She had already made it through one last night alone under the freeway bridge, through the vomiting and shakes of withdrawal, through cravings so intense she'd scraped a bathroom floor searching for leftover traces of heroin. It had now been 12 days since the last time Amanda Wendler used a drug of any kind, her longest stretch in years. "Clear-eyed and sober," read a report from one drug counselor, and so Amanda, 31, had moved back in with her mother to begin the stage of recovery she feared most.
"Is this everything I have?" she asked, standing with her mother in the garage of their two-bedroom condominium, taking inventory of her things. There were a few garbage bags filled with clothes. There was a banged-up dresser she had put into storage before moving into her first abandoned house.
"Where's my good makeup?" Amanda asked.
"Maybe you pawned it with the jewelry," said her mother, Libby Alexander.
"What about all of my shoes?"
"Oh, God. Are you serious?" Libby said. "Do you even know how many pairs of shoes you've lost or sold?"
Amanda lit a cigarette and sat in a plastic chair wedged between the cat food and the recycling bins in the garage, the only place where she was allowed to smoke. This was the ninth time she had managed to go at least a week without using. She had spent a full decade trying and failing to get clean, and a therapist had asked her once to make a list of her triggers for relapse. "Boredom, loneliness, anxiety, regret, shame, seeing how I haven't gone up at all in my life when the drugs aren't there," she had written.
She had no job, no high school diploma, no car and no money beyond what her mother gave her for Mountain Dew and cigarettes. A few days earlier, a dentist had pulled all 28 of her teeth, which had decayed from years of neglect. It had been a week since she'd seen her 9-year-old twin sons, who lived in a nearby suburb with their father, and lately the most frequent text messages coming into her phone were from a dealer hoping to lure her back with free samples: "Got testers," he had just written. "Get at me. They're going fast."
In the addicted America of 2016, there are so many ways to take measure of the pain, longing and despair that are said to be driving a historic opiate epidemic: Another 350 people starting on heroin every day, according to estimates from the Centers for Disease Control and Prevention; another 4,105 emergency-room visits; another 79 people dead. Drug overdoses are now the leading cause of injury-related death in the United States — worse than guns, car crashes or suicides. Heroin abuse has quadrupled in the past decade. Most addicts are introduced to heroin through prescription pain pills, and doctors now write more than 200 million opiate prescriptions each year.
But the fact that matters most for a chronic user is what it takes for just one addict to get clean. The relapse rate for heroin has been reported in various studies to be as high as 97 percent. The average active user dies of an overdose in about 10 years, and Amanda's opiate addiction was going on year 11.