Heroin, prostitution: If this mom and daughter can beat addiction, can America, too?
KANSAS CITY, Mo. _ The mother's hands tremble too much to try this alone.
"Are you going to do my eyeshadow?" Nancy Spencer says.
Short and round at 54, Nancy draws on a cigarette inside the old midtown Kansas City studio apartment she shares with daughter Liz Weber, 33 _ two women once so addicted to heroin, they worked as prostitutes.
Nancy's thick auburn hair is striped gray at the roots. Her mouth is missing teeth: 16 were once bashed out by a man who beat her during an argument.
Liz drops a clear plastic case of eye makeup onto their tabletop cluttered with lotions, prescription bottles, an ashtray filled with crushed cigarette butts.
"I'm doing a lighter purple, a darker purple and then a blue," she says, dabbing her mother's eyes with hues to complement her blouse. "I like to match colors."
As morning routines go, this new one _ happily doing hair and makeup in expectation of a good day _ is so much better than when Liz, barely four months ago, was injecting heroin into the main vein in the front of her mother's neck.
Or into the backs of her knees, or between her toes, or piercing the thin veins near her mom's nipples before Liz would inject herself.
"I know that sounds really bad. Yeah, my daughter shot me up," Nancy says. "It was, like, the only way there was going to be a relationship between us. I couldn't get clean (off drugs). It, like, formed a closeness between us. I know that sounds strange. But it did."
"Yeah," Liz agrees, "it really did."
Of all drugs classed as opioids _ including the prescription pain pills oxycodone, hydrocodone and fentanyl, which work inside the brain like morphine from opium poppies _ heroin tends to hold the most notorious reputation.
But it is out of concern that all such drugs have spawned a deep and deathly public health crisis that President Donald Trump on March 29 signed an executive order creating a commission to fight opioid abuse, addiction and overdose.
"We want to help those who have become so badly addicted," Trump said, calling the United States' opioid addiction a "total epidemic" that now afflicts some 2.5 million people.
Of the 52,000 fatal drug overdoses in 2015 _ a number that has tripled since 1999 _ 33,000 involved opioids.
Critics faulted the president for including no specific funding increase as part of his move. Others cast doubt on the president's commitment, noting that had the Republican replacement for the Affordable Care Act passed, it would have stripped the requirement that insurers cover substance abuse as an "essential" benefit.
The new commission's chairman, New Jersey Gov. Chris Christie, said he and Trump "want to save lives."
"Addiction is a disease," Christie said, "and no life is disposable."
If any two people illustrate both the depth of the problem as well as possible hope for recovery, it might be Nancy and Liz.
"If you believe in a higher power, he or she definitely has a purpose for this lady," Truman Medical Center psychiatrist Doug Burgess said of Nancy. "She should have died 10 times, 100 times over."
Not only do Nancy and Liz spell hope, said Burgess, who treated them as director of the hospital's outpatient behavioral health unit, they also represent an overlooked population.
While many media reports have focused on suburbanites with back pain who accidentally become hooked on OxyContin, or on teenagers who turn to heroin after toying with prescription drugs, Nancy and Liz both started on drugs as children to self-medicate the trauma of what Burgess called their "horrific" lives.
Physical abuse. Emotional abuse. Countless incidents of sexual abuse.
"I have been raped 15 times," Nancy shared.
She was 11 the first time. For Liz, her first sexual assault occurred at 18 months.
"I never would have made it through what they made it through," Burgess said.
Yet on a recent morning, both women _ off drugs since December _ were up long before the sun, preparing for a full day of counseling and recovery classes at Truman's Recovery Health Services with the excitement of teenagers primping for a date.
They did their hair and makeup, held hands to read prayers, smoked cigarettes and ate blueberry muffins fresh from the oven.
"It's like a whole new lease on life," said Liz, who agreed to speak with the desire that their story might bring hope to others. "It's a complete 180. Everything is different now that we're sober."
"We have a life now," Nancy said.
Their speech, facial movements and gestures are often fidgety and hyperkinetic, a consequence of the inseparable nature of their personalities and decades of drug use.
