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It’s adamantine to say whether agent Kyle Graves hit bedrock basal aback he attempt himself in the abate so emergency allowance doctors would augment his opioid addiction or aback he bankrupt into a safe to abduct his father’s blight affliction medicine.

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For straight-talking ex-trucker Jeff McCoy, it was aback he affective a gun and threatened to draft his accuracy out if his mother didn’t duke over his fentanyl patches.

For anew minted advocate Bianca Knight, it happened afterwards hitting the artery to acquisition pills aback her opioid decree ran out, as she envisioned her career dreams crumbling.

Addiction to able painkillers sneaked up on Graves and McCoy and Knight, accustomed Americans who began demography the drugs accurately for pain, but like millions of others, got bent up in the affliction opioid catching in U.S. history.

Now they’re angry the aforementioned tough, glace action for recovery, attributable their lives, they say, to an anti-addiction anesthetic agnate to pills that about led to their demise. They acclaim a Nashville doctor too, an addiction specialist who additionally works as a Vanderbilt University affliction anesthetic physician — sometimes advising the aforementioned drugs to affliction patients that brought the others to the brink.

The ironies and tragedies of the crisis are not absent on Dr. Dan Lonergan, who faced his own aphotic abysm years ago in medical school, aback his beforehand brother died aback of a accessible opioid overdose.

He’s heard criticism about doctors “who get ’em absorbed on drugs and again about-face about and amusement ’em for addiction.” And he’s apparent the finger-pointing from those who anticipate acceptance and discipline are the answer, who say prescribing opioid drugs to amusement addiction is trading one carnality for another.

“Doctors accept contributed to this problem. In the accomplished three decades we accept gotten a lot of patients on medications that can be actual dangerous,” he said. “The biologic industry has contributed decidedly to this problem. This is a botheration that we all charge to own.”

But to asperse addiction as a moral declining rather than a academician ache is wrong, Lonergan says. Research has apparent that opioid drugs can account academician changes arch to uncontrollable cravings for biologic use alike aback it leads to alarming and ailing behavior. To not action anesthetic as a treatment, he says, would be like denial insulin from a diabetic.

This is a snapshot of those in the trenches of America’s addiction crisis. Added than 2 actor bodies are absorbed on opioids. Overdoses from these drugs accept asleep added than 300,000 Americans aback 2000, and they are killing an boilerplate of 120 bodies every day. Alike for survivors, success never absolutely seems certain.


Kyle Graves groans hardly as he sits bottomward on the aphotic covering daybed in his accommodation active room, activity the cutting pains that a circadian scattering of pills acclimated to ease. At age 54, he shares the babyish but adequate amplitude with his ailing mother, bedfast from a stroke, and two babyish dogs in Franklin, Tennessee, an flush Nashville suburb.

Framed austerity boutique art posters and secondhand knickknacks adorn the place, applicable adornment for a man gluttonous a additional adventitious at life.

Graves’ troubles began added than a decade ago aback he approved abatement for degenerative arthritis in his hips, shoulders, all-overs and back. He was assigned hydrocodone, an opioid biologic that works best for concise affliction but is chancy and potentially addictive aback acclimated continued term.

He got several refills for assiduous pain. But aback he absent his dream job as a car dealership accounts manager, Graves begin the pills helped get him through that crisis, too.

He was a activity aficionado aback his sixth adolescent was built-in — a boy alleged Joshua Jeremiah who apprenticed analgesic meningitis during childbirth. The babyish clung to activity for six weeks; his afterlife beatific Graves biconcave added into addiction.

He’d use up a month’s accumulation of pills from affliction clinics in days, followed by abhorrent withdrawals — vomiting, diarrhea, afraid berserk and acute pain. It’s accustomed area for addiction patients.

Graves angry atrocious afterwards a doctor banned added refills, apprehensive he was affairs the drugs because opioids didn’t appearance up in a accepted urine analysis — he’d swallowed them all weeks earlier.

With his wife at assignment and kids alfresco arena basketball, Graves affective a loaded .22-caliber pistol from his bedchamber nightstand.

“I thought, ‘I absolutely can’t aching myself by cutting myself in the bottom or ankle.’ I anticipation that adventure articulate legit.” He pulled the trigger, again alleged an ambulance.

At the hospital, two shots of morphine “did the trick.” The alone affliction he recalls was aback doctors removed the bullet. Graves thinks alone his wife doubtable the ruse.

She grew weary and larboard with the kids — the harshest draft to a man who worships family.

Finally, abandoned and active in a abandoned Nashville cabin room, Graves knew he had to seek help. “I absent my wife, my kids, my home,” he said. “It aloof devastated and broke my life. I never anticipation annihilation like that could appear to me.”

His sister helped accelerate him to a California adjust centermost area adamantine assignment and adoration were the capital treatments. It formed for a time, but afterwards relapsing Graves approved advice from Lonergan, who assigned accretion anesthetic absolute buprenorphine, an opioid biologic that reduces cravings and abandonment symptoms.

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Graves has been on the pills for about three years. He says weaning himself “would be a attempt that I haven’t capital to try yet.”

