PharmD. Candidate: St. John’s University Class of 2018
Farah Khorassani, Pharm.D., BCPS, BCPP
Assistant Clinical Professor | St. John's University College of Pharmacy & Health Sciences
Clinical Coordinator, Psychiatry | The Zucker Hillside Hospital
“Junkies”. “Addicts”. “Crack heads”. These are all common derogatory terms referring to people suffering from drug addiction. Requiem for a Dream depicts four different kinds of drug addiction each leading different outcomes for the characters. Sara Goldfarb (Ellen Burstyn) is addicted to amphetamines, Marion Silver (Jennifer Connelly), Tyrone Love (Marlone Wayans), and Harry Goldfarb (Jared Leto) are all addicted to heroin. The lives of these characters are all drastically changed as they progress further into their drug addiction. Requiem for a Dream is not like a typical drug abuse film in which the characters have successfully overcome their addiction or are on a path to recovery. Instead, it shows how drug abuse completely engulfs an individual to the point where they are unrecognizable.
Sara Goldfarb, mother of Harry, is shown to be addicted to amphetamines after taking a weight-loss medication prescribed by her doctor. She received an invite to a game show and wants to wear her red dress that she used to wear when her husband was alive; when she goes to try it on, she does not fit into it. As a result Sara tries to lose weight, but ultimately fails. Her friends refer her to a doctor that prescribes medications for weight-loss. Sara is adherent to her dosing schedule but eventually, starts to take extra doses when she notices the medication was not working fast enough. Her increase in the medication leads her to develop psychosis characterized by severe hallucinations and paranoia.1 During one of her psychotic episodes, Sara went to the studio for the TV show because she was convinced it was time for her to appear on the show. When she arrived, she was admitted into a hospital after employees at the network realized that she was delusional. The doctors started her on an array of drugs that were ineffective in and she was eventually treated with electroconvulsive therapy (ECT).
Harry Goldfarb, Tyrone Love, and Marion Silver are all heroin users; Harry and Tyrone dream of becoming successful drug dealers while, Marion wants to start a clothing line. In the beginning their business is going well, they are bringing home a lot of money and have successful relationships. When there was stall in the heroin supply and not enough was available to use or sell, the three of them become very desperate for both heroine and money. Their relationships deteriorated and they had to resort to drastic measures to obtain heroin. Marion had to engage a pimp who gave her heroin in exchange for sexual pleasures and the two men attempted to drive from New York to Florida to visit a heroine wholesaler. During the roadtrip, Harry’s arm becomes infected and must seek treatment in the hospital. It becomes clear to the physicians treating Harry that he is a heroine abuser and both men are sent to jail. While in jail, Tyrone and Harry develop severe symptoms of drug withdrawal including sweating, shakiness, agitation, and cravings.1 Harry’s symptoms are replaced with the pain from his gangrenous arm; the spot that he uses to shoot up has become severely infected and Harry is readmitted to the hospital to have his arm amputated off to prevent the gangrene from progressing.
As pharmacy students, this movie brings to life the heroine epidemic that we often hear about, but do not see first-hand. According to recent CDC statistics; there has been a 22.4% increase in heroin abuse from 2014.2 As students and professionals, increased awareness of the mindset of someone suffering from drug addiction may help us work against the stigma and support these patients. A requiem is a service offered to the deceased as per the Catholic Church; this movie serves as a service to the unfulfilled dreams of each of the characters, as they fell further into the downward spiral of their addictions. Both ends of the addiction spectrum are seen within the movie – abuse and withdrawal. Sara’s addiction showcases the extreme end of amphetamine abuse whereas the others addiction showcases the side effects of withdrawal. This movie very clearly portrays the message “don’t do drugs” portraying the traumatic physical and psychological effects drugs has on a person. As health care professionals we must attempt to understand the strife of these patients and assist them with recovery.