What Do You See?

If a picture is worth a thousand words, this one is worth many more than that to me. And a thousand smiles and a thousand tears.  That's Michael, my only child. It represents all that was and all that will never be.  It was taken a few years ago on a really good day.  There won't be another one because Michael is dead. 

Michael's father, John, and I had a rocky marriage that didn't last long.  A Vietnam vet, John suffered from post-traumatic stress disorder, alcoholism and drug addiction. We split up for good when Michael was two months old. Though John eventually got sober, he wasn't a big part of Michael's life in the first few years. My parents have always had a special bond with Michael, and my father became Michael's de facto father.  A photo of my mom holding Michael, just a few days old, sums up how both my parents were with him and me, too.  In the photo, Michael is in my mother's arms, curled up against her shoulder. He was safe there, and loved unconditionally.

We had a great time while he was young.  We traveled and spent many weekends camping in the woods or at the beach.  We had birthday parties and play dates and all the stuff you do with kids.  We attended concerts.  We went to church.  Michael learned to play the drums and the guitar and became a great musician.  We had pets – did we ever have pets!  At one point, we had guinea pigs, rabbits, mice, a cat, two dogs, an iguana, several Burmese pythons and a boa constrictor.  Michael loved animals and they loved him. 

When he was five, he was severely bitten by our Bassett Hound, Barney. (We learned later Barney had a brain tumor that had apparently caused the attack.) Over 200 stitches were required, mostly on Michael's face.  Michael came home from the hospital with his head wrapped up in gauze like a mummy.  When the animal control people came to get Barney, Michael just wanted to comfort him.  He rubbed Barney's head and said, “It's okay Barney, I forgive you.” 

That's how Michael was.  He forgave and he gave freely.  He fiercely defended his family, friends, animals, and even strangers, when warranted.  He would go to bat without hesitation for an underdog in a bad situation.

But he wasn't always pleasant to be around. There is a dichotomy of personality that develops as addiction, a problem that would develop later, takes hold.  Drug abuse would drive Michael to do things he wouldn't have done otherwise, and if he were here he'd insist on honesty about that. 

When Michael was thirteen he ran away from home.  Because of his camping experience, Michael knew what he might need and had prepared to be own his own. But he wasn't prepared for every danger.  Sometime during the first days after he left, he was abducted by a predator who hung out at a popular spot for teenagers.  The guy is in prison now because he was convicted of molesting more than two dozen boys Michael's age.

Sometime while Michael was held captive, the man left his apartment and Michael had the presence of mind to call a friend.  The friend's mother knew something was wrong and without hesitation went to Michael's aid. When she reached the man's apartment she said she saw some of Michael's clothes on the floor. The man had apparently urinated on them. What else happened during those days? Michael didn't tell his friend's mother. He never talked about it with anyone. He wouldn't testify at the man's trial. Whatever occurred was defining, corrosive -- the moment Michael's life took a hard turn down a bad path.

Soon after suffering this horror, Michael started experimenting with drugs.  Pot, then prescription pills his classmates had stolen from their parents' medicine cabinets.  By eighth grade Michael was a regular and indiscriminate user of any drug he could get. His dad, my parents, me – we all did everything possible to help him.  He was in and out of drug rehab and psychiatric facilities many times. He went to twelve-step meetings.  He saw various counselors. We tried a residential facility that worked with children with similar issues. We tried moving out of state and starting fresh. We tried everything, but the disease of addiction had taken its hold.  Michael had discovered that drugs killed his pain and he wasn't willing to give them up.  And he wasn't willing to talk to anyone about his problems. 

Perhaps even worse than the pain of Michael's death was watching him struggle for so long and without being able to help him. He built walls we couldn't penetrate.  Michael knew he was loved and had many friends, but all that he had been through left him with little self-esteem. He felt alone and unworthy, a thread common to many drug addicts no matter their history.  Low self-esteem is not only a result of addiction, but one of its root causes. 

Not that there weren't some hopeful times. For a while during his mid-twenties, it looked like Michael was going in the right direction. He had shaken drugs and had a great job working for the same company I did.  It was an awesome time for us and we became even closer than we'd ever been.  Michael was a sales manager and because of his charismatic personality, he was highly successful.  He was respected and well liked by his co-workers and clients and he was making a lot of money.  He had a serious girlfriend.  He bought a new car. 

