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Sitting on a dresser in the back bedroom of a house in Austin, Ind., is the bottom of a soda can. A woman places a sliver of a pill, a powerful prescription opioid called Opana, on the jagged half-can. She begins to heat the pill with a cigarette lighter, melting its hard white coating and turning it the color of whiskey.
Her name is Joy.
Using a syringe, the former nurse squirts water into the can and the substance turns to gel. Quiet falls over the bedroom of the rural house as Joy and two other people fill their syringes and inject their hits. (We are using only her first name because she uses drugs illegally.)
Afterward, Joy fishes around in her purse for an appointment book, where she points to the 13th of the following month. She has an appointment with a doctor who can prescribe outpatient treatment, she says. She's ready to get help for her addiction.
Joy does not keep that appointment.
The road to here
Like so many people addicted to opioids in this country, Joy doesn't fit the picture most people have in their heads when they hear the words "drug addict." Joy was a nurse working in a hospital. She had three kids, a good job — she was even a Girl Scout leader.
Her addiction to prescription painkillers began after a back injury on the job. She says she never thought she would use a needle to inject drugs.
"This time last year, I had a home," she says. "I had a car, a house full of furniture, a lot of nice stuff."
Joy describes her big sectional sofa, cherry dinette set, appliances and gadgets like flat-screen TVs, game consoles and other electronics — most of which she sold to feed her addiction to Opana. She lost the house.
Now she's living in her mom and dad's living room. Her parents' house outside of Austin is a little one-story house with a screened-in porch, a barn out back and stacked firewood.
For a while, though, Joy says she had nowhere to stay. She slept in a slide at a park at a local elementary school. Once she broke into an empty, boarded-up house just to get out of the rain.
"Anything could have happened to me there. I didn't care — I was just so high," Joy says.
Every day was about figuring out how to get money, how to buy a pill and get high. Joy says it was all about the feeling of first shooting up.
The grip of addiction
Joy ended up in jail, charged with visiting a place were people used illegal drugs. She says it's the first time she's been arrested.
"Never been in any kind of trouble in my life," Joy says. "You would think that would have been enough for me. No."
Joy got out of jail after a few days. One condition of her release: she had to wear a GPS monitor on her ankle. She also had a 9 p.m. curfew.
But she was withdrawing from Opana, and all she could think about was getting back to Austin and getting a pill.
"I was supposed to be home at 9 o'clock — and at 10 'til 11, I still wasn't home, and they issued an escape warrant on me," she says. "I got home about 11:30 p.m. and my dad's like, 'You got a warrant on you!' "
She went back to Austin, cut off the GPS monitor and hid it in a bush. Police found and arrested Joy the next morning, slapping her with more serious charges since she'd violated the conditions of her release.
Joy spent more than 40 days in jail. She spent six of them in a padded cell on suicide watch after she used the underwire in her bra to cut herself. Slowly, she started to feel better. She started thinking she wanted to stay off drugs for good.
"I started going to church in jail and reading the Bible, and I thought, you know, this is not who I am," she says. "The more my head got clear, the more I just decided that that's I'm not going back to this when I get out of jail."
But that wasn't the end of it.
"The day I came home, I went and got a pill. After all that," Joy says. "I went and got a pill."
This happens to people who are addicted to opioids like Opana. Health workers and researchers say it's hard to stay off the drugs without some kind of treatment — ideally, medication and counseling.
Finally, Joy says, something in her mind told her stop. She decided to go to the clinic.
But the methadone clinic where she receives treatment is half an hour away from her parents' house, in a different county.
Austin is a town of about 4,300 people with what public health officials say are at least 500 known intravenous drug users. But it has no full-time drug treatment facility. The nearest inpatient treatment is 30 miles away, with at least a month-long waiting list.
Like a lot of people in the area, Joy doesn't have a car — but she got lucky when she ran into a neighbor and he offered to take her to the methadone clinic. Every day, he came to pick her up and drive her there. Sometimes a friend loaned her the $15 she needed to pay for the methadone.
After a few days, she started to feel a lot different.
"I didn't think constantly about when I woke up, 'OK, what am I going to do today to get that quarter of a pill?' " she says. "I got up and like 'I'm alright today. I don't feel too bad. I'll go to the clinic, get my medicine, come back home and help Mom around the house.' Gradually, my way of thinking started to change."
But she still faces cravings. She says even hearing the word "Austin" makes her crave Opana. Sometimes those cravings are too strong.
Two months into her methadone treatment, Joy picked up the phone and called a pill dealer.
"I had a bad day — a really bad day," she says. "And I called somebody up wanting a pill, and I knew I wouldn't feel the pill because the methadone blocks it. The guy [I called] was like, 'What are you talking about? You've been in treatment for two months. You're not going to feel this pill. You're going to get drug tested down there. You're going to fail it — for what? You're not going to buzz.' "
Joy got lucky again. Her dealer talked her down, and she did not go get a pill.
Joy is still on methadone. She's going to counseling three times a week, and she sees her son every day after school. Sometimes he stays with her on weekends. She's talking to her daughters again, too.
Her nursing license lapsed while she was on the street. She had to take 24 hours of classes and pay a fee to get it reinstated, but now she's applying for jobs.
Joy says she's worried about being around pain medication back at work. She says at first she might try to do office work such as billing or case management in order to stay away from temptation.
She's also saving money to get a car — and maybe even her own place.
"I have a bank account now," she says. "I have over $400 I've managed to scrimp and scrape since December, when I started taking methadone."
Joy says she wants to have a home again, where her son can live with her.
"That's all I can focus on right now," she says. "I never thought my kids would forgive me, my parents would forgive me. I thought my only way was to just commit suicide and let me kids be raised by their dad or my parents or whatever. And then I seen it — they do need me. They do still love me, and I'm still their mommy. It's time I did right by them again. I thank God that I have the chance to do that."