By No Means Immune

“If this gets any worse, I’ll think I can fly,” Wes thought, as he looked down onto College Street from the top of the Silliman tower. He had taken LSD and cocaine an hour or two earlier. Afraid of what might come next, he backed away from the window.
Within moments, he threw up.

He closed his eyes. A feeling of doom swept over him. He was certain that he had died and was experiencing a post-death state.

He dialed home.

“Mom, I think I’m dying.”

“Physically or mentally?”

“Both.”

He hung up the phone, got in a cab to Union Station, and boarded a train home to New York.

It was a Friday afternoon in October 2015, the fall semester of Wes’s sophomore year at Yale. Wes was not dying. He was hallucinating. Although he feared he was overdosing, he was actually just having a bad trip, an experience marked by overwhelming terror and anxiety that can occur when using LSD. About thirty minutes before arriving in New York, Wes sobered up. Only then did he realize he was safe.

“Yale is by no means immune to the national opioid epidemic.”

Five days after this harrowing episode, Wes (a pseudonym used to protect his identity) requested a medical withdrawal from Yale, telling school officials that he needed time off to seek help for “depression and anxiety.” He intentionally omitted the real reason: substance use disorder, otherwise known as drug addiction.

Wes did not disclose his drug use because he worried about getting in trouble. He thought the university would be more sympathetic if he claimed he was seeking help for depression. If he told his dean he did drugs, he assumed there would be disciplinary or legal consequences.

At the time, there was no written policy suggesting that the University would treat the use of illicit drugs as a medical concern. The Yale College Undergraduate Regulations lists “unlawful possession, use, purchase, or distribution of illicit drugs or controlled substances (including stimulants, depressants, narcotics, or hallucinogenic drugs)” under “offenses subject to disciplinary action.” In other words, Yale’s only written policy on drug use was labeled as a disciplinary issue.

On October 23, 2017, the University updated its Medical Emergency Policy. The new Policy states that if a student overdoses on alcohol or drugs and another student calls for help, neither student will face disciplinary action. The goal of the policy is to ensure that students will not hesitate to seek help in the event of a substance use emergency. Before the change, the Medical Emergency Policy only covered alcohol. If a student overdosed on heroin or cocaine, for example, they would not have been exempt from disciplinary charges.

It was and still is Yale policy that if a student gets caught using drugs in any non-emergency situation, even if they suffer from substance use disorder, they are subject to disciplinary action. However, this does not mean the student will be disciplined. There have been cases in which students struggling with substance use disorder were forthcoming with school administrators and did not face punishment.

After becoming the first-ever director of Yale’s Alcohol and Other Drugs Harm Reduction Initiative (AODHRI) in June 2017, Dr. Lynn Fiellin pushed hard to update the Medical Emergency Policy to encompass “other drugs.” Emphasizing that the health and safety of students should be the University’s primary concern, she argued that it “makes no sense” for a medical emergency policy to apply only to alcohol. Students are more likely to trust a policy that covers all substances.

As for why the policy was not changed until October 2017, Yale College Dean of Student Affairs Camille Lizarribar said the delay was not due to concerns with changing the policy, but rather the fact that “it took time to get input, changes, and processes in place.” She said the biggest challenges were logistical, such as the arrival of Dean Chun and the death of three students last fall, which required more urgent attention.

Riley Tillitt, a senior and president of Yale Students for a Sensible Drug Policy (SSDP), an undergraduate organization that pushed for the policy change, said his organization did not face much resistance from the administration. “I think most deans would support a drug amnesty policy,” he said, adding that the most common argument against it was a concern it would encourage drug use.

Tillitt’s predecessor at SSDP, Clay Dupuy, a senior, said the University wanted to wait and see how the alcohol Medical Emergency Policy would pan out before they extended it to all substances. According to both him and Dr. Fiellin, there has been an uptick in the number of transports called for alcohol-related emergencies since the alcohol policy was adopted. The increase could have been due to higher levels of alcohol consumption or the fact that people are more comfortable calling for help. Dr. Fiellin believes it is the latter, saying the alcohol Medical Emergency Policy has been a success and ought to serve as further evidence that the policy should include other drugs.

