West Virginia's new drug czar was once addicted to opioids himself

CHARLESTON, W.Va. – West Virginia’s new drug commissioner 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 has been treating patients with substance use disorders since he left rehab two decades ago. He says battling opioid addiction in the state with the highest rate of overdose deaths isn't just his job. It's an integral part of his recovery.

“I really feel like it's been the biggest driver of my personal recovery,” says Loyd, who last month became director of West Virginia's Office of Drug Control Policy. “I feel like the longer I do this, the less I mind the guy I see in the mirror every morning.”

Loyd often speaks 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 doctor in a mining community who becomes addicted to prescription drugs. Loyd also served as an expert witness in a case that resulted in the first conviction of a Tennessee doctor for running a drug factory in 2005. He has also testified in trials against opioid manufacturers and distributors outlining their responsibility for the U.S. opioid crisis, resulting in large settlements across the country.

West Virginia received nearly $1 billion in settlement payments, and a private foundation is working with the state to send checks to affected communities to support addiction treatment, recovery and prevention programs.

Loyd says he is willing to provide the foundation with advice and support in distributing the money, because the state has a “moral and ethical responsibility” to spend the money wisely.

The doctor began abusing painkillers when he was an attending physician at East Tennessee State University Hospital. After a dental procedure, he was given a handful of hydrocodone pills – opioid painkillers. He says he threw the pills in his glove compartment and forgot about them until he stopped at a red light while driving home after a particularly hard day at work.

Anxious and depressed, he struggled to cope with his weekly hospital stay of over 100 hours.

“I thought, 'My patients take these things all the time,'” he says. “And I broke one in half and took it. When I got home, all my ailments were cured. My job wasn't so bad, my home life was better. And I wasn't so worried anymore.”

Over the course of four years, he increased his dosage from half a 5-milligram tablet of hydrocodone to 500 milligrams of oxycodone—another opiate—in a single day.

He understands the shame many feel about their addiction. To finance his addiction, he stole pills from family members and bought them from a former patient.

“Would I have stolen from you then? Yes,” he says. “I did everything I needed to do to get what I thought I would never get when I died.”

However, he didn't realize he was addicted until he first felt the intense nausea that comes with opiate withdrawal. He thought he had caught the flu.

“And then the next day, when I got my hands on some pills and took the first one, I felt better within about 10 minutes,” he says. “I realized I couldn't stop or I would get sick.”

It was a “pretty devastating moment” that he says he will never forget.

After an intervention by his family, Loyd was admitted to the Vanderbilt University Medical Center rehab facility in July 2004. After five days, he entered a treatment program and, he says, has been sober ever since.

During his recovery, Loyd devoted himself to addiction medicine, focusing on pregnant heroin users, who often face prejudice and stigma. He said his own experience allowed him to see these vulnerable women in a different light.

“I couldn't believe that someone could just keep sticking a needle in their arm – what are they doing? – until it happened to me,” he says.

While in rehab, Loyd first noticed the differences in addiction treatment. There were 24 people on his ward, and the doctor, then 37, was the only one referred for treatment. The rest were simply discharged.

“I get a free pass because I have MD behind my name and I've known that for a long time,” he says. “And that's not fair.”

He calls this “the two treatment systems” for substance use disorders: a robust and compassionate system for people with money and another, less effective model “basically for everyone else.”

He is determined to change this.

He says he also wants to expand access to prescription drugs like methadone and Suboxone, which can help people with substance use disorders wean themselves off opioids. Loyd says he was not offered any of those drugs during his detox 20 years ago, “and it kind of makes me angry that I suffered needlessly.”

One of Loyd's priorities will be to figure out how to measure meaningful outcomes – something he says is happening in all areas of medicine except addiction medicine.

A cardiologist can tell a patient with heart disease the course of treatment and estimate the chances of recovery or freedom from pain in a year or 18 months, he says.

“We don’t have anything like that with addiction. We look at the results differently,” says Loyd.

When people are referred for treatment, the metrics are not the same. How many showed up? How many participated in and completed the program? How many continued their recovery and progressed in their lives?

“We don't know how effectively we've spent our money because I don't think we've really talked much about looking at meaningful outcomes,” he says.

As for his own measurable accomplishments, Loyd said there have been several, including walking his daughter down the aisle and serving as his son's best man.

He also has a folder on his phone with baby photos and photos of recovery milestones sent to him by former patients.

“That's what drives me,” he said. “The great paradox is that if you give something away, you can keep it. And I can do that.”