The synthetic opioid adds an additional challenge
to treating drug use and overdoses in Michigan.
By Michael Pearce
In the weeks leading up to nineteen-year-old Erika’s death, in 2011, her parents had been feeling hopeful. Erika had just been released from prison after her second time in rehab for a heroin addiction, and seemed to finally be doing better. But then Erika relapsed and overdosed, using heroin laced with fentanyl. Her parents found her in bed, motionless and purple, according to her father, Rob. Multiple doses of Narcan could not revive her.
Erika is one of many in mid-Michigan whose life has been claimed by a fentanyl-laced heroin death in recent years. In July 2018, sixteen people overdosed on heroin in Genesee County in a span of ten days. At the time, Genesee County Undersheriff Chris Swanson told the Tri-County Times the drug was “everywhere.”
Genesee county’s biggest city is Flint, the birthplace of General Motors, which was hit hard by the 2008 recession and the collapse of the auto industry. The county has a poverty rate of twenty percent, compared to 15.5 percent in the state of Michigan as a whole. The overdoses in Genesee county are part of a national public health crisis, especially as the use of drugs laced with lethal fentanyl has increased. In 2011, fentanyl was involved in four percent of American drug overdose deaths, according to the Centers for Disease Control and Prevention; by 2016, it was involved in 28.8 percent, first among deadly drugs.
“[Fentanyl] is highly addictive—you take it and you’re addicted,” said Fenton Police Department officer Thomas Cole, who is a court-recognized expert in methamphetamines. “Other street drugs don’t compare. The addictive qualities are so gripping. It is so debilitating, even if users know it’s wrong, they can’t stop from doing it.”
Rob is not Erika’s father’s real name—he requested a pseudonym for privacy purposes. After years of retelling the story of his daughter’s death, he is tired of people coming up to him and tiptoeing around the elephant in the room.
Erika and Rob were “super close.” Whenever Rob would get his boat out, his daughter Erika raced to his side, begging to go with him on a fishing trip. In his words, they were a “good family.” They ate dinner together at the table. Erika and her sister participated in activities from Girl Scouts to soccer to volleyball. “She was always a bit rebellious and always wanted to find her own way. She was a free spirit,” Rob said. “She got hooked up with a bad girl and her boyfriend…She started hanging around that type of crowd.”
Erika’s friend and her boyfriend began using heroin, and they introduced Erika to a boy they knew, a fellow heroin user. He and Erika clicked. Given their strong relationship, Rob and Erika were open and honest with each other, and on Erika’s sixteenth birthday she expressed a desire to try the drug. Rob urged her not to, and said that using heroin would be a dark alley with “no doors, no windows, and no room to turn around.” After tracking her down, finding her at a friend’s house and talking to her for two hours straight in the car, Rob was able to convince Erika to not try heroin that evening. His success was short lived. Soon, Rob and his wife began noticing changes to her physical appearance and mood, which led them to believe she had moved on to harder drugs.
After they learned Erika was using, she went to rehab. But her forty-five-day sobriety streak was broken after exiting rehab, and a second ninety-day stint in a different rehab center soon followed. Once again, the sobriety was short lived. Rob ended up turning his daughter in to her probation officer when she narrowly avoided a drug test and confessed to him that she had begun using once more. Rob mouthed the words “I love you, I am trying to save your life” to Erika as she was being wrestled into a state police car, and she was sentenced to nine months in jail.
When Erika was released from prison just before Christmas, the family began to feel like everything was getting better, and Erika was on the right track. She was clean and under strict parental rules. But just before Valentine’s Day, Erika’s parents discovered that she had been lying to them about where they were dropping her off. She was still using.
Then, on Valentine’s Day, one of Erika’s friends fatally overdosed. Erika was “distraught,” Rob said. The night before the funeral, she begged to go out. Rob refused, but finally agreed to let her have a friend over. He had no idea that this friend was a dealer.
Two milligrams of fentanyl is often a lethal dose. The typical dose of heroin is 100 milligrams, which means that if only two percent of the dose contains fentanyl, the user may die. According to the DEA, fentanyl is an opioid that is “80-100 times stronger than morphine.” This can lead to overdoses because “many users believe that they are purchasing heroin.”
Fentanyl overdoses are not a new problem, says Thomas Cole, who worked undercover for the Flint Area Narcotics Group (FANG) from 2010 to 2013 and now works for Fenton High School in Genesee County as the district officer.
“People were overdosing big time with fentanyl back then,” Cole said. “I dealt a lot with methamphetamines, dismantling the meth labs and testifying in court. Even then, you could see the fentanyl epidemic was huge, it affected everyone.”
Fentanyl’s intended use is to treat pain in cancer patients. The drug is applied as a patch on the skin to improve quality-of-life for cancer patients undergoing chemotherapy, radiation, or surgery. But now it has taken over the streets.