Concerns about the worsening opioid epidemic also influenced the policy change. Although the rate of opioid overdoses at Yale is lower than the national average, “Yale is by no means immune to the national opioid epidemic,” Dr. Fiellin said.

The crisis extends well beyond needles and heroin. Many people get hooked on prescription painkillers after undergoing surgery or getting wisdom teeth removed. Some do not know they are addicted until it is too late. Opioid use disorder “doesn’t stay away from smart and talented people,” Dr. Fiellin said.

Opioid use is claiming the lives of tens of thousands of people around the country, including New Haven and the rest of Connecticut. According to the CDC, on average, 142 people die from a drug overdose per day in the U.S., and at least ninety of those deaths are caused by opioid use. In Connecticut alone, the Office of the Chief Medical Examiner projects 1,078 drug overdose deaths in 2017, which is more than a 15 percent increase from last year.

The risk of a Yalie overdosing is greater now than ever. Lindsey Rogers, a student at the Yale School of Public Health who is studying the opioid epidemic, said she is “one thousand percent sure” that, given the extent of the crisis, there will be an opioid-related death on Yale’s campus in the next five to ten years.

Last year, Jeff came close. Jeff, who is a current Yale student but was not enrolled at the time of the incident, does not fit the profile of a stereotypical heroin addict. Jeff (a pseudonym used to protect his identity) is smart. He wears nice clothes. He is a talented musician. He is, by all standards, functional. Yet despite this exterior, Jeff struggles with opioid use disorder.

Before arriving on campus, Jeff did not do drugs. He had smoked marijuana only three times in his life and rarely, if ever, drank alcohol. His views aligned with societal norms; he thought drugs were “bad” and had no desire to start using them, he said.

But after coming to Yale, Jeff’s attitude changed. He began drinking during his freshman year at parties and other social gatherings—but only moderately, “like any normal freshman,” he said. In addition, many of the older students in Jeff’s music group smoked often, and Jeff and his fellow freshmen in the group felt encouraged to join them. “It wasn’t anything crazy, just about once a week,” Jeff said, describing the frequency of his use. He remembers being really excited about drinking and smoking with friends. Getting high and drunk was novel and fun, he said.

During his sophomore year, Jeff’s drug use ramped up. He started smoking much more regularly—one, two, even three times a day. He had grown tired of the pressure of school and found that smoking helped him cope with stress. By the end of his sophomore year, “I was addicted to weed,” he said.

Jeff’s foray into drugs other than alcohol and marijuana did not start until the spring semester of his junior year, when he was studying abroad in Amsterdam. He made a group of friends there who introduced him to a variety of new substances: MDMA (ecstasy), cocaine, LSD, and hallucinogenic mushrooms.

Jeff was excited to push his limits. Marijuana and alcohol had become all too familiar. The new drugs seemed like windows into unknown worlds. “I was using for the novelty,” he said. “My overall theory was that I would know myself better as a person if I had had every experience known to man.”

He tried several new substances overseas and continued using them, though less often, when he returned to the U.S. But there were some paths he was afraid to go down: “The two drugs I told myself I’d never do were methamphetamine and heroin,” he said, knowing them to be especially addictive.

Then, just a few months later, Jeff got his wisdom teeth removed and was prescribed oxycodone, an opioid painkiller. He was given dozens of pills but told to take only a few as needed. Jeff started with a couple, but he did not stop there. Loving the way they made him feel, “I took one, two, three, until I finished the bottle,” he said. “I had no idea that I was getting addicted to these [pills]. I was so oblivious to the fact that these are aggressively addicting.”

Because Jeff appeared “functional”…his struggle with opioid use stayed under the radar.

Before he knew it, he was hooked. He went back to the pharmacy and got a refill. When he finished the refill, he searched around his house and found several of his parents’ old prescriptions. When he ran out of those, he turned to the Dark Web—the black market of the Internet—where he ordered a nasal spray laced with fentanyl, an opioid up to 50 times more potent than heroin. (According to the Office of the Chief Medical Officer, fentanyl is projected to kill 644 people in Connecticut in 2017, more than any other drug.) Jeff used the nasal spray every day for the rest of the summer.