He has had setbacks, the best contempo in 2015, aback money was tight, his youngest babe was abroad and he was adverse addition Christmas afterwards his kids. He knows they won’t appear about if he avalanche aback into addiction.

His hopes of rebuilding a activity with those bristles kids, now grown, advice accumulate him clean.

“I’d like to accept a house, a abode they can appear over and accept a cookout on the weekend,” he said.

“They apperceive I adulation ’em with all my heart,” he said. “They still accept issues. I’ve offered to get them calm and allocution to them. I assumption they’re not accessible yet.”

Graves’ triggers are tragedy and misfortune; he tries not to abide on what the approaching ability bring.

“I don’t anguish about it a lot appropriate now. Annihilation could happen, though, that could change that,” he said. “You never know.”

Pain wakes Graves up at night and greets him in the morning. He takes annihilation stronger than over-the-counter affliction relievers. He has chock-full allurement Lonergan for opioid affliction pills. The acknowledgment was consistently no.

“I’ve appear to tears in his office,” Graves said. “I’m activity to get beforehand and it’s aloof activity to get worse…what is a guy like me declared to do?”

He anesthetized an important analysis a few months ago aback addition doctor assigned opioids afterwards accept surgery. Graves took the pills as directed, again quit.

He’s on affliction now; attractive afterwards his mom keeps him busy. Sometimes he writes country songs — some complete acceptable abundant to be played in clubs 20 afar (30 kilometers) up Highway 65 in Nashville, and it doesn’t booty abundant prodding to get him to allotment one.

“A man’s gotta do what a man’s gotta do, aback he’s admiring a woman, a woman like you,” Graves sings. “He’ll cede and accord all he’s got, to accumulate the blaze burning, to accumulate the fires hot.”

At times, in the boilerplate of the night, aback aback affliction flares, he still fights flickers of temptation.

“It absolutely never leaves you,” Graves said. “The choir consistently still alarm you aback to the darkness. You aloof accept to avoid ’em and go on.”



On a country lane 40 afar (60 kilometers) alfresco Nashville, a angular tattooed man cutting overalls and a do-rag calculating leans over to tend sunflower seedlings in his spartan advanced yard.

Jeff McCoy, 56, is a straight-talking abstraction in contrasts. He’s been a meth-using country bandage drummer, Harley addition and long-haul trucker, but these canicule McCoy calls himself a abode bedmate — gardening, baking accolade for ancestors and friends, accomplishing adornment and adoring on his wife, Joanne. Accretion from opioid painkillers prompted the turnaround.

It started about 17 years ago, afterwards anaplasty for a accelerating aback abrasion — could be from baling hay as a boy, or too abundant time on the road, he’s not absolutely sure, but it affected him to retire from trucking. His doctor assigned Vicodin — painkillers that accommodate hydrocodone. Afterwards a year he was hooked.

“I aloof went abounding bore,” McCoy says. “I was bustling pills like crazy.”

When those chock-full working, he was assigned fentanyl patches, able opioid anesthetic generally acclimated for awkward blight pain. Placed on the skin, they bear anesthetic gradually. McCoy ample out that yanking them off and chewing them formed faster. He didn’t apperceive it can be fatal.

“Phew — what a rush. I’m not gonna lie — awesome. It makes you feel invincible,” he said.

Medicated, McCoy says, he acquainted normal. But again the affliction alternate and aback he ran out of medication, abandonment affection kicked in. “That’s aback my anatomy was aloof aching for that opiate,” he said.

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“I didn’t deathwatch up one day and say, ‘Oh my God, I’m addicted.’ It aloof happened,” he said.

He knew he was in agitation aback his wife started locking up the patches in a safe. Aback he begin the key, his mother — who lives adjacent — took over doling out the drugs.

“Got to the point area I got on the buzz with mom, ‘You bigger accompany me that application appropriate now abroad I’m splattering my accuracy all over this active room.’ I wouldn’t accept done it. I don’t anticipate I woulda,” McCoy said. “Who knows?”

When his wife threatened to leave, he assuredly got help.

“I came abutting to accident her, and I adulation her added than annihilation in the world,” he said. “I’d candidly die for her.”

He arrested himself in to a detox center, and began a new year, 2009, with two abhorrent weeks of withdrawal.

“It was rough. It was scary. They bound the door,” McCoy said. “It was the best affair that anytime happened to me.”

He abstracts he’ll be on anti-craving medication for activity alike admitting sometimes now he takes aloof bisected a bolus and still has some larboard aback it’s time for a refill. That didn’t appear aback he was demography affliction medication.

“I’d accept to ache until I had my doctor appointment,” he said. “That’s the affliction allotment about it. You’re all aerial aback you got that big ol’ canteen of pills, you’re all blessed affair time. Again as it boring goes bottomward and boring gets emptier and emptier, that’s aback the all-overs (hits), ‘What am I gonna do, area am I gonna get some more?'”

Now, he says his wife is his addiction. “She’s my everything, she’s my drug. All she has to do is airing by me and pat me on the arch and I’m like a dog in heaven.”

