Heroin - killer of a generation - Palm Beach Post

SUNDAY, NOVEMBER 20, 2016

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Heroin epidemic, hidden in shame, draws little action

By Pat Beall Palm Beach Post Staff Writer

Gregory Gartside was first to fall.

The year wasn’t an hour old in 2015 when the Florida Atlantic University student’s parents returned from a New Year’s Eve party to find their son had overdosed on heroin.

Roughly once every other day last year, heroin, fentanyl and illicit morphine claimed the life of a man, woman or teenager in Palm Beach County, more than all fatal traffic crashes and double the number of homicides.

Young mothers who doted on their children lost their lives to the needle; so did young men from wealthy families, Iraq war veterans, lawyers and former drug counselors.

Parents discovered their dead children. A 10-year-old boy found his dead father. An 8-year-old found his dead mother.

People died alone in cars, or in the locked bedrooms of sober homes where they had sought sobriety.

Mostly, though, they died quietly in their home, in their bed, a door or two away from family or friends.

Nationwide, the heroin body count rivals the number of young Americans who died at the height of the Vietnam War. But the killer of this generation has not prompted

marches in the street demanding change. No one is packing city hall pushing for expanded treatment. The faces of the dead are not on the nightly news.

They remain invisible, victims of addiction’s stigma as well as the disease, rarely mentioned by name and almost never seen.

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HEROIN | Killer of a generation In Florida in 2010, a person with heroin poisoning showed up at a hospital emergency room about every two days.

In late 2015, it was one every 90 minutes.

Some die so quickly needle is still in arm Heroin

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Overwhelmingly white, overwhelmingly young and overwhelmingly middle class, many traveled from other states to get treatment in Palm Beach County, long recognized as one of the major recovery destinations of the world.

For some, it would be the first effort at recovery. For others, it was the latest bid for help in a years-long struggle.

They died all the same.

Addiction is a poorly understood brain disease. People cannot argue, love or threaten someone out of an addiction, any more than they can argue, love or threaten someone out of diabetes.

As with other chronic diseases, it is a disease with an element of choice. Type 2 diabetics fall ill if they eat the wrong food or fail to exercise. They must choose to control their blood sugar.

Similarly, heroin addicts must first choose to seek sobriety if they hope to live.

Yet the drug rewires the brain in such a way that it becomes increasingly difficult for a user to act in his or her self-interest. Relapse is common — just as with smoking — and appears to be more likely with powerful opiates such as heroin, among the most addictive substances known to man.

But a heroin relapse is especially cruel: People who got clean are at much greater risk of dying if they go back to the drug, because their bodies are no longer able to tolerate the dose they used to take.

The toll is staggering.

In Florida in 2010, a person with heroin poisoning showed up at a hospital emergency room about every two days.

In late 2015, it was one every 90 minutes.

That is only heroin.

Once in the body, heroin converts to morphine almost immediately. In Palm Beach County, the medical examiner says most morphine overdoses reflect heroin use.

Further, the Mexican drug cartels dominating heroin sales in the United States are mixing another narcotic, fentanyl, into heroin. At the street level, dealers can order

fentanyl online from China and mix it themselves. Some don’t bother mixing. They add any powdery, non-narcotic substance and pass it off as heroin.

Up to one hundred times more potent than morphine, a dose of fentanyl as small as a few grains of salt can kill, and quickly: People in Palm Beach County are dying before they have time to get the needle out of their arm.

Last year, heroin, fentanyl and morphine caused the deaths of 2,333 Floridians, medical examiners’ figures provided to the state show.

Yet the county and the state have moved slowly — and in some cases not at all — to acknowledge the scope of the epidemic, much less take steps to curb it.

Outside of medical examiners, who daily see the bodies behind the numbers, almost no one is fully counting the dead.

As a result, The Post has compiled the only comprehensive list of the epidemic’s local toll.

That’s in sharp contrast to the string of politically conservative small towns dotting Appalachia, where even the smallest communities have moved to treat addicts and revamp law enforcement strategies.

In Huntington, W.Va., which keeps meticulous statistics on heroin use, Mayor Steve Williams shakes the hands of addicts he meets in drug-riddled neighborhoods — and then holds their hands a few moments longer. “‘I’m not going to let you go,” Williams said he tells the drug users.

“And that’s the message that we have to send to those in recovery,” he said. “This community is going to be around you, we’re going to embrace you, and we’re not ever going to let you go.”

By contrast, in one early meeting of the Palm Beach County’s Heroin Overdose Task Force, a member suggested buying drug users bus tickets so that they could leave town.

In Virginia, New York, Maryland, Kentucky, Ohio, Rhode Island and New Hampshire, governors created expert, statewide groups to monitor the epidemic and ordered state agencies to come up with solutions. Needle exchanges were created. Access to the overdose antidote Narcan was broadened.

Yet Gov. Rick Scott, who told Congress he has a family member who suffers from addic-

tion, in 2011 abolished Florida’s state agency overseeing drug control policy.

Massachusetts’ governor declared a public health emergency after statewide overdose deaths from all narcotics grew by 15 percent between 2013-14.

Florida deaths from heroin alone — not counting fentanyl and morphine — soared by 111 percent the same year; Palm Beach County’s heroin deaths grew by 155 percent. But the surge of heroin-related deaths in Florida has not triggered a similar urgent declaration.

The most recent high-profile state of emergency from Tallahassee involved the Zika virus, which, while serious, has yet to claim a Florida life.

And the butcher’s bill continues to grow.

Former drug counselor and Air Force engineer Clint Parker died on Dec. 2, the first of 21 who would lose their lives in the final weeks of 2015.

Nicholas Ricciardi would die with a copy of the Narcotics Anonymous 12-step book next to him. Christopher Folsom Jr., a father of 4-year-old twins died. So did Courtney Walraven who was getting ready to enter a rehab facility.

And then the year rolled over.

Late in 2015, former Lake Worth Christian School s t u d e n t Ma g g i e Marie Saitta had posted on Facebook: “Everything heals. Your body heals. Your mind heals. Your soul repairs itself.” “ Yo u r h a p p i Saitta ness always comes back.”

She overdosed and died Jan. 8.

She was 18. pbeall@pbpost.com Staff writers Joe Capozzi, Lawrence Mower, Mike Stucka, Christine Stapleton, John Pacenti and researcher Melanie Mena contributed to this story.

SNORTING, SMOKING AND SHOOTING UP

Although injecting heroin produces the strongest high, the drug can also be inhaled or smoked. People who would never think of using needles can still take the highly addictive drug.

Why heroin? Why now?

By Pat Beall Palm Beach Post Staff Writer

In early 2012, law enforcement and elected officials frantic over the proliferation of pill mills in Palm Beach and Broward counties thought they had reason to breathe easy.

Florida had months earlier initiated a crackdown on the barely regulated clinics where, for hard cash, anyone with a real or fake pain could walk out with bottles of prescription narcotics, particularly oxycodone.

Palm Beach and Broward counties were the pill mill capitals of the

country.

But also in early 2012, treatment counselors in Palm Beach County were warning of the next wave of narcotics: heroin.

It wasn’t much of a leap. Oxycodone and heroin are both ultimately derived from the poppy plant, the source of morphine and opium. Their molecular structure is nearly identical. So are the highs. And so is their addictive potential.

The pill mill crackdown curbed the supply of oxycodone. That drove the street price higher. Heroin, the cheaper high, filled the gap.

For treatment professionals and many families of those who died from heroin, the connection is a given.

Among those who died of heroin in Palm Beach County last year was Sean Olds, 40, who built a million-dollar remodeling business before he injured his knee at work and was prescribed painkillers. Tate Lindsey Jr., 27, of Boca Raton, was prescribed oxycodone for a worker’s compensation injury and transitioned to heroin. Sean Murdick, 22, of Albany, N.Y., loved sports and rode dirt bikes. He broke his arm and was prescribed oxycodone. When the pills got too expen-

sive, he turned to heroin.

Still, the idea that oxycodone resulted in a heroin epidemic is not a universally shared sentiment.

But James Hall, a nationally recognized epidemiologist at Nova Southeastern University’s Center for the Study & Prevention of Substance Abuse, points to a study in which 80 percent of new heroin users told researchers they had started with oxycodone.

Said Hall, “This epidemic has its breeding ground in prescription use.” pbeall@pbpost.com

The pill mill crackdown curbed the supply of oxycodone.

That drove the street price higher. Heroin, the cheaper high, filled the gap.

THEIR STORIES

‘Jewels on the moon’

Jewel was 23 when she died.

Jewel Everson and her fiancé, Joshua Weiss, both lost relatives to overdoses, he said.

She came to Palm Beach County to get clean but ended up helping others.“We always said she should wear a cape, she was always helping people,” Joshua said.

Joshua said his son is too young to know where Jewel has gone.“We sit and look at the sky and I tell him, she is up there.

“And he says there are Jewels on the moon.”

Telling her son’s story to help others

Scott was 27 when he died.

Scott Gillen’s mother shares her son’s story at treatment centers. As she talks, she holds photos of her son — with his family, on the football field – then pictures of her kneeling at his coffin.

“When I tell our story,” Dee Gillen said,“I want to be sure people understand just how ordinary of a family we are. And be sure that they understand this can happen to anyone.

We thought we ... could keep bad things away from our kids. ... But it still managed to barge its way into our family.”

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HEROIN | Killer of a generation

Left: Casey McRae’s 4-year-old daughter, Emory, says goodbye at her mother’s funeral in Texas. Casey, above right, visited Palm Beach County. Her boyfriend said she had never tried heroin before. She overdosed at age 20. FAMILY PHOTOS

Why today’s heroin is so deadly ‘5 RIPs a week on Facebook’

By John Pacenti Palm Beach Post Staff Writer

They peer from photos on abandoned Facebook and Instagram pages. They hug their loved ones, their children, their pets.

They pose for selfies. Smiling, they look like their whole lives lie ahead of them.

They certainly don’t look like junkies.

But these seemingly happy people are ghosts, victims of a growing epidemic of heroin-related deaths sweeping the nation.

Last year, 216 people died overdosing from heroin, fentanyl or illicit morphine in Palm Beach County. That’s more than died in car crashes and twice the number of homicides, a Palm Beach Post analysis of medical examiner records found.

Three-fourths were younger than 40, lives cut short long before they could hit bottom — a critical step for many addicts to get clean in 12-step programs.

They are found in homes, motels and gas stations. They die in sober homes where they go to stay clean.

They die in cars, backyards and residential streets.

They often are found kneeling, frozen with heads resting against floors, toilets, bathtubs.

Many times loved ones or roommates see them fast asleep on a couch or bed, snoring loudly. A few hours later, they check back and find them without a pulse.

And their deaths are sudden.

Kevin Alvarez of suburban Boynton Beach went up to the attic, where he spoke to his wife at 11:30 p.m. When she checked on him 45 minutes later, he was dead, a tourniquet on his arm and a needle at his side.

“Everyone is at a loss for words.

