From Adderall to Opioids, the Personal Side of an American Tragedy

The Centers for Disease Control and Prevention tracks drug overdose deaths by county on color-coded maps. In 1999 a spot of deep red staining southern West Virginia marked the first flaring in a calm sea of blue painted across most of a country oblivious to the early contagion.

Year by year, the red sprawls across the bottom half of West Virginia and eastern Kentucky. The blue gave way to yellows, and yellows darkened to shades of orange as the death rate crept up in the Rust Belt, New England, Florida, and parts of the West. In time, blotches of red erupted across the map even as the deepest hue remained painted over that part of Appalachia where the first warning flicker appeared. But in large parts of the country, if they heard about the crisis at all, they had little sense of the threat it posed. Addiction of that kind was written off as an affliction of others. Hillbillies or African Americans or the homeless. It couldn’t happen to them.

The opioid crisis invaded the upscale community of San Ramon, east of San Francisco, on an October day in 2003 after Carmen Pack walked out of her front door with her two young children in search of ice cream. California was enjoying an Indian summer, and, after a hot afternoon in Halloween costumes, seven-year-old Alana was riding her bike and Troy, ten, was on his scooter as they set off down the sidewalk.

Jimena Barreto’s gold-colored Mercedes came down the road at about 50 mph, weaving a little. As it drew level with the Packs, the car veered across two lanes and jolted over the curb and into the family. Alana was killed instantly. Troy was barely alive. Their mother was injured. Barreto, a 46-year-old nanny who worked for several wealthy families, fled on foot. Troy died in the hospital a few hours later.

Barreto was found in Southern California. She told the police she’d taken at least eight Vicodin pills and muscle relaxants and blacked out at the wheel. Investigators examined her medical records and saw she had several prescriptions for hundreds of opioid pills from six doctors all working in the same Kaiser Permanente hospital. She may also have been drinking vodka.

There are doctors who think the mass prescribing of Adderall helped lay a foundation for the rise of opioids in universities.

Barreto was convicted of second-degree murder and sentenced to at least 30 years in prison. The Packs welcomed the sentence, but the more they learned about the circumstances of the case, the more they thought responsibility for the loss of their children lay with more than a driver high on drugs. Barreto had gone from one doctor to another in the same hospital complex, collecting prescriptions for Vicodin and muscle relaxants by faking injuries.

“There were six doctors prescribing to her for a long time,” said Bob Pack. “They never talked to each other or shared a medical file. She would go in one week, get 60 Vicodin, and a week or two later go in and get another 60 from a different doctor. That can’t be. Aren’t they required to share medical files so they know what they’re doing, or isn’t there some kind of computer system where they can look that up or track it? I couldn’t believe that there wasn’t any of that.”

When Bob looked, it turned out there had been a system in place in California for decades requiring pharmacists to report narcotics they dispensed to the state’s Justice Department. But the Controlled Substance Utilization Review and Evaluation System, known as CURES, was so backward that drugstores were still sending in their reports by fax. The records were stored and rarely looked at again.

Bob Pack worked in technology. He knew it couldn’t be that difficult to turn the system into an electronic database to check that people were not getting multiple prescriptions for opioids.

The grieving father was right about the technology, but he had not counted on the entrenched interests, medical and political, that would turn a simple measure to save lives into a decade-long odyssey. It was a struggle shared by other grieving parents around the country as they determined to find a way to fight back against the epidemic after it ripped into their lives.

Bob Pack’s hometown, San Ramon, is about as far, geographically and economically, as it is possible to get from West Virginia in the contiguous United States. It has among the highest median incomes in California. As another of its residents, April Rovero, used to see it, whatever may have been going on with drugs in Appalachia was part of another world, just as when heroin and crack hit New York.

Now, just before Christmas each year, April marks the anniversary of the death of her son, Joey, in 2009 by tending a tree in a memorial garden in San Ramon. The tree was bare of leaves as she decorated it with red ornaments for a seventh year. “I keep thinking maybe as the years go by it will get better. What I noticed this year was that I didn’t start having that sense of foreboding a week before. It was more two or three days. It is a tough day.”

April spent those years putting together the pieces of what happened to Joey and with it an understanding of an epidemic swirling around her but that, like many Americans, she never saw coming. Much of what she found is discomforting. Even now, she doesn’t know if her son was actually addicted to oxycodone.

Joey was a senior at Arizona State University, and his mother was expecting him home for Christmas. Instead, she got a call saying he had been found dead in an apartment he shared with two fraternity brothers. A detective told April her son’s room was littered with empty medicine bottles. The doctor’s name on the labels was Lisa Tseng. Joey died from a mix of oxycodone, Xanax, and alcohol. Through her grief, April struggled to understand how she could have missed such a thing. But there was a clue when Joey was home for Thanksgiving during his first semester at college. He told his mother he thought he had attention deficit/hyperactivity disorder (ADHD). April asked what on earth he was talking about. No teacher in high school had ever said he had a problem concentrating. “He said a friend gave him an Adderall pill, and he was able to study for a test and did really well on it, so he must have ADHD. That told me right there that there is a perception out there that kids think these medicines are safe just because they’re prescription.”

There are doctors who think the mass prescribing of Adderall helped lay a foundation for the rise of opioids in universities. The number of children said to have ADHD surged over two decades. By 2012, 1 in 10 Americans under the age of 17 was diagnosed with the disorder, and 3.5 million were being prescribed stimulants to treat it. But Adderall is an amphetamine and over time users develop a tolerance and dependence, and before long it had become the second most illicitly used drug on campuses after marijuana. The drug also proved another step in the conditioning of young Americans to believe that their problems can be solved with a pill.

April asked herself why she hadn’t heard of this epidemic. This wasn’t a small thing. It was everywhere, but she hadn’t seen it. Why was no one talking about it?

April learned that Joey and two other men drove six hours to a small clinic in Rowland Heights, California. It was her son’s first visit to Dr. Lisa Tseng. Joey cooked up a story about a sprained wrist, anxiety, and aching muscles. Tseng wrote him a prescription for 90 muscle relaxants, 30 of the highest dosage of Xanax, and 90 oxycodone pills.

“What he got was the Holy Trinity. That combination of medication that can absolutely be deadly. It’s ridiculous,” said April.

She discovered Joey was selling pills to his fraternity brothers. The police found a log in his room listing who owed him money. Joey’s roommates were also using opioids. One of them, John, took his own life nine months after Joey’s death. “Joey was the first of nine students at Arizona State University in a twelve-month period who passed away from either prescription drug overdose or related to a heroin overdose. They all started with pills,” said April.

Once she got past the initial shock, April asked herself why she hadn’t heard of this epidemic. This wasn’t a small thing. It was everywhere, but she hadn’t seen it. Why was no one talking about it?

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