A run-down of the direct financial costs of my opioid addiction over the past 15 years of full-blown active addiction. I've also estimated some of the indirect costs in medical / legal fees and lost income to give a truer picture of total financial loss. God, this one's depressing.
A high school graduation photo (I'm fourth from the left and in the back). Incidentally, not a single one of the fourteen guys pictured is looking at the camera. I was salutatorian (second in my class academically) and was accepted to my first-choice university, which is in the Ivy League, through its Early Decision program. I had a lot of "friends," but I bounced between social groups, and in those days, I was a lonely loner. I also had a desperately deep crush on a straight guy a year older than me.
By this time, I had experimented with at least a dozen mind-altering chemicals. Although my high school was known for partying, injection drug use was not just unmentionable; it was unthinkable to 99.99% of my high school. No one knew that I had shot heroin for the first time during my sophomore year, when I was 15.
American banking heir Matthew Mellon, who died while seeking treatment for his opioid addiction in Mexico, reportedly spent upwards of $100,000 per month on OxyContin pills.
Southern gentleman-lawyer Alex Murdaugh, who murdered his wife and son and defrauded dozens of law partners and clients, claimed that financial stress from his oxycodone habit was the impetus for his white-collar crimes. He, too, spent tens of thousands at a time on oxycodone.
People are shocked when I tell them that homeless addicts often scrounge up 50 to 100 dollars per day to fund their dope habits.
The great truth of drug addiction is that no matter how much money you have coming in, it will never be enough.
The Needle and the Damage Done
I tried oxy for the first time when I was 14 and heroin for the first time when I was 15 (there's more information on my early drug use here). However, I didn't pick up a habit* until I found a reliable heroin connection in my college town midway through my sophomore year.
*In junkie parlance, having a habit means that you are using regularly enough to experience withdrawal when you stop taking the drug. During that first year of collegiate use, I had what's called a chippy, which is sort of a baby habit: Something small and cuddly; a thing to be nurtured. During the second year, I descended into full-time, frenetic addiction.
Even though I spent at least $3,000 to $4,000 on drugs during high school, most of which went to OxyContin and heroin, I'm chalking that up to youthful experimentation expenses because my addiction hadn't really gotten its hooks in me yet.
To arrive at a reasonably accurate estimate of the direct financial costs of my opioid addiction over the 15 years during which my struggle with these drugs was the defining feature of my existence, I divided my addiction into several periods.
(1) Collegiate use beginning halfway through my sophomore year and ending halfway through my senior year. This ended with the sh*t really hitting the fan when my drug dealer, a fellow student, was arrested with $50,000 worth of heroin while leaving my house.
The arrest was covered in national media, which dubbed her the Ivy Queenpin. The incident led to the DA threatening me with a B felony conspiracy to distribute charge, which carries a prison term of 1 to 10 years, the mere specter of which was nearly enough to get me expelled from college.*
*My dealer ended up going down for all of us; she served a year in prison. After her release, she became an award-winning journalist and documentarian who covers prison reform and addiction-related topics for national publications. She also wrote a bestselling memoir that earned praise from Piper Kerman, the author of Orange is the New Black. So many crazy stories to come.
Subtotal for this two-year period: $20,100
A random soiree from my freshman year of college, which was one of the best years of my life. I had the highest GPA in our building (over a 4.0, which is very rare at my university), and I was one of the social leaders of our freshman group.
Once again, however, I bounced around between cliques, keeping my distance without really meaning to.
I avoided opioids almost entirely during this year, but I burned the candle at both ends by binge drinking on the weekends (which, in the grand collegiate tradition, occasionally stretched from Thursday night until Sunday afternoon).
Another freshman year party night. This time, my friends and I traveled across town to party at the university that my cousin Megan attended (she's the brunette on the far right here; she's now a lawyer who works for a group that provides free legal counsel to incarcerated people).
A photo that speaks for itself is a wondrous thing.
Ah, the damp fall leaves / crackling Gothic fireplace nostalgia. The small city that my university is located in is the quintessential quaint East Coast college town. I basically chose my college because it was voted the most Hogwarts-y Ivy the year before I graduated high school.