No one knows what to do. All my friends are saying, ‘Everyone is dying,’” said Josh Gamaitoni, a 26-year-old Delaware transplant who is 5½ years clean.

“Our generation has had more people die. If you look at it, this is like going to war. We are at war right now. There is like five RIPs a week on Facebook from my friends across the country. Everybody knows someone who has died.”

Money and drugs

While higher purity heroin and the introduction of fentanyl, a powerful narcotic, have played a critical role in in this unprecedented wave of overdose deaths, the common denominator is money — cold hard cash.

Traffickers and dealers cut heroin with deadly fentanyl to increase potency and profit. A kilo of fentanyl costs between $1,000 and $2,000, compared with $40,000 to $60,000 for the same amount of heroin, said John McKenna, assistant special agent in charge of the Drug Enforcement Administration in West Palm Beach.

THEIR STORIES

Why are they dying?

FENTANYL

Fifty times more powerful than heroin, fentanyl is mixed in with heroin to give the addict a more powerful high, but it can turn a familiar dose into instant death.

More than 40 percent of the Palm Beach County deaths involved fentanyl.

PURITY

Heroin today is much more pure and costs less than decades ago. The increase in purity makes the drug so strong that it can have the same effect on the brain by inhaling it, making it much easier to use.

LETHAL COCKTAILS

Addicts are mixing heroin with cocaine, Xanax and a host of designer and prescription drugs. The Post found nearly half of those who died of overdoses in 2015 had at least five drugs in their system.

THE HOT SHOT

Many addicts overdose after a stint in detox or a recovery program when their tolerance has dropped. A return to the familiar dose is often deadly.

And fentanyl, prescribed in hospitals, often in patch form for severe pain such as gunshot wounds, can be bought on the Internet and often is found in Mexican heroin. Chinese manufacturers make slight alterations to the drug’s man-made chemical makeup to get around bans.

Florida’s economy benefits from these addicts. Many come here to get clean, attracted by the sun and a recovery community that generates about $1 billion annually in Palm Beach County. Exploitative players in the industry attracted to fast insurance money don’t educate addicts about the dangers of relapse. As a result, addicts are caught in a revolving door, putting them back on the streets before they’re ready.

“The treatment industry is so much based on a business model instead of a helping model, it’s insane,” said Justin Kunzelman, a recovering addict and the director of business development at Ebb Tide Treatment Centers in North Palm Beach.

And fueling it all is a pharmaceutical industry that makes more than $8 billion annually off prescription painkillers, led by the king of them all, OxyContin. Many

young heroin addicts started with their hands in the cookie jar of their grandparents’ pain prescriptions and graduated to something more sinister.

Bathtub painkillers

But to those on the front lines — police officers and medics, researchers, recovery centers — the immediate culprit is fentanyl and other bathtub painkillers brewed up by traffickers and dealers.

A whole new market of synthetic opioids has taken root, producing drugs so strong that police and medics are warned to avoid touching them, said Dr. Bruce Goldberger, director of the University of Florida’s Health Forensic Medicine.

“We are riding a wave right now and who knows where we are going?” he said. “We still have large numbers of people dying from prescription drug overdoses and now we have many people dying from heroin, illicit fentanyl and other synthetic opioids.”

And while heroin’s potency is stronger than ever, an addict never knows what he is getting when it is mixed with fentanyl.

“You might think you are injecting heroin, the dealer might think you are injecting heroin, but you are being fed a hybrid of heroin or fentanyl or something like an elephant tranquilizer,” said David Ray, chief executive of Immersion Recovery Center in Boynton Beach.

Age of fentanyl

Fentanyl, 50 times more powerful than heroin, will take out even an experienced drug user.

Stephanie Bergman, 43, mothered three sons and worked in the medical billing field. She also battled addiction to opiates for 15 years.

She was found in a bedroom of her parents’ home in a West Palm Beach gated community. Her blood showed a deadly mixture of heroin and fentanyl. In the drawer of a dresser next to her body, police found a copy of the “Narcotics Anonymous” guide to sobriety through a 12-step program.

Gamaitoni, who works for Transformations in Delray Beach, once had a $1,000-a-day prescription pill addiction. He considers himself fortunate to not be using in today’s environment, doubting he would survive in the age of fentanyl.

In September, he attended a funeral out of state for a friend who overdosed. When he returned, he got the news that one of his best friends sniffed “half a cap and fell out on Military Trail,” referring to the man’s near-death from snorting heroin from a capsule.

Paramedics revived Gamaitoni’s buddy with four doses of Narcan, the medicine that can bring an overdose victim back from death’s door. He suspects the over-

Chose life on the streets over trust fund

Nicole was 36 when she died.

Nicole McNine Brown had a trust fund, investigators reported, but she would have to give up life on the streets to get the money. Instead, Nicole panhandled. Offered social services help, she told an officer that she was just begging until she received her inheritance.

Nicole’s sister told authorities she kept in touch by phone and offered Nicole the chance to start fresh.

Nicole always refused.

dose was caused by a type of fentanyl known as carfentanil, the elephant tranquilizer now being mixed with heroin.

Despite seeing friends and roommates die, some addicts still seek fentanyl for a better, more powerful high — a testament to the power of addiction.

“The desire to get high overrides the rational thought process so much, and I know it sounds like a cliché, but you are playing Russian roulette,” Ray said.

Gamaitoni said the soul-crushing physical pain of withdrawal is really what forces heroin users to put their life on the line.

“So if you are out there and you are withdrawing, and you feel like you are dying and you know your boy just died from this one drug dealer and you can’t get anything from anyone else — you are going to that drug dealer because you have to feel better,” he said.

Heroin’s more deadly

T h e p u r i t y o f h e ro i n h a s increased from 10 percent in 1981 to more than 30 percent, DEA reports show. At the same time, the cost of a gram has fallen from more than $3,000 to about $500.

For the uninitiated, this new-andimproved heroin can be deadly, even without fentanyl.

Casey McRae, the young Texas mother of a 4-year-old girl, never took heroin before, her boyfriend told police, but tried it with him in Lake Worth. They snorted the drug, police reported. The medical examiner did not find fentanyl in her system.

Her father, Richard McRae, said his daughter wasn’t a drug addict and was a devoted mother. “The heavy drugs scared her,” he said.

Her funeral in her hometown of Wautaga, Texas, drew 300 people.

The modern addict

Derived from the poppy plant, heroin once was considered taboo even among those who indulged in illicit substances. Now, it is becoming more acceptable and accessible.

“Back home I’m hearing the kids are having parties now — 14-, 15-year-old kids — and they are busting out pills of heroin there.

When I was that age, that was a shameful thing,” Gamaitoni said.

Younger addicts also have no compunction about mixing heroin with other hard-core drugs, such as cocaine, ecstasy, Xanax, even bath salts — often a deadly mix. Of the 216 heroin- and fentanyl-related overdoses here in 2015, more than 100 had five or more drugs in their system.

Hot shot

A recurring problem is immediate relapse after a stint in detox or a 30-day recovery program, when their tolerance has waned.

Ellen Witkowski, 20, of Wellington, left the Drug Abuse Founda-

tion’s treatment facilities in Delray Beach on Dec. 29 and crashed on a friend’s couch. The next morning she was found propped up against the bathtub, not breathing.

Police found a syringe and an empty capsule with a brown residue in Witkowski’s makeup bag.

Her autopsy revealed six drugs in her system.

Her father told police she was in court-ordered treatment and was not supposed to leave DAF. “People are going back home after treatment and two days later they are passed away,” Gamaitoni said. “These are friends of friends, cousins. Some people never have been in treatment. ... They never got the chance.”

‘Lazy and entitled’

Many in the recovery industry want to help addicts get clean, but they say it’s difficult getting through to millennials.

Not all of it can be laid at the feet of the recovery industry, Gamaitoni said. Getting clean takes work and many millennials are not up to the task, which leads to relapse, overdose and death.

“Our generation is lazy and entitled and they don’t know how to work. They want everything given to them,” Gamaitoni said.

Julia Burd, 25, a recovering addict and manager at Sober Cit y Recovery Center in Lake Park, said young addicts know they are a valuable comBurd modity. “These kids have their insurance cards memorized,” Burd said.

Both Gamaitoni and Burd are millennials.

Burd got clean two years ago at Lucida Treatment Center in Lantana and for eight months she didn’t own a car, biking to work for a minimum-wage job. She watched as other young addicts were given cars by their parents and money to live on. And she watched those addicts relapse.

“It comes down to, you got to want it. I didn’t get two years clean floating in the wind,” said Burd.

All Gamaitoni knows is that something has to change. He is tired of burying friends and clients whose survivors include grandparents.

“The people who are sober have had so many friends die, we are numb,” he said. “We are like, say a quick prayer, maybe write something nice to the family and move on, and think, who is the next one? It’s a shame. I’m comfortable at funerals now.” jpacenti@pbpost.com Staff writers Joe Capozzi and Pat Beall and researcher Melanie Mena contributed to this story.

Lil’ Joe had a big heart The trophy case at Aiken High School in Cincinnati includes the awards of one of the school’s football stars, Anthony Joe Gaston. But“Lil’Joe,” as he was known to his friends, injured his shoulder in college, dashing his pro dreams and starting a fatal path toward addiction.

“Ain’t a day when I can’t go anywhere in Cincinnati without somebody bringing up my brother,” said his Anthony was 51 sister, Tonya.“They’ll just say they miss Lil’Joe.” when he died.

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HEROIN | Killer of a generation Opiate, opiod, Narcan?

Words to know about the heroin epidemic OPIATE VS. OPIOID Opiate Opiates are painkillers with natural ingredients from the opium poppy (opium, morphine, heroin, codeine) Opioid Man-made and semi-synthetic compounds that act like opiates in the body. (Fentanyl, oxycodone and hydrocodone).

OPIUM, MORPHINE, HEROIN — WHAT’S THE DIFFERENCE?

Drug-free brain

Brain after heroin abuse

A SPECT scan of a brain with one year of abstinence from drugs.

A SPECT scan of a brain after 10 years of heroin abuse and 7 years on methadone. The holes are areas lacking blood flow.

PHOTOS COURTESY OF AMEN CLINICS

WHAT IS ADDICTION?

Why some can’t give it up, others can walk away

By Christine Stapleton Palm Beach Post Staff Writer

Imagine you’re driving a car. Ahead, you see a little girl playing in the road, but she does not see you. You desperately want to stop, but you can’t — you have no brakes.

That is how Dr. Nora Volkow, director of the National Institute on Drug Abuse, describes addiction. It’s not that an addict chooses to do drugs despite catastrophic consequences — it’s that the addict cannot stop despite those consequences.

“The person that is addicted does not choose to be addicted,” Volkow said. “It’s not a choice to take the drug.”

The definition of addiction has morphed as advances in neuro-imaging, technologies that produce images of the brain such as CAT scans, allow researchers to see the inner workings of an addict’s brain. That research is debunking the myth that addicts are weak-willed and undisciplined and that if they really wanted to quit, they could.