I don't know when exactly, but during this time he started using again.  He found heroin, an opiate. (Not all heroin users progress from one drug to another, like Michael did.  Some move from prescription opiates to heroin. Even those with no previous connections in the drug world have no trouble finding heroin.) Michael discovered that heroin dulled his emotional pain and it became his best friend and worst enemy.  It wasn't long before he contracted hepatitis C from sharing needles, and he couldn't get treatment for it because he couldn't stay clean six months. (In the last few years before he died, Michael complained regularly of his liver hurting and had persistent uncomfortable symptoms, but still he used.  His liver didn't kill him, but according to his autopsy report it likely would have in the coming years.)

Once Michael found heroin, his life deteriorated.  The business we worked for closed in the summer of 2008 due to the economy and a few months later I left for Florida.  Michael stayed in Pennsylvania with his girlfriend, but they were both using and their relationship faltered.  They broke up when Michael's dad visited them, and John drove Michael to Florida to stay with me.  Michael was broke and broken-hearted, and about to go through a terrible period of withdrawal.

The picture above was taken on a beach in Florida the day Michael had stopped vomiting, crapping, cramping and freezing long enough for us to leave the house.  It took him three weeks to get to that point and it wasn't over.  Some days, we sat on the couch and I held him and we cried and prayed for him to have the strength to get through it.  He had short periods of respite – the symptoms came in waves – and he'd play the guitar and we'd record some of his music.  After about eight weeks, the worst symptoms had dissipated and regular activities had become bearable. One evening Michael felt well enough to play at an open mic night at a local restaurant. I went to listen to him but I arrived after he did. Right away I knew he was high.  Later that night, he stole my Jeep and sold it to a dealer for $300.  He left Florida the next day.

From the time Michael was thirteen until his death, he was consumed, except for brief periods, by drugs.  He did whatever he felt was necessary to support his habit, at times abusing me, his grandparents, and every other relationship.  When he was without drugs he'd become verbally cruel, on the very edge of violence.  He was a formidable presence, so there were times when he frightened us, but that's as far as it went.  His behavior mattered and discouraged us, but it didn't change how much we loved him. 

Michael made a choice to be on the street. He would show up for food, a shower, and some sleep every few days.  When he needed money, he'd “fly a sign”  ̶  stand at an intersection with a hand-lettered sign, begging for money or work as a day laborer.  Not all homeless people are addicts.  Many are just down on their luck.  Some have mental illness issues, many don't, but they all need help in one way or another, perhaps only in finding employment and making ends meet. Michael was one of these, but he still had a desire to help others.  He would give money when he had it, even if it diminished his ability to get dope.  He would help others get food, arrange for transportation, or anything else he could. 

The week after Michael died, my dad and I went in search of some of his homeless friends to let them know he'd passed. On one of those excursions we spoke with a woman flying a sign near Walmart.  She wasn't one of the people we were looking for, but we talked to her for a while.  We told her about Michael and she told us about a woman named Peggy who died of an overdose in one of the fast food restaurants near there that same week.  She was the first one to tell us that when someone dies like that, the other addicts really want to get hold of the same stuff.  They think that means it's really good dope. Of course, they never think they will die – it won't happen to them.  Michael was one of half a dozen overdose deaths here the week he died.

So you're guessing Michael died of a heroin overdose. No. It was much worse.  In recent years a new problem drug -- Fentanyl -- has been spawned and grown into a monster.  I hope what I've learned can help you avoid a similar tragedy.

My son thought he was taking heroin, but he got something exponentially stronger and more lethal: non-pharmaceutical drug-cartel manufactured and distributed Fentanyl.  In some cases the dealers may not even know that's what they are selling, though in most cases it appears they do.  Sometimes they deliver lethal doses purposely because they know the addicts will desperately search for the same supply in the hopes of a better high.

Fentanyl is sold in prescription form.  In that form, prescribed by a doctor, it is legal.  The Fentanyl sold on the street is made of the same chemical components and is indistinguishable chemically from the pharmaceutical variety.  It is by the extreme proliferation and a few arrests that law enforcement officials have learned they're dealing with Fentanyl from sinister sources.  There are some fatalities from prescription Fentanyl, but almost all of those are from mistakes in using the medication or because it was handled incorrectly by a caregiver or the patient.  In cases where the deceased is known to be a drug user, the deaths are attributed by law enforcement to be from the illegal kind.

Typically, the precursors or components of Fentanyl are purchased by drug cartels from China and shipped into Mexico.  There, the workers put on clean suits, respirators, and surgical gloves and mix the deadly drug.  In its pure form, Fentanyl is a white powder.  Heroin is brownish.  Sometimes Fentanyl is sold on the street as a drug called China White -- Fentanyl that has been cut (to give it more volume) with another white powder substance.  Most of the time Fentanyl comes from Mexico already mixed with heroin -- which gives it the color the user expects.  It is sold on the street as heroin and the addicts don't know that they're getting Fentanyl.  Most of the “heroin” being sold contains Fentanyl. 

