Editor\u2019s Note: \u201cFentanyl in America: A Way Out\u201d on \u201cThe Whole Story presented by Anderson Cooper\u201d at 8 p.m. ET\/PT Sunday.<\/p>\n
In a letter dated March 9, Quigley, 39, said she had been sober for two years before relapsing on illicit fentanyl. Her anguish poured out onto the notebook pages she sent us. <\/p>\n
\u201cI threw away all I had going for myself because I never felt worthy of my accomplishments,\u201d she wrote. \u201cIn true Crystal fashion, I self-sabotaged \u2026 all because I didn\u2019t know how to be comfortable sober.\u201d <\/p>\n
But the reasons why she relapsed may be\u202fmore complex. <\/p>\n
Two-thirds of Americans say that either they or a family member has been addicted to alcohol or drugs, been homeless because of an addiction, or overdosed and died from drug use. Statistically speaking, addiction has affected the lives of most people reading this. What also may hit close to home with readers is the complicated battle to fight it. <\/p>\n
Fentanyl is one of the most powerful synthetic opioids to have infiltrated the street drug supply. Since 2020, fentanyl overdoses have been the leading cause of death for American adults under 50. However, drug overdose death rates that had been soaring since 2018 have begun to drop in at least 45 states, according to the US Centers for Disease Control and Prevention. <\/p>\n
Public awareness of its dangers and the distribution of naloxone, a medication that rapidly reverses an opioid overdose, have been credited as reasons for the drop. But overdose death rates are not dropping across all demographics. In fact, they\u2019re still on the rise for certain groups of people. <\/p>\n
Nearly a decade into the opioid crisis, new challenges and solutions have emerged. Among them: a growing number of Americans who use illicit fentanyl and survive. <\/p>\n
Crystal Quigley\u2019s substance use started with meth and heroin well over a decade ago. When fentanyl entered the street drug supply, she said, she tried to avoid it. <\/p>\n
\u201cI\u2019ve overdosed probably two dozen times\u201d on fentanyl, the 39-year-old said through tears. \u201cMy mom found me in the bathroom one time and had to call 911.\u201d <\/p>\n
Quigley is a mother of five. Her two boys don\u2019t speak to her. \u201cI still don\u2019t have a relationship with my sons,\u201d she said in 2023. \u201cI know that the person I am now has a fighting chance to get my sons back.\u201d <\/p>\n
She first encountered buprenorphine while incarcerated at Camden County Correctional Facility in south New Jersey, the state\u2019s first jail to offer multiple medications for opioid use disorder. <\/p>\n
Quigley started using Sublocade, a monthly injectable form of buprenorphine. <\/p>\n
\u201cI\u2019ve been in recovery several times,\u201d she said, \u201cbut that shot made me feel more normal than I\u2019ve ever felt in my entire life.\u201d <\/p>\n
Buprenorphine has shown to be successful in treating opioid use disorder. In downtown Camden, New Jersey, Cooper University Health Care EMS is the first in the nation to carry buprenorphine, and paramedic Eric Tuttle has seen his share of opioid overdoses. <\/p>\n
\u201cWe\u2019re probably seeing three to seven overdoses a shift,\u201d he said, and he believes they are mostly caused by illicit fentanyl. <\/p>\n
\u201cWe\u2019re already precipitating withdrawal with the Narcan [a brand name for naloxone], but we don\u2019t have a choice,\u201d Tuttle said. \u201cThe Narcan is needed to get them resuscitated and breathing again.\u201d <\/p>\n
Once Tuttle and his team administer Narcan, they offer buprenorphine. \u201cOnce you treat the withdrawal, then you can have a nice casual conversation,\u201d he said. As part of that conversation, he offers to take them to the hospital, which will then refer them to an addiction recovery center. <\/p>\n
It\u2019s working. Cooper University Health Care conducted a study of its EMTs carrying buprenorphine and found that \u201cthe intervention was associated with a nearly sixfold increase in the odds of engagement with treatment within 30 days.\u201d This means administering buprenorphine gives opioid overdose patients a much higher likelihood of getting into an addiction rehabilitation facility. <\/p>\n
But buprenorphine has its limits when it comes to illicit fentanyl, according to Dr. Paul Updike, medical director of substance use services at Catholic Health hospital in Buffalo, New York. <\/p>\n
Updike finished his medical residency in 1998. \u201cPretty quickly in my career, I started seeing a lot of patients who were struggling with opioid addiction,\u201d he said. <\/p>\n
\u201cBuprenorphine historically did work very well, in my experience, for patients who were using prescription opioids,\u201d he explained. \u201cI personally have hundreds of patients who are on buprenorphine in a maintenance situation. <\/p>\n