That false belief fuels the stigma that prevents addiction from being widely accepted as an illness — even in the medical community. As a result, medical schools in the past provided little training and insurance companies provided little coverage.

“It was never considered a disease; it was considered a lifestyle,” said Thomas McLellan, former deputy director of the White House Office on National Drug Control Policy and founder of the Treatment Research Institute in Philadelphia.

What is addiction?

The simplest answer: Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences. That’s according to the National Institute on Drug Abuse.

To Dr. Barbara Krantz, a researcher and director of Addiction Medicine at Caron Renaissance and Ocean Drive in Boca Raton, it is about understanding how and why that compulsive behavior occurs in an addict’s brain and not in the brain of a non-addict — even though they may be taking the same drugs.

“There are definite structural and chemical changes in the brain of an addict as opposed to a non-addict,” Krantz said.

Reward for sex, eating

All scientific discussions about addiction begin with dopamine — a chemical messenger that motivates us for doing things we need to do to stay alive.

It is our brain’s way of rewarding us for doing things that feel good: When you are hungry, dopamine gets you off the couch and to the refrigerator. Cold? Dopamine prompts you to reach for a blanket.

If food and sex were not pleasurable, humans would not eat or procreate.

“You need three things to exist,” said Dr. Corey Waller, an addiction researcher and senior medical director for education and policy at the Camden Coalition of Healthcare Providers in New Jersey. “Food, water and dopamine.”

But in the brains of addicts, drugs damage the dopamine-reward system.

The measure of dopamine in a healthy person’s system is 50 on an average day. “Win the lottery, lay on the beach,” the dopamine may double to 100, Waller said. Eat your favorite food: 94. Sex: 92.

But heroin blows the roof off our bodies’ natural dopamine levels. A hit of heroin: 1,000. A shot of alcohol: 875.

“Drugs crank up the reward system above where it is supposed to go,” Waller said.

Power of euphoria

Overstimulating the system with drugs produces euphoria, a powerful reward that reinforces the behavior, teaching the user to repeat it, without thinking about it.

Also, the brain dials down the amount of dopamine it produces naturally. An abnormally low level of dopamine leaves a person unable to experience any pleasure without the drug. So the addict must shoot up heroin again. But he

THEIR STORIES

will not feel the same euphoria with the same amount.

Tolerance increases, meaning the addict needs to take larger amounts. Thus begins the phenomenon of “chasing the high.”

These constant jolts to the dopamine system and the resulting stress response triggered by withdrawal damages the addict’s brain circuitry responsible for judgment, impulse control, decision-making, learning, memory and behavior control.

As the disease advances, so does the damage to the dopamine pathways.

“The disease attacks the part of the brain it needs to get better,” Waller said. “The motivation system is being destroyed by the disease itself.”

Morphine Opium mixed with other chemicals. The gold standard of painkillers. Named after Morpheus, the Greek god of dreams. It is less powerful than heroin.

Heroin Morphine mixed with other chemicals. Illegal in the U.S. Prescription heroin is legal in England and certain other countries.

Named for the German word for“heroic.”

WHAT IS FENTANYL?

An extremely powerful, man-made painkiller that is 50 times more potent than heroin and 100 times more potent than morphine. May be prescribed for extreme pain, such as cancer, and can be used with surgical anesthesia. Measured in micrograms — units about the size of a grain of salt – fentanyl can also be absorbed through the skin, an issue of concern for paramedics and others treating overdose victims.

WHAT IS NARCAN?

Narcan, also known as the generic naloxone, can reverse the effects of heroin, morphine and fentanyl overdoses. It does so by blocking drugs from latching onto certain receptors in the brain.

WHAT IS AN OVERDOSE?

A toxic amount of a drug or combination of drugs. An overdose is not always fatal, but it is a medical emergency. A heroin overdose depresses breathing. The lack of oxygen can kill or cause brain damage.

Obesity, addiction similar

Volkow likens addiction to obesity — where the brain’s ability to exert self-control is compromised.

In her research, brain scans revealed that obese people had deficiencies in the same part of the brain as addicts.

“Can you imagine food being so pleasurable that you are willing to forego 10 years of your life because of the adverse consequences?” Volkow said.

“The dismissal of addiction and obesity as just a problem of self-control ignores the fact that for us to be able to exert self-control requires proper function of areas in our brain that regulate our behaviors,” Volkow said. “You know, I never ever met an addicted person who wanted to be an addict.”

THEIR STORIES: SOULS WE’VE LOST TO HEROIN

Is addiction built in?

Researchers are still trying to find out what causes addiction, but it appears that nature and nurture both play a role.

“Not everybody who gets exposed to drugs responds in the same way,” Volkow said. “Not everybody exposed to drugs will become addicts.”

Genetics plays a significant role — responsible for about 50 percent of a person’s likelihood of becoming an addict. Other factors, such as environment and social development, contribute.

“If you are the child of a severe alcoholic and you begin drinking, you are predisposed to react differently to that substance — or any substance,” said Dr. Anthony Campo, medical director at Caron Renaissance and Ocean Drive.

The age a person begins using and how long they abuse drugs is especially important. Drug use at an early age increases the likelihood of abuse later in life.

Kids damage their brain

Also, the area of the brain responsible for decision-making, impulse control and moderating behavior is not fully developed until a person’s mid-20s.

Using drugs at an early age can cause permanent damage to a developing brain, Krantz said.

Studies on marijuana use by 14- to 16-year-olds found structural changes in the brain that can be irreversible, she added.

“So, an adolescent who thinks he’s just smoking weed is gravely mistaken,” Krantz said. “It’s having profound effects on the development of neural synapses in the brain and brain structure.”

Tragically, addiction is a family disease. On Aug. 18, Boca Raton police found Amanda Ross’ lifeless body slumped on the floor of her apartment — a syringe next to her and a tourniquet on the bathroom vanity. It was exactly one year after her brother’s death from a heroin overdose, her sister said in a police report.

In her purse, they found a letter Amanda had written to her family.

“What happened was completely the disease.

It’s the disease’s fault,” she wrote. “I tried so hard to straighten out my life. I did not do this on purpose. This is not a suicide.”

The medical examiner found heroin and Xanax in her system. He ruled her death a suicide. cstapleton@pbpost.com Twitter: @StapletonPBPost

Died on a bench outside Lake Worth City Hall

Randy was 62 when he died.

Opium The dried milky juice from the poppy pod seed. It’s the least powerful of the three.

Randy Baynes’world had shrunk to whatever he could stuff into a blue backpack: a cellphone and charger, two keys, a wallet with a few dollars.

Sometimes he hung out at a Burger King in hopes of getting something to eat.

Sitting on the bench in front of Lake Worth City Hall in midAugust, he talked at people walking by until he nodded off, a cigarette between his fingers. No one knows when he died.

Jim Masciantonio, who died Feb. 27, 2015 at age 30 of a heroinrelated overdose, with his son Jimmy III. FAMILY PHOTO

‘Jimmy Mas,’ champ of mixed martial arts, dies

By Joe Capozzi Palm Beach Post Staff Writer

Jim Masciantonio loved mixed martial arts.

He had a green belt with four stripes and dreams of competing professionally. He watched cage fights and started a training program in Boynton Beach.

He wrote a blog and conducted interviews for websites such as cagejunkies.com.

One of his biggest thrills came in 2012 when he stood in front of a camera and interviewed his idol, Randy “The Natural” Couture.

“He was a bit nervous as you can see by his constant body movement. Boy, we had a good laugh,’’ said his mother, Diane Castiglione of Indian Shores in Pinellas County.

While Masciantonio could withstand punches and kicks in the ring, he couldn’t beat his addiction to heroin.

“Jimmy Mas,” as he was known to friends, was found dead in a Boynton Beach motel room on Feb. 27, 2015, after his mother asked police to make a welfare check.

He was 30. He had survived an overdose just two days earlier.

A native of Philadelphia, Jim had been in and out of at least 25 treatment programs over a struggle with drug addiction that

started with marijuana when he was 11 and escalated to heroin when he was 16, his mother said.

That included treatment programs ordered by Pinellas County stemming from arrests for drug possession. She said his addiction was aggravated by bipolar disorder.

“He would cry, ‘I just want to be normal.’ I could see the pain when he would use,’’ Diane said.

She said he found recovery in 2009. He fell in love with a woman with whom he had a child in May 2010.

But he relapsed in 2011 when doctors prescribed opiates after surgery for hemorrhoids.

“He struggled to get back his recovery, to seek treatment to get back on track,’’ Diane said.

“He hadn’t used heroin since he moved from Philadelphia in 2008.

My son was an opioid addict but swore he would never go back to heroin.’’

When he overdosed and died on Feb. 27, the heroin was laced with fentanyl, records show.

“A murderer walks the streets of Florida dealing heroin laced with fentanyl,’’ she said.

“So many people have failed my son. I want the system to change.

The system is just fouled.” jcapozzi@pbpost.com

Bought heroin in Miami, overdosed in Ibis community

Lidio was 22 when he died.

Lidio Meira traveled with a friend to Overtown in Miami to buy heroin, police reported. They visited a friend in the Ibis community, where Palm Beach County Sheriff Ric Bradshaw, West Palm Mayor Jeri Muoio and Republican presidential contender Ben Carson had homes at the time.

Lidio died in a spare bedroom in the guest house, his religious cross necklace on the nightstand.

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HEROIN | Killer of a generation WHEN HE WALKED OUT OF THE BATHROOM, HIS FRIEND WAS ON THE FLOOR.

THEIR STORIES: SOULS WE’VE LOST TO HEROIN

“My first thought wasn’t, ‘I better call the cops’ or ‘I better call 911,’” Emerson said.

“My first thought was like,

‘Did he get a better batch than me?’”

Haunted by half-brother’s OD death, 25-year-old dies of overdose 3 years later

By Joe Capozzi Palm Beach Post Staff Writer

The last four years of his life, Drew Van Horn was haunted by guilt.

Drew, who was 25 when he died last summer after overdosing on heroin in a Palm Beach Gardens motel, had struggled with addiction for eight years, first with OxyContin, then with heroin, said his father, Scott Van Horn.

Emerson F., recovering addict, lives in West Palm Beach and graduated from the University of Connecticut with a 3.6 grade point average. ALLEN EYESTONE / THE PALM BEACH POST

LIFE AS AN ADDICT

‘Five bags in the morning in one shot was how I started my day . . . That was my cup of coffee.’

By Christine Stapleton Palm Beach Post Staff Writer

This is a story that Emerson F. has not told in public. He is not proud of this story.

It haunts him and he does not want his full name made public.

He wants to tell it now because it might help people who are not heroin addicts understand the power of craving and the depravity of addiction — what it feels like when every cell in your body screams for you to shoot some dope before calling 911 about your lifeless friend on the floor.

“I had a friend who was a couple of years clean and he knew that I was getting high — knew I was selling dope — and he reached out to me and wanted to get high,” Emerson said.

Emerson gave his friend a hit of heroin in a little bag stamped with a design, which are used to designate the dealer, batch or type of drug. He went to the bathroom to shoot another bag — about one-tenth of a gram in a bag stamped with a different design.