While he was using, no one, himself included, realized that he was becoming seriously addicted. He was able to keep up his music and maintain strong friendships. Some of his friends were faintly aware that he was using narcotics recreationally—Jeff said he sometimes even offered his friends the nasal spray at parties—but it did not strike them as a big deal.

Because Jeff appeared “functional”—he had a job that summer and the “Yale student” label still applied to him—his struggle with opioid use stayed under the radar. “It’s definitely possible to be a productive member of society as an addict,” Jeff said. A few times, his friends caught him nodding off, a sign of an opioid high. Still, no one suspected he was struggling with addiction.

Upon returning to campus in the fall, Jeff stopped using for a few days when he did not have access to narcotics. He felt extremely hot one moment and awfully cold the next. Every minor prick and pressure caused him immense pain, and he suffered uncontrollable diarrhea. Going through withdrawal was one of the most miserable experiences in his life, he said.

The solution was clear to him: he would swear off opioids forever. He had not signed up for this when he started abusing prescription painkillers a month earlier. Jeff described having a “coming to Jesus moment” and was determined to get sober.

Boredom and loneliness were his two biggest triggers.

But after two months without opioids, Jeff was feeling restless on a dreary November day and decided to order more fentanyl from the Internet. Boredom and loneliness were his two biggest triggers. On nights when not much was happening and he did not have an outlet for his restlessness, he struggled to resist using narcotics. Even though he was well aware of the risk of relapsing, “I was not in a place where I cared,” he said.

A couple evenings later, Jeff, high on fentanyl, fell to the floor of his off-campus apartment. Upon finding him lying unconscious, one of his roommates called an ambulance, which arrived in time to inject him with Narcan, a highly effective antidote. Had an ambulance not come, Jeff almost certainly would have died. He was discharged from the hospital the next morning.

Although Jeff was in New Haven at the time, he was not enrolled in Yale. As a result, he was not at risk of facing disciplinary consequences, and his roommate was able to call for help without any hesitation.

Had Jeff been enrolled, he could have been brought before the Executive Committee, which could have imposed a punishment ranging from “reprimand” to “expulsion,” according to Yale College Undergraduate Regulations. Jeff overdosed in the fall of 2016. At the time, the University handled all drug-related incidents on a case-by-case basis, so there was no way of knowing exactly how Jeff’s situation would have turned out. In the spring of 2014, thirty-three drug-related cases were brought before the Executive Committee, according to the Executive Committee Chair’s Report from that spring. The Report does not specify the outcomes of those cases.

The new Medical Emergency Policy, however, states that a person “consuming alcohol or other drugs who is helped will not be charged by the Yale College Executive Committee with alcohol or other drug violations, but may have to complete counseling, educational, or training programs within an agreed upon timeframe.” Under this policy, a student in the same position as Jeff would not be brought before the Executive Committee.

In January 2014, Clay Dupuy stood helpless in the Hopper College courtyard as he watched his friend get handcuffed and carried away by four Yale policemen. He and his friend had taken LSD a few hours earlier.

Clay began using LSD during his freshman fall to cope with his depression, which was undiagnosed at the time. “I discovered that I could use [LSD and marijuana] recreationally, and have everyone believe that I was using just as they were, when really it was quite therapeutic for me,” he said.

Over winter break, Clay was formally diagnosed with bipolar disorder and prescribed medicine, so he resolved to stop using LSD. But he and his friend had been planning to take LSD for over a month. Clay did not want to reveal his diagnosis, so he decided to take the drug one last time.

The friend had a bad trip, freaked out, ran down a flight of stairs in Hopper and broke a vase in a fellow’s suite. The fellow, who was in the suite at the time, immediately called the police.

When paramedics arrived, Clay told them everything—when, what, and how much he took—concerned his friend was in medical danger and hoping that the information might save his life. He was also entirely forthcoming with his dean. It did not occur to him that he might face serious disciplinary or legal consequences.