\u201cAs a short-term intervention, buprenorphine is very appropriate and could be very effective. What we\u2019ve been finding, though, because of the potency of fentanyl being so high, is that buprenorphine in the long run is not as effective as it used to be.\u201d In other words, buprenorphine may get you in the door and on your way to recovery, but it may not be what helps you stay. <\/p>\n
\u201cThe past 15 years with my mom have been like a roller coaster,\u201d Audrena said. \u201cNights with her not being there, I would just worry her a lot. I was mad at my mom because I didn\u2019t really understand.\u201d <\/p>\n
Audrena paused and then said with a maturity well beyond her age: \u201cI\u2019ve realized I shouldn\u2019t be mad at her. It\u2019s a hard thing to overcome. So I just let that be.\u201d <\/p>\n
Sitting next to her, Quigley replied, \u201cI was mad, too.\u201d <\/p>\n
Months later, after two years on buprenorphine, Quigley would relapse. <\/p>\n
\u201cWhat kind of piece of shit uses when they\u2019re pregnant?\u201d 26-year-old Marisa Delles asked. \u201cBut it\u2019s reality, and it\u2019s not that simple.\u201d <\/p>\n
Delles grew up with an intimate understanding of opioid use. She said her mother became addicted to prescription opioids after a back surgery, although she was reluctant to speak ill of her. \u201cShe was pretty normal up until I was 12. \u2026 I don\u2019t like talking about all the bad stuff. She definitely did her best. She was a good mom. It was really just when I was older that she started using heroin.\u201d <\/p>\n
In Buffalo, New York, where Delles lives, the street drug supply changed well before the Covid-19 pandemic. \u201cYou can\u2019t really get heroin anymore. It\u2019s just not really out there,\u201d she said. Illegal fentanyl took its place. <\/p>\n
Delles\u2019 mother died of a fentanyl overdose in 2022. \u201cShe took a nap, closed her bedroom door, and she was gone,\u201d she said. <\/p>\n
At that time, Delles was also using illegal fentanyl. She started using in 2018, when she was 19. After a bad breakup, she said, \u201cI just didn\u2019t want to feel.\u201d <\/p>\n
Her use quickly escalated. \u201cI would wake up in the morning, and my legs would be shaking. I would be sweating, and I realized that I need this every day now, and I just never put it down. I was using so much fentanyl a day just to stay unsick, not be shitting myself and throwing up and like rolling around on the floor from withdrawal.\u201d <\/p>\n
Withdrawal from fentanyl, according to Delles, is the hardest thing she\u2019s ever gone through. \u201c[Withdrawal] is the number one reason that I never stopped using. \u2026 I would beg God to help me get through it. I wanted to be clean so bad, but \u2026 it\u2019s too hard.\u201d <\/p>\n
Then she beenme pregnant. <\/p>\n
\u201cIt\u2019s actually more dangerous to stop using if you\u2019re already pregnant,\u201d said Dr. Lauren Davidson, neonatologist at Sisters of Charity Hospital\u2019s NICU in Buffalo. \u201cThe baby can die inside. The baby will also go through withdrawal, much like the mom will if she stops using. And it can cause the baby to actually die in utero.\u201d <\/p>\n
Davidson said the number of her patients affected by opioid use disorder has tripled since she started practicing in neonatology. \u201cThe more that we judge these mothers,\u201d she said, \u201cit will continue to get worse, because they won\u2019t come for help.\u201d <\/p>\n
Delles carried an immense amount of guilt. \u201cI hated myself for getting pregnant,\u201d she said. \u201cWhy would I bring a kid into this world \u2026 addicted to drugs?\u201d <\/p>\n
She used fentanyl for the first three months of her pregnancy, until she found medication to help her wean off. \u201cI definitely had to,\u201d she said. \u201cI couldn\u2019t just quit. I was eating healthy. I was taking my prenatals. I was doing everything that I felt like was going to help.\u201d <\/p>\n
She tried a form of buprenorphine called Suboxone, which combines the drug with naloxone, but it was not potent enough, according to Delles. \u201cI was just scrambling to find a way [to stop using fentanyl]. Every day that went by and I was still using was the worst day of my life. They tried putting me on Suboxone, and it didn\u2019t work. I was just rolling around in bed, in withdrawal.\u201d <\/p>\n
Then she started methadone treatments and finally stopped using fentanyl. Methadone is a full opioid agonist while buprenorphine is a partial one. To put it simply, it\u2019s a stronger medication. Since the 1960s, methadone has been used as medical treatment for people recovering from heroin use. If she had not found methadone, \u201cI probably would have lost him, or I would have overdosed and died,\u201d Delles reflected. \u201cI don\u2019t even want to think about it. I don\u2019t know how I would have crawled out of this hole.\u201d <\/p>\n
