CHARLESTON, W.Va. — West Virginia’s new drug czar has a very personal reason for wanting to end the state’s opioid crisis: He was once addicted to prescription painkillers himself.
Dr. Stephen Loyd, who has been treating patients with substance use disorder since he got sober two decades ago, says combating opioid addiction in the state with the highest rate of overdose deaths isn’t just his job. It’s an integral part of his healing.
“I really feel like it’s been the biggest driver of my own personal recovery,” says Loyd, who became the director of West Virginia’s Office of Drug Control Policy last month. “I feel that the longer I do this, the more I don’t mind the guy I see in the mirror every morning.”
Loyd is no stranger to talking about his addiction. He has told his story to lawmakers and was an inspiration for the character played by Michael Keaton in the Hulu series, “Dopesick.” Keaton plays a mining community doctor who becomes addicted to prescription drugs. Loyd was also an expert witness in a case leading to Tennessee’s first conviction of a pill mill doctor in 2005, and has testified against opioid manufacturers and distributors in trials spelling out their culpability in the U.S. opioid crisis, resulting in massive settlements nationwide.
West Virginia was awarded nearly $1 billion in settlement money, and a private foundation has been working with the state to send checks to affected communities to support addiction treatment, recovery and prevention programs.
Loyd says he is ready to help advise the foundation on how to distribute that money, saying the state has a “moral and ethical responsibility” to spend it wisely.
The doctor started misusing painkillers when he was chief resident at East Tennessee State University hospital. He was given a handful of hydrocodone pills — opioid painkillers — after a dental procedure. He says he threw the pills in his glove compartment and forgot about them until he was stopped at a red light, driving home after a particularly hard day at work.
Anxious and depressed, he was struggling to cope with his more than 100-hour-a-week hospital schedule.
“I thought, ‘My patients take these things all the time,’” he says. “And I broke one in half and took it. By the time I got home, all my ills were cured. My job wasn’t as bad, my home life was better. And I wasn’t as worried.”
Within four years, he went from taking half a 5-milligram hydrocodone pill to taking 500 milligrams of oxycodone — another opiate — in a single day.
He understands the shame many feel about their addiction. To fuel his addiction, he stole pills from family members and bought them off a former patient.
“Back then, would I steal from you? Yes,” he says. “I would do whatever I needed to do to get the thing I thought I would die without.”
But he didn’t understand he was addicted until the first time he felt the intense sickness associated with opiate withdrawal. He thought he had come down with the flu.
“And then the next day, when I got my hands on pills and I took the first one, and I got better in about 10 minutes,” he says. “I realized I couldn’t stop or I’d get sick.”
It was a “pretty devastating moment” that he says he can never forget.
A family intervention ended with Loyd going to the detox unit at Vanderbilt University Medical Center in July 2004. After five days, he joined a treatment program and, he says, he has been sober ever since.
In recovery, Loyd threw himself into addiction medicine with a focus on pregnant heroin users who often face judgment and stigma. He said his own experience enabled him to see these vulnerable women in a different light.
“I couldn’t believe that somebody could just keep sticking a needle in their arm — what are they doing? — until it happened to me,” he says.
It was when he was in the detox unit that Loyd first noticed disparities in addiction treatment. There were 24 people on his floor, and the then-37-year-old doctor was the only one who was referred for treatment. The rest were simply released.
“I get a pass because I have MD after my name, and I’ve known that for a long time,” he says. “And it’s not fair.”
He calls this “the two systems of care” for substance use disorder: A robust and compassionate system for people with money and another, less effective model “basically for everybody else.”
He’s intent on changing that.
He says he also wants to expand access to prescription drugs such as methadone and suboxone, which can help wean people with substance use disorder off opioids. Loyd says he was never offered either medication when he was detoxing 20 years ago “and it kind of makes me angry that I suffered unnecessarily.”
One of Loyd’s priorities will be working out how to measure meaningful outcomes — something he says happens in every field of medicine except addiction medicine.
A cardiologist can tell a patient with heart disease about their course of treatment and estimate their chances of a recovery or of being pain free in a year or 18 months, he says.
“In addiction, we don’t have that. We look at outcomes differently,” Loyd says.
When people are referred for treatment, the metrics are not the same. How many showed up? How many engaged in the program and graduated? How many continued to recover and progressed in their lives?
“We don’t know how effective we’ve been at spending our money because I don’t think that we’ve really talked a lot about looking at meaningful outcomes,” he says.
As for his own measurable outcomes, Loyd said there have been a few, including walking his daughter down the aisle and serving as his son’s best man.
And on his phone he has a folder of baby pictures and photographs celebrating recovery milestones, sent to him by former patients.
“It’s what drives me,” he said. “The great paradox is you get to keep something by giving it away. And I get to do that.”