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VOL. 11 | NO. 12 | Saturday, March 24, 2018

Prescription for Tragedy

Opioid addiction, overdoses taking lives across the city and the country

By Don Wade

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He has his own GPS, an internal shield that keeps him from driving anywhere near 637 Poplar Ave. Home to the Memphis morgue. That’s where they showed Jerry Davidson his 22-year-old son, Oliver, his eyes closed and his lips purple.

Yet on this day, just a month after he was forced to look at that truth, he spoke easily about how father and son had gone to the 2008 NCAA national championship game when the University of Memphis played Kansas. Once, it mattered that the Tigers had lost the game. Now, it only matters that little Ollie had painted his face blue to embrace the spirit of the moment. It only matters that the father can remember that time and smile.

What Davidson can’t take is hearing “The Weary Kind,” the theme song from the film “Crazy Heart.” They saw that movie together; every note is like a hammer shattering glass.

And this ain’t no place for the weary kind
This ain’t no place to lose your mind ….

Sometimes he can find a measure of peace while he’s at work at the Metal Museum, where he’s facilities manager. Other times, his thoughts start to close in on him. He needs space. He gets in his Isuzu Rodeo and crosses the bridge into Arkansas.

He’s going nowhere and he’s going everywhere.

“Sometimes 20 miles, sometimes 10,” he said. “Just to clear my head.”

Other times, the wave is on top of him before he knows it.

“I went to Home Depot last week,” Davidson said. “Nothing set me off. I just started crying.”

Oliver Davidson was another casualty in America’s opioid epidemic, one of the 115 people that die in this country every day, on average, from an opioid overdose, according to the Centers for Disease Control and Prevention (CDC). Further, early data projections for all overdose fatalities for 2016 was a staggering 64,000. Roughly 15,500 of those were from heroin overdoses.

Oliver Davidson’s death is under criminal investigation. The goal is to trace the heroin, and perhaps fentanyl, a synthetic and far more powerful opioid that is showing up in heroin and in many overdoses across the country, back to the dealer.

Oliver Davidson had overdosed perhaps a dozen times before dying on the floor of a longtime Memphis rehab center, they were always fighting the good fight to help him get clean and stay clean. (Memphis News/Houston Cofield)

“We’ve started looking at this as a deadly weapon, because that’s what it is,” said Shelby County District Attorney General Amy Weirich, whose office has prosecuted several drug overdoses as second-degree murders that carry a mandatory sentence of at least 15 years. “Just like if we found somebody with a bullet to the head, we’d investigate to find out where the gunshot came from.”

Oliver’s father and mother, Amy Davidson, are but two of the many loved ones he left behind. By one definition, they might be described as collateral damage. Except that civilians caught in a crossfire just happened to be in the wrong place at the wrong time. As parents of a son addicted to heroin and who had overdosed perhaps a dozen times before dying on the floor of a longtime Memphis rehab center, they were always fighting the good fight to help him get clean and stay clean.

Jerry and Amy had divorced, but they were in this together. The war lasted almost five years. Amy kept NARCAN, the nasal mist form of naloxone used for the emergency treatment of an opioid overdose, at home. It is nothing short of a miracle drug, with a study from the CDC noting that the majority of overdose reversals in the U.S. in one four-year period were performed on people by their family and friends.

Amy would end up using it multiple times. She’d find Ollie on the bathroom floor unconscious, maybe foaming at the mouth, not breathing or barely breathing, turning blue, and in that instant she was again less his mother than a battlefield medic.

“It’s awful,” she said. “And then the moment he does wake up, you’re mad. I slapped him. We’d usually have a big cussing match.”

Professional first responders see similar scenes play out across Memphis every day. Drug overdoses, the CDC reports, are now the leading cause of death for Americans under the age of 50. Repeat ODs are expected.

Johnny Tubbs, from left, Jason Berry, Jason Tunstal, Justin Payne and Adam Stafford. "The sheer volume of calls, it's become routine," Tunstal says. "I personally try not to hang onto any of it. Just because we see so much." (Memphis News/Houston Cofield)

Recently, five Memphis firefighters/paramedics spoke to The Daily News about what they see on the front lines every day; they couldn’t even put an approximate number on the OD calls they’ve personally made in the last five to 10 years.

All they could agree on is that the number was well beyond 1,000, that they see the same faces over and over, and overdose reversal medication (they use an injectable form, too) is to OD calls what water and hoses are to a fire call.

The difference being, they probably won’t be summoned to put out a fire at the same house three times in one week.

Lt. Jason Berry remembers an OD call where a man died and his female companion watched him die. A week later Berry was at the station by himself when somebody dumped her outside the door. He recognized her and knew what he had: another repeat customer.