Her son, Luca, was born fairly healthy, Delles says. <\/p>\n
Like buprenorphine, methadone curbs cravings and eases withdrawal symptoms \u2013 and it is partially an opioid, which means Delles\u2019 son would still go through withdrawal symptoms after birth, and he had to stay in the NICU for five days for monitoring. \u201cHe only scored a 1 out of 10\u201d on withdrawal severity, Delles says. <\/p>\n
No matter the continued risk of withdrawal symptoms, medications like methadone for those who are pregnant are still safer than quitting illicit fentanyl cold turkey, according to Davidson. \u201cIt\u2019s monitored,\u201d she said. \u201cIt\u2019s not something they\u2019re buying off the street and maybe laced with something that\u2019s even more dangerous and accidentally overdosing and causing both mom and baby to pass.\u201d <\/p>\n
Compared with buprenorphine, Updike said, \u201cessentially the patients are sicker, meaning their tolerance is just much higher because of the use of fentanyl\u201d and \u201cmethadone is simply more potent.\u201d He believes that it is the most effective treatment for those in recovery from fentanyl abuse. <\/p>\n
Delles used methadone for more than two years after her son was born and said she has yet to relapse. But her journey is far from over, according to Updike. \u201cAddiction is very cruel,\u201d he said. \u201cIt can kind of lay in wait. You could kind of be doing OK, but life happens. It alters our stress response and people, are just at great risk again.\u201d <\/p>\n
Updike believes that most opioid users in recovery from fentanyl should be on methadone for the rest of their lives. \u201cI\u2019m not saying that no patient could be weaned off and remain stable. I\u2019m saying very few. I look at this as the treatment of a chronic illness. It\u2019s not that difficult for me to think of it as not much different than if I was prescribing insulin.\u201d <\/p>\n
March 22 was Delles\u2019 last day on methadone. <\/p>\n
It\u2019s been over three years since she started treatment, and she believes she\u2019s ready to be done, even though her doctor advised her not to. \u201cIt saved my life,\u201d she said. \u201cI wouldn\u2019t ever take it back for anything. But it\u2019s still an opiate. And I think healing my body and my brain is my next step now.\u201d As a new mom, her continued recovery is also motivated by a simple goal for her child. \u201cI just want to give him a normal life,\u201d Delles said. <\/p>\n
She credits not just methadone, but a nurse-family partnership program run by Catholic Health hospital in Buffalo. The program supports first-time mothers by helping them with medical care and socioeconomic challenges from pregnancy until their child\u2019s second birthday. Partially because of this program, Delles said, she is in a stable living situation and has graduated from an esthetics program. \u201cYou don\u2019t know what you don\u2019t know,\u201d said Delles. \u201cIt was night and day. The difference it made.\u201d <\/p>\n
This program is funded in part by federal grants, however, and it\u2019s unclear how it might be affected by the Trump administration\u2019s cuts to federal grants and loans. <\/p>\n
Jen Gauthier, 39, battled opioid use for over a decade and half. In 2006, she was in a car accident and was prescribed hydrocodone for what she called a minor injury. \u201cSoon as I got that prescription, I felt that euphoria. It was off to the races,\u201d she said. <\/p>\n
In 2014, the federal government reclassified hydrocodone as having the highest addiction potential, and it became more restricted. As prescription opioids started to become heavily restricted, they became more expensive to purchase illegally, according to Gauthier. \u201cThe heroin is so much cheaper,\u201d she said, \u201cbut that was before it all kind of switched over to full-blown fentanyl.\u201d <\/p>\n
The difference between heroin and fentanyl is not just strength, but duration of effect. \u201cFentanyl would not last long,\u201d Gauthier explained. \u201c[It] is out of your system within a couple hours. Within like four hours, you\u2019re sick again.\u201d Like Delles, Gauthier suffered through severe withdrawal until she would use again. \u201cThink of the worst flu that you have ever had and amplify that times 100,\u201d she warned. \u201cIt\u2019s brutal.\u201d <\/p>\n
For roughly nine years, her life was consumed by illicit fentanyl. Then, also like Delles, she became pregnant. <\/p>\n
Gauthier started taking methadone while pregnant with her son, Parker, nearly three years ago and has yet to relapse. \u201cYour brain, everything goes up and down, up and down. And the methadone keeps it level.\u201d <\/p>\n
Given how severe and how long her opioid use was, she has no plans to stop the medication. \u201cIt doesn\u2019t go away,\u201d she said. \u201cIt is still there. I have accepted that whatever I have to do to be sober and be here for my baby and myself, I\u2019m going to do it.\u201d <\/p>\n
