LAWRENCE — When Nickol Pereira visited her doctor while recovering from a serious car accident, he had a question for her.

“What flavor dope do you want this month?” Pereira, 36, of Lawrence, recalled his asking when she returned for a new prescription.

Pereira was being treated for a severely shattered right foot in a car accident. She had fallen asleep with her feet on the dashboard and the driver crashed into a tree.

Pereira instilled her trust in a doctor who promised he could do the surgery to reconstruct her foot. Between the initial accident, surgeries and physical therapy, Pereira became hooked on the painkillers prescribed to her.

“I couldn’t walk. Once I took the pills, I could walk on clouds,” said Pereira, who would ask her doctor to up her dosage or seek opioids from other physicians around the Merrimack Valley when her prescription no longer lasted through the month.

“I didn't know what I didn’t know," she said. "I knew the pills were helping my pain and helping me function.”

She finally began walking, but the need for opioids didn't go away. The physical pain from the accident and emotional pain caused by what she calls an abusive boyfriend both were numbed by the painkillers, she said.

Six months after walking — two and a half years after the accident — Pereira turned to the streets instead of pharmacies to buy pills. She bought Oxycontin. When that became too expensive, she turned to heroin.

Pereira now is in recovery, but the story of her path to addiction is a familiar one.

Government bodies and officials in communities in Massachusetts and New Hampshire are trying to pinpoint how opioid addiction became so prevalent, partially blaming over-prescription.

And, according to data provided by the Drug Enforcement Administration, fueling such addictions were 1.56 billion doses of hydrocodone and oxycodone that made their way into pharmacies in Massachusetts and New Hampshire between 2006 and 2012.

More than a billion doses 

That data from a DEA study recently was made public in a lawsuit against drug manufacturers and distributors including Purdue Pharma, the Connecticut company that marketed OxyContin.

Across the country more than 2,000 municipalities — including Londonderry and Haverhill — are participating in the lawsuit, in which Purdue Pharma reached a tentative settlement announced Wednesday that will total about $12 billion paid out over time, according to the Associated Press. 

"Like many others, Haverhill has been hard hit by the opioid epidemic," City Solicitor William Cox said. "We are seeking monetary damages," 

He said expenses for fighting the opioid crisis are far-reaching, including the cost of public health, police and emergency services, and public education.

"It's not just (the costs) to treat people, but educate people and get people into recovery," he said.

States, including Massachusetts and New Hampshire, are suing separately. The New Hampshire lawsuit moves to trial next year in Merrimack Superior Court. The Massachusetts suit is making its way through the system.

"Dangerous opioid drugs are killing people across Massachusetts. Prescription medicines, which are supposed to protect our health, are instead ruing people's lives," state court documents filed by Massachusetts Attorney General Maura Healey's office. "Purdue Pharma created an epidemic and profited from it through a web of illegal deceit."

Across New Hampshire between 2006 and 2012, pharmacies received 281 million doses of opioids. The majority were manufactured by SpecGx LLC and distributed by McKesson Corporation, according the DEA study. 

More than 11.4 million of those opioid doses went to Londonderry, according to the data. A majority, 5.7 million doses, went to a pharmacy called Neighborcare of New Hampshire LLC, the firm that received the most pills in the state.

“The town of Londonderry has expended substantial resources to combat the opioid crisis. We joined this litigation in order to seek compensation for the tax dollars we have spent and continue to spend in addressing the overabundance of opioids in our community,” Michael J. Malaguti, assistant town solicitor, wrote in a statement.

“More importantly," he wrote, "the town felt it was important to play a leading role in seeking to hold accountable those responsible for the human toll of this epidemic.”

Derry received the second-most prescription opioids — nearly 8 million pills over the six years, according to the DEA.

During the same time period in Massachusetts, 1.28 billion doses of hydrocodone and oxycodone were delivered to pharmacies, with most manufactured by SpecGx LLC and distributed by Cardinal Health, according to the DEA. More than 36.1 million of those doses went to Andover — the majority, 34.3 million doses, to Injured Workers Pharmacy, the data reveals.

Haverhill pharmacies received 14.3 million doses, and Methuen pharmacies received 10 million doses during that time, according to the DEA.

Between 2006 and 2012 prescription opioids contributed to the majority of overdose deaths in Massachusetts and New Hampshire, according to data from the Center for Disease Control. 

In 2013 heroin contributed to about as many deaths as prescription opioids in both states. Then in 2014 there was a spike in overdose deaths coinciding with the rise of those related to synthetic opioids, such as fentanyl, according to the CDC. 