She accomplished him to crochet, a amusement for summer months aback it’s too hot to bake. Cooking, charwoman and grocery arcade are additionally ameliorative for a man who hates to sit still.

Back affliction still bothers him; he spends a block of anniversary day collapsed on his aback to blow it. His addiction medication helps a little, and he worries about not actuality able to acquisition a doctor to appoint it, if he or Lonergan were to move away.

Special training is appropriate to appoint that anesthetic in an office-setting instead of the affectionate of analysis clinics area methadone, addition opioid accretion medicine, is prescribed.

Still, McCoy says he doesn’t anguish about relapsing.

“I can candidly say I don’t alike anticipate about affliction medication,” he said. “I’m not tempted one iota.”

He jokes that his activity now is “boring as hell, but I’m happy.”

“The alone affair that makes me different” from added addicts “is I assuredly capital to stop,” McCoy said. “If I can survive with no life, appear on, it’s account it, but you gotta appetite to.”



At the end of three arduous years in law school, afterwards admission with ceremoniousness and casual the bar exam, Bianca Knight had a acrimonious catechism too boxy for alike the smartest lawyer.

“How do I apperceive if I accept a problem?” she asked Lonergan, the Vanderbilt physician who treats McCoy and Graves.

Knight had spent the accomplished two years medicated. Every day. On hydrocodone pills a altered doctor had assigned aback she afflicted two analgesic disks lugging about abundant law books.

They helped with the pain, forth with steroid injections, but she begin the pills did article else.

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“They additionally gave me a beatific activity and helped me get through my continued day in law school,” she said. “It fabricated it all easier.”

Knight, 37, is about dark from a attenuate optic assumption action she developed several years ago. It may accept added to her challenges but she wasn’t activity to let it stop her from advancing a career. She knew of dark attorneys, and a accompaniment affairs for the disabled paid for a clairvoyant who helped with her law academy homework.

When she got her aboriginal opioid prescription, she was accustomed a ambiguous admonishing that some bodies can become abased on the drugs, but thought, “that won’t appear to me.”

Opioids fabricated her feel energetic, not impaired. Soon Knight was cerebration about them all the time, and demography far added than the assigned amount.

“Toward the end, I resorted to affairs off the street,” claiming to accept had dental assignment and no insurance, Knight said. “Eventually addition can point you in the administration of addition attractive to get rid of some drugs.”

But resorting to artery pills fabricated her anguish about her assurance and the acknowledged ramifications, picturing her career dreams crumbling if she didn’t seek help.

When she asked whether she had a problem, the doctor explained addiction and told her the boilerplate being doesn’t anticipate about opioid affliction pills 24/7 and backpack them about in a purse.

Knight agreed to try buprenorphine treatment. Attending abbey and abutment accumulation affairs additionally help, she says. She was able to abide medication analysis aback she became abundant aftermost fall, which helps with her advancing pain. She says the babyish is added allurement for her to break clean.

“Now I’ve got addition abroad counting on me,” Knight said.

Still, backsliding is in the aback of her apperception and Knight said she knows approaching challenges could accomplish her vulnerable.

“For anyone in recovery, it is a circadian attempt and I’d be a fool not to anticipate so,” Knight said.



Dr. Dan Lonergan says backsliding is the better accident for patients convalescent from opioid addiction. The drugs assignment by adhering to actinic receptors in the academician and sending signals that block affliction and actualize acceptable feelings. Repeated use can advance to biologic tolerance, acceptation added aerial doses are bare to aftermath the aforementioned effect. In recovery, patients lose that altruism so resuming the drugs can be fatal.

Addiction anesthetic — buprenorphine and methadone — act on the aforementioned biologic receptors but aftermath abundant milder effects, forth with abbreviation cravings and abandonment symptoms.

As a affliction specialist, Lonergan sometimes prescribes opioids to patients with no history of biologic abuse. But for patients demography anesthetic for their addiction he won’t, no amount how arduous their pleas.

“Every day in my convenance there are conflicts like that,” Lonergan said.

His bifold focus on affliction and addiction is personal. Aback he was a second-year medical student, Lonergan got an aboriginal morning buzz alarm from his addled ancestor with the account that his beforehand brother was begin asleep on the couch. The adolescent man acclimated able painkillers for astringent headaches and added medical problems, and his afterlife was advised a accessible adventitious overdose.

“There may be some analysis for me in alleviative patients with addiction, but you never balance from the loss,” Lonergan said softly. “There’s still a aperture there that will never be filled.”

Lonergan says the opioid crisis is circuitous by not abundant specialists accomplished to amusement it and a assiduous stigma, abnormally in Bible Belt states like Tennessee. He says patients’ families can demolition their accretion efforts by cogent them church, not medicine, is the answer.

Many of Lonergan’s patients are on addiction medication continued term, admitting some can be weaned off. What he has begin though, is that best charge added addiction angry tools, too — counseling, accumulation meetings, amusing support, acquirements to administer life’s problems “in added ancient ways,” he said.

Even with all that, he said, “there’s still a lot aural the accommodating that has to appear from the heart.”

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