Affable and open, they spoke inside the same apartment where each day they routinely injected between $100 and $150 worth of heroin, the money or drugs supplied by a man who gave it to them in return for sex.
"Everything was for the drugs," Nancy said. "There's nothing that wasn't for drugs. Our entire life and being was drugs."
LIFE WAS GOOD 'UNTIL I WAS ABOUT 9'
The nature of the torment that led them to drugs can hardly be ignored.
In recounting her life _ born in Florida, never knowing or meeting her father _ Nancy told of one abuse after another.
"It (life) was certainly good until I was about 9," she said. "A good friend of the family molested me for about a year. ... Nothing happened to him."
They moved often, to Indiana, Missouri, Colorado and Tennessee. Poverty and drinking reigned.
"I used to get the shit kicked out of me," Nancy said. "We had big rats in the house. You could hear them in the kitchen. You could see them running along at the top of the ceiling."
By 12, she was smoking pot. By 13, she was snorting cocaine. She got pregnant from another sexual assault and had her first of several abortions. By 14, she was shooting up methamphetamine and using cocaine. Other drugs followed: crack, psychedelic mushrooms, Ecstasy, LSD.
She won't lie.
"It made me feel...," she searched for the word, "acceptable. Accepted by everyone around me."
Life on drugs was peaceful or fun and allowed her to cope. Life off drugs was a nightmare.
"The drugs killed me," Nancy said, "but on the other hand, they saved me. If we were sober, we probably would have ended up killing ourselves."
The rest of her life followed suit: She learned to cook meth on an open stove before the age of 18. She'd get pregnant seven times and would have three children, all of whom she's still in touch with. There were marriages and other relationships, and a stint in jail for check forgery.
Liz, meanwhile, said she has few memories of her childhood, other than men beating her and her mother.
"I know I was born in Memphis," Liz said. "I started smoking weed at 14. I started doing methamphetamine the night of my 17th birthday."
She would eventually have two daughters she would lose to the state of Missouri.
Over time, Nancy and Liz's bodies would bear the brunt of their hard lives, leading to prescription opioids. That led to cheaper heroin that coursed through their veins with delirious effect.
"Your whole body turns warm," Liz said.
"It's like shooting perfection into your body," her mom said.
CAPTIVE TO DRUGS
Perfection has a price.
Opioid withdrawal, Burgess said, is arguably more painful and difficult than coming off of any other drug.
Sweating. Shaking. Vomiting. Cramps that double up the body. Some call it a deep "bone pain."
"It's probably the worst feeling you'll ever feel in your life," Liz said. "You really just feel like you will die: pain, diarrhea, you can't stop vomiting. Your bones feel like they're being crushed."
To be sure, specialists make a clear distinction between individuals who are physically dependent on opioids and the more intense state of addiction.
Dependence, which can happen in as little as six to eight weeks, means the body has grown accustomed to operating on the drug. Suddenly ceasing the drug triggers some level of withdrawal, from mild symptoms like insomnia, anxiousness and lack of appetite to crushing pain.
"The thing that makes opioids so tricky," Burgess said, "is even if you take them exactly as prescribed, if you take them long enough and at high enough doses, there is a chance you will become physically dependent."
Addiction: "You're talking about a complete loss of control over use," he said.
Burgess explained that a prime reason opioid dependence or addiction is hard to beat has less to do with the desire to get high or feel numb. More, users fear the pain of going off them.
"This is true of all addictions," Burgess said, "but you'll hear it a lot from people who use opiates. They get to the point where they're not using it to get high. They are just using it to prevent the withdrawal."
Unless, that is, life becomes even more unbearable. Captive to heroin and prostitution, Nancy felt exactly that way.
"I couldn't take it anymore," she said. "I couldn't take it. I wanted to die."
SUBOXONE AND HOPE
Nancy received her first treatment at Truman Medical Center's Suboxone clinic Dec. 6, barely a month after the new clinic opened.
