What Do You See?

It has been said a picture is worth a thousand words. This one is worth at least that, and a thousand smiles and a thousand tears to boot. That's Michael, my only child, and I'm grateful to have a lot of photos and memories of him because there won't be any more. Michael is dead.

I'm inclined to write a volume about his life but that's not what this is about. I'm going to talk about his life a little though, because it'll help you understand what has to be said about how he died. Buckle up, it's going to get personal.

Michael's father and I had a rocky marriage and it didn't last long. He was a Vietnam vet and suffered from PTSD (Post-Traumatic Stress Disorder), alcoholism, and drug addiction. We split up for good when Michael was two months old. John got sober eventually, but he wasn't a big part of Michael's life in the first few years. My parents always had a special bond with Michael and my father became Michael's de facto father. I have a photo of my mom holding Michael when he was just a few days old that sort of sums up how both my parents were with him and me, too. In the photo, he's all curled up laying against my mom's shoulder and she has her arms wrapped around him. He was safe there, all warm and fuzzy, and loved unconditionally.

We had a great time while he was young. We traveled and spent countless 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 – boy, did we have pets! At one point, we had guinea pigs, rabbits, mice, a cat, two dogs, an iguana, several Burmese pythons and a Boa. Michael loved animals and they loved him.

When he was five, he was severely bitten by our Bassett Hound, Barney (we found out later it had a brain tumor that had apparently caused the attack). It took over 200 stitches, mostly on his face, to sew him up. 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.”

His entire life he forgave and he gave freely. He was a fierce defender of his family, his friends, animals, and strangers if the situation warranted. He would always fight for the underdog. However, there was a definite dichotomy of personality that developed as the addiction took hold, so he wasn't always a joy to be around. Drug addiction would drive him to do things he wouldn't have otherwise and if he were here he'd insist on honesty about that. He wasn't proud of his mistakes, but he never hid from them.

When Michael was thirteen he ran away from home. Since we'd camped so much, he knew what to take and he left prepared to do that. After two days, the police warned us the odds were decreasing dramatically that we'd find him. Sometime during the first day or two after he left, he was abducted by a grown man who hung out at a popular spot for teenagers. I guess you can imagine what happened. The man is in prison now after being convicted of molesting dozens of boys Michael's age.

At one point, Michael's abductor left him alone and he took the opportunity to call a friend. His friend's mother knew something was seriously wrong and went to get him without stopping to think about it. Thank God. He didn't tell her mother what had happened, but she told me when she got there she saw some of Michael's clothes on the floor and the man had urinated on them. We can only imagine what he must have gone through in those few days because he would never talk about it.

It was during that week that Michael's psyche was damaged in ways that were never going to get repaired. Suffice it to say that was the defining moment, the point where Michael's life took a hard turn in the wrong direction. We tried to get him help, but he would never open up to anybody about what happened.

Soon after that he started experimenting with drugs. Pot at first, then prescription pills his classmates had stolen from their parent's medicine cabinets. By eighth grade he 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. Michael was in and out of drug rehab and psychiatric facilities so many times we lost count. He went to twelve step meetings. He went to see psychiatrists and psychologists. 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 and it wasn't going to let go. Michael had discovered that drugs killed his pain and he wasn't willing to give them up. Everything we tried to do to help him was to no avail because he wouldn't talk to anyone about his problems.

Perhaps as bad as the pain of his death was watching him struggle for so long and not being able to help him. Michael knew he was loved and had many friends, but all that he had been through left him with no self-esteem. No matter what any of us did, we were not able to get through the walls he'd built. He felt alone and unworthy. That is a common thread with probably every drug addict no matter their history. Low self-esteem is not only a result of addiction, but one of its root causes.

Still, there were pockets of normalcy and for a little while during his mid-twenties, it looked like he was going in the right direction. He was off 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 the 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 exactly when it happened, but it was during that time he started using drugs again. He found heroin. As you may know, heroin is an opiate and it kills pain. Michael discovered that it killed his emotional pain and it became his best friend and worst enemy. It wasn't long before he'd contracted Hep-C from sharing needles and he couldn't get treatment for it because he couldn't stay clean six months. In the last couple of years before he died, he'd complained regularly of his liver hurting and had persistent uncomfortable symptoms, but still he used. His liver didn't kill him, but according to the autopsy report it likely would have in the coming years.