(2) My time in New York City, which I relocated to after graduating from college and securing my first job at one of the nation's cutting-edge hospitals. By chance, I ended up living in Williamsburg, a hipster haven that happened to be the dope capital of New York City, which conveniently happened to be one of the heroin capitals of our world. Predictably, this ended a year later when I was fired for being impaired and sketchy on the job.
Subtotal for this period: $24,000
(3) An interlude for my first year of medical school in New Jersey, during which I mainly used prescription opioids and benzos / barbiturates. Right before Christmas, I overdosed and was treated at the teaching hospital affiliated with my school, which was mortifying.
Somehow, I finished my first year at the top of my class academically. Nonetheless, my mental health was abysmal; the strain of my Jekyll-and-Hyde existence was really wearing on me, and I wanted nothing more than to return to being a full-time drug addict. I disclosed my addiction to my school and was granted a one-year leave of absence to get help.
Subtotal for this period: Negligible (almost entirely prescription drugs covered by insurance)
(3) Several years during my mid- to late-twenties after I left medical school, during which I moved around from Upstate New York (home) to Lebanon (Oregon), Delray Beach (Florida), and Maui (Hawaii). During this period, I was earnestly trying to get clean, but I just could not make it last. I alternated between Suboxone maintenance, which I detested, and being completely clean (my thoughts / feelings about opioid maintenance treatment are here and here [second link is specific to methadone]).
There was a clear pattern: I would go to residential rehab for 30 days, graduate with flying colors, and hit early recovery full steam. Then, two to six months later, after securing a new job, apartment, personality, et cetera, I'd relapse. I'd use with increasing frequency / intensity until some crisis blew up my current incarnation*, after which I'd enter treatment again.
*For example, a car accident that I caused in which I hit another car - whose driver was blessedly unharmed - and demolished my left elbow. Also, the time when I got a finish-line DWI in Oregon after veering off the road and taking out a goodly stretch of a white picket fence (court-assessed fence value: $950; symbolic value vis-à-vis the destruction of the American Dream: priceless).
At the end of this period, fentanyl was contaminating the heroin supply all along the East Coast. My junkie friends began dropping like flies. I knew that I had to get out, so I took my friend up on her offer of a teaching job in Shenzhen, which began the next great adventure of my life.
Subtotal for this period: $40,500
(4) My four and a half years in China. Despite the fact that I arrived in Shenzhen dopesick, I was clean for the first year and a half, which was one of the most tranquil, beautiful, challenging, and productive periods of my life. I met my fiancé, traveled extensively all throughout China, ate literally everything, and taught bio and chem to some of the country's best students (see "I Was Simon Song" if you're interested in these stories).
After a year and a half, I discovered how to get prescription opioids and benzos from private hospitals catering to foreigners. This was epically bad news. I spent the next two and a half years heavily dependent on OxyContin and clonazepam / alprazolam, which I had a nearly limitless supply of.
At the end of this period, I was forced to return to the U.S. because A) the pandemic had made it almost impossible for foreigners to live in China, and B) the police searched the apartment of a friend who I was staying with and questioned me regarding why I was taking 600 milligrams of oxycodone per day (although I wasn't technically committing a crime and obtaining gray-market meds is commonplace in China, they assumed that I was dealing because of the quantities involved). Again, insane stories to come.
Subtotal for this period: $91,250*
*That's right. Jay, my fiancé, is an accountant.
Eiffel Tower with Chinese characteristics at Window of the World in Shenzhen (if you get that joke, then you're either Chinese or an expat who has spent quite a bit of time in Mainland China).
Arriving in Shenzhen dopesick was a Tarantino-esque dream. We call Shenzhen the Silicon Valley of China, and it has a whimsical, futuristic vibe that sometimes made me wonder if I had died in an OD and been transported to some strange afterlife.
My older brother saw this sign and summarized it as "no hovering hawks." He's brilliant like that.
I've written elsewhere about how my relocation to China saved my life (geographical relocation had worked in my favor before, and this was an extreme case of new environment / new neurology). I lost six friends during my first two years in China, during which fentanyl was replacing heroin in the U.S. illicit opioid supply.