The change over the next days was so quick and positive, she gave her daughter an ultimatum: Get into treatment with me, or get out of the apartment.
Liz hardly needed it.
"I saw how wonderful she was doing," Liz said. "She wasn't in pain. She wasn't high. I was like, 'Wow, I want that.' "
Liz began treatment 13 days later.
"I have such a great outlook on life now," she said. "I'm looking forward to every day that I wake up."
A number of medications exist to treat dependence to opioids and heroin. Few are without controversy.
The oldest and best-known is methadone, which has been available for use in the U.S. since the 1940s. The drug, administered at specialized clinics, is considered a "replacement therapy" in that it attaches to the same receptors in the brain as do heroin and other opioids.
In doing so, it cuts back on drug cravings and withdrawal symptoms while creating no high.
A longstanding criticism of methadone is that some addicts will remain on what are known as methadone maintenance programs for years. As such, the criticism goes, they are effectively just substituting one drug dependence for another with a death toll of its own that is not insignificant. In 2015, methadone overdoses killed 3,300 people.
At Truman, Nancy and Liz received Suboxone. Approved by the Food and Drug Administration in 2002, it is a combination of two anti-opiate drugs, buprenorphine and naloxone.
Like methadone, buprenorphine is its own type of replacement that links to opioid receptors. It, too, prevents heroin and other drugs from attaching, cuts cravings for more opioids and all but eliminates withdrawal. Instead of going to a clinic, the women can take it at home.
As Nancy discovered, because the brain's opioid receptors are filled with buprenorphine, trying to get high with other opioids is of little use.
"When I first started (on Suboxone), I tried to shoot up other pills," Nancy said. "Nothing happened."
The naloxone part of the drug is a safeguard against addicts trying to misuse Suboxone for any possible high.
Suboxone is supposed to be taken up to three times a day as a pill or film that dissolves under the tongue. Should addicts try to melt it down and inject it, the naloxone (typically used as a life-saving drug to reverse opioid overdoses) kicks in and sends users into sudden withdrawal _ which itself acts as sharp physical warning to use the drug correctly.
It took three visits each to Truman for Burgess to get Nancy and Liz up to their full doses.
"After the first week," Burgess said of Nancy, "she came in and said, 'I can't remember the last time I felt this good.' "
He and other addiction specialists insist that the women's opioid addictions _ or America's, for that matter _ can't be solved with medications alone. He estimated that only about 10 percent of the women's long-term recovery will come from Suboxone.
It's unknown how long they'll have to take it. If they make enough personal improvements, they'll be able to wean themselves off.
Sobriety and lasting life changes will come only as the women deal with the trauma and abuse that brought them to drugs in the first place.
Already, they have made drastic changes. Shortly after beginning treatment, the women banished the abuser who provided them heroin or money for sex. They've opened their apartment to fresh air. Liz has worked to re-establish contact with her daughters.
Poor, with some money coming from disability, recovery for each is now a full-time job.
"I'm dead serious," Liz said. "When I was on drugs, I basically thought I was a piece of trash and I was never going to amount to anything."
Nationally, the relapse rate for severe opioid use disorders can run as high as 90 percent for people who don't receive appropriate treatment.
Several days each week, Nancy and Liz attend multiple classes at Truman with names like Mindfulness; Me and My Mind; and Catch-22's of Depression.
"When faced with tough situations," Burgess said of Nancy and Liz, "their default is going to be escape through alcohol or drugs. When this happens, we hope we have provided them with enough alternative tools ... to avoid relapse."
"There is always hope," he said, "and people who are engaged and stay in treatment are almost universally successful."
That's certainly what Nancy and Liz want. Hope is what they have.
Hair and make-up done, they gather their purses and cigarettes. Nancy grabs her walker. They'll walk nearly a half mile and take buses to get to Truman.
"I never thought life could be like this," Liz says.
Nancy offers a message.
"Don't give up," she says. "No matter how bad your life has been _ and mine, it's been bad _ you didn't think you can recover from it. You can. ... I feel just amazing. I feel like I can do anything."
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