Clay said he knew the punishment for marijuana was not severe, and since LSD is “safer,” he thought the punishment for it would not be bad either. The University’s written policy did not and still does not differentiate between marijuana and LSD. Both fall under the category of “illicit drugs.”

The next day, Clay went before the Yale Executive Committee, facing a penalty that could range anywhere from a slap on the wrist to full expulsion. After a series of hearings, the Committee decided to suspend Clay for three semesters. In addition, Clay was charged criminally by the Yale Police Department. If he had been found guilty, he would have had to serve up to 22 years in prison and pay up to $100,000 in fines. Eventually a deal was struck: charges would be dropped if Clay did not get arrested for a year.

Clay is still suffering the consequences. His family went into serious debt paying for a lawyer, which Clay has had to work hard to pay off, and his suspension will be visible to potential employers for the rest of his life.

It is hard to know exactly how things would have played out had the updated Medical Emergency Policy been in place at the time. Although the policy does not define “medical emergency,” Dean Lizarribar said, “A ‘medical emergency’ has no one answer. Anytime a student is concerned or in distress they should always call for help, and as long as they do so and follow through on what AODHRI and [Yale College] requests of them, they will not be subject to discipline by [Yale College].” A bad trip, such as the one Clay’s friend had, would likely qualify under this broad understanding of “medical emergency.” Clay’s specific case, however, would not have been covered because neither he nor another student called for help.

Unlike Clay, Wes was not upfront about his drug use. In the two years before his bad trip in the Silliman tower, Wes was able to hide his struggle with substance use disorder from just about everyone, including his parents, friends, and girlfriend. Cocaine and LSD—the two drugs Wes was on that day—were not the only ones he regularly used. During the first month of Wes’ sophomore year, he was doing anything he could get his hands on: alcohol, marijuana, LSD, MDMA, cocaine, painkillers, ADHD meds, tranquilizers, and antidepressants. “I couldn’t go an hour without doing something to change how I felt,” he said. Wes was using multiple substances a day, often attending class intoxicated, if attending at all. He had developed a constant craving for stimulation. He needed the high.

To make matters more difficult, his growing dependency was complicated by worsening anxiety. “The constant rush of chemicals was devastating as far as my ability to absorb stress,” he said. His psychological state was in endless flux, up one moment and down the next. Wes observed that the “comedown” associated with stimulant use—the state of feeling very low after experiencing a rush—exacerbated his anxiety. His frequent stimulant use caused a never-ending psychological rollercoaster, which had crippling effects on his emotional stability. The more he used, the worse his anxiety got, and the worse his anxiety got, the more he used. It was a “chicken and an egg sort of thing.”

The more he used, the worse his anxiety got, and the worse his anxiety got, the more he used.

Yet despite the extent of his drug use and emotional turmoil, no one had a clue about just how far his life had gotten away from him. Wes did a remarkable job of concealing his struggle. “If you looked in on my life from the outside,” he said, “it would’ve looked like I was put together. I was always going to pull some shit, make something up, and come out on top, feeling in control. But I was becoming increasingly depressed and anxious.” Wes had built up a façade that no one could see through. From the outside looking in, he could have been any Yalie.

Wes’s relationship with drugs began long before he enrolled at Yale. As a kid, he was diagnosed with severe ADHD and prescribed Ritalin. He took the pills on a daily basis through middle school and high school. In addition, Wes struggled with anxiety disorder. When he was fifteen, he started smoking with marijuana with friends and discovered that it helped him cope with his anxiety. By junior year, he was smoking just about every day. “I knew from the beginning that the way I related to substances wasn’t normal,” he said.

During his senior year of high school, Wes’s drug use took a turn when, as in Jeff’s case, Wes got his wisdom teeth removed. He was prescribed thirty Vicodin pills to ease the pain but told to take only three. Wes finished the entire bottle in the course of a weekend. On Monday, out of pills, he felt terribly ill. “A darkness came over me,” Wes said. And so began his addiction to hard drugs.

Opioids were not the only ones. As high-school senioritis kicked in, Wes started snorting his ADHD medicine, giving him a more intense high. To offset the anxiety of the comedown from that high, he began using Klonopin, an anti-anxiety medication that Wes called “pretty much a tranquilizer.”

