AUDIE CORNISH, HOST:
When health officials in Massachusetts studied the number of deaths from drug overdoses, they found this key factor - the majority of overdoses there were from heroin in combination with cocaine, anti-anxiety medications or alcohol. So what does that mean for the doctors who treat those suffering with addiction? WBUR's Martha Bebinger begins our story from the city of Chelsea near Boston.
UNIDENTIFIED MAN: What do you think?
ANTHONY: It's a harsh world.
MARTHA BEBINGER, BYLINE: A half-dozen faces turn towards a bald but still youthful man in gray sweats who bounds into the square.
ANTHONY: I OD'd.
BEBINGER: Anthony, whose last name we've agreed not to include because he uses and deals heroin, has just come from the hospital. He overdosed the night before on a particularly strong bag of heroin laced with fentanyl, the dealer said, or something like it.
ANTHONY: He told me how strong it was, but everybody says that just to sell their dope.
BEBINGER: Anthony says he's overdosed 12 times, mostly after taking heroin in combination with pills.
ANTHONY: The potency now is so inconsistent you don't know. So you'll eat a bunch of Klonopins and do a shot of heroin and then you're dead.
BEBINGER: When a drug combo or cocktail doesn't kill you, says Anthony, it's worth the extra $2 or so per pill.
ANTHONY: It intensifies the heroin high. And it keeps you higher longer.
BEBINGER: On the street, there's a hot market for lots of prescription medications.
NICOLE: Promethazine, gabapentin, clonidine.
BEBINGER: Nicole, who only wants to give her first name because most people in her family don't know she's used heroin, lists an amphetamine, an anti-seizure medication and one that lowers blood pressure.
NICOLE: So you think - you're like, oh, it's not a narcotic. It's going to be OK, like, but little do you know that they all take a toll on your heart and on your breathing.
BEBINGER: Nicole says some heroin users pill shop, knowing which symptoms to mention so their doctor will prescribe something for anxiety or depression. Patients who have a legitimate need for these medicines and take them as prescribed may also trigger an overdose.
NICOLE: But you think that, oh, my doctor's giving this to me, so it's fine. Nothing's going to happen to me. Like, I'm prescribed to take it.
BEBINGER: Even physicians who specialize in addiction medicine have trouble figuring out what's safe to prescribe for anxiety or depression, says Dr. Kavita Babu, a toxicologist at the University of Massachusetts.
KAVITA BABU: Not only is it difficult to put our knowledge of pharmacology into play, but sometimes managing patient expectations about how their pain or their anxiety should be treated, our clinical knowledge falls apart at the bedside.
BEBINGER: Now with the revelation that so many overdose deaths in Massachusetts are heroin in combination with a prescription medication, state leaders are urging physicians to be more careful. They promise to streamline a database where doctors are supposed to check what drugs patients are already taking. For now, Dr. Jim O'Connell, president of the Boston Health Care for the Homeless Program, asks patients which pills are big sellers on the streets and tries to avoid prescribing them.
O'CONNELL: We as doctors don't really have a good sense of what we should be prescribing, what we shouldn't. It's really the combination of other drugs that is going to be the battle down the line.
BEBINGER: Many addiction specialists also urge paying more attention to the emotional pain at the root of addiction.
We're back in Chelsea on a park bench with Anthony who has overdosed a dozen times.
ANTHONY: There's times where I really do want to die.
BEBINGER: I ask Anthony why.
ANTHONY: The more I do the more guilt I feel and the more I want to I kill myself 'cause I can't deal with the guilt and the pain and the shame.
BEBINGER: From the many times he feels he's betrayed his family with continuous relapses. Anthony clutches his hospital discharge notes in one hand. They say he's to schedule follow-up appointments, but he doesn't have a phone. He borrows mine, gets the answering service and doesn't leave a number. For NPR News, I'm Martha Bebinger in Boston.
CORNISH: This story is part of a reporting partnership with WBUR, Kaiser Health News and us at NPR News.
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