When he walked out of the bathroom, his friend was on the floor.

“My first thought wasn’t, ‘I better call the cops’ or ‘I better call 911,’” Emerson said.

“My first thought was like, ‘Did he get a better batch than me?’”

Emerson went through his friend’s pockets, shot the rest of the dope he found and then called 911. His friend was already dead.

“And now I think a lot about, like, if I had called them before, would they have been able to save him?”

Emerson, 32, has 18 months clean. He used drugs most of his life. He calls himself a “Dumpster” addict because he would get high on anything. But heroin was his drug of choice.

He is not one of those addicts who started with prescription painkillers and then moved on to heroin. He started with a syringe. He was 14.

Emerson has tattoos, gauges in his ears and bling around his neck. He also graduated from the University of Connecticut with a 3.6 grade point average and a bachelor’s degree in American studies. He paid his own tuition.

His mother is a college professor who named him after Ralph Waldo Emerson. He and his brothers were raised as Buddhists and he loves the Grateful Dead — even followed them around the country for a few years.

He had hopes of getting married but introduced his fiancée to heroin and that dream ended. She is still using — despite a recent overdose. Somewhere along the way, heroin stopped being fun.

“There is a tipping point where it goes from, like, recreational use to, like, when you realize, OK, I’m f——d up,” Emerson said. “I couldn’t do anything without getting high.”

Before going to bed, he prepared a shot for when he woke up.

“Five bags in the morning in one shot was how I started my day,” Emerson said. “That was my cup of coffee.”

It took more and more dope to get high.

He overdosed eight times — twice in one day

THEIR STORIES

when he left the emergency room after being revived with Narcan then went out to his car and shot up again.

He tried to quit, concocting ideas that never worked: ■ “I’m not going to use for three days in a row because that’s where the physical dependency comes in.”

■ “I’m not going to use larger amounts.

I’m just going to go until, like, I feel good.”

■ “I am not going to, like, go to get the nod” — his term for describing a good high.

A good night’s sleep was five or six hours — longer than that and he would start getting withdrawal symptoms. He didn’t take vacations because he couldn’t fly without his heroin.

“It got to the point where I would wake up sick,” Emerson said. Withdrawal symptoms were excruciating. It begins with fatigue, chills, sweats and then vomiting, bone and muscle pain, shaking and diarrhea.

The fear of getting dope-sick coupled with changes in the brain cripple the addict. Eventually, using drugs is no longer a choice — it feels like life or death.

“It gets to the point where you’re crying while you are fixing the shot,” Emerson said.

“You’re using it against your will.”

In the battle between consequences and craving, consequences always lost. Emerson was not blind to them — he bounced between not caring and feeling so guilty that getting high was the only way to feel better. Besides, he figured he was going to die anyway.

“I didn’t care about the consequences because I didn’t think I was going to live long enough to see them,” Emerson said.

He cut the dope he sold with fentanyl he bought on the Internet. He didn’t know how much of the deadly painkiller to use. “You just play around with it and do a shot and it’s like, ‘Oh, that feels good.’”

He lives with that consequence now — not knowing if the dope he sold caused an overdose.

“I have that one on me, too,” Emerson said about living with what he has done.

Finally, he decided to stop trying to quit on his own. He came to Florida, went to detox and then treatment. He moved in to a sober home and this year got an apartment, a dog and a roommate.

Emerson helps other addicts whenever he can. He works, takes his dog to the dog park, goes to 12-step meetings and spends Sunday afternoons with a group of recovered addicts called the Wharf Rats, listening to a Grateful Dead cover band at a bar in Delray Beach.

More friends die — he stopped counting at 72. He is proud to be a recovered addict — among the lucky few who have not relapsed.

He knows there is no second chance.

“I know that if I pick up, I can’t stop and I will die,” Emerson said. “I have no doubt in my mind.” cstapleton@pbpost.com Twitter: @StapletonPBPost

Not long after Drew started using, his younger half-brother Blake Vail “followed in his footsteps and started doing drugs because his big brother did,’’ Scott said.

On March 12, 2012, Blake died of an overdose.

Drew would later learn that Blake, after taking a combination of drugs, called his big brother at 12:30 a.m.

Drew Van Horn, 25, that day in a panic. overdosed at Drew, who had gone a Palm Beach to bed, looked at his phone when it rang Gardens but didn’t answer and motel. went back to sleep, his father said.

“That was absolutely devastating to Drew,’’ said Scott.

“I told him, ‘You’ve got to live for something. Don’t let him die in vain by you doing that, too.’ That was a big struggle for him in rehab. He had that hanging over him.’’

Drew, a native of Oklahoma City, was likeable and easily made friends.

He was a good-looking kid and for a while he dated a Thunder Girl, as the cheerleaders for the NBA Oklahoma City Thunder are known, Scott said.

Drew also had been in and out of treatment centers in Oklahoma and Tennessee and spent time in jail for offenses related to his addiction, Scott said.

“He hated what he had become. He would come to me and be so devastated: ‘Dad, I’m so sorry. I can’t believe I did it again.’ I know he meant it,’’ his father said.

His mother sent him to a treatment

facility in West Palm Beach in 2015, said Scott.

On June 30, Drew overdosed on heroin at the Windsor Hotel. He died three days later at Palm Beach Gardens Medical Center. He was one of four heroin-related overdose deaths in Palm Beach County on July 3.

After he was taken to the hospital, Palm Beach Gardens police found a letter on the bed of Drew’s hotel room from Unity Recovery Center, a substance abuse treatment facility in North Palm Beach.

The letter said he had entered the program on May 3, 2015, and successfully completed it on June 3, 2015. It also said Drew started a 30-day residential intensive outpatient therapy program on June 3.

Police also found his journal. On June 27, the entry said: “As of now I am in full relapse mode. It’s just a matter of when I get to do it, not if.”

When Blake died in 2012, dozens of friends attended his service in Oklahoma. “Drew told me later that after the funeral a big group of them went to Dallas, three hours from here, and did drugs,’’ Scott said.

“I told Drew, ‘I’m just telling you, man, if you OD, I am not having a funeral for you. I am not going to have all your friends celebrate and get high.

That’s not going to happen.’’’

When Drew died, the family had a private funeral with immediate family.

In his obituary, the family pointed out that Drew died of a drug overdose: “We will all remember Drew with so much promise and potential, and we hope and pray that others facing this struggle will overcome this terrible disease.”

Scott said there was “no doubt in my mind” that he wanted the obituary to explain why his son died so young, as many parents of addicted children across the country are doing.

“I just felt like, if anyone else out there reads it or some of his friends saw it and said, ‘Enough is enough,’ and it saves one person, then great,” he said. “I doesn’t do me any good to hide it.’’ jcapozzi@pbpost.com Twitter: @jcapozzipbpost

THEIR STORIES: SOULS WE’VE LOST TO HEROIN

Yo-yo ace considered among top 20 players in the world

By Joe Capozzi Palm Beach Post Staff Writer

They handed out yo-yos at Andrew White’s memorial service.

Drew, who was 23 when he died after a heroin overdose in Lantana last fall, was an expert “yo-yoer” who had competed at tournaments around the country since he was 14.

A native of Richmond, Va., he designed yo-yos for two companies and can be seen in action on YouTube videos shown at his service.

“He was a great yo-yoer. When he was on, he was probably in the top 20 in the world,’’ said Joey O’Neill, president of the New York City Yo-Yo Club, which held a moment of silence and dedicated a weekly meet in Drew’s memory in Washington Square Park in October 2015.

Drew earned a bachelor’s degree in psychology from George Mason University in 2014. He came to South Florida in December 2014 to seek help for depression and addiction, said his mother, Laura White.

Laura said she doesn’t know when her son first started using heroin.

She said Drew first went to a treatment center on Singer Island but also spent time at sober homes in Broward County after relapsing.

During his recovery, he was outgoing and tried to help others. “He was the one who would help everybody else feel better. He was the one who helped me out,’’ said Kim Christensen, a friend Drew met in rehab who said she’s been clean from a pain-pill addiction since July 2015.

Andrew White, 23, designed yo-yos for two companies. YOUTUBE

She said Drew also performed yo-yo tricks and pointed others to his yo-yo videos on YouTube. But his mother said he knew that yo-yos were “not a professional thing.’’

“The joke is, ‘What’s the difference between a professional yo-yoer and a pizza? A pizza can feed a family of four,’” Laura recalled.

On Sept. 29, 2015, he was found in a motel room in Lantana struggling to breathe. He died at JFK Medical Center on Oct. 7 “after losing a hardfought battle with addiction,’’ his obituary noted.

His mother, who wrote the obit, said: “People ought to know the truth.’’

About 130 people attended the wake before his memorial service in Richmond. At the entrance was a big bowl with little plastic yo-yos. jcapozzi@pbpost.com

Heroin poem: ‘I gave you the sun, and you gave me the rain’

David was 30 when he died

David Conant was infectiously funny, said his father, and people gravitated toward both his sense of humor and his willingness to counsel others.

His first job was in landscaping, but he loved working with a steel beam construction crew and two cell tower companies.“Being 200 feet off the ground put David right at home,” wrote his father, Richard.

David came to South Florida for rehab and was doing well.

“I think he had one weak moment,” said his father.

Earlier, David wrote a poem about his foe: I gave you the sun, and you gave me the rain; I gave you my happiness and you gave me your pain.

You see my dear heroin,

there is no more I can give; For all I have left is my last chance to live.

I have given you up, I have put you down; It is now my time to find solid ground.

Today when I wake up and open my eyes; I am filled full of freedom, I have seen through your lies.

When he died, he was wearing a silicone bracelet that read:“I hate heroin.”

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| SUNDAY NOVEMBER 20, 2016

THE PALM BEACH POST REAL NEWS STARTS HERE | SUNDAY NOVEMBER 20, 2016

‘If love could have saved you, you y would have lived forever.’

CECE LINDS POSTED THIS QUOTE FROM DAVID ELLSWORTH IN HONOR OF TATE LINDSEY, JR.

