ST. ALBANS – Sally Constantine is six months sober.

Today, she’s recovering from a broken femur, spending much of her time at home and taking much of her life day-by-day and hour-by-hour. She recently finished cleaning her house, where she lives with one of her three sons.

But only a few months ago, she was struggling with her tenth year of an addiction to painkillers, one of many whose experiences with what is now called the opioid epidemic didn’t come through crime and black markets, but over a pharmacy counter.

It was a struggle she and her family said derailed her life and very nearly ended it earlier this year. This March, an overdose led her to die three times. It took three doses of naloxone, better known as Narcan, to revive her.

It led her to quit narcotics. Cold turkey.

“I feel like a different person,” Constantine said.

According to the National Institute on Drug Abuse (NIDA), a federal research institute studying drug abuse nationwide, as many as 18 million Americans misused painkillers in 2017, with older adults cited as those most at risk for abusing or misusing their painkillers.

In Vermont, a 2015 state survey found as many as 7 percent of the state’s adult population misused prescription drugs at some point in their life, with complications from prescription opioid abuse sending users to an emergency department at a rate of one for every 10,000 Vermonters in 2016.

Overprescription of painkillers – opioids and otherwise – is something both Vermont and the nation at large have had to reckon with as the medical world begins to better understand its role in the opioid epidemic. It’s an issue at the core of everything from recent reforms at local hospitals to the 2,000 lawsuits filed nationally against the country’s largest prescription opioid manufacturers, including a suit recently filed by St. Albans City.

“As a state, as a country, there was a ton of overprescribing,” said Melinda White, a medication-assisted treatment coordinator in Northwestern Medical Center (NMC)’s Partners in Hope and Recovery. Anecdotally, as she only joined the hospital within the last few years, White said it was a shock for many of the area’s healthcare providers, who would say they were helping people and were “torn up to find out they were causing harm.”

Sometimes lost in those larger stories, however, are the personal histories of people like Constantine, who insisted on sharing her story so that others could learn what she’s gone through and could possibly find encouragement to break their own addictions.

“I hope people learn that if they’re on narcotics, they can quit,” Constantine said.

Addiction

According to Constantine, her addiction began gradually.

She struggled with pain before her eventual addiction, the result of a broken back and a disease that’s left her bones brittle and easily broken. Eventually the pain became too much, and she sought medical help for treating it. “I couldn’t tolerate the pain,” she said.

After some prodding, her doctor prescribed her with an over-the-counter painkiller, written for a lower dosage Constantine was required to take several times a day.

It wasn’t enough to dull the pain, she said.

“It wasn’t helping me,” she said. “It wasn’t helping at all.”

When she raised the issue with her doctors here in St. Albans, the response, according to Constantine, was increased dosages or a new drug, gradually building a decade-long list of narcotics spanning everything from steroids to pain patches and many of those narcotics now intimately tied to today’s opioid epidemic.

That list eventually culminated with hydromorphone, a prescription opioid Constantine said she’d taken consistently for the last five years. “I couldn’t live without the medicine – I wanted more,” Constantine said. “I’d be crying all the time with pain.”

Her drug use, however, began taking a physical toll on Constantine. She talked about how often she’d forget things and how she was always passing out. Depression set in. “I was doing things I wouldn’t normally do,” Constantine said.

She also talked about how often she’d lose control and fall, resulting in more than a few broken bones over the past several years, and about how, in only a matter of months, she totaled two different vehicles in car accidents she believes were caused by her drug use.

There are side effects consistent with Constantine’s level of abuse, according to NMC’s White, and consistent with the experiences of a lot of people struggling with addiction. “There’s a lot of exhaustion and lethargy. Apathy sets in,” White said. “People are not capable of participating in life.”

Constantine’s family noticed.

“For me it was frustrating,” said Tina Kretser, the fiancé of Constantine’s oldest son Howard and, according to Constantine, one of her best friends. “I knew she was on too many medications – enough to tranquilize a horse.”

In a letter she penned about her experiences with Constantine’s addiction, Kretser described watching Constantine’s life slowly deteriorate between the constant falls and accidents, as well as the mental effects of her addiction, such as the memory loss and fatigue. “It scared me,” Kretser told the Messenger.

Her letter, as well as a letter penned by Constantine, can be found on page seven in today’s Messenger.

Still, Constantine continued using painkillers.

“I wanted the pain to go away,” she said. “I had too much pain in my life.”

Health care providers at the Northwestern Medical Center’s pain clinic, where Constantine had sourced her prescriptions, began to taper patients off of their prescriptions and to refer them back to primary care providers as a part of the clinic’s larger transition to focus on addiction recovery. A few of those who were addicted to painkillers were referred to the hospital’s medication-assisted treatment program.

Constantine, who had been on prescription painkillers for a decade and was actively taking a prescription opioid for managing pain at the time, was one of those patients who found their prescriptions gradually tapered off as the clinic transitioned into today’s Partners in Hope and Recovery.

Still, between a short term prescription for painkillers to help manage pain from a recent surgery and her stash of prescription narcotics she built up over those ten years, Constantine said she had enough to sustain her addiction even as she was formally tapered off of her prescription by the clinic.