In the most recent data, the CDC reported a nearly 24 percent decline in drug overdose deaths. But the latest CDC data tracking drug overdose deaths by demographic shows that while they are down among White Americans, they continue to go up among Black Americans and Pacific Islanders. <\/p>\n
\u201cBeing a woman and being of color, I\u2019ve learned that sometimes talking about my experience can help somebody,\u201d said Britiny Mapp, 29. <\/p>\n
Mapp is a user in Kensington, Pennsylvania, where a new combination of street drugs entered the market about five years ago: illicit fentanyl combined with sedatives used on animals, known colloquially as \u201cdope\u201d or \u201ctranq.\u201d <\/p>\n
\u201cThe tranq, that\u2019s a whole different ballgame,\u201d said Mapp, a former student at the Art Institute in Philadelphia. The animal sedatives cause horrific physical damage to users because they restrict blood circulation. \u201cIt\u2019s like rotting people\u2019s bodies,\u201d Mapp said. \u201cYou got sores all over.\u201d <\/p>\n
Mapp said her substance use started after she tore her ACL at age 15 and was prescribed opioids for the pain. In college, she started using heroin. Heroin turned into fentanyl, which turned into tranq. <\/p>\n
\u201cI\u2019ve been on methadone,\u201d she explained. \u201cMethadone is only treating the withdrawal from the fentanyl, not the tranq. Tranq is more in like the barbiturate category.\u201d Because tranq is not an opioid, naloxone also doesn\u2019t work in reversing an overdose. <\/p>\n
For her, a future in recovery is difficult to picture. <\/p>\n
It\u2019s been five years since Mapp started living on the streets in Kensington. In desperation, friends have posted on her Facebook page as recently as February 13: \u201cI miss you, Brit. Contact me. Love you.\u201d \u201cI\u2019ve been thinking of you brit. I hope you\u2019re okay out there.\u201d \u201cJust checking in, hope you\u2019re alright.\u201d <\/p>\n
Mapp said she doesn\u2019t look at her Facebook page because it \u201cjust gets [her] emotional.\u201d But she knows that her family would \u201cdo anything\u201d for her and will be \u201csupportive as possible\u201d whenever she wants to start recovery. <\/p>\n
Before the interview ended, she wanted to make one thing clear. \u201cWe\u2019re not bad people,\u201d she said. \u201cPeople don\u2019t give up their children,\u202ftheir homes,\u202ftheir jobs, for no reason. When you put that in perspective, there\u2019s got to be something to it.\u201d <\/p>\n
If you or someone you know need help with substance use, call SAMHSA\u2019s National Helpline, <\/em>1-800-662-HELP (4357)<\/em><\/em> <\/p>\n<\/p>\n Editor\u2019s Note: \u201cFentanyl in America: A Way Out\u201d on \u201cThe Whole Story presented by Anderson Cooper\u201d at 8 p.m. ET\/PT Sunday. In a letter dated March 9, Quigley, 39, said she had been sober for two years before relapsing on illicit fentanyl. Her anguish poured out onto the notebook pages she sent us. \u201cI threw …<\/p>\n","protected":false},"author":1,"featured_media":2164,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"loftocean_post_primary_category":0,"loftocean_post_format_gallery":"","loftocean_post_format_gallery_ids":"","loftocean_post_format_gallery_urls":"","loftocean_post_format_video_id":0,"loftocean_post_format_video_url":"","loftocean_post_format_video_type":"","loftocean_post_format_video":"","loftocean_post_format_audio_type":"","loftocean_post_format_audio_url":"","loftocean_post_format_audio_id":0,"loftocean_post_format_audio":"","loftocean-featured-post":"","loftocean-like-count":0,"loftocean-view-count":462,"tinysalt_single_post_intro_label":"","tinysalt_single_post_intro_description":"","tinysalt_hide_post_featured_image":"","tinysalt_post_featured_media_position":"","tinysalt_single_site_header_source":"","tinysalt_single_custom_site_header":"0","tinysalt_single_custom_sticky_site_header":"0","tinysalt_single_custom_sticky_site_header_style":"sticky-scroll-up","tinysalt_single_site_footer_source":"","tinysalt_single_custom_site_footer":"0","footnotes":""},"categories":[35],"tags":[],"class_list":["post-2163","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-news"],"_links":{"self":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/posts\/2163","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/comments?post=2163"}],"version-history":[{"count":0,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/posts\/2163\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/media\/2164"}],"wp:attachment":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/media?parent=2163"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/categories?post=2163"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/tags?post=2163"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}