Brian E. Gershon, 27

Michael D. Perry, 41

Scott Anthony Rupich, 25

Tyler J. Foxx, 31

Brian B. Heir, 55

Richard H. Unger, 36

William C. Watson, 30

Tate Lindsey Jr., 27

Alexander K. Platt, 24

Anthony G.“Tony” Brasso IV, 29, with his son Anthony

Paul P. Ketchersid, 45

Gregory L.“Doc” Chapman, 26

Steven P. Cerenzio, 29

James R. Masciantonio, 30, with son Jimmy III

LaRae M. Dorsten, 23 Diann Otero Lopez, 40 Michael P. Driscoll, 46 Ian C. Southwell, 30

Clint A. Parker, 36

Brian M. Garcia, 27, with daughter Autumn

Brian L. Ginsberg, 32, with dog Blue Jeremy D. Chaika, 50

John J. Baker, 23

Samuel C. Deford, 27

Chris D. Burkhardt, 26

Victoria M. Satterfield, 29

Christopher J. Nichols, 33

Daniel J. Ilomaki, 30 Casey L. McRae, 20, with daughter Emory Michael T. Lynn, 24 Joseph T. Schreck III, 25 Charles G. Challinor III, 37

Corey S. Noel, 25

George M. Rhine, 38 Joseph E. Goff, 47, with brother’s dog Jack

Scott F. Gillen, 27, with mother Dee

Lucas G. Anderson, 22

Alexis S. Presberry, 23

Chandler P. Aldridge, 20

Brian J. Grieb, 24

Jewel S. Everson, 23

Sean M. Murdick, 22

Christopher D. Folsom Jr., 27

Stephen A. Bono Jr., 28, left , with brothers Michael (center) and Nicholas

Ryan S. Martin, 24, with son Hayden

Roughly every other day in 2015, at least one person died of a heroin-related overdose in Palm Beach County AMONG THE POST’S FINDINGS:

OF ALL THOSE WHO DIED,

95%

WERE WHITE

More than half were 35 and younger

Median age:

33

Youngest to die:

19

Oldest to die:

65

MORE PEOPLE DIED LAST YEAR FROM HEROIN-RELATED OVERDOSES THAN TRAFFIC CRASHES IN PALM BEACH COUNTY

FENTANYL:

42% 50x

of autopsy reports revealed the presence of fentanyl FENTANYL IS 50 TIMES MORE POWERFUL THAN HEROIN

Most overdosed in their homes One in 10 died in a sober home

20% died in a public place, including motels

Forty percent were 30 or younger

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| SUNDAY NOVEMBER 20, 2016

HEROIN | Killer of a generation THEIR STORIES: SOULS WE’VE LOST TO HEROIN

How a hero of Hurricane Sandy turned to heroin

By Barbara Marshall Palm Beach Post Staff Writer

Cassandra Vitale watched closely in October 2012 as Super Storm Sandy roared up the Eastern Seaboard toward the Jersey Shore.

From her home in Fort Lauderdale, Vitale — smart, opinionated, a bossypants, if you want to know the truth — warned her family and friends living on the Shore.

They were in the bullseye of a monster hurricane.

“She kept calling saying, ‘You’re not ready, this is going to be bad,’” said her mother, Dawn Vitale.

It was worse than bad.

The storm leveled wide swaths of the Shore, the place of Cassandra’s childhood memories, for which she felt a fierce protectiveness.

As soon as she could, the 26-year-old jumped on a plane and headed into the chaotic aftermath to help.

She talked her way past police barricades to hand out buckets of cleaning supplies to devastated residents of hardest-hit Ortley Beach in Ocean County.

She called her single-handed effort “Bucket Brigade NJ.” For a year, she and her volunteers worked on hundreds of homes. They shoveled off the sand that buried the beach community. Cassandra became the crusading arbiter between those who had something to give and those who needed help, providing hot lunches and scrounging furniture and winter clothes for residents who had lost everything.

“I went down to see her one day and she was grumbling, saying, ‘They don’t follow directions,’” said Dawn. “I said, ‘Who are you talking about?’ She said, ‘the Red Cross.’”

Cassandra told a TV reporter, “I grew up on the beach, been a beach bum forever. ... I wasn’t sure how I could help, but I found my niche here.”

She worked at a furious pace, sometimes going without sleep for days.

“She’s one of those people who put everyone else first, she didn’t care about how she had to live at the time, peeing in a bucket, staying in the van and sleeping on couches,” said Joe Minnella, a filmmaker whose documentary, “After Sandy,” is dedicated to Cassandra.

Ocean County named Cassandra Vitale Woman of the Year for 2013.

But when the 24-hour-a-day intensity of the Bucket Brigade started to wind down more than a year later — when Cassandra’s fierce drive was no longer needed — she felt hollowed out, says her brother, J.R. Vitale.

He says she filled the void with heroin, which in Ocean County is almost as easy to buy as a six-pack of beer, according to J.R., who has also struggled with addiction. He’s lost at least 10 friends to heroin in the past year, he said.

After rehab and a subsequent relapse, Cassandra returned to Florida for a second round of rehab, this time in Delray Beach.

For a while, she was clean.

By the summer of 2015, Cassandra was excited about a new job and had a nursing student boyfriend.

“Feeling loved,” she wrote on her Facebook page.

In 2015, one person died roughly every other day from a heroin-related overdose in Palm Beach County.

A few days after she turned 29, Cassandra joined that devastating list. She died in a shabby house she’d rented on West Palm Beach’s north end, with fentanyl-laced heroin in her blood.

Near her feet was a pink makeup bag of syringes.

The pink bag was imprinted with the image of a skull.

Always the good kid

Cassandra’s older brother thinks he knows why she couldn’t stay clean because, for a long time, he couldn’t either.

“We have this hole in our souls,” he said.

“Something that’s hard to fill. There was always something missing.”

They talked about it sometimes on the phone late at night. They were that close, even though J.R. was seven years older.

In her family, Cassandra was always the good kid. The brilliant one with stellar grades and her pick of colleges.

She was a gypsy, said friends, a woman who took solo surf trips to Central America. For college, she chose the University of

THEIR STORIES

Cassandra Vitale, 29, became a hero of Hurricane Sandy after she organized volunteers to help residents of the Jersey Shore dig out of the super storm’s aftermath. She died July 31, 2015, of a heroin-related overdose. FACEBOOK PHOTO

Cassandra died alone on her bed, holding a cellphone, a used needle and burnt spoon next to her, near empty capsules holding a grey powder.

Her family believes she had received her first paycheck that day.

Miami, where she earned an international business degree.

Cassandra loved fishing, crabbing, and above all, the beach.

She and J.R. shared a taste for offbeat documentaries and indie movies.

He breaks into sobs remembering his sister.

“It wasn’t supposed to be her. I was the family (screw-up),” said J.R., who spent time in prison.

J.R.’s own addiction began a few years ago after he was prescribed heavy doses of OxyContin for pain from a rare cancer called paraganglioma.

“I was hooked in, like, a month,” said J.R., who lives in Brick, N.J., and works as a cook.

His doctor tried to wean him off the drug too rapidly, he said. He thinks his brain couldn’t handle the withdrawal.

“I was a mess. The thing about getting off opioids is that the boredom is ridiculous,” said J.R. “Your brain doesn’t have anything to do without the stimulation.

“Nothing is fun, you can’t watch TV or a movie or even listen to music. Then a friend gave me heroin. All of a sudden, I could function, I could go to work.”

For a while, Cassandra found fulfillment in the daily intensity of the Bucket Brigade.

“When that started stopping, she was grounded, stuck in this area surrounded by blight that still looked like a war zone.

The excitement and urgency were gone,” said J.R. He recognized the beginning of her addiction, but, like everyone who knew her, couldn’t stop it.

She started with Percocet, he said. But the hole she was trying to fill was large.

“There was nothing to keep her busy.

Nothing to throw herself into except heroin,” said Marissa Borsac, Cassandra’s best friend since first grade.

Cassandra re-connected with an old boyfriend who had been an addict. Borsac thinks he introduced her to heroin.

After they broke up, he died of an overdose a year before Cassandra.

“She was addicted to him, but they were a toxic mix. Sid and Nancy, it was almost like that. They fought a lot, throwing things, breaking things. It was very volatile,” Borsac said.

To get her away from the boyfriend, Borsac and her husband brought Cassandra to live with them and their toddler daughter in their Toms River house the summer of 2013. With other agencies absorbing the work of the Bucket Brigade, Cassandra wasn’t needed every day.

“People hear a lot of things about heroin, that users are junkies lying in the street,” said Borsac. “Cassandra was never like that. Cassandra was really good about keeping things together.”

Until she couldn’t.

“She was so strong-willed, she felt resistant, that she could quit whenever she wanted,” said Borsac.

Borsac, with a second daughter on the way, could no longer ignore the signs. Cassandra was nodding off; her conversations became increasingly bizarre. Borsac found the tell-tale signs of heroin use — syringes and burnt spoons — in her house.

At the end of the summer, she ordered Cassandra to leave. Cassandra responded by passing out on the sofa.

Around the same time, Dawn found a syringe one day while washing her daughter’s clothes.

“I noticed Cassandra was going down-

Son dies while dad rallies against abuse

Stephen was 28 when he died.

Stephen A. Bono’s father wanted so much to help his son that he traveled to Washington for a rally against addiction on the Mall. Rock stars Steven Tyler and Sheryl Crow and the nation’s surgeon general were among the boosters.

By the time the rally started that day, Stephen had died in his Delray Beach sober home.

His dad was heading home from the rally on a bus when he got the call.

hill,” said Dawn. “I told her, ‘I want you to get this under control,’ knowing it wouldn’t be easy.”

She and her ex-husband got Cassandra into a New Jersey rehab center and crossed their fingers.

Cassandra followed the program and got out. She relapsed.

“I’ve tossed it around in my mind so often,” said Dawn. “Did I not make it seem serious enough? Could I have done a better job?

Her family thought a return to South Florida might help. Delray Beach seemed to be the epicenter of rehab centers and halfway houses.

“At every stoplight up here, there are signs on the telephone poles with phone numbers for rehab centers in Delray Beach,” said Dawn. “And Cassandra loved Florida.”

After rehab and a halfway house in Delray Beach, Cassandra moved in with her grandmother in Boca Raton.

By early summer in 2015, she seemed stable. For reasons her family doesn’t understand, she rented part of a house in a rough neighborhood west of Broadway in West Palm Beach’s north end.

When J.R. visited, he was shocked at the rundown street filled with old cars and unkempt houses.

“That was Cassandra,” he said. “She liked that little bit of walking the line. She liked shaking the devil’s hand.”

When he returned to New Jersey, J.R., who has a 9-year-old daughter, overdosed and almost died. It was the push he needed to try rehab again.

J.R. was in treatment in July, when Cassandra got a job with a Palm Beach Gardens company that sells fuel oil to cruise ships.

She seemed excited, even hopeful. She had a nurturing boyfriend, who bought her favorite Otis Spunkmeyer chocolate chip cookies.

J.R. graduated from rehab on a Thursday in late July. That night, he and his mother called Cassandra, who sounded healthy and happy.

Late the next day, Dawn noticed her cellphone was full of messages from the West Palm Beach police.

Her daughter died alone on her bed, holding a cellphone, a used needle and burnt spoon next to her, near empty capsules holding a grey powder.

Her family believes she had received her first paycheck that day.

“Maybe she thought she could do it once more and put it down,” said Dawn.

She was clean, without an addict’s drug resistance, so the shot of heroin cut with potent fentanyl was more than her body could tolerate.

J.R. thinks he understands what happened to his sister: “She got money, she went out and said, ‘Let me put my feet in the water,’ and she fell in.”

Imagine if she had stayed clean

Wearing a hot pink Bucket Brigade sweatshirt, Cassandra still smiles from the group’s Facebook page where grateful residents thanked her for providing help and sanity in a world blown apart.

“We will never forget what Cassandra did for us!”

“Just know that you and your group made such a difference in so many lives!”