So he reached for the NARCAN and brought her back. One more time.

“Heroin,” Berry said, “has deep claws and deep teeth.”

The Evolution of an Epidemic

In the late 1990s, pharmaceutical companies promoted the idea that their prescription opioid pain relievers, such as oxycodone (OxyContin, Percocet) and hydrocodone (Vicodin), were effective without being addictive. Health care providers began to prescribe the drugs at greater rates.

According to the National Institute on Drug Abuse (NIDA), 21 percent to 29 percent of patients prescribed opioids for chronic pain abuse them.

Alisa Haushalter, director of the Shelby County Health Department, says that in the past, accepted training standards guided health professionals to equate a patient’s pain with “vital signs.”

Said Haushalter: “Physicians, nurse practitioners, physician assistants were led to believe these products were not addictive.”

Over time, it became clear just how addictive the medications were. In 2015, 21 percent of Blue Cross and Blue Shield commercially insured members filled at least one opioid prescription. Data also show BCBS members with an opioid use disorder diagnosis spiked 493 percent over a seven-year period.

From a cost standpoint, the CDC estimates the economic weight of prescription opioid misuse alone in the U.S. at $78.5 billion a year, including health care expenses, lost productivity, addiction treatment and criminal justice involvement. Additionally, about 80 percent of people who use heroin were first misusing prescription opioids.

Madison Erby and her daughter. Erby, currently in her second outpatient stint at New Season DeSoto County Treatment Center, traces her addiction back to the prescriptions she was given after the birth of her first child 11 years ago. (Memphis News/Houston Cofield)

That’s what Madison Erby, 31, says happened with her. She had a daughter more than 11 years ago. Erby believed she was allergic to codeine and when she went home after the birth, she was prescribed hydrocodone, 10 milligrams, every four hours, and provided a 30-day supply.

“I remember I couldn’t wait until the four hours were up,” she says now. Erby is in her second outpatient stint at New Season DeSoto County Treatment Center after numerous stays at in-patient treatment centers over the last decade.

She was able to get that first hydrocodone refill. And then another. When she finally couldn’t get a refill, she started buying pills from a drug dealer. When that became too expensive, she started snorting the cheaper alternative: heroin. When she built up a tolerance to snorting heroin, she began injecting.

Eventually, she lost custody of her children, alienated most of her family, and did whatever she felt she had to in order to get the next fix: “When I took my kids’ pennies from their piggy bank, I still couldn’t quit, and that was everything to them.”

It’s simultaneously one story and many stories. Memphis firefighter/paramedic Adam Stafford says the notion that there are many people who are now addicted to heroin after taking prescription painkillers following an injury or a surgery is not just urban myth.

Stafford talks to them after they have overdosed and the NARCAN has brought them back, hears them say they once had it all.

“You take their driver’s license out from like two months ago, and the picture looks like the person that goes to work every day 9 to 5, has the house, the kids, the white picket fence,” Stafford said. “And then you look at them and go, ‘Wow.’”

A Community’s Response

At Baptist Memorial Hospital-Memphis a new program was started about a year ago: “Opioid Light,” an initiative through the emergency department to reduce the number and strength of opioid prescriptions.

Todd Eury, from left, Channelle Johnson and Adrian Hall at New Season DeSoto County Treatment Center. Johnson says she sees the cycle play out over and over again – prescription pain meds run out and, unable to get more, withdrawal sets in, pushing a person to heroin to solve the immediate crisis. (Memphis News/Houston Cofield)

In the first year, the emergency department had a 60 percent reduction in the volume of opioid milligrams used, a 50 percent decline in the number of patients receiving opioids, while also reporting more patients had asked not to be prescribed opioids for pain management.

“Opioids only help with one pathway for pain,” said Dawn Waddell, a clinical pharmacy manager at Baptist. “There are a lot of other pathways, or receptors, for pain, and other medications that can be utilized to treat pain.

“We’re really trying to decrease that first exposure.”

In part, because reactions to opioids are individual and unpredictable. One person might develop an addiction over a 60-day period, someone else over a 30-day period, and someone else in just 10 days.

The risks grew from a concern into a problem, and from a problem into a societal plague.

“We’re dealing with a crisis,” said Shelby County Mayor Mark Luttrell.

In a January meeting with the Shelby County Commission, Haushalter provided evidence: From 2013 through 2016 in Shelby County, there were 474 fatal opioid overdoses. By commission districts, District 5 covering East Memphis into unincorporated Cordova had the most with 58.

