Drug addiction crosses all economic boundaries.
It can affect factory workers, restaurant workers, the homeless and even professional people.
Carolyn Greer, a former Kokomo obstetrician, is one of those professionals who fell to drug addiction.
As a result of such widespread pervasiveness, addiction has become a major stumbling block in Howard County, where the drug poisoning death count reached 115 from 2009 to 2013, the eighth-highest total in the state, according to the Indiana State Department of Health.
During the same time period, Howard County ranked 13th of the state’s 92 counties with 203 non-fatal emergency department visits due to opioid - a type of prescription drug - overdoses, and had the 11th highest rate per 100,000 residents, according to the ISDH, highlighting the county’s prescription drug abuse problem.
Greer graduated from the Indiana University School of Medicine in 1996 and did her residency at the school in obstetrics and gynecology. She then starting working for Howard Community Hospital, which is now Community Howard Regional Health, in 2000.
About 10 years later, she resigned her privileges from the hospital in 2009.
"I couldn't get along with the administrators, and I was going in a different direction," she said of losing her job.
Dealing with the stress of being out of work and raising four children, ages 11, 9, 5 and 2, one of which is deaf, Greer turned to the very same medication she was prescribing her patients.
"I was a 40-year-old who didn't have a job."
"I was a 40-year-old who didn't have a job," she said.
While Greer's position as a doctor certainly placed her in a unique position, prescription drug addiction often starts in a similarly innocent manner before ballooning into a full-scale disaster, according to Indiana Attorney General Greg Zoeller.
"They become addicts, and they get their friends to give them some. They take some from the home, and after running out of money, they are stealing from anyone," said Zoeller, who runs Indiana's Prescription Drug Abuse Task Force. "It may have all started with a typical 90-day supply...There are reasons why we have such rates that have now reached epidemic proportions. There's no laying blame at any one person or group, but there's been a complete failure to recognize that we have started this system of abuse."
A few pain pills here and there to take away the stress turned into months of abusing pain killers. Greer became addicted.
“At first I would chew up a few pills during the day thinking everything would be alright," Greer said.
Greer then started writing prescriptions in the names of her mother, brother, friends, patients and co-workers for hydrocodone, Lortabs and Xanax.
"I was a horrible parent. I couldn't have been of sound mind. I ask my kids about it now, but they don't say anything."
"Then after a while, I had to chew up a few just to get out of bed," she said. "I was a horrible parent. I couldn't have been of sound mind. I ask my kids about it now, but they don't say anything.
"But, I know that it couldn't have been OK. I was so afraid of not being able to handle everything, and I was worried about my son," she said of her youngest son who is deaf.
"In my heart, I was thinking 'this is crazy. This isn't happening to me.'"
As a doctor, Greer believed she was above the law and wouldn't get caught.
"I thought I was invincible. I was a doctor. They can't do anything to me."
Being a doctor also meant Greer wasn't subject to many precautionary measures enacted by legislators, law enforcement and pharmacists to discourage pain medication abuse. In fact, Greer avoided a whole slew of evaluations that regularly weed out potential addicts, including mental history checks and necessary referrals.
"I thought I was invincible. I was a doctor. They can't do anything to me."
"Typically, a patient comes in, and we look at the paperwork they've filled out, past medical history, mental and social history, past surgeries, current medication and what they have tried in the past," said Lafayette Pain Care Medical Director Shazia Siddiqui, a board certified anesthesiologist. "They also have to be referred by a family doctor or a specialist they have worked with. What we typically get on that referral is a synopsis of what has happened medically to the patient."
When Indiana Attorney General Greg Zoeller learned from the Centers for Disease Control and Prevention that drug-related fatalities now outpace car accidents as the nation’s leading cause of death, he knew he had to take action.
In addition to these protocols, Siddiqui said Lafayette Pain Care and similar pain clinics are also on the lookout for deviant behavior from people who have been given prescriptions. To decrease the chances of addiction, clinics will provide consistent urine tests and variety of other safeguards, she added.