“Your tireless devotion to the folks affected by the storm was so inspiring.”

“She was doing all these wonderful things on heroin,” said Borsac. “Imagine what she would have done if she stayed clean. The possibilities for her life were endless.”

On Cassandra’s birthday in late July, Dawn went over to Ortley Beach, where the Bucket Brigade supply trailers still stand.

“I pictured myself walking into her office, like she was still there,” said Dawn. “I tried to reflect on all the good she did. I’ll never understand why it wasn’t enough.”

In life, Cassandra couldn’t save herself.

But in death, this Hurricane Sandy hero managed one more rescue.

“Cassandra’s death has kept me clean,” said J.R. “I haven’t touched (heroin) since she passed away.”

He’s crying so hard into the phone he can barely speak.

“This was her final gift to me, her final lesson,” he said. “I have to stay clean because otherwise it means she died for nothing.” bmarshall@pbpost.com Twitter: @Bmarshallpbp

Both parents gone, daughter being raised by grandfather

Shane was 27 when he died.

Shane La Croix Jr.’s young daughter was orphaned by addiction.

She is living with her grandfather after losing both her mother and father to overdoses, said the grandfather, Shane La Croix Sr. Shane Jr. also left behind a 3-month-old son when he overdosed in August after leaving one of the many drug treatment programs he attended.

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HEROIN | Killer of a generation

HOW TO FIND HELP

216 lives: Read their stories mypalmbeachpost.com/ourdead

By Pat Beall and Christine Stapleton Palm Beach Post Staff Writers

As of yet, no one-size-fits-all treatment for addiction exists. Even so, millions of people with drug use and alcohol disorders have found recovery.

Sources of help for both drug and alcohol users, and their families, are growing. While not a comprehensive list, the established places and sources of information below can serve either as a destination, or a starting point to find additional resources.

IN GENERAL

National Institute on Drug Abuse: The nation’s premier resource for scientific information on addiction and treatment methods. On the web at drugabuse.gov.

BUPRENORPHINE

Benefits: Buprenorphine, the active ingredient in the trade brands Suboxone, Subutex and others, reduces cravings from opiate withdrawal. It is most frequently dispensed in prescription pill form and the prescription can be written by any doctor certified to do so. The number of those certified doctors in Florida is growing rapidly. Insurance may cover the cost.

Considerations: Doctors do not have to have experience with addiction medicine to prescribe the drug. The pills can be abused. People using certain versions of the drug may need to be completely detoxed from heroin or other opiates before they can use it.

On the web: The National Alliance of Advocates for Buprenorphine Treatment.

METHADONE

Benefits: Widely offered in the United States for addiction treatment by the early 1970s, methadone, which is highly regulated, has for much of that time been referred to as “the gold standard” of Medication Assisted Treatment. It curbs cravings. The chemical makeup of methadone makes it more difficult to get high from heroin.

Medical oversight and some addiction counseling is part of methadone treatment, by law.

Considerations: Typically, a new client must travel daily to a licensed clinic to get a single dose, and the paucity of clinics in Florida can mean a long daily drive.

Insurance may not be accepted, and doses run about $15 to $18 each. Methadone is lethal if not taken correctly or if taken with alcohol, and withdrawal from methadone typically takes place under medical supervision.

On the web: National Alliance for Medication Assisted Recovery.

TWELVE-STEP PROGRAMS

Benefits: Since its inception, Alcoholics Anonymous and its offshoot, Narcotics Anonymous, have helped millions of alcoholics and addicts find and maintain sobriety. It is anonymous, costs nothing, and meetings are widely available.

Considerations: Although rooted in specific steps and traditions, AA is not a centralized program, and the general tenor of meetings can vary. People may try several meetings before finding a “fit.” In some meetings, AA’s abstinence approach may discourage Medication Assisted Treatment.

On the web: Alcoholics Anonymous/Palm Beach County and Narcotics Anonymous/Palm Beach County.

FAMILY SUPPORT SERVICES - AL-ANON

Benefits: Established by the wife of AA’s co-founder, Al-Anon focuses on assisting and supporting the family member or friend of an addict or alcoholic in creating a better life for themselves. It uses the same 12 steps and other traditions of AA, including anonymity, with minor changes in wording. Those who have lost someone to addiction may attend, so can members of AA and NA in recovery. It is free.

Considerations: The program does not focus on getting the addict or alcoholic to stop drinking or using.

Like AA and NA, it is decentralized, meaning meetings can vary in tone and approach, and people may try several meetings before finding a “fit.”

On the web: Al-Anon/Palm Beach County or Al-Anon of South Palm Beach County.

JEROME GOLDEN CENTER

Benefits: Offers behavioral services, including help for people who have a dual diagnosis of mental illness and substance abuse. Fees are based on family income, number of dependents and availability of insurance benefits.

It does not refuse service on the ability to pay.

Considerations: Limited space. Relies on charitable giving and some government support.

On the web: Goldenctr.org.

DRUG ABUSE FOUNDATION

Benefits: Withdrawal management services. Outpatient and inpatient services in group facilities. Sliding scale fee. Focus includes IV drug users and pregnant female IV drug users.

Considerations: Limited space. Relies on charitable giving and government support.

On the web: Drug Abuse Foundation of Palm Beach County. pbeall@pbpost.com cstapleton@pbpost.com Twitter: @StapletonPBPost

THEIR STORIES

THEIR STORIES: SOULS WE’VE LOST TO HEROIN

The youngest to die: 19-year-old mom

By Joe Capozzi Palm Beach Post Staff Writer

One line in the police report of Morgan Johnson’s death offers a sad commentary on how a young mother’s struggle with heroin affected her family.

When West Palm Beach police notified Johnson’s grandmother in Texas about Morgan’s death, Ellen Gaudin told them that she knew one day she would get that call.

Just 19, Morgan was the youngest of the 216 people who died from a heroin-related overdose in Palm Beach County last year.

Morgan had been in and out of treatment centers in Texas for five years, trying to kick an addiction to drugs that started when she was 14.

“It was like a roller-coaster,’’ said Gaudin, who raised Morgan since she was 2.

A treatment center in Texas recommended a new setting for Morgan, out of state, far away from the environment where she was struggling, Gaudin said. Morgan came to West Palm Beach in spring 2015.

On June 26, 2015, she was found dead in a house south of Belvedere Road, a few blocks from the sober

FAMILY PHOTO

home where she had moved just two months earlier.

In the police report, one of the responding officers remembered Morgan from a heroin overdose call just a week earlier, at the corner of Allendale Road and Parker Avenue.

On June 19, Morgan was treated at Good Samaritan Medical Center.

She told the police officer that day that she was living at New Directions Halfway House in West Palm Beach.

After that relapse, Morgan was sent to a detox facility. But she left a

jcapozzi@pbpost.com Twitter: @jcapozzipbpost

THEIR STORIES: SOULS WE’VE LOST TO HEROIN

Ex-cop, addiction coach dies in CVS parking lot

By Joe Capozzi Palm Beach Post Staff Writer

A 28-year veteran with the Palm Beach County Sheriff’s Office, Terry Marvin used to bust drug dealers for a living. He later helped open a treatment center to help first responders with addiction problems.

But Marvin also battled his own addiction demons for years. On June 23, 2015, he died in his Chevy Camaro in front of a CVS pharmacy in West Palm Beach after overdosing on heroin. He was 56.

“I knew Terry’s drug of choice was alcohol. How the hell did he get to heroin? That’s like leaping football fields,’’ his friend Sean Riley wrote in a blog post, “but with the disease of addiction there is no logic, excuses or explanations for the things we do.’’

Riley, a recovering addict and former cop, is president of Safe Call Now, a Washington-based hotline that helps first responders seek treatment for substance abuse.

In his blog, he credits Marvin, whose wife is executive assistant to Sheriff Ric Bradshaw, with helping turn his life around at The Recovery Team in North Palm Beach.

“I sent a lot of first responders to Terry for help and he got them sober and gave them their lives back. I will always be forever grateful for what he did for others,’’ Riley said.

“His smile was infectious and ... his dedication towards first respond-

Terry Marvin, 56, a former Palm Beach County sheriff’s lieutenant, made it his mission to help first responders with addiction. LINKEDIN

ers and getting them help was unmatched.’’

Marvin wasn’t the only person who worked at a local addiction treatment center but died of a heroin overdose last year.

Michael A. Beato was a rehabilitation administrator with The Watershed Addiction Treatment Center in Delray Beach. “Most lives saved!” he wrote next to a photo he posted on social media in late 2014 of an award he received for his outstanding work with addicts.

Beato overdosed a month later.

He was 30.

“Unfortunately the disease took over and he used again after 5 years

clean,’’ his brother James wrote on a gofundme page.

“He agreed to go back to (a) halfway house after using for just a few days, and when he arrived there, used one last time in the bathroom and overdosed. By the time police got there, it was too late for my brother.

We lost the greatest person I’ve ever known.”

Clint Parker, an addiction counselor, worked at Proactive Recovery Center in Delray Beach. His autopsy showed he died Dec. 2 with fentanyl in his system. He was 36.

Michael Incognito, who opened Way of Life Recovery in Lake Worth in 2012, died July 2 in a Marriott hotel room on Singer Island after overdosing. He was 29.

“When he passed away, so many people on Facebook said, ‘I wouldn’t be here if it wasn’t for Michael,’’’ said his mother, Diane.

She said Michael had his own addiction, starting with pain pills in New Jersey and then heroin. He sought treatment before coming to Florida, where his mother said he was able to get clean for a while.

He always helped people, even strangers. “He came to my house once and he had no shoes. I said, ‘Mike, why don’t you have any shoes?’ He said, ‘There was a homeless man.

His feet were bleeding. I gave him my sneakers.’’’ jcapozzi@pbpost.com

How to recognize an overdose and save a life A missed opportunity to save a life: If someone is making unfamiliar sounds while“sleeping”it is worth trying to wake him or her up. Many loved ones of users think a person was snoring, when the person is overdosing. Here are some other signs (If you see them, don’t hesitate to call 911): ■ Loss of consciousness ■ Unresponsive to outside

Disease didn’t define her

Josie was 27 when she died.

Morgan Johnson, 19, died June 26, 2015 of a heroin-related overdose.

day early, against the advice of clinic employees, according to a statement given by a New Directions official to West Palm Beach police.

Gaudin said she had been in contact with her granddaughter. She said Morgan had become upset when the detox center wouldn’t allow her to talk on the phone with her 3-yearold daughter in Texas for longer than an hour, as stipulated by the center’s rules.

Morgan told her grandmother the night before her death she had used heroin and regretted it.

In an interview with The Palm Beach Post, Gaudin said she and her husband had been optimistic about Morgan’s chances of recovery after she moved to West Palm. “We were planning to visit her in July for our anniversary,’’ said Gaudin, who is now caring for Morgan’s daughter.

Instead, they shed tears together on March 9, which would have been Morgan’s 20th birthday.

“I’m not blaming anybody. I know it’s everywhere,’’ Gaudin said of drug addiction. “She just lost the battle to it.’’

