyContin, was ranked fourth among manufacturers with about 3 percent of the market.
• The volume of the pills handled by the companies climbed as the epidemic surged, increasing 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. The states that received the highest concentrations of pills per person per year were: West Virginia, Kentucky and South Carolina.
• Opioid death rates soared in the communities that were flooded with pain pills. The national death rate from opioids was 4.6 deaths per 100,000 residents. But the counties that had the most pills distributed per person experienced more than three times that rate on average.

The data reveal the depth of the prescription opioid epidemic in every state and county in the nation down to individual pharmacies. In Mississippi and in Warren County:

• From 2006 to 2012 there were 854,553,185 prescription pain pills supplied to Mississippi.
• From 2006 to 2012 there were 14,787,270 prescription pain pills, enough for 43 pills per person per year, supplied to Warren County, Miss.

‘Please stop giving this to her’

“The pills would make her crazy,” Beth said. “She was like a zombie.”

Rachel would fall asleep putting on mascara. She would fall asleep standing up while cooking dinner. After one such incident, Rachel’s son told her she would never be alone with her grandchildren again.

When she wasn’t nodding off, Rachel would go out drinking or looking for more pills. She got a couple of DUI citations, Beth said.

By the time Beth was 16, she was the last of Rachel’s four children living at home. “I was taking care of her,” she said. Beth could see that Rachel was taking far too many pills. In one week, Rachel would go through a prescription meant to last a month. Then, she would buy more pills off the street.

At one point, Rachel began leaving Beth notes. “Please leave some money, I need to get stuff for the house,” Beth recalled her writing. If Beth left money, Rachel would buy pills with it.

From time to time, Beth would find solace with one of her sisters. “Anytime my mom was not OK, she would take me,” Beth said. When they were younger, Beth’s siblings thought it was cool to stay with Rachel because she would let them do whatever they wanted. As they grew older, though, Rachel’s children wanted less and less to do with her.

Rachel knew she was addicted. Beth remembers clearly that her mother called and asked for help to get off the pills. Whatever help she got, though, didn’t work. Rachel never had the support systems needed to beat her addiction.

“It was easier for her to numb everything than to try to deal with it,” Beth said.

Things came to a head one day when Rachel fell asleep and crashed her car into a mailbox. Beth knew she had to act. She called her mother’s doctors and told them she was abusing the drugs. “Can you please stop giving this to her?” she begged.

The doctors didn’t pay attention, dismissing her as nothing more than a hysterical teenager. They continued to prescribe the opioids that were slowly destroying her mother.

By 2008, the courts had taken Beth away from Rachel, giving custody to her youth pastor. Beth wasn’t unhappy about it, she said, because Rachel “was high all the time, and I hated it.”

“The whole week before she died, she had been calling for me to spend the night,” Beth said. Instead, Rachel went out with Beth’s oldest sister, who was an alcoholic at the time. The two went out on the town and had a great time the night before Rachel was found dead of an overdose. She was 52.

‘It is what it is’

Deaths from opioid overdoses continue to rise. The Centers for Disease Control says that two-thirds of the 63,632 drug overdose deaths in 2016 were due to opioids. Drug overdoses resulted in 70,237 deaths during 2017; among these, 47,600 (67.8 percent) involved opioids (14.9 per 100,000 population), representing a 12.0 percent rate increase from 2016. Roughly 41 percent of opioid deaths were from prescription pain relievers.

The rate of drug overdose deaths has not significantly changed in Mississippi over the past several years, and in contrast with national statistics, the rate is deceptively low.

In 2017, there were 12.2 drug overdose deaths per 100,000 persons in Mississippi. However, “While the majority of drug overdose deaths in 2017 involved an opioid, overdose deaths involving opioids are not included for the state because the data reported did not meet inclusion criteria,” the CDC states.

Recently, Mississippi Bureau of Narcotics Director John Dowdy acknowledged that prescription drugs make up the largest number of opioid-related deaths in the state.

Drug overdose deaths, rate per 100,000 persons, in the U.S. and Mississippi. Source: National Institute on Drug Abuse, CDC WONDER

“Typically, what we had been seeing for the last two or three years is about 70 percent to 74 percent of all overdose deaths in the state of Mississippi were opioid related,” Dowdy told WAPT. He added that doctors who understand there is an over-prescribing problem in the state have helped decrease the number of opioid prescriptions, and pharmacists are paying more attention to patients who try to get multiple prescriptions from different doctors.

When Rachel died, the autopsy showed tranquilizers and Benadryl in her system, Beth said. “She also had pills in her pocket.”

Beth and her family have come to terms with Rachel’s addiction and her death. “She was kind of set up to be an addict from the beginning,” she said, given the family tendency toward addiction and her constant pain from RA.

“I just wish things were different,” Beth said. “It is what is.”

Every year on Rachel’s birthday, Beth writes a long Facebook post using her mom’s story as a cautionary tale. “If you need help, get help,” she tells her friends.

Beth has been married for 10 years now and is raising three boys. On many days, she wishes Rachel had lived long enough to meet them. “She was always talking about grandbabies,” she said.

Asked what she wants to tell readers about opioid addiction, Beth was quick to answer. “If you know somebody that has a problem, don’t ignore it,” she said.

”Don’t let no news be good news.”

This story is the second of an ongoing series about the opioid drug crises in Mississippi, focusing on the people of Vicksburg and Warren County. Read the first story: “‘It was just kind of normal.’ A Vicksburg family struggles with opioid addiction.”

*At their request, we have changed the names and some personal details to protect the privacy of the family featured in this story.