Shelby is one of just several counties in Tennessee that has brought litigation against prescription opioid manufacturers and distributors and/or is considering legal action against so-called Big Pharma. Tennessee Gov. Bill Haslam has rolled out a $30 million opioid abuse program that includes limiting certain prescriptions.

Good government, Luttrell says, should provide public education, public health and public safety.

“This issue crosscuts all three of those domains,” he said.

Similar governmental efforts are going on nationwide and over time could impact the drug companies’ bottom line.

Law enforcement has a major role to play. While the so-called pill mills are not as prevalent in West Tennessee as in East Tennessee, District Attorney General Weirich says authorities raided a Gibson County pharmacy and offices in Whitehaven and on Park Avenue of a Memphis physician.

Totally eliminating opioids is not the answer. Waddell reminds that for some people with severe chronic pain or a terminal illness, an opioid prescription may be appropriate; that doesn’t mean she has any sympathy for the pharmaceutical companies.

“Dead patients can’t buy future medications,” she said. “They’ve made billions.”

Same Game, Different Drugs

Late in 2017, a six-month undercover operation through the Memphis Police Department’s organized crime unit led to 25 indictments in a drug investigation related to heroin/fentanyl distribution. The trafficking routes that bring the drug here are largely the same ones that have brought large quantities of cocaine, methamphetamine and marijuana to Memphis.

Shelby County District Attorney General Amy Weirich's office has had success prosecuting some fatal overdoses as second-degree murders: "We rely heavily on cellphone data and that type of technology" to prove the link between drug dealer and victim. (Memphis News/Houston Cofield)

“It comes up from Mexico, through Texas, and into our fair city,” Weirich said. “We see it coming from California, down from Chicago. A lot of the same reasons that Fred Smith put FedEx here are the same reasons we are a hotbed for the trafficking.”

President Trump recently suggested the death penalty for drug traffickers, where the law allows.

The NIDA estimates fentanyl to be 50-100 times more powerful than morphine. Mixing fentanyl with heroin allows dealers to stretch the heroin. And as Michael Worley, a narcotics detective in the Shelby County Sheriff’s Office, puts it: “Drug dealers are businessmen, too.”

Agents doing drug interdiction on the interstate have taken to wearing gloves for fear that their skin could come in contact with fentanyl, says Tim Helldorfer, who heads up the West Tennessee Violent Crime and Drug Task Force and the criminal investigative division in the Shelby County DA’s office. They’re also wary of the even more deadly, if much more rarely seen, carfentanil, which the DEA says is 100 times stronger than fentanyl.

And if a drug dog just gets a whiff of fentanyl, it could kill the dog; fortunately, NARCAN works on canines, too.

In 2012, laws made it more difficult to get opioids in pill form, Helldorfer says. That’s when overdoses and deaths started to go up, spiking again about three years ago as fentanyl began making it into the local heroin supply (the drug typically is manufactured illegally overseas, often in China).

Tommy Farmer of the Tennessee Bureau of Investigation oversees the state’s task force on dangerous drugs and he has a knack for illustrating just how lethal fentanyl is.

Said Helldorfer: “He’ll take a pack of Sweet ‘N Low, shake it, and it’s about a gram, and he’ll say, ‘Divide that by 1,000 parts and you’ll kill the city of Jackson, Tennessee.’”

Lucky to be Alive

Madison Erby’s last overdose easily might have killed her. She had some heroin earlier in the day, then bought more from another source.

“I sprinkled a tiny bit of the new stuff with the old. I guess it had fentanyl,” she said. “You just don’t know. I usually would do the whole pack. I would not be here if I had done the whole pack.”

As Erby speaks, she bounces her 18-month-old daughter on her knee. The little girl is wearing a frilly dress with a ribbon in her hair. The girl represents perhaps Erby’s last chance to be a full-time mother. Her own mother has custody of her 11-year-old daughter and her 10-year-old son. Erby’s sister adopted her second son, born in 2015.

“June 25th he was born, and I was on heroin,” she said, a large purple mark visible on her left arm from where she missed a vein. “I couldn’t quit. The whole time I was pregnant, I planned on it. I could not quit. I ended up going to rehab and running off.”

This time, she has been clean almost three months. New Season has 72 treatment centers across the country including the one in Walls, Mississippi, and two others in the state. Recently, state grant funds became available to assist people coming to New Season for Medicated-Assisted Treatment (MAT), which uses FDA-approved medications in combination with counseling and behavioral therapies. More than a dozen patients, who otherwise couldn’t afford it, are now in treatment at the Walls facility.

