My Battle With Fentanyl

Opioids, such as fentanyl, are a huge part of my life. As an ER physician, I’ve worked with and around them for twenty years. I’ve seen the merciful relief they provide to patients in agony. And more and more, I’ve seen the damage they inflict.

I wrote The Last High to encapsulate my experience and to warn people of the risk. Not only to hardened substance users. This opioid crisis touches everyone, from young to old, the disenfranchised to the elite, and everybody in between.

Never before have I tackled a more urgent theme. I could cite the horrid death toll, but people grow numb to statistics. I do. Instead, I thought I’d share a story about one of the people who inspired me. To protect his confidentiality, I’ve changed several details about him, but I hope I’ve captured his spirit

I first met Moe in 1999. He was still so drunk after six hours in the ER that he urinated on the neighboring bed, mistaking it for a toilet. I would see Moe multiple times over the next five years. Always intoxicated. But Moe was impossible not to like. When drunk, he was very funny, intentionally or otherwise. When sober, he was all smiles. I once saw Moe wobbling down the hallway, balancing an older woman’s bulky suitcases as he escorted her out to a taxi.

About ten years ago, Moe fell into heroin use. And he started to show up with the usual complications of an IV drug user’s life: infections, opioid withdrawal, and assorted injuries. Moe was as likeable a drug addict as he was an alcoholic. Still all smiles. He once brought in a dozen donuts for the nursing staff, likely stolen from a local store.

Then Moe got clean. Not only did he get clean, but he found his purposes in life. To help others struggling with addiction. Moe got married. He had a child. He had a good life.

About two years ago, I was summoned urgently to see a patient in cardiac arrest following an opioid overdose. Even with the tube sticking out of his mouth and the mechanical CPR machine pumping away on his chest, I recognized Moe. After twenty frantic minutes of resuscitation, we were rewarded with a faint heartbeat. But even as the staff was celebrating a successful resuscitation, I had a sinking feeling.

Moe never woke up. He had been pulseless too long, and his brain never recovered. But Moe was giving to the end, donating his organs to those who desperately needed them.

Later, I ran into his grief-stricken wife. Through her sobs, she told me that after nine years of sobriety, Moe began using fentanyl the week before upon learning of his little brother’s death from an overdose. You might find that an odd reason to fall off the wagon, but I don’t. The pain opioids cause is so often contagious.

In terms of opioid tragedies, Moe’s story is kind of mundane. Unlike so many other tragic victims—first-time or accidental overdoses—he was an addict for much of his life. The risk was always there. But it doesn’t diminish the senseless of his loss. Or my anger. Not only at the criminal elements propagating this mass murder or the pharmaceutical corporations that are complicit in “legitimizing” the opioid epidemic, but at us. The doctors, the patients, the government and the public who have allowed this crisis to get so far. And at such a cost.