Fighting the dragon

Image by LUEK.

Angelo Pricolo opens up about how the death of a young patient focused his approach to helping find support

Working part-time in the inner Melbourne suburb of North Fitzroy was an eye opener for a young pharmacist. I went in with my private school/university trained ideas and came out starting to be my own man, richer with the experience of life and a desire to make a difference.

Addiction was only touched on briefly when I studied pharmacy in the 80’s and to be honest it still probably doesn’t get enough attention even now. But the content has improved, lots of the bias and stigma has been removed and students receive a more balanced understanding of it being a the chronic, relapsing disease.

It wasn’t until I managed a pharmacy full-time that I really became involved in the treatment of addiction and back then it was all about heroin. Hesitant to take on the management of these patients at first I quickly grew to enjoy it. There were challenges attached to administering one of the biggest opioid replacement treatment (ORT) programs in the state.

The pharmacy was located on a shopping strip on a main road in the northern suburbs of Melbourne. Over 100 patients attended daily for a dose of methadone, the long acting opioid substitute. Take-away or take-home doses were more restricted then, so most patients became daily visitors and naturally we got to know each other well.

As with any patient group some were challenging, but most enjoyed the benefits offered by the substitute drug that gave them another opportunity at life. This pharmacy environment re-enforced what I had started to learn in my part-time job and encouraged me to channel my energy into helping this group.

I engaged with the patient’s families, instigated lengthy discussions about the importance and benefits of the program, I even organized a movie night that everyone was interested in, but no one attended. It couldn’t deflate my interest; I could see how life changing the program was for so many people. I was saving lives and it felt good.

Devastatingly while in my care one young man, Stan, overdosed and died. The police had informed me of his death and requested a dosing history as they pieced together his final days. The exercise revealed a checkered attendance at a relatively low dose. Methadone is an incredibly useful drug but it must be taken every day at the correct dose for maximum success.

What that dose is and what does success look like are two questions beyond the scope of this piece, suffice to say there are key requirements. The dose needs to be high enough to stop craving and success means you get your enthusiasm for life back.

Stan was caught between a rock and a hard place. He was not the only one. Over time I had noticed some patients torn between the advice of health professionals and the wishes of their network of family and friends.

In Stan’s case I had encouraged him many times to talk to his doctor about increasing his dose as he struggled with the effects of withdrawal. I also wanted him to talk more to his parents about opioid replacement therapy as they were opposed to it and vehemently prohibited his involvement. Hence the low dose and many missed doses, when he couldn’t sneak down to the pharmacy.

He managed to get his dad to come and see me and what was evident was a devotion and love for his son. He wanted his son to just stop and he would do anything to help him, even ultimately hasten his son’s overdose death.

Stan had not attended the pharmacy for over a week while his father oversaw a withdrawal regime as cruel as it was simple. He locked him in his room, fed him and only opened the door for bathroom breaks. It was on one of these breaks that he broke out.

Like release from prison or the days immediately after rehabilitation or detoxification treatments, Stan was at the most vulnerable point in his drug-using life. His father’s enforced incarceration had stripped him of the tolerance that protected him from uncertain strength of dealer doses of heroin. 

Unfortunately the new batch of heroin his dealer sold him on the day of his overdose death was more potent than the last few he had purchased. He injected it, stopped breathing within minutes and died alone on a park bench around the corner from his home.

His father was inconsolable. He visited me a week later in tears. We both cried and embraced. The same man who would have likely said “I’d rather he was dead than on methadone” had now changed. “I wish he was on methadone if it meant he would still be alive”. It was too late.

Stan’s death more than anything else was the catalyst for me trying even harder to convince people close to the patient to better understand addiction. Without the support of family and friends my job became like walking up the down escalator. I was getting nowhere.

I’d written articles that no-one read, organised movie nights that didn’t work, so now wondered just how I could help patients explain their pain to the people closest to them. It was these people they needed to understand their disease but often they were unable to provide them with the vital information.

Hiding the disease and trying to beat it solo was a lonely road and rarely ended in success.

I stumbled on a talking-heads videotape (that dates me!) made in the UK. It was a 20 minute interview format with a group of people struggling with the problems that their addiction had caused. Family breakdowns, job losses, homelessness, and incarceration… the list goes on.

The idea was born. The way to reach people is through film, the medium that attracts everyone.  And my patients needed local voices and issues to engage.

I floated the concept without any interest for over a year. In that time I had changed jobs, was running my own pharmacy and growing an ORT program. I went on and off the idea for a long time. My frustration was mounting and finally this pushed me to explore the possibility of making the film myself many years later.

The thought of a pharmacist making a first-time documentary albeit daunting to me seemed almost fictional to others. Nevertheless I tentatively made some enquiries, cautious to keep my real intentions pretty quiet to avoid ridicule.

Some preliminary investigation was not very fruitful until a young filmmaker called Shannon Swan contacted me. He seemed very confident and was aware of my project and wanted to discuss his possible involvement.

We met for lunch at a coffee shop opposite the old home of Turning Point in Gertrude Street, Fitzroy. He came with his business partner Jason and he impressed me with his highlight reel. His breadth of work was comprehensive and definitely beyond my price range, he was fishing for a big payday from a wealthy pharmacist-type and was ready to reel in his prize catch.

I explained my situation. This was a love project. I needed a filmmaker/director but had limited funds, just lots of experience and access to raw compelling stories. Rich with praise for his obvious credentials and impressive CV, I declined his offer on the grounds that I thought he was gold digging. I repeated my low budget for a venture that was at best speculative.

Unless he came clean, we had had a pleasant lunch and time was up. And that was when he played his trump card, the one he was holding back on in case he needed it. He needed it.

“My mum was a heroin addict and gave me away to a foster family when I was four years old. I want to tell this story.”

I didn’t have to think for too long. “You had me at my mum was a heroin addict. We can start tomorrow.”

The project commenced in earnest on a small budget (as promised) and shot over only 3 days. Although many more hours went into research and editing, its simplicity and honesty made it a compelling documentary.

In 2008 I produced the documentary called Fighting the Dragon with Luck. It followed the journey of six patients on my Opioid Replacement Program, their doctor and pharmacist. The Health Department in Victoria distributed more than 15,000 copies to every patient on ORT in the state. It has been subtitled in Vietnamese.

The film played at film festivals and conferences around the world including USA, UK, India and NZ. It was subtitled in Vietnamese, which helped its message reach a vulnerable population group where language was a barrier.

To this day I receive messages from people who have enjoyed the film and sometimes go further and say it changed or saved a life. My thanks always goes to the people that shared their stories and the friendships that we formed.

So where does the title of the documentary come from? One night in the boxing gym with Fab (the main protagonist in the documentary), after running out of conversation, I commented on the enormous tattoo on his leg.

He explained the significance of the image and how it represented his struggle with addiction. The Chinese lettering and big dragon in the tattoo reflected his journey as he was “Fighting the Dragon… with Luck”. He told me the dragon symbolised the heroin and he needed a lot of luck to beat it. 

Then he pointed to his other leg and chuckled. This leg was a blank canvas he hoped one day will tell the story that he’s beaten it.

Angelo Pricolo is an addiction medicine pharmacist and former National Councillor of the Pharmacy Guild of Australia.

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