New Season therapist Channelle Johnson sees a pattern repeated time and time again: Someone is cut off from their prescription opioids, they start withdrawal, they’re desperate, and heroin seemingly solves the immediate crisis.

“So many people, they just want to be able to function for their kid,” Johnson said. “And they can’t go to soccer games or birthday parties because of withdrawal.”

Ron Hiers, an opioid and heroin addict for more than 40 years, became a face of the epidemic in 2016; that's when Hiers and his wife overdosed at South Pauline Street and Eastmoreland Avenue, and a passerby shot a video that went viral. Hiers says he has been in treatment and stayed clean for 18 months. (Memphis News/Houston Cofield)

Erby has put herself in danger over and over, not just by using the drugs, but trying to get them.

“I would walk down Orange Mound, all by myself at night, to the drug dealer’s house,” she said. “To the point, the dealer would tell me you don’t need to be walking out here at night. Taking rides from complete strangers. You hear people doing that one time and being gone.”

But she had a goal. To feel the way nothing else but heroin could make her feel.

It was a long way from that first day, more than a decade ago, of taking hydrocodone once every four hours with a glass of water. Exactly as prescribed.

“Instant relief. Happiness, happiness, happiness, euphoric,” she said of the heroin high. “Nothing matters. Everything is great. Even though it’s not, you don’t care. It’s a physical and mental happiness – this warmth all over your body. You think you’re glowing.”

Until you OD and fall off the toilet, coming to when you hit your head on the bathroom floor.

Erby has normal days now. Full days that she remembers. Days when she and her husband get along reasonably well. Fun times singing and dancing and playing outside with her little girl. Watching her sleep in her arms, getting a hug from her just because.

It’s a glimpse of what her life could be, if she can stay clean.

“Ninety days doesn’t sound like a lot, but it’s a miracle,” Erby said, adding that she just doesn’t hope to maintain custody of the youngest of her four children, but return to junior college and have a career.

“I want to be a kindergarten teacher.”

A Nation’s Crisis, a Family’s Heartache

Jerry Davidson says he wasn't surprised when he learned his son Oliver had died from an overdose: "You don't want to think you're gonna get that call, but you kind of know." (Memphis News/Houston Cofield)

For Jerry and Amy Davidson, there is who their son was, who he became, and too many questions.

“Quirky, funny, loved to play pranks,” Jerry recalled.

“Growing up, he was like the perfect child,” his mother said. “Polite, sensitive … after (the drugs), he’d steal from you, lie to your face, get violent.”

Long before Oliver Davidson had an addiction to heroin, he took medication for both his epilepsy and depression. Did this somehow put him more at risk for later addiction to an opioid, either because he was on this medicine or often stopped taking his prescribed medication?

There is no 100 percent answer.

Oliver, his parents say, was plenty smart enough, did well on standardized tests, but his grades at Arlington High School were not good. He started smoking pot in high school, and during his senior year it was becoming clear he was hooked on heroin.

When Oliver would overdose, Amy would go through his phone and flag any numbers she believed might belong to a dealer and pass them on the MPD’s organized crime unit and hopefully cut off her son’s supply for at least a little while.

She estimates they spent more than $200,000 on multiple in-patient treatment centers. Coming to understand the depth of his addiction, they do not in hindsight blame anyone who tried to help their son. They only know those efforts fell short.

They are hopeful the authorities will arrest, prosecute and convict the person that supplied Ollie with the heroin (and perhaps fentanyl) that killed him; they are still waiting on the toxicology report. That Oliver was in a Memphis recovery center when he overdosed only further clarifies the “deep claws and deep teeth” of his addiction.

Yet even as he spiraled downward, there were moments that reminded of who he once was and might have become. When he was young, Ollie dreamed of being a veterinarian. At his mother’s house today is a dog named Molly that he rescued from an abusive drug dealer.

Hours before he died, Ollie had talked to his girlfriend. She would later tell Jerry that Ollie sounded good, just fine. In his last Facebook post, he said he missed his grandmother and that he wished she could hold his son the way she once had held him.

Yes, he was about to become a father.

Gavin Oliver Coleman was born on Feb. 8, 2018, exactly one week after his dad, Oliver Davidson, died of a heroin overdose.

“Let it live on, a little bit,” Jerry said of his grandson carrying his son’s name. “It’s heartbreaking to think he won’t have a dad.”

He has a grandfather, though, and the grandfather visits and loves on the boy a couple of times each week.

It fills the grandfather with joy. It makes the father ache with pain.

“It’s bittersweet,” he said. “They look just alike. You leave and you cry. A lot of crying. I’m not embarrassed to tell anybody.

“I didn’t realize this was an epidemic, until it started happening with my son.”

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