Josie Michniak called her sister Duck. She did it once, out of the blue, and her sister didn’t like it. So after that, she kept calling her Duck.

That’s her sense of humor. Pranks. Laughs. Always ready with a word to perk someone up, her sister, Amanda, said.

After Josie’s best friend was murdered by her boyfriend, who killed himself, Josie“just spiraled out of control,” Amanda said.

“The disease beat her,” Amanda said.“It didn’t define her as a person.”

stimulus ■ Awake, but unable to talk ■ Breathing is very slow and shallow, erratic, or has stopped ■ For lighter skinned people, the skin tone turns bluish purple; for darker skinned people, it turns grayish or ashen.

■ Choking sounds, or a snore-like gurgling noise, sometimes called the“death rattle,” which can mean

something is obstructing the person’s airway, such as vomit.

■ Vomiting ■ Body is very limp ■ Face is very pale or clammy ■ Fingernails and lips turn blue or purplish black ■ Pulse (heartbeat) is slow, erratic, or not there at all SOURCE: HARM REDUCTION COALITION

Painted houses by day, played music at night

Tony was 29 when he died.

Anthony“Tony”Brasso, who had two sons, painted houses by day and performed with his band, Knockdown, at night, said his father, Anthony Brasso III. “He was an amazing musician. A great, loving familyoriented man,’’his dad said.

Days after his death, a shoulder-to-shoulder crowd and four bands packed a Greenacres sports bar in tribute to him and to raise money for Tony’s two sons.

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S10

THE PALM BEACH POST REAL NEWS STARTS HERE

| SUNDAY NOVEMBER 20, 2016

HEROIN | Killer of a generation

MAKING STRIDES WITH ADDICTION TREATMENT: Retired Huntington Police Chief Jim Johnson; Kenneth Burner, deputy director of Appalachia region of the High Intensity Drug Trafficking Area; and Huntington Deputy Fire Chief Jan Rader, are coordinating efforts to combat heroin problems in the city.

THOMAS CORDY THE PALM BEACH POST

HEROIN FAILURES

Who will act to stop the dying?

By Lawrence Mower, Christine Stapleton and Pat Beall Palm Beach Post Staff Writers

When people started dying in every neighborhood in Huntington, W.Va., the mayor rallied his city to come together and fight the crisis, gaining national attention.

When a young man died on his parents’ lawn, just around the corner from the Staten Island, N.Y., district attorney’s house, the county’s top law enforcement official vowed to go after the dealers killing people in his district.

In Palm Beach County, addicts have been dying nearly everywhere — outside city hall, in parking lots, even in the upscale Ibis neighborhood near the home of the Palm Beach County sheriff.

But aside from a core of dedicated treatment providers and volunteers, addicts in Palm Beach County and throughout Florida can find little in the way of public resources to get off the drug and live regular lives.

“The problem is everywhere and there’s not a thing being done about it,” said Amanda Michniak, a recovering addict whose sister, Josie, died the day after Christmas 2015. “The system is broken. They’re not helping people.”

It doesn’t have to be that way. In many cities and states in America, it isn’t.

Urgent action? In Massachusetts in 2014, Gov. Deval Patrick declared a public health emergency after the number of overdose deaths from all narcotics in his state had grown by 15 percent from the year before.

In Florida, deaths from heroin alone grew by 111 percent during the same period; in Palm Beach County, it was 155 percent. But other than hurricanes, Gov. Rick Scott’s most recent state of emergency was to combat Zika, which has killed no one in Florida.

Student loan forgiveness — Governors in seven states responded directly to heroin deaths and addiction by assembling emergency statewide task forces.

Some, like Virginia, came up with creative solutions, such as the state providing police officers with Narcan to reverse overdoses and offering to forgive student loans for doctors who practice addiction medicine in the state.

But in Florida, Gov. Rick Scott abolished the governor’s Office of Drug Control in 2011, replacing it with a nine-member advisory council. Its mission, to “eliminate substance abuse in Florida,” is so vague as to be unattainable.

In its 2015 report, it noted a 705 percent increase in heroin overdoses over five years. Yet, its response to expand treatment? The council recommended: “expanding treatment availability.”

Who missed the addiction vote? In 2016, Congress had bipartisan support for the first major federal addiction legislation in 40 years, covering prevention, treatment, recovery, law enforcement, criminal justice reform and overdose reversal. Both Florida senators voted for it.

But when the bill came to pay for it, Sen. Marco Rubio missed the vote. It failed 48 to 47. One senator said, “It’s the equivalent of offering a life preserver with no air in it.”

Giving out clean needles: It’s a crime — In Indi-

‘The problem is everywhere and there’s not a thing being done about it.

The system is broken.

They’re not helping people.’

AMANDA MICHNIAK, A RECOVERING ADDICT WHOSE SISTER, JOSIE, DIED THE DAY AFTER CHRISTMAS 2015.

ana, after roughly 200 people contracted HIV from sharing needles, conservative governor and Vice President-elect Mike Pence lifted a ban on needle exchanges in 2015 in affected counties. Many other cities give addicts clean syringes, too, and the Centers for Disease Control and Prevention encourages the programs.

In Florida, where Dade and Broward counties led the nation in new HIV cases in 2014, the Legislature this year allowed the University of Miami to establish a pilot needle-exchange program. But lawmakers refused to pay for it. And everywhere else in the state, including Palm Beach County, supplying addicts with clean syringes is a third-degree felony.

Librarians with Narcan — The failure to combat the epidemic lies in Palm Beach County, as well.

In Huntington, population 49,000, nearly every public official carries Narcan, the life-saving drug that reverses heroin overdoses. Police, firefighters, members of the mayor’s cabinet — even librarians carry it — and the health department gives it away to anyone willing to take a class. So when 27 people there overdosed in four hours in August, all but one were saved.

In Palm Beach County, a few police departments and fire departments use Narcan. But Sheriff Bradshaw has refused to let his deputies carry it, even when

Huntington, W. Va., Mayor Steve Williams’ efforts to combat heroin have received national attention.

He created an office that has had success with unconventional methods.

THOMAS CORDY / THE PALM BEACH POST

offered the medicine for free. He cited liability issues.

Detox at the jail — Other places have found creative ways to provide treatment for addicts who don’t have insurance. Officials in Gloucester, Mass., offer immediate care for addicts who turn over their drugs to police. New Jersey lawmakers set aside money for a pilot program in five counties that finds beds for addicts recently revived with Narcan.

In Palm Beach County in 2015, the largest detox facility for indigent addicts closed. The entire county has fewer than 50 beds for indigent addicts. The largest provider of detox services today? The county jail.

Understanding the epidemic — In Huntington, the police department understood that it needed good numbers on the epidemic — when, where and why people were overdosing. So they dedicated a detective solely to understanding the numbers. It has helped them get the community to spend resources on treating addicts.

In Palm Beach County, there has been no such investment. The only person collecting numbers on overdose deaths is an overworked employee at the Medical Examiner’s Office. And the numbers are months old.

Using addicts’ phones — In Staten Island, they don’t wait on the medical examiner for data. The district attorney there launched an initiative with New York police to go after drug dealers by seizing the phones of dead addicts and working with their families. Prosecutors and police have been assigned to feed phone numbers into a database to trace dealers and deaths. The data has led to the arrests of 18 dealers linked to two overdoses this year.

In Palm Beach County, State Attorney Dave Aronberg launched a law enforcement task force this year, but it was not to hunt down dealers who kill addicts.

The task force was formed to go after fraud in the sober home industry, something Aronberg had been warned about years earlier.

Who’s in charge? Palm Beach County administrators still have no “point person” assigned to the epidemic. Few city or county politicians have made this a central issue. The word “opioid” doesn’t even appear on the county Health Department’s website.

There are some signs of hope. Aronberg’s task force has busted one treatment center owner and two sober home owners on patient brokering charges and promises more. One county task force just proposed a pilot program to provide detox services for people who overdose.

But the changes have come too late for the hundreds of people who have died in the county in the past three years.

Compare their responses to Huntington Mayor Steve Williams, who has made the heroin crisis a top priority: “If we’re all saying that this is happening in my community, to my residents, I have an obligation to do something about it.

“And if I don’t, I don’t deserve to be sitting here.

You forfeit the right to lead.” lmower@pbpost.com, cstapleton@pbpost.com, pbeall@pbpost.com

Addicts in Palm Beach County and throughout Florida can find little in the way of public resources to get off the drug and live regular lives.

THEIR STORIES

Saw China, studied religion, couldn’t overcome drugs

Bradley was 33 when he died.

Bradley R. Fitzgerald was a cross-country runner in high school who made the national honor society.“This was a kid who could do his calculus homework on the school bus,’’said his dad, Bradley A. Fitzgerald.

In college, he studied at Beijing University and visited ancient Chinese villages before they were flooded by the Three Gorges dam project.“He was a young man who badly wanted to kick this and get over it,” his father said.

Traumatic brain injury at 13

Alexander was 22 when he died.

By middle school, Alexander Chopp was a published poet.

He liked cult movies, cult music and Ron Paul. Among friends and his large family in Kenosha, Wis., he snort-laughed and danced wildly.

But Alexander faced major challenges at a young age: At 13, he sustained a traumatic brain injury. And he was transgender.

At the Palms Springs sober home where he died,“he kept to himself,” roommates told police.

<PAGELABELTAG>

THE PALM BEACH POST REAL NEWS STARTS HERE | SUNDAY NOVEMBER 20, 2016

S11

HEROIN | Killer of a generation THEIR STORIES: SOULS WE’VE LOST TO HEROIN

Former assistant state attorney lost to epidemic

By Joe Capozzi Palm Beach Post Staff Writer

Jessica Rose had the credentials of a rising courtroom star: a lawyer with the Palm Beach County State Attorney’s Office, an assistant public defender in Jacksonville, a private practice on Clematis Street.

A young attorney brimming with talent and promise, she also struggled with an addiction to drugs, a battle that shattered her career, scarred her family and ultimately took her life.

Just before 9 a.m. on Dec. 17, 2015, she was found dead on the bathroom floor of her West Palm Beach apartment, a white Rose unplugged electric cord in her left hand, a syringe and spoon with heroin residue on the sink above her. She was 32.

Her death is no more tragic than any of the other 215 heroin-related overdose deaths in Palm Beach County in 2015. But it underscores how the heroin epidemic is killing people from all walks of life, even white-collar professionals who don’t fit the stereotype of drug addicts in seedy urban alleyways.

People like Victoria Satterfield, the daughter of a former U.S. ambassador, who studied ophthalmology at the Duke University School of Medicine and worked at an eye center near JFK Medical Center; John Yeend, a longtime Lake Worth resident who founded a respected accounting firm; and Sam Deford, who earned a physics degree from the University of Colorado-Boulder and worked at a Delray Beach marketing agency.

“No matter how smart you are or how many degrees you have, the disease will always come back if you feed it,’’ said Michael Pike, a West Palm Beach attorney who dedicates his personal time to helping lawyers with substance abuse problems. “This disease has no face, it has no discriminatory intent. It takes everyone.’’