Once Michael found heroin things got really bad really fast and stayed that way. 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 so it didn't last long. They broke up while his dad was visiting them and he drove Michael to Florida to stay with me. He was broke, broken-hearted, and about to go through a terrible period of withdrawal.

The picture of Michael was taken on the beach in Florida the day he'd finally stopped throwing up and crapping and cramping and freezing long enough for us to leave the house. It was a happy day. It took three weeks to get to that point and the withdrawal still 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 – symptoms seemed to come in waves – and he'd play the guitar and we'd record some of his music.

After about eight weeks, the worst symptoms had become somewhat bearable. Michael decided to go out and play guitar at an open mic night. I went to listen but I got there a couple of hours after he did. I could tell right away 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 he was thirteen until his death he was consumed, except for short periods, by drugs. He did whatever he felt necessary to support his habit and at times abused me and his grandparents and every other relationship. When he was without drugs, he'd become verbally abusive and seem on the very edge of violence. He was a pretty formidable presence, so there were times when he frightened us but that's as far as it went. I can't say that none of that mattered, but it didn't change how much we loved him.

Michael chose 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” (standing at an intersection with a cardboard sign asking for money) or work as a day laborer. I need to say here that not all homeless people are addicts. Many of them are people who are just down on their luck. Others have mental illness issues. They all need help in one way or another if only just in finding employment and making ends meet. Michael was one of them, but he still had a desire to help. He would give money when he had it, even if it shorted his ability to get dope. He would help them get food, arrange for transportation, and 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 and, of course, they won't die – it won't happen to them. Michael was the fifth or sixth overdose that week. Four of them died.

So you're probably thinking Michael died of a heroin overdose, right? Wrong. It's much worse than that. In the last few years a new problem drug has reared its ugly head and grown into a monster. I have done a lot of research and the facts you'll read are accurate to the best of my knowledge. I am not a medical professional. I'm a grieving mother who wants to keep this from happening to someone else.

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 dealer may not even know that's what they're selling, in most cases they do. But it's even worse than them knowing what they're selling – sometimes they deliver lethal doses on purpose 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 virtually, if not totally, chemically indistinguishable from the pharmaceutical variety. It is by the extreme proliferation and a few arrests law enforcement officials have learned they're dealing with Fentanyl from sinister sources. There are a few fatalities from the prescription variety, 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, the Fentanyl is a white powder. Heroin is kind of a brownish color. Sometimes Fentanyl is sold on the street as a drug called China White. It seems China White is Fentanyl that has been cut (to give it more volume) with another white powder substance of some sort. Most of the time the 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 some recent cases in North Carolina, the user thinks 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 in 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 give us much information we didn't already know. We'd been prepared to some degree by the detectives working the case, but nothing really prepares you to read about your child being cut up into parts – his brain being removed and weighed, his heart, and every other organ in his body - and then all that explained in glaring 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. Many times, when someone overdoses on just heroin they are found lying where they injected the drug with the needle still in them. Heroin reaches its full effect more quickly than Fentanyl and often they just drop where they are. Not necessarily so with Fentanyl. With Fentanyl, half an hour or more may go by before they get really sleepy. Then they nod off and never wake up. They may have respiratory distress – frequently called a death rattle – before they die, but that won't last long and doesn't always occur. One of the people that was with Michael told me that he was “snoring” just before he passed away, so it appears that 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 most often the case. But it probably wouldn't have mattered if they called for help sooner. 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.