Although I had been using heavily before I left for China, the adjustment to total sobriety wasn't nearly as agonizing as it should have been. It helped that I had to learn a new language (one with thousands of letters), acclimate to a new culture, get acquainted with a new way of doing business (cash was almost obsolete, so I quickly mastered making payment via WeChat Pay QR codes). In addition, I had to adjust to a radical change in diet and even used a squat toilet once or twice, which was intriguing. I was fully engaged in my teaching, and my students were incredible; that certainly helped, too.
A late night at the aptly-named Fun Flower nightclub in Shenzhen, where rose petals flutter down from the ceiling of the three-story atrium at 4 a.m. One time, I woke up the next morning and found rose petals in my underwear when I went to use the bathroom.
My thirtieth birthday party. Don't mind my hair; somehow, "auburn highlights" must've gotten auto-translated into "ruin my special day."
Me at the end of the golden period that was my first year and a half in Shenzhen. I have pupils! And some meat on my face. Witness the deterioration of my appearance and affect in the next several photos as my relapse progressed.
Me giving a talk to Chinese undergrad students about how PhD candidates in STEM subjects fund their research and living expenses in the United States. By outward appearance, I was a put-together young professional, but I had become physically dependent on OxyContin again.
Me talking to a group of students and parents about the importance of personal narrative essay writing for undergraduate admissions in the United States.
The disease is gaining momentum: I look wan and depleted at this event, during which representatives of American boarding schools gave talks for Chinese students and their parents.
Frightening. I don't see myself gazing at the camera; I see the disease of addiction. All of a sudden, rather than getting 40 milligram OxyContin pills, which contain only oxycodone, I was forced to switch to a Chinese Percocet brand, which contained 5 milligrams of oxycodone and 325 milligrams of acetaminophen per pill.
I was taking 70 to 90 of these pills on my worst days, which amounted to over 20 grams of acetaminophen. Anything over 12 grams of acetaminophen a day will cause liver damage, and 15 to 25 grams is considered a lethal dose.
I was in acute liver failure and my kidneys were stressed to the point of serious dysfunction. I couldn't eat solid food for weeks. I was passing out randomly at work and home.
I started searching for info about what happens when a foreigner dies in China because I didn't particularly want to end up a box of ashes on a shelf in some warehouse, which is what happens to most Chinese who don't have living family, but I certainly didn't want my family to bear the costs of bringing my body or ashes back home, either.
Still, I couldn't stop taking the pills. I'm lucky that I survived this period.
Grand total: $175,850
If any of you are interested in the prices that I paid for the legal and illegal opioids that I was using in the United States and in China, feel free to ask questions in the comments section. I've got a detailed spreadsheet that I used in arriving at this estimate, which I'd be happy to share; it provides a fascinating forensic accounting of a textbook opioid addiction progression.
Hidden Costs
The indirect costs were in the same ballpark. Over this fraught 15-year period, I accumulated medical bills for copays that totaled in excess of $20,000, over half of which I never paid.
The legal fees from the incident during my senior year of college, my DWI in Oregon, and my car accident in New York easily totaled $10,000 to $15,000 (it would've been three times that if I hadn't had family help with these matters).
I abused lines of credit by converting them into cash at casinos or through other tried-and-true junkie tricks, which led to further debt.
I also had a year's worth of student loans from my (expensive) medical school, plus about $20,000 from undergrad. Needless to say, I wasn't paying these loans down during this period.
Of course, the lost income from the months that I spent in treatment added up, too, but I'm not factoring that in right now.
Overall, I ended up about $250,000 in the hole from these 15 years of soul-sapping opioid addiction. Sometimes when I relapsed, I would think about my financial picture and feel that there was no way out; I had already written myself off of the planet.
Most of all, my opioid addiction screwed me by keeping me stuck. As a friend of mine once put it, I felt like I was playing the same level of a video game over and over.
Until I moved to China, I had been working for seven years without making an iota of progress in my career. Because of this, my income wasn't increasing in the way that it should have been.*
*It didn't help that my class graduated into the worst job market in my university's history, either. Economics has shown that recessions have a significant, lifelong effect on the earning potential of college grads who enter the job market during them.