“It was scary to be doing this,” Wes said. “I knew it was out of control. I knew it wasn’t a good idea.”

Two days after he delivered the valedictory speech at his graduation, Wes voluntarily went to rehab. The second he arrived, he was terrified. As an educated kid from a privileged background, he said he couldn’t relate to the people there, who were much less well-off. “Yet the way they spoke about drugs and alcohol—the way they obsessed over drugs, the way drugs made them feel—I identified with it. That terrified me,” Wes said.

Wes hated rehab so much that after a month he checked himself out against medical advice. That created a huge rift between him and his parents, who wanted him to continue treatment. Things got so heated that Wes contemplated cutting off all ties. He came out of rehab thinking, “Fuck my parents. I’m not done [doing drugs]. I can handle this.” A month before coming to Yale, his parents told him that they would only pay for college if he had a sober coach, drug testing, and took steps to seek treatment and stay sober on campus.

His parents bought his lies. They thought he was recovering, but his addiction was actually progressing.

For the next thirteen months, Wes lived what he called a “double life.” He faked his drug tests with synthetic urine, and he successfully convinced his parents to get rid of the sober coach. His parents bought his lies. They thought he was recovering, but his addiction was actually progressing. During his freshman year, Wes smoked and used stimulants daily and began experimenting with new drugs, like cocaine, LSD and MDMA. His substance use and anxiety gradually worsened throughout the year, but he was able to keep up with his social life and academics, even maintaining above a 3.5 GPA.

After the incident in the Silliman tower early in his sophomore year, Wes spent the weekend at home. Although his parents could tell that something was wrong, he did not tell them about the cocaine and LSD, saying he had had an anxiety attack and needed to unwind for a few days at home.

Wes returned to campus before the next school week, but his façade was about to come crashing down. His drug use was out of control, and a month finto the semester, he was nearly a month behind on his schoolwork. One night, he had to read an entire book for seminar the next day and felt he needed something to get him through it. “If I do cocaine, I’ll be able to read the whole book,” he thought. While his girlfriend lay asleep in bed beside him, he snorted lines off his desk. By 6 a.m., he had run out of the drug. He crashed. When he woke up, he realized he had slept through the seminar.

“I was in the middle of a trifecta: I had crippling anxiety; I was a month behind on schoolwork a month into the semester; I couldn’t stop doing drugs and drinking,” Wes said. It was at that moment that he decided to take a medical withdrawal.

The threat of disciplinary action is not the only barrier between students who struggle with substance use disorder and a willingness to seek help. “Shame about having a problem with drugs or alcohol, compounded with concerns about how the person with the problem will be viewed, get in the way of people talking openly about substance use or getting help when they need it,” said Dr. Richard Schottenfeld, former Head of Davenport College and a leader in the field of addiction science.

Wes said much of the shame he felt kept him from seeking help. And Jeff observed that being stigmatized for using drugs is harmful: “The one thing that I’d tell Yalies is to question the stigma, to question the prevailing norms surrounding substance abuse, and in that, to question the way they treat people.”

Two days after overdosing, Jeff resumed using fentanyl. A few months later, he quit, but then relapsed within weeks. Eventually, at the beginning of the summer of 2017, he went to rehab and has been sober ever since. But he still worries that, if he ever gets bored or lonely enough, he might relapse again.

Wes spent his year and a half away from Yale at a residential treatment center, where he made large strides in his struggle with substance use disorder. He was reinstated in Yale in the spring of 2017.

As he finished telling me his story on a sunny September day in the Silliman courtyard, his mood was remarkably upbeat. “I’ve built myself into a person I can be proud of,” he said. There were a few setbacks along the way, but “every time I slipped, I picked myself up faster each time.”

With Yale’s updated drug policy, students will hopefully be more upfront about their drug use and seek the resources they need. Although the policy applies only to emergency situations, it is a step toward creating a culture of openness. Still, students and school officials must continue working on ways to dispel the stigmas that have prevented many from seeking help.

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