When she finally became an anesthesiologist, after years of studying and training, Jennifer Smith* found that being a first-year physician wasn't as great as she'd hoped.
"I was very unhappy with the job I was in. It was a lot harder work and a lot less gratifying than I had imagined it would be," Smith says. "I was working a lot of 24-hour shifts. I was exhausted all the time. I had very little time for my personal life and I felt isolated because I lived alone. And the workplace wasn't a collegial environment — it was common for people to get into arguments with surgeons or the operating room staff. In medical school and in residency, you keep working for something — for that next step. But when I got the job, I realized: This is it. "
The depression and eating disorders (anorexia and bulimia) she had struggled with since her teen years were getting worse. She had tried various treatments throughout her life, but nothing helped.
One day, about five months into her new job, she realized she had some extra fentanyl left over from a patient she'd been treating and put it in her pocket. Instead of "wasting" the drug (disposing of it safely — what she was supposed to do), she took it home with her.
Fentanyl is part of the opioid family of drugs, which includes heroin, morphine, oxycodone, hydrocodone, codeine, and others. As a legal prescription medication, it's typically administered as an anesthetic to treat severe pain related to certain procedures, such as surgery, or cancer. It can take many different forms, including liquid (injected intravenously), patch (applied to the skin), film or spray (applied under the tongue), pill, and lollipop. Fentanyl powder is also common, but it's used illegally.
"Fentanyl attaches to an area of the brain that's a pleasure area and gives you a particular high. It's approximately 50 times stronger than heroin and 50 to 100 times stronger than morphine," says Gail D'Onofrio, MD, professor of emergency medicine and chair of the department of emergency medicine at Yale School of Medicine in New Haven, Connecticut. "It's the most powerful of all the opioids, and it's becoming one of the most prevalent overdoses — that's why we're all nervous."
Because fentanyl is so much more potent than other opioid painkillers, the consequences of overdosing are much more likely to be fatal. (Pop superstar Prince died from a fentanyl overdose in April of 2016.) And if you don't die from an overdose, you could potentially have brain damage for the rest of your life.
An Addiction Begins
Once Smith took home the extra fentanyl, she wasn't exactly sure what she'd do with it. "I didn't have any set plans, but I kind of had a thought in my head that maybe I'd use it to just relax," she says. "I knew it was illegal and I was worried about becoming addicted to it. And I knew if I got caught, I could get fired and lose my medical license."
As a doctor, she was also well aware of the life-threatening dangers that overdosing could bring, as well as the drug's side effects, such as nausea, constipation, confusion, dizziness, dry mouth, and sleepiness.
"But I was in such a desperate place, it was like: I just need to make the pain go away," she says.
A couple of weeks later, Smith got into her bed, injected the drug, and lay still to let the unfamiliar — but very welcome — feelings of calmness and euphoria wash over her. Then she told herself that she would never try it again. But about two weeks later, after a particularly long, tiring day at work, the allure of the drug was too much to resist.
"It sounded like a nice escape from the stress that I had experienced during the day," she says. "I wanted to go back and visit it again."
But after that second dose, Smith's addiction quickly began to take over her life. Throughout the following eight months, she progressed from using a couple of times a week to using as often as five times a day, and her dosage increased tenfold. At work, she'd sneak injections in the bathroom or in the on-call room. At first, being high actually made it easier for Smith to do her job.
"I didn't feel any of the pressure that I normally felt," she says. "I was able to have a clear head. Thank God I never hurt anyone on the job."
And it was easy to feed her addiction, because she could always get more fentanyl and needles.
But as her addiction became more serious, Smith started to feel ashamed and embarrassed, and then she would use more to drown out those feelings. She also became paranoid that her bosses were catching on to her, though they never said anything.
Smith injected the drug into her arm at first, but then she moved to her foot so nobody would see any marks on her exposed skin. At one point, probably due to inadequate sterilization, her foot became infected, so she asked a doctor friend to write her a prescription for antibiotics.
"I gave her a lame excuse that my cat bit me on my foot," Smith recalls.
"I remember the day that I realized I was addicted," she says. "I was sitting on my couch at home, thinking to myself, Could I stop using it if I wanted to? And I thought: Absolutely not. I could never stop in a million years."
She was trapped, and she didn't know how to escape.