“I didn’t get street drugs, but I got pills when I wanted it,” Constantine said. “When you want them enough, you can get them.”

Despite her prescription’s tapering off in December 2018, she had hoarded enough pills from past prescriptions to continue using well into March 2019.

But in March, everything changed for Constantine.

“Spiritual awakening”

In March, Constantine was in Upstate New York to visit her oldest son and his fiancé, Kretser.

According to Kretser, Constantine was hallucinating, “lashing out” at her and Constantine’s son, and generally not making sense when she spoke. Things would only get worse during the visit, with a pair of falls that the family now attributes to Constantine’s drug use and broke a femur.

In Constantine’s words, her “body gave out,” but it was also the start of a “spiritual awakening” for her.

After 9-1-1- was called and the ambulance arrived to pick her up, Constantine had sunk to a point where paramedics had to administer two doses of Narcan to revive her, with a third dose after Constantine arrived at the hospital.

She would die three times at the hospital.

“I have a hard time believing it,” Constantine said, looking back. “It’s by the grace of God that I’m still here. It must mean that I still have something I need to do.”

According to Constantine, doctors in New York had taken the stash of painkillers she had brought with her, leaving the addicted Constantine without the narcotics she had grown dependent on.

She said that, while in New York, she hallucinated and felt sick, that she was experiencing depression and the pain that originally drove her to painkillers had returned. “I was still in pain,” she said. “I missed them because I was still in pain.”

All the while, she recuperated at a nursing home, an experience Constantine said was so miserable she signed herself out. She was brought to her son’s and Kretser’s home, where she recovered enough to eventually return to Vermont.

Those were the first weeks in almost a decade where Constantine went without painkillers.

According to NMC’s White, the first weeks are some of the hardest weeks of the recovery process, where someone goes through their initial withdrawal. “It feels like one of the worst flus of your life,” White, herself seven years in recovery, said. “It’ll feel like you’re dying, but you’re not actually dying.”

Constantine’s experience was a shock for her.

As a lifelong Catholic, she described it as a “spiritual awakening” that led her to outright quit taking painkillers “cold turkey,” uncommon in the recovery community, according to White.

In Vermont, recovery typically takes the form of a medication-assisted treatment, or MAT, where a user is prescribed one of two possible controlled opioids to help stabilize addiction cravings as they learn how to address their addiction through other methods, like counseling or behavioral therapy.

“It’s rarely cold turkey,” White said. “It’s not a best practice or common, especially in a medical setting. Non-narcotic comfort meds can make a big difference.”

However, White added, recovery can impact everyone differently, and, for some, maybe outright quitting a narcotic could be the answer. “It’s not going to kill you,” she said.

When Constantine returned to Vermont, she combed her house for her stash of painkillers and told the Messenger she almost immediately turned them over to the St. Albans Police Department (SAPD). A second stash was found soon after her interview with the Messenger, which Constantine later confirmed had also been handed over to the SAPD.

“I didn’t know I took so many,” she said.

It’s been six months since she first gave up her painkillers, and Constantine said she’s still committed to remaining clean and taking back her life.

She already plans on attending a wedding soon – Kretser and Constantine’s oldest son have a wedding date planned sometime for 2020 – and Constantine, a fan of traveling with a home decorated by more than one photo from family adventures, said she’s ready for her next vacation.

“We’ve been through a lot,” Kretser told to the Messenger. “It was mind boggling – a lot of stuff.”

“But,” she added, “I asked her to come with me to get my wedding dress.”

Constantine said there are still bouts of depression, that she’s felt cravings again and that she’s still in pain from all of the bones she’s broken, but Constantine said she’s getting help when she needs it.

She manages her pain now with Tylenol and is seeking another treatment for managing pain in her back.  She’s also busied herself with housekeeping – “cleaning the house was a chore and a half,” Constantine said – and she reached out to White ahead of speaking with the Messenger with the hope of telling others her story.

“Her story’s a message of hope,” White said. “She’s participating in life again. There are people who are still going through this… and now they can see her story.”

“For me, I hope talking to people helps me and anybody else out there,” Constantine said. “If you keep something bottled up, you’ll go back to drugs. That’s what I think.”

White told the Messenger that recovery can be different for a lot of people, but that the first year will be one of the hardest, with the typical peaks and valleys that come with breaking addictions. “As this goes on, it gets better,” White said.

“It’s hard, but I take it each day at a time,” Constantine admitted. Still, she was hopeful as she moved forward with recovery.

She said she sometimes wondered what her late husband would’ve thought. He, too, struggled with substance abuse. In his case, it was alcohol. “My husband would’ve been proud of me,” Constantine concluded.

Apart from her oldest son, Howard Jr., her second and third oldest sons still live within St. Albans and are regularly checking in with her. One still lives with her and the other just up the road. “I think she’s a lot better now,” her son CJ said. “She has people.”

“I do feel like a different person,” Constantine said. “If I need help, I can get it… and I’m ready to keep busy and talk to people.”

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