For almost two decades, Geni Swartzwelder has played an elaborate game of hide-and-seek with her daughter, Heather. Every day, Geni, 52, takes a bottle of little white pills and sneaks it away to a secret location. Every day, 32-year-old Heather then goes on a hunt for the bottle. Many days, she succeeds in finding it. Geni knows because when she counts the pills at the end of the day, she often finds their numbers depleted.
The game began when Heather was 14. Geni noticed, haltingly at first, but with growing alarm, that her husband’s opioid painkillers, prescribed after he was injured in a motorbike accident, were coming up short.
“Heather tried to convince us that we’d lost them, but there was no other way and in the end we concluded she had to be taking them. So I started hiding them, every day, some place different,” she said.
Geni was forced to confront the fact that her only child had begun stealing her husband’s pills and had become hopelessly addicted to them. When her efforts to hide the drugs failed, the Swartzwelders bought a metal safe and locked them up. That put a stop to the game, but not for long. Heather used a video camera to film her mother opening the safe and studied the footage to extract the combination.
Heather’s father died three years ago, but the game of hide-and-seek goes on. Now Geni hides her own little white pills. She has end-stage cancer and takes opiate derivatives — medically prescribed synthetic heroin — to ease the agony in her back and chest.
Geni desperately wants to increase the strength of the medicines she is taking because she is in excruciating and intensifying pain. However, she knows that if she does the consequences for her daughter could be devastating.
“I’m in pain, very much so, more and more each day,” she said. “But I know that if I move to stronger drugs, I could make her problems so much worse.”
Geni’s dilemma captures in a microcosm one of the great unfolding tragedies of our time. Over the past 20 years, societies in the developed world have made it a priority to eradicate pain, encouraging hospitals and doctors to combat it as aggressively as they might a life-threatening virus. A public expectation has taken hold that we should all be entitled to lead pain-free lives in rather the same way that we have come to expect to be able to own a car or to holiday abroad. However, the pursuit of painlessness has come at a high price. The level of prescribing of opioid painkillers — Percocet in Geni’s case — has soared and with it the incidence of addiction, and addiction’s grim best friend: fatal overdoses.
The same escalating use and abuse of powerful painkillers can be found in rich societies from the UK, across Europe to the antipodes. Yet the country that really knows all about prescription pill excess and the human toll it claims is the US. Americans make up less than 5 percent of the global population, but consume 80 percent of the world’s supply of opioid prescription pills. Sales of the drugs have increased more than fourfold in the past 10 years, grossing US$11 billion annually. To express that figure more personally, in 2010, enough of Geni’s pills or their brand-name equivalents were handed out by doctors to medicate every American adult with a typical dose of hydro-codone — a pure opioid as powerful as morphine — every four hours for a month.