And there's a clear connection between pain pill addiction and the path to heroin and fentanyl addiction, experts say.

Documents filed in the lawsuits against the pharmaceutical companies, including the DEA database, have shed light on how addictive the prescription opioids are and who knew about the potential for the epidemic. 

"The documents being provided to everyone lay out the deceptive marketing and messages (about the pharmaceuticals) that mislead the medical community and the public about the risks associated with prescription opioids," Cox said. "Board members and executives personally sanctioned these actions. This is an attempt to hold them accountable. ... This kind of behavior isn't acceptable."

No lawsuit, however, can undo the wreckage of addiction in the lives of so many addicts, their families, and society at large.

Jacque Ingersoll, a community engagement specialist with the Methuen Police Department, sees the damage firsthand as she responds to calls of overdoses and helps addicts find treatment.

More than half of the addicts she talks to were first prescribed a painkiller, she estimated.

"Personally I think if Oxy never came on the market the epidemic wouldn't be the way it is," Ingersoll, 38, said. "Oxy ruined so many lives. (The makers) should have been open and honest about the dangers of becoming addicted."

She and her partner Cole Welch work together to respond to overdoses and offer treatment options as part of the Methuen CARES — Community Addiction Resource Engagement Services — team, which is one of the services the town has added to help combat the opioid epidemic.

'I would get 110 pills at a time'

Ingersoll, herself, is a recovering addict who celebrated nine years of sobriety this month.

She was first prescribed painkillers in her early 20s to combat rheumatoid arthritis. Initially she took Vicodin, then Percocets and then Oxycontin when each had less of a painkilling effect.

Then her doctors cut her off.

"I was wondering why did I have the flu," she said, describing her symptoms after stopping the medications. "It was withdrawal."

Without a prescription from a doctor and suffering severe withdrawal symptoms, Ingersoll turned to the street to buy oxycodone. She continued to take the dose she was prescribed, but her tolerance grew.

Then came heroin. 

Pereira's path was similar. She lost her health insurance, but she still needed pain medication. 

“I would get 110 pills at a time, and without insurance it cost so much money,” she said.

She tried to ween herself off the drugs, but the withdrawal symptoms were overwhelming. So she turned to buying them on the street, until that was too expensive.

Then someone told her: “You know there is something else that will work the same that is half the price.”

And for Pereira, too, that was heroin.

Pereira grew up in Sandown and went to a small high school where the hardest drug she ever encountered was marijuana. Even in college she only experimented with alcohol, just to find it made her sick, she said.

She had always known heroin was a thing that people did, but it was an abstract concept, she said. She recalls judging those figurative heroin addicts.

But once she tried it, she was hooked, taking heroin every day for about a year.

She got clean for two years, then relapsed less than a year ago when three discs in her back ruptured.

“I had only seen the doctor one time, one X-ray for my back, and he took out the prescription pad,” said Pereira, who also pointed out that she didn’t disclose her addiction at the appointment.

Now five months sober, Pereira is happy she turned to help instead of heroin this time. She's living at a sober house and keeping a busy schedule of recovery and temporary work while she looks for a full-time job.

She was able to reach out for help “because I have no shame about my addiction,” she said.

After working through the 12 steps of recovery and participating in group therapy, she has become more open with her story, she said. She hopes that telling it might help others.

She said she knows she cannot take opioids and has learned to question what a doctor prescribes.

“You figure they would be more careful and more caring about what could happen to their patients when they leave their office with a script,” she said.

WHERE TO FIND HELP

If you or anyone you know has a substance abuse issue there are resources at local, state and federal levels.

Andover CARES: Group's mission is to  address substance abuse and addiction in the community through three pillars of support: education, intervention and enforcement. Visit andovercares.org.

Methuen CARES: Support and resources those struggling with addiction and their families. Call Jacque Ingersoll, 978-701-8195.

Circle of Hope: A family support group for addicts. Call 978-866-2949.

Merrimack Valley Prevention and Substance Abuse Project: Promotes awareness, education, prevention and treatment of substance abuse. Visit mvpasap.com.

Massachusetts Substance Use Helpline: Call 800-327-5050, Monday to Friday, 8 a.m. to 10 p.m. and weekends 8 a.m. to 6 p.m. Online at helplinema.org

211 New Hampshire: 211 is a 24-hour hotline. For anyone outside New Hampshire call 866-444-4211. Online at 211nh.org.

New England Narcotics Anonymous: 866-624-3578. Online at nerna.org.

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