Opioid addiction is a serious problem in America. In 2015, 2 million teens and adults had a substance use disorder involving prescription pain medication, and more than half a million teens and adults were addicted to heroin, according to the American Society of Addiction Medicine. These types of drugs are so potent that opioid-related overdose deaths made up more than half of all lethal drug overdoses in 2015.
And we're likely to see ever-worsening numbers in the coming years: Fentanyl encounters (meaning the number of times drugs were submitted for testing by law enforcement and came back positive for fentanyl) more than doubled between 2014 and 2015 in the United States, according to the Centers for Disease Control and Prevention, and the Drug Enforcement Administration reports that, nationwide, fentanyl availability, seizure, and known overdose deaths have never been higher.
What's even scarier is that fentanyl — again, the most powerful drug in its family — is a synthetic opioid, meaning it can be made easily in a lab. Then it can be mixed into or disguised as illegal "street" drugs that are called something else — it's often sold with or in place of heroin — which makes it much easier and more likely for people to accidentally overdose. In other words, what you see isn't always what you get, and what you get can kill you.
"Here in New Haven, we had 18 overdoses in one night and three died. The individuals thought they were buying cocaine, but in actuality, it was fentanyl," says Dr. D'Onofrio.
Addiction, of course, can happen to anyone. But Smith was at higher risk than the average person, because she was an anesthesiologist and because she had an eating disorder.
"Anesthesiologists are overrepresented in addiction treatment. It has to do with access — they administer medications, so they're carrying the drugs around with them," says Joseph Garbely, DO, medical director and vice president of medical services at Caron Treatment Centers. "And co-occurring substance use disorder is common among eating disorder patients."
After eight months of fentanyl abuse, Smith was sick of feeling paranoid and knew that she'd either get caught or killed if she kept using, so she tried detoxing during a one-week vacation. But a couple of days in, she hit a new low.
"I was scared that something dangerous was going to happen to me, so I called my psychiatrist and admitted everything to her," Smith says. "She insisted that I go to a hospital (not the one that I worked at)."
In the hospital's psych ward, Smith detoxed and the doctors there talked her into going to a treatment center for four months.
"At first I was very against it," she says. "I thought I could just return to work and pretend that I wouldn't start using again. But I realized that I needed separation from my job and the drug."
So Smith went to a Caron Treatment Center, where she talked to others who had been through similar experiences and felt less alone. And she learned healthier coping mechanisms for dealing with stress, such as calling friends and family members, going for a walk or run, or reading.
The approach to addiction treatment at Caron Treatment Centers is comprehensive. Dr. Garbely says that the center's focus is four-pronged: Patients tend to receive anti-craving medicine, counseling and/or drugs for any co-occurring mental illness, invitations to join support groups, and a spiritual consultation.
"We teach them cognitive behavioral therapy, dialectical behavioral therapy, and mindfulness meditation, so they have an actual tool box that they can use in the moments that cravings come up," Garbely says. "Like any other chronic disease, you're really working on keeping it in remission."
After Caron, Smith moved into a "sober house" with others who were recovering from addiction. They went to AA meetings together and she found a sponsor whom she could call whenever she felt an itch for drugs.
Now Smith is living on her own and has a serious boyfriend who knows all about her past and is supportive. She's been opioid-free for roughly two and a half years, she no longer has disordered eating habits or depression symptoms, and she's starting a yearlong fellowship this summer on addiction medicine to become an addiction specialist. She continues to go to AA meetings two to three times a week and keeps in touch with her sponsor.
"I feel a lot better — I feel hopeful for the future, happy, and more energetic," Smith says.
Smith hopes that, by sharing her story, she can help get rid of the stigma that's too often attached to addiction.
"There's a lot of shame that we feel, and I don't think that should be necessary," she says. "It's a disease like any other disease. I think it shows a lot of strength that we have gone through something like this and have overcome it. I think the stigma prevents people from getting treatment, and I hate to think that people aren't getting treatment. I want people to know that it's OK to ask for help. I was scared to do that at first. But you don't have to go through it on your own."
If you or someone you know is overdosing on a drug, call 911 immediately. If you or someone you know is suffering from an opioid addiction, click here to find the contact information for your state's department of public health, which can direct you to addiction treatment and other local resources.
*The subject's name has been changed to protect her identity.