Erin McClelland, director of clinical services at New Paths, Inc., an adult treatment center in Flint, MI, said that it’s not hard to get fentanyl online; as the DEA chases and shuts down one site, another opens up. “You don’t need much of it at all. It’s the smallest amount that can kill somebody.” McClelland said. “And that’s one of the issues that first responders are having. If they even touch it mouth-to-mouth, it can be transferred. And so there’s some paranoia there from first responders with regards to the fentanyl. They’re also have to use multiple Narcan doses. With fentanyl it takes at least four or five doses of Narcan to be revived. For heroin or opiate pills, one to two doses of Narcan would revive the individual.”
While fentanyl is commonly associated with heroin, it can be laced in all types of drugs, including marijuana, methamphetamine, cocaine, and opioid pills. Vox recently reported that in 2012, there were around 4,400 cocaine-related overdoses, with 180 of those deaths related to fentanyl or other synthetic opioids. But by 2016, total cocaine overdose deaths had more than doubled, and nearly 4,200 people died from cocaine overdoses that were related to fentanyl or other synthetic opioids.
While Erika and Dylan were hanging out, Rob’s wife came home. Rob asked if she had had trouble parking with Erika’s friend’s car in the driveway, but she said there were no extra cars. Rob knew something was wrong—where had her friend gone? They went to check on her and found a parent’s worst nightmare.
“Beth ran upstairs and she just started screaming,” Rob said. “I ran upstairs and saw Erika in her bed with her open bedside arm outstretched and she was already purple. I could see all the blood vessels and veins in her arms popping out.” Paramedics tried to revive her, but did not succeed.
After his daughter died, Rob began working with other families who were dealing with a relative who overdosed. They created a program called “Chasing the Dragon,” and spoke to gyms full of high school students around the state about addiction. Over two years, they spoke to about 150,000 Michigan students. Rob always had something prepared to say and threw it all out the window once he began speaking. He was known in the group as the one who pulled on the heartstrings of the audience.
“I’d look at a six-foot-two, 270-pound football guy and I’d talk directly to him and I’d have him crying before it was all over with,” Rob said. “And I cried. I cried every single time.”
Speaking was emotionally draining—Rob was “pretty much useless” the day before and after the presentations, he said. Up until a couple of years ago, it was tough for Rob to even think about Erika without breaking down. “Two years ago, I wouldn’t even be able to get through this conversation” Rob said. “I used to have to pull over while driving. I’d think about Erika and I’d just start crying so hysterically bad that I couldn’t see the road. I’d have to pull over to the shoulder and get my composure back.”
Since Erika’s death, Rob has thrown himself into his many businesses. He does landscaping, apartment remodeling, and snowplowing. “Ever since we lost Erika, I have probably tripled my business I used to think it was her looking down on me trying to help me out, and I think that’s been part of it,” he said. “I buried myself in work to keep my sanity. I constantly have my nose to the grindstone. It’s kept me sane.”
New Paths Inc, the Flint recovery center where Erin McClelland works, continues to search for solutions to help heroin users like Erika. New Paths provides short-term and long-term programs for people with addiction. New Paths also hire former addicts, put them through a training program to become “recovery coaches,” and then pair them with patients. Government funding supports recovery coach programming at New Paths and other agencies.
The New Paths recovery coaches also act as first responders for people who enter the hospital for overdoses or withdrawal. Recovery coaches stay linked with patients for sixty to ninety days, helping them transition to recovery programs. The coaching program gives the addicts currently struggling a mentor who knows what they’ve been through.
New Paths also works with hospital staff, including nurses, doctors, and social workers, to help them understand addiction better. “This has been amazing because they are seeing addiction in a different way now,” McClelland said. “We’re seeing individuals get treated with compassion and more empathy”
Since April, the center’s opioid overdose recovery program has treated more than 200 people and placed over half of them in treatment programs in their facility. In recent years, “there has definitely been more specific attention to programs who are willing to provide additional service for opioid treatment,” McClelland said. “We need more detox facilities. We need more residential facilities. We need more agencies to provide medication-assisted treatment.”
Medication-assisted treatment involves giving medications like methadone or buprenorphine to help recovering addicts with the symptoms of withdrawal. Hospitals and treatment centers in the Genesee County area have increased their methadone programs in response to the opioid epidemic. McClelland said that in Genesee County alone, there are over 600 clients on methadone through the two methadone providers, and the state was still looking for more providers.
“You definitely see growth in those areas,” McClelland said. “I think it’s going to continue to expand, I know the need is there. I really honestly feel that gaps in services are being recognized. The federal, state, and local authorities are trying to accommodate those by providing additional dollars and support.”
McClelland has learned throughout her career that treating addiction is not “cookie cutter.” A relapse doesn’t mean you should give up, because successfully treating addiction can take “a lifetime,” McClelland said. “Making the decision to just not use one day is not that simple. It takes time.” ■
Michael Pearce is a journalism student at Oakland University near Pontiac, Michigan. He has worked for the Oakland Post and the Tri-County Times.
Cover image: U.S. Department of Justice photo. (Public Domain.)
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