In recent cases all across the country, users think they are buying cocaine.  This has been established because of toxicology and personal histories.  These users often have no tolerance built up for opiates and most will die the first time they get Fentanyl instead of or mixed with cocaine.  The reason, of course, that most heroin these days contains Fentanyl and that Fentanyl is being substituted for cocaine is profit.  Fentanyl is much cheaper to produce than heroin or cocaine.  Fentanyl is twenty times more potent than heroin. 

Michael's autopsy report didn't tell us much we didn't already know.  To a certain degree the detective working Michael's case had prepared us for the report, but nothing really equips you to read about your child being dissected – his brain, his liver and every other organ in his body being removed and weighed -- and it all being explained in stark detail. Nothing can prepare you for that.  After reading many scholarly papers on toxicology and talking to medical professionals, I know that the amount of Fentanyl found in Michael's blood during autopsy was enough to have killed three people. The Fentanyl by itself was more than enough to be fatal and there was also a small amount of heroin. 

Fentanyl can kill slowly in comparison to heroin. Often when someone overdoses on just heroin they are found where they injected the drug, the needle still sticking in the injection point.  Heroin reaches its full effect more quickly than Fentanyl and users may just drop where they are.  Not necessarily so with Fentanyl.  With Fentanyl, half an hour or more may pass before a user gets really sleepy. Then he may nod off and never wake up.  There may be respiratory distress – frequently called a death rattle – before death, but it won't always occur and doesn't last long if it does.  In Michael's case, we were told he was “snoring” shortly before he passed so evidently he experienced some difficulty like that before he died. 

Even though they knew he was in trouble, it was a good while before the people he was with called the ambulance.  That is common.  But it probably wouldn't have mattered if they called for help sooner.  Because of the amount of fentanyl in Michael's blood, it was explained to me that if Michael had been sitting in the emergency room when he used, they would most likely not have been able to save him. They used Narcan, a life-saving opiate overdose antidote, three times on Michael to no avail.  Fentanyl has been shown to be fatal in doses as small as 3ng/ml.  Michael had 27 ng/ml according to the autopsy report.

These days there are newer and vastly stronger types of Fentanyl in circulation.  One, called Carfentanil, is an elephant tranquilizer that has been reported to be 10,000 times stronger than morphine.  The miniscule amount of Carfentanil needed to cause death in humans is so minute it can't be described it in believable terms.  It's millionths of a gram.  Millionths.  Even newer is W-18, which comes in a gray pill; it's in the same drug family as Carfentanil.  Carfentanil and W-18 are not as prevalent here yet as Fentanyl, but they're around and it's just a matter of time before the community is feeling the tragic costs of them as well.

Some view this as a victimless crime.  That is not correct.  Yes, Michael was an addict and he had been aware that there was some heroin mixed with Fentanyl on the street.  He knew the risks included death.  Going back to what I said before, no one really believes it will happen to themThe point is, even though he was an addict, he didn't want to die.  He was a victim in that sense, at the very least.  Everyone who loved him is a victim.  Whether you see it or not, you are a victim as well.

As a parent or family member of an addict, your life, your emotions, everything becomes a rollercoaster ride.  I was so afraid of getting “the call” there were times I wouldn't answer the phone when my parents called.  If the phone rang early in the morning or late at night, I would turn the ringer off and wait for my husband to check the voicemail whenever he got around to it.  We all lived in fear of that final notification.  Unless you've lived with that fear, it's hard to explain.  It literally never leaves your mind.  Michael and I talked about it.  His dad talked to him about it.  My parents talked to him about it.  I'm sure he thought it would never happen to him even though he acknowledged that it could.   

Then I answered one of those late night calls.  It was my dad and he told me Michael was dead.  The police notified my parents because they are local and he had their information in his wallet.  I don't remember a lot about that night, but I remember the absolute agony and the screams that just kept coming.  It was hard to breathe.  I can tell you because Michael talked to me openly about some things, that he'd be really mad about dying the way he died.  I know because we discussed this very scenario.  He didn't want to die in some seedy motel room of an overdose.  He didn't want to be a cliché. 

Michael tried over and over again to get off the dope, but the withdrawal sickness was a big reason he wasn't able to stay clean.  One of the biggest stumbling blocks for addicts getting clean is the fear of withdrawal.  It is absolutely awful in ways I cannot adequately describe.  I watched and helped Michael through it more than once and it's not an experience for the faint of heart.  There were times when he tried to get into a detox or treatment facility and no beds were available.  Those were the worst.

