A COSTLY HABIT TO BREAK

One in a series of occasional articles about opiate abuse and its consequences.

There is a young man living at a homeless shelter in Quincy, age 21,
sandy-haired with a face full of freckles, an earnest manner, and a
heroin addiction.

He loves his parents, hates rules, and can explain with sweet-voiced
precision why, despite costly efforts, his family in Scituate cannot save him.

"My parents did everything right, they did, to the best of their
abilities. I know I've stressed them out. It's a weight on me. But
you want to know how to stop a kid on a crazy heroin run?''

He asks this question on the patio at a galleria in Quincy, drawing
the notice of office workers, teenage girls, shoppers, many seated at
nearby tables, listening, waiting for an answer from this clean-cut
looking young person.

"You can't.''

Addiction to opiates, whether to heroin or some natural or artificial
form such as OxyContin, is exacting a high emotional and financial
toll in the suburbs south of Boston, devastating families as growing
numbers of young people are lost to a drug with a malignant hold few
parents get wise to until it is well established.

These parents, along with others across the state and nation, are
struggling to keep ahead of an opiate crisis, recently labeled a
national epidemic by the White House's Office of National Drug
Control Policy, that took off in the mid-1990s and, since then, has
been escalating at a rapid pace.

The widespread abuse of OxyContin became evident in 1995, almost
immediately following FDA approval of the potent painkiller,
according to a 2009 report by the Massachusetts OxyContin and Heroin
Commission. The legislative panel found that the opiate addiction
rate in the state increased by 950 percent from 1992 to 2002, based
on treatment admissions, which had soared from 325 to 3,089.

Between 2002 and 2007 the Commonwealth lost 78 soldiers in
Afghanistan and Iraq. In the same time period, 3,265 Massachusetts
residents died of opiate-related overdoses, the commission wrote in its report.

One other statistic - that two people a day die of opiate-related
abuse in the state - is often cited by US Representative William R.
Keating, who is well aware of the impact after serving 12 years as
Norfolk district attorney.

"People are just stunned by that statistic. I tell people everywhere
I go,'' said Keating. "This is a major public health issue - people
are dying. I did my best when I was DA to promote early education and
get families talking about it. This is happening on the South Shore,
and people need to open their eyes.''

In Scituate, the parents hoping to save their son - the 21-year-old
in the Quincy homeless shelter - have spent nearly $90,000 on private
treatment facilities over the past few years. None of these efforts
stopped his heroin use for more than a month or two.

"At this point, we've done all we can,'' says Marie Rakestraw, who
asked to be identified by her middle and maiden name in deference to
family members afraid of a social or professional backlash if linked
to this stigmatized addiction.

"What drove him to it? What is he going to do? Why doesn't he have
any direction?'' she asks. "I know there is a good kid in him that
wants to come out. He knows we love him and we will support him if he
makes the right choices.''

For Rakestraw, the opiate epidemic is personal, evidenced by an empty
seat at the dinner table; a strained marriage; exhausting circular
conversations; crying spells at random moments; and, for a few
months, her depressed inability to do more than walk the dogs before
retreating back to pajamas and bed.

"It is just so hard to wrap your mind around the idea that this child
is not my own,'' she said. "He's been taken over by drugs.''

The total cost of substance abuse and addiction to the Commonwealth
in 2005, the most recent year for which aggregate data are available,
was more than $4.5 billion, which represented 21.8 percent of the
total state budget in 2005, according to the 2009 report by the
OxyContin and Heroin Commission. Out of the more than $4.5 billion,
98 percent represents the cost to public programs, which includes
spending on justice, education, mental health services, and public
safety, according to the report. Private insurance payments for
substance abuse treatment decreased 11 percent from 1991 to 2001
while public payments increased by 68 percent, the report noted.

In Quincy, Rakestraw's son is fiddling with his cellphone, belongings
by his side, politely speaking with a reporter because he believes
this story matters. He says he cares about his parents, they tried,
but they were way out of their league. He believes parents cannot
beat heroin once it enters the scene - unless the addict is ready to
overcome the habit and embrace help.

"Look, you can motivate your kids to stop. But you can't stop them
from getting high - not after it starts,'' he says, adding that his
parents had no idea what kind of drugs he was experimenting with as a
teenager, and by the time he told them, he was hooked.

"Look, it's just this - one day, I took some OxyContin, and I loved
it and it went from there. Unless you've really experienced it,
you'll never understand.''

This habit, adopted with other young people while he stocked shelves
at a grocery store in Scituate, was a revelation. "I felt like I was
alive. I was happy. I could work all day. That was my thing, I was
going to do that forever, when I felt that feeling.''

Within months, his OxyContin abuse led to an all-consuming heroin
habit, which distanced him from his co-workers at the market. "When I
started doing heroin, my friends were like, ‘See you later. You
have a problem.' ''

"You know what? All the kids who looked at me that way, the same
thing happened to them. It just took longer. I was, like, a step ahead.''

The recipient of thousands of dollars' worth of opiate abuse
treatment - both through private and, after his parents demanded he
go on MassHealth, public means - he now says he is kicking his habit.
He has been clean four months, he says, the longest stretch of time
since he started using opiates.

Why did he stop? It wasn't the loss of the more than 50 people,
friends, and acquaintances, that he says have died. It wasn't any
particular treatment program, although he doesn't dismiss them. It
wasn't the love of his parents, although he says it helped. It was a
desire for a better life.

"I decided to get it together,'' he says. "The biggest thing keeping
me off heroin? I feel good. I am proud of myself.''

Several months ago, he found himself living in an abandoned building
in Dorchester, driving a stolen car, hopping over convenience-store
counters with a knife in his sweatshirt, lacking empathy for the
traumatized store clerks, all to support a $200-per-day heroin habit.
This was a low point.

At the time, he was on probation after his arrest for possession of
about an ounce of marijuana with a scale and other drug
paraphernalia, indicating intent to sell. He received a suspended
three-month sentence with 18 months probation but proceeded to fail
multiple drug tests. In a moment of hope and self-preservation, he
elected to serve the 12 weeks in jail and, he hoped, change his life.

In jail, he stopped using heroin for a full three months, and it was
also in jail that he discovered, during a phone call from his
parents, that a close friend from Scituate, his companion during
heroin stints and many times his ally in trying to kick the habit,
had died this spring from a heroin overdose. She was 22.

Now, with pride, he says he has been out of jail more than a month
and, despite easy access, hasn't touched heroin.

He says the memory of living in that abandoned house in Dorchester,
the loneliness and rules of jail - a place his mother refused to
visit because the image of him there was too distressing - the
grittiness and consequences of such a depressing life, are what he
holds in mind when tempted daily to use again.

"There I was, doing drugs, robbing people, with my parents all
stressed out back in Scituate,'' he says. "I decided I don't want to
end up going to jail, or end up dying. I want a different life.''