These days there are newer and exponentially stronger versions of Fentanyl also in circulation. One type, called Carfentanil, is an elephant tranquilizer that has been reported to be 10,000 times stronger than Morphine. The miniscule amount of that needed to cause death in humans is so minute it can't be described in believable terms. It can be as little as millionths of a gram. Millionths of a gram. There's also something even newer called W-18 that comes in a gray pill. I haven't found much information about it, but it's in the same family of drugs. 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 people view this as a victimless crime. That is totally incorrect. Yes, Michael was an addict and he knew the risks of using included death. Going back to what I said before, no one really believes it will happen to them. The 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 voice mail 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 late one night I got the dreaded call. It was my dad and he told me Michael was dead. The police notified my parents because they're 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 things, that he'd be really mad about dying the way he did. I know because we talked about 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 clean, 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 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 pretty typical. The standard for detox in these places is three days. That isn't nearly enough time, even with some mitigating medication like Suboxone. Once the three days are up, they are off the detox medications 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 often last for months. In the few facilities that provide opiate detox, the length of stay including detox is usually thirty days or less. It's not nearly enough time. It's a no brainer that isn't a good plan.

There are medications to help addicts get off heroin, but they 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 are pretty much typical so I have a good understanding of them.

Suboxone is a prescription that goes home with the addict or is sometimes given during detox in a facility. In essence they are trading a street drug for a legal one that keeps them 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. In many instances, Suboxone winds up being used like Methadone as a maintenance drug that the addict will take indefinitely. Big pharmaceutical companies make tons of profit and nothing changes for the addict.

Most addicts 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.

According to Michael and other people I've talked to that 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 Greensboro, 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 am well versed in the problem, but have no clue what the answers might be. One thing is for sure, the key to saving lives and resources is not just treatment, it starts with prevention. Until we get to where the focus can be on prevention alone, there has to be more resources allocated to the fight. The police department in Greensboro can't keep up with the problem because it is so widespread. Other public and non-profit organizations are also unable to keep up. ARCA, the only facility offering opiate detox in Guilford County, serves thirty-seven counties with only 24 beds available for 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 that affects everyone. I know what happened in Michael's case, and it is typical. The first responders were called at 7:00 and arrived at 7:08. They spent one hour and thirty-one minutes trying to save 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 shortly after midnight and they had just left. Michael was taken to the morgue at Cone Hospital where he stayed until late the next morning when he was transferred to Raleigh for the autopsy. Then he was delivered back to Greensboro to the funeral home we'd selected. The police, almost six months on, are still investigating. All of those 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 cost of providing for them can run into hundreds of dollars per day. There are other associated costs like extended mental health care, treatments for illnesses that often accompany addiction, increased criminal activity, homelessness, and child welfare issues just to name some. All of those issues necessitate expenditures that are paid for with tax money.

One last and important point before I close. Not all heroin users started out like Michael. There are as many paths to heroin addiction as there are addicts. Only some of them live like Michael did, plenty of others are professionals with families and careers and no obvious indication that they're hiding an addiction that is going to kill them. Just a month ago I saw a young man I knew who by all accounts had not been using any drugs. He was close with his family, had a circle of good friends and had just become engaged. He was successful in his career. Now he's dead. The autopsy results haven't yet been reported, but like Michael, the family was told it was a probable heroin overdose.

It's also become more and more common for people to move from prescription opiates to heroin. This is much more prevalent than it might seem to be among a group of people who otherwise have no history using illegal drugs. Usually, they've been prescribed opiates for chronic pain but because of recent concerns about opiate addiction and more stringent guidelines for prescribing, many of these patients can no longer obtain those prescriptions. Some people who can't get medicated legally will seek alternatives rather than suffer chronic pain and the horrible opiate withdrawal. Even people who have no previous connections in the drug world have no trouble finding them if they are desperate enough. The odds are pretty good that you know someone who is addicted to heroin – a neighbor, parent, partner, co-worker, or even your child.

If I've done Michael any justice, you should have a clear picture of the seriousness of the problem and how it can affect anyone. How it is affecting you and your community. If Michael's story made you cry, that's good. If it shocks you or angers you, even better. Hold on to that feeling and 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.

Here's a list of some local organizations who need your help:

ARCA (336) 784-9470 (detox and inpatient treatment center)

Daymark Recovery Services (336) 899-1550 (inpatient treatment facility)

Re4Him, (719) 244-2456. (helps homeless individuals with meals and placement into drug and alcohol treatment