When an addict is ready to try to get clean and they're refused admission to a facility because there isn't any space, which happens much more often than not, it can be a death sentence.  They have to keep using to avoid the awful withdrawal.  Addiction is a disease and addicts are no more able to just stop using than a cancer patient can just stop having cancer.  Some addicts will reach a point of desperation, a point where they are willing and ready to get help.  If the opportunity for help isn't there, their choices are to continue using or be horribly sick.

When Michael was lucky enough to gain admission to a facility, he often didn't last more than a few days. That's typical. The standard for detox in these places is three days.  That isn't nearly enough time, even with some mitigating medication. Once the three days are up, they are off the detox medications (if they got any) and moved to the treatment section of the facility.  It's way too soon, the throes of withdrawal are just beginning to set in, and they are too sick to do anything but think about “getting well” (in an addict's terms, that means using some heroin).  The withdrawal symptoms can last for months.  There are very few facilities providing opiate detox, and the total length of stay including treatment is usually thirty days or less.  Again, it's not nearly enough time. 

There are medications out there to help addicts get off heroin, but most are just substitute drugs that have the same effects.  Two of the most widely used are Suboxone and Methadone.  Michael tried both and his experiences were typical. Suboxone is a prescription that goes home with the addict and is sometimes given in a detox facility.  It's a pill that is a kind of substitute for heroin.  The addiction is transferred from an illegal substance to a legal one that keeps the addict from going through withdrawal.  The idea is to keep them off heroin and slowly taper off the Suboxone.  It usually doesn't work out that way.  Most wind up selling the Suboxone pills – they go for about $10 each on the street – and buy heroin with the money.  Others abuse the Suboxone by taking more than prescribed because they are addicts and that's what addicts do.  Then they run out before they are allowed a refill and have no choice but to go back to heroin or through withdrawal.

Methadone is even worse.  According to Michael and others I've talked with who have gone through it, Methadone is much harder to stop than heroin.  The withdrawal is similar, but more physically painful and lasts longer.  Even if it were a good option, it's not available or possible for a lot of addicts.  In our town, they have to get to the clinic downtown every morning between six and nine to get dosed.  Many people who are on Methadone stay on it for years.  I read an article a few years ago written by an attorney in Atlanta who was an addict on Methadone and she'd been taking it for over twenty years.  In almost all cases the cost of Methadone and Suboxone treatments are borne by the taxpayers.

I don't have the answers to this problem.  One thing is for sure, the key to saving lives and resources is not treatment, it's prevention.  Until the point is reached where we can focus on that, there have to be more resources allocated to the fight.  Police departments around the country are struggling because there is simply too much product out there and too many dealers.  Other public and non-profit organizations are also unable to keep up.  The only opiate detox facility in our local area, serves thirty-seven counties with only 24 beds available for opiate detox.  That's not even a drop in the bucket.

Aside from the toll on friends and families, addiction is an expensive burden on the community.  I know what happened in Michael's case, and it is emblematic.  The first responders were called at 7:00 and arrived at 7:08.  They spent one hour and thirty-one minutes trying to revive him.  During that time, they used Narcan three times.  The fire department arrived first and began working on him, then the ambulance, then the police.  All of those responders were on site throughout the rescue effort.  After he was declared dead, the police spent the next several hours confirming his identity and then making the notification.  Two police officers went to my parent's house and were there about an hour.  My dad called me when the officers left, shortly after midnight.  Michael was transferred to the morgue at our local hospital where he stayed until late the next morning when he was transferred to to another facility for the autopsy.  Then he was delivered back to the funeral home we'd selected.  The police, over six months later, are still investigating.  All of these efforts and movements are costs paid by taxpayers. 

The costs related to emergency care don't begin to reflect the financial costs of addiction to a community.  Many people seek treatment without any insurance or other means to pay for it.  If they are able to get into a rehab facility, the costs of providing for them can exceed hundreds of dollars per day.  There are other associated costs, too such as extended mental health treatment and treatments for serious illnesses that often accompany addiction, again, paid for more often than not with tax dollars.  Still other costs related to addiction, like increased criminal activity and homelessness and child welfare issues, necessitate expenditures that are paid for with public money.

So what do you see in the photograph now?  If I've done Michael any justice, you should have a clearer understanding of the seriousness of the drug problem and how it can affect anyone -- how it is affecting you. If Michael's story made you cry, good.  If it shocked or angered you, even better.  Hold on to that feeling. Let it sink in.  Then do something.  Make a donation.  Give your time.  Spread the word.  Do any or all of those things and you can help save a life and make your community a better, safer place.

©2017 In.Tribute.to.Michael@gmail.com.  Publication and distribution are prohibited without written permission.





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