"It's clear that mental health issues equal a high risk for addiction, so we do urine tests consistently. And if we see aberrant behavior, such as calling many times for refills, losing refills, medication getting stolen, demanding medication, those things will put our alert mechanisms at a high level," said Siddiqui. "If they have an addiction problem, we confront them."
Unfortunately Greer was on her own and not subject to consistent professional evaluations.
At first, Greer said, no one knew about her addiction. Then slowly, her colleagues started taking notice, including her husband, who also worked as a physician.
"My husband started seeing a lot of pill bottles laying around and confronted me," she said.
After learning of her over-writing or prescriptions, the state licensing board instructed her to go through a 10-week in-patient rehab program for medical professionals in Oklahoma.
"It was pretty clear I had a problem," she said. "I was lucky. Not very many people can afford it. Because of my medical license, I had to do it.
"For the first time in life I had someone tell me to shut up and listen and do what you're told. It wasn't about the addiction. It was more about my personality. I needed every minute of it."
"It wasn't like I woke up one day and said, 'I need help,'" she said. "It wasn't my choice, but it was extremely helpful. For the first time in life I had someone tell me to shut up and listen and do what you're told. It wasn't about the addiction. It was more about my personality. I needed every minute of it. Now, [my husband and I] try to be more open and we both learned we can't try to protect each other and we have to be more open and honest."
When she returned to Kokomo, the law was waiting for her.
Greer became the focus of an investigation by the Howard County Sheriff Department after a local pharmacy contacted the Indiana Professional Licensing Agency concerning fraudulent prescriptions.
During a 15-month period, Greer wrote 22 fraudulent prescriptions for thousands of controlled substances, which she reportedly kept for her own use, according to a probable cause affidavit filed in the case.
She was charged with a Class D felony count of possession of a controlled substance, five Class D felony counts of obtaining a controlled substance by fraud, and one Class D felony count of insurance fraud.
Greer was 100 percent cooperative during the investigation.
“She gave a complete confession to her wrong-doing,” Detective Matt Roberson wrote in the probable cause affidavit.
Greer was sentenced to drug court and continued her recovery there. After, Greer worked with The Gilead House and now works with Howard County Community Corrections to help others with substance abuse disorders.
9-26-14 Carolyn Greer gives a tour of the facilities during the Gilead House grand opening in the former YWCA building. Tim Bath | Kokomo Tribune
Greer also travels to the Oklahoma rehab facility every year to see patients for about 10 days and shadows a therapist as part of her fellowship with the program.
"I'm not a therapist," she said. "I'm a physician. When I work with people, I am a doctor, and my job with the court systems is to continue to impress upon the court evidence-based medical treatment for addiction and how medical care affects people with addictions.
"When I'm in that position, I talk to people with the message their goal is to be productive members of society. Whatever it takes to get you there, the criminal justice system will get you there."
While Greer never turned to street drugs like heroin or cocaine, more and more addicts are taking that next step, said Matt Oliver, chief operating officer of Behavioral Health Services at Community Howard Regional Health.
“Addiction is definitely a growing program,” Oliver said in his office near downtown Kokomo.
“Agencies are struggling to keep up. It’s not just a local problem, it’s nationwide,” he said.
Oliver said his staff has seen an increase in patients who are addicted to drugs like heroin, meth and cocaine as the state cracks down on physicians for over-prescribing pain medication.
"Some get addicted as a result of an injury through a car accident and get addicted to pain medication, and then when it runs out they turn to street drugs.”
“The state realizes there is a problem and has made steps to make it harder to get prescription drugs,” said Oliver. “Some get addicted as a result of an injury through a car accident and get addicted to pain medication and then when it runs out they turn to street drugs.”
Echoing many of Oliver's statements was Zoeller, who has witnessed firsthand during his time with the task force a shift from prescription drug abuse to heroin addiction.
"I'm very proud of the work we have done on the task force, but as we cut back the prescribing practices, there will be more people that move to heroin before there are fewer addicts overall," he said. "Unfortunately, it will get worse before it gets better."