Not just ‘in the shadows’

Jessica’s death shocked many people at the state attorney’s office, which is responsible for charging drug traffickers with crimes. They knew her when she worked in the office in 2012.

“Heroin abuse cuts across all socioeconomic lines. Families need to know this can happen to anyone. It’s not just relegated to people in the shadows,’’ said

Palm Beach County State Attorney Dave Aronberg, who didn’t work with Jessica but met her during his campaign for the office in 2012.

“She was intelligent and thoughtful and kind. It’s a tragedy. There are so many families going through what Jessica’s family is going through now and we speak to those families, unfortunately, too often,’’ he said.

The daughter of a Michigan gastroenterologist, Jessica had a background that impressed her future employers. She graduated from the University of Wisconsin and the Benjamin N. Cardozo School of Law in Manhattan, where she concentrated on litigation and international and corporate law.

On her application to the state attorney’s office in 2011, she said that she helped raise her two young sisters after their mother left home when she was 12.

She participated in high school symphony, taught herself to play the guitar and piano, and studied in England, France and Spain.

She also had a history of abusing prescription drugs, cocaine and “heroin intravenously,’’ starting about 10 years ago when she attended law school in New York City, said a statement her father gave to the Palm Beach County Medical Examiner’s Office. The statement said her diagnosis included bipolar disorder.

Never give up attitude

Although the report said Jessica “recently voiced suicidal ideations,’’ her father could not confirm to authorities whether the overdose was accidental or intentional.

The ME’s office listed the manner of death as “undetermined.’’

Jessica made a positive impression on many people she worked with over the years. They described her as outgoing, confident, intelligent and eager to seek advice.

On an application question asking what she learned from a mistake she made, Jessica wrote: “To pick myself up after I have failed. I’ve learned to not give up and keep fighting.’’

She was hired in September 2011 as a victim witness coordinator for the State Attorney’s Office. Three months later, passing the Florida Bar, she was appointed as an assistant state attorney under Michael McAuliffe.

But after her transfer from county court to juvenile court in March 2012, Rose’s supervisors were “made aware of instances’’ where she made errors, didn’t prepare for cases and offered pleas without consulting the victim, according to a memo in her personnel file.

Jessica Rose, 32, who graduated from Benjamin N. Cardoza School of Law, died of a heroinrelated overdose in December 2015.

ONLINE OBITUARY PHOTO

The heroin epidemic is killing people from all walks of life, even white-collar professionals who don’t fit the stereotype.

At one hearing in May 2012, “it was obvious that Jessica did not know her cases, was using terms incorrectly and could not answer simple questions from the judge.’’

In June, “employees were feeling uneasy” because Jessica “had been repeatedly asking for money, food and rides.’’

The complaints in her file make no mention of substance abuse concerns.

‘Spiraled out of control’

On June 19, Jessica quit after State Attorney Pete Antonacci told her in a memo that “it would be in our mutual best interests to receive your letter of resignation immediately.’’

She landed a job three months later with the Public Defender’s Office in Jacksonville.

At first, Jessica was “an excellent attorney,’’ said Greg Strickland, a former police officer who worked with her. “She could walk right into the courtroom as soon as she got here. There was no training necessary for her.’’

It wasn’t long, though, before Strickland and others noticed problems. “She wasn’t making it to court,’’ he said.

She was fired on June 26, 2013. Her termination letter does not explain why she was let go, but Strickland said one reason was performance problems related to her

How The Post gathered the names and photos of those who died During months of probing fraud in the sober home industry, the investigative team at The Palm Beach Post encountered another disturbing problem: young people dying from heroin or fentanyl overdoses at an alarming rate.

They decided to unveil the scope of the epidemic and put a face on the people dying by telling each and every story of the 216 men and women who lost their lives to heroin-related overdoses in Palm Beach County in 2015.

Until The Post began its reporting, no one had compiled a comprehensive list in the county of the people who had overdosed on heroin, fentanyl or illicit morphine. As a result, local politicians, police and fire-rescue officials and community advocates lacked the most basic information needed to combat the epidemic.

The linchpin of the project would be a single image, the wall of photos on today’s front page.

I-team reporters studied hundreds of pages of police reports from 15 agencies. The team compared police findings against autopsy results to sift through a list kept by the Palm Beach County Medical Examiner’s Office of more than

350 people who died with the presence of up to 100 different drugs in their system. Few knew the list existed.

For further verification, police and autopsy records were matched against official death records assembled by the Florida Department of Law Enforcement from local medical examiners.

While overdose deaths typically involve multiple drugs, The Post looked for the presence of one or more of the three narcotics linked to the opiate epidemic: heroin, fentanyl and morphine.

Fentanyl often is mixed with heroin or sold as a more powerful replacement for the better-known opiate. Morphine deaths were considered because illicitly obtained morphine is used as a substitute for heroin, its chemical cousin. Further, once ingested, heroin quickly turns into morphine. It is standard practice for medical examiners to consider all evidence relating to a death to determine which morphine deaths are caused by heroin.

The Post did the same. If the person had at least one of the drugs in his or her system at autopsy, editors and reporters then discussed each person’s records on a case by case basis,

looking for a history of drug use, drug paraphernalia found at the scene and observations made by friends, family and law enforcement.

The Post excluded cases in which heroin was not detected and morphine or fentanyl appeared to be a legitimate medical treatment, unrelated to addiction.

But The Post realized the numbers, no matter how powerful, could never tell the story. The decision to publish names and photographs followed extensive discussion among editors and reporters. The paper reached out to experts in ethics, people in recovery and treatment counselors.

Reporters called family members throughout the country, reaching at least one member of the family of 60 percent of those who died. Of those, nearly 100 supported publication of their loved one’s name and another two dozen took no position. Fewer than a dozen expressed objections.

Reporters conducted more than 100 interviews with friends, family members and business associates. They scoured social media, web sites and corporate, financial and property records.

BEHIND THE PROJECT: PALM BEACH POST INVESTIGATIVE TEAM Pat Beall pbeall @pbpost.com

THEIR STORIES

Joe Capozzi jcapozzi @pbpost.com

Lawrence Mower lmower @pbpost.com

Mike Stucka mstucka @pbpost.com

Christine Stapleton cstapleton @pbpost.com

‘I know now that you had no control’

Corey was 25 when he died.

Corey Noel, wrote a family friend, had“sneakers to match every outfit.” He loved his baby girl, but addiction ripped apart his family life.

After his death, his former wife wrote,“I used to take it so personal when you didn’t do what everyone wanted you to. I know now that you had no control. My main goal is to educate (our daughter) on what you went through so that ... she never has to experience the pain.”

John Pacenti jpacenti @pbpost.com

addiction issues with alcohol and pain pills.

“I don’t understand why she would have gone the direction she went in, but she definitely spiraled out of control after she got here,’’ he said.

After she left Jacksonville, Jessica returned to West Palm Beach to work in private practice, according to her resume.

The day before she died, Jessica’s roommate said she was “in a good mood” because she “had a job interview at Duffy’s” scheduled for the next day and “possible other interviews with unknown law firms,’’ according to a police report.

In an autopsy report, Palm Beach County Medical Examiner Michael Bell said Rose, who was also on anti-depressants, “died from an alprazolam (Xanax) and heroin overdose.”

“I thought she was absolutely a wonderful person. I thought she was going to go a long way in the office,” said Alton Kelly, who was director of investigations for the public defender’s office in Jacksonville when Rose worked there.

“I don’t want to say she pulled one over on me. I’ve been in law enforcement for 40 years. I think I’m a pretty good judge of character. Just talking to her one on one, I wouldn’t have dreamed that because she seemed so energetic and she loved her job.”

Palm Beach County Circuit Judge Daliah Weiss wrote a condolence message on Jessica’s online obituary: “For a short time I was Jessica’s supervisor at the prosecutor’s office when she was hired on as an attorney. Jessica was a kind, thoughtful, and sweet person who will be missed.’’

“She was a sweetheart,’’ said Strickland.

“What she wanted to be, what she set her life to be, was completely interrupted by drug addiction. Then, of course, it was her demise.’’ jcapozzi@pbpost.com Twitter: @jcapozzipbpost

Why did The Post publish pictures of those who died?

The Palm Beach Post did not casually decide to publish the pictures and personal stories of every person in Palm Beach County who died after taking heroin, fentanyl or illicit morphine in 2015.

Though most families of those who died and who spoke with The Post expressed gratitude for the decision, others objected.

But we believe that the staggering toll this epidemic is taking has been largely hidden from public view, and as a result has not been aggressively addressed.

Addiction is a disease, but much like the AIDS epidemic in the 1980s, it remains shrouded in secrecy and stigma. The people who are dying in our communities have remained invisible.

We believe that is wrong.

Burke Like other newspapers, The Post could have published the horrifying numbers and not talked about the people behind them.

But those who lost their life to addiction are not numbers. They are people, with fathers, mothers, husbands, wives and children.

They did not want to die. They did not plan on becoming addicted. They did not plan on losing their struggle.

If, by seeing the people behind the numbers, our community is moved to push for change; if parents, children, wives or husbands come to realize they are not alone in their terrible loss; if one person now struggling with addiction seeks assistance, then these tragic deaths will have brought hope and help to others still alive.

TIMOTHY D. BURKE, PUBLISHER AND EDITOR

Ocean-loving man beat cancer but not addiction

Joseph was 38 when he died.

When he was younger, Joseph Malone was so in love with the ocean that his family would tease him about the“Adventures of Joe Malone,” his sister, Shelley Trevisol, said.

But both addiction and cancer ran in his family. He beat alcohol and drug addiction and was sober for a while. When he was diagnosed with stage 3 colon cancer, he beat that, too.

“We could almost see the light,” his sister said.

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THE PALM BEACH POST REAL NEWS STARTS HERE

| SUNDAY NOVEMBER 20, 2016

Family means everything

Ozzie Medeiros, left, and Eddie Schmidt, right, with their son Mark Goncalves.

Our restaurant, Table 26, is a happy place for loved ones to gather, a place where delicious food and good company make friends feel at home.

Bringing families together around the dinner table is our passion and our life.

And, like so many families, ours has been touched by addiction.

Our son, Mark, nearly died of a heroin overdose earlier this year.

Like all recovering addicts, he fights every day to stay clean and beat his disease.

‘I make the choice to love myself,’ Mark says, ‘to work hard for my successful future and enjoy the path of recovery and self-actualization.’

Heroin kills. We know this all too well.

We are proud to join with The Palm Beach Post in shining a light on this epidemic.

And we will not give up until all children are safe, and every family can gather with joy around the dinner table.

OZZIE MEDEIROS AND EDDIE SCHMIDT Owners and hosts, Table 26

Table 26

Eddie and Ozzie’s Table 26 is a neighborhood restaurant with world-class cuisine.

Most of all…it is place to gather with family and friends, where there is always a smile to share.

Table 26 1700 S. Dixie Highway, West Palm Beach (561) 855-2660 table26palmbeach.com