The worst aspect of this financial stress was constantly being down to my bottom dollar.
For at least 10 of these 15 years of active addiction, my bank account was overdrawn. I paid thousands in overdraft fees.
I was working hard, but I didn't have money for food or basic expenses, let alone a book that I really wanted to read or a drink with a friend.
I had always enjoyed picking out gifts for friends and family, and I missed being able to give thoughtful presents more than I missed anything that I could have gotten for myself (I'm a monk at heart when it comes to possessions, including home decorations).
When I had free time, I explored parks and libraries simply because they were free.
The stress of always wondering if I was going to get the "insufficient funds" notification when I paid for something really took its toll.
My Life Is an Anti-Drug Commercial
The grand total of $175,850 was actually less than I expected, and it likely represents an underestimate.
When I saw this figure, my first reaction was "It's bad, but it's not fatally bad."
Some of my medical school classmates owed this much or more by the time that they graduated and began practicing.
Starter homes in California cost twice or even four times this amount.
On the other hand, it's a beautiful Victorian home for me, Jay, and Ti Qi the Wonder Poodle in my hometown. Bought, taxes paid - owned free and clear.
It's a significant boost to my parents' retirement savings, which would change their quality of life.
And imagine if I had put even half of that money into a small business, an investment property, or a riskier bet like Bitcoin. My future would be appreciably brighter, and I would have a nice nest egg by now.
Instead, Jay is shouldering most of the financial burden of us hopefully relocating to the U.S. in the next couple of years.
The cliches are painfully correct: What hurts most of all is the lost time.
And time truly is a priceless commodity.
During these 15 years, I lost my beloved grandmother. I am ineffably grateful that I was in my first year of medical school and by all appearances doing well when she passed. Nevertheless, my addiction tainted and overshadowed many beautiful moments with her.
My parents grew old.
I still don't feel that our dynamic has been reversed in the way that it should be for adult children. In some ways, I'm stuck at the same level of the video game, which makes it difficult for me to take care of them in the way that I should be.
My friends from high school and college completed graduate school, got married, and had kids.
I've only attended one wedding in my entire adult life. I've made the funerals / calling hours of several friends who died by overdose in their 20s and early 30s.
I missed out on the rollercoaster romances of my 20s because I was in love with a chemical. There is no lover more jealous than heroin.
I know that it's stupid, but when I was young, I used to daydream about the future relationships I'd have with handsome guys like the ones that I saw on TV.
I imagined the deep talks we'd have, the trips we'd take, the dramatic fights we'd get into before reconciling into an even-closer love. I envisioned the secret worlds that we would weave together.
I missed out on all of that. By the time that I met Jay, I was almost 30, and dating had become a more pragmatic, future-focused affair.
I gave up the career in medicine that meant more to me than anything. It was my true passion, my raison d'être, and my God - there were moments when I was brilliant at it.
At times, I prayed for an overdose just so that I didn't have to wake up and think about all of the hurt that I'd caused, all of my failures. The departed dreams and AWOL hopes.
I spent much of my 20s and early 30s feeling like I had outlived my expiration date. I used recklessly because I was convinced that it was only a matter of time before I joined my dead friends.
I didn't plan for the future in any meaningful way because it was inconceivable to me that I would have a future.
To this day, I struggle to let go of the life I should have had.
What I wouldn't give for a do-over.
For those of you who are drug addicts, what has your habit cost you per day and over time? I'm very curious to know how this varies by area of the U.S. and how much legal and illegal drugs cost in other countries.
As a heroin addict in the U.S., I was spending upward of $80 for a 10-bag bundle per day when I was in college. Then, when fentanyl replaced heroin in the dope supply, bundles became dramatically cheaper (down to $30 to $40 each), but because fentanyl doesn't last nearly as long, I needed to use three to four times as much per day.
In China, two boxes of 40-mg OxyContin pills, each of which contained 10 pills, cost 700 RMB (about 100 USD). Benzos were much cheaper.
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