Fallout from drug overdose: ‘We need some help in just dealing with the grief’
Jackson Smith died at age 22 in Fresno of a drug overdose.
Tears flow as family describes him: Kind, loyal, loving, sweet, good, respectful, polite – the kind of young man you would want for a son or a son-in-law.
“Whenever I would describe him to someone,” his mother, Pamela Smith, says, “the first thing I would always say is, ‘He had such a kind heart.’ ”
As a student at Central High West, he was a member of “helping clubs – the ones that took care of people.” He earned an associate’s degree in mathematics at Fresno City College. More recently, this son of a high school science teacher and paralegal worked as a waiter while going to college at California State University, Northridge. Smart, handsome and charming, family say, he had everything going for him.
But beneath the surface, there was pain. He took antidepressants and anti-anxiety medication, and later told his family he first turned to illegal drugs at age 18 to numb the pain of losing a friend who was shot to death in northwest Fresno.
Of his drug use, his stepmother, Mary Dougherty, says: “He was always so, so sorry, and always so upset that he had disappointed people. That was the thing that really got him toward the end. He just couldn’t bring himself back up from the fact that he had disappointed his parents and his siblings and people that looked up to him, because everybody did.”
On July 3, his addiction claimed his life.
Smith’s family was told he asked a drug dealer for a drug that wasn’t available, so the dealer suggested something else. Something stronger.
“He takes one of those,” says his father, Danny Dougherty, “and he’s dead.”
The coroner found oxycodone, fentanyl, alprazolam and hydroxyzine in his system. All can be prescribed to treat pain and at least one – fentanyl – is also illegally manufactured. Two are considered opioids and two are commonly found in anti-anxiety medication.
“In the old days,” Mary Dougherty says, “you used to say, ‘No, our kids don’t do drugs, those kind of kids do drugs.’ It’s not like that anymore. It touches everybody.”
Smith’s father personally knows of four young men who died of drug overdoses within the past few months, and says at least three people from his son’s graduating class died of drug overdoses.
Data from the Fresno County Department of Behavioral Health shows far more children under the age of 18 receiving treatment locally for substance use disorders than the statewide average for that age group – 22.9 percent compared to 7.2 percent – although the number includes some children from nearby counties receiving treatment in Fresno.
“As parents,” Danny Dougherty says, “we realize this is a tragic pandemic that’s going on in our society right now, and we are frustrated.”
Drugs obtained illegally aren’t the only concern. Opioids prescribed by doctors to treat pain also are claiming lives.
At least 280 deaths in Fresno County from 2009-13 were related to these over-the-counter drugs – the 17th-highest out of 58 California counties, according to data from the Office of Statewide Health Planning and Development. Nonfatal emergency department visits in Fresno County related to all opioids – prescribed and illegal – totaled at least 577 during the same time period.
U.S Surgeon General Vivek Murthy on Aug. 24 sent a letter to more than 2.3 million health care professionals asking for their help to “solve an urgent health crisis facing America: the opioid epidemic,” stating that “nearly 2 million Americans have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C.”
“Everywhere I travel, I see communities devastated by opioid overdoses,” Murthy writes. “I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure.
“It is important to recognize that we arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. This coincided with heavy marketing of opioids to doctors. Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain.
“The results have been devastating. Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed.”
Data from the Fresno County Department of Behavioral Health, gathered from a number of health care providers, reveals the most abused substances locally. Rounded to the closest half percent, they are: methamphetamine (29 percent), marijuana/hashish (25), alcohol (18.5), heroin (18), other opiates/synthetics (3.5), oxycodone/oxycontin (2) and cocaine/crack (1.5). Those percentages are similar to statewide averages provided by the department, except in the case of marijuana/hashish, where the number spikes about 12 percent higher than the state average.
“It is overwhelming,” says Andy Petersen, a board member for Comprehensive Addiction Programs in Fresno. “The Valley has been talked about as the drinking capital of the state and now I believe that drugs are just as rampant.”
Drug addiction begins in childhood for many youths in the central San Joaquin Valley. That was the case for Eric Collins, who was addicted to methamphetamine from age 11 to 18.
“I lost my mother when I was about 11 years old to a drug overdose, prescription pills,” says Collins, now 19. “And a few years later, my grandma from the same thing. That took me down a dark road.”
It started with drinking alcohol and smoking marijuana in his hometown of Modesto with a neighbor in his 20s. Then one day, at the neighbor’s suggestion, Collins tried meth.
“I loved it,” Collins says. “I was able to get out of myself and not think about all the pain, and then that started causing more pain to me, but I didn’t care. I didn’t care at all. I just wanted to get high. It’s the only thing I wanted.”
He says it made him feel similar to how he felt taking Ritalin, prescribed to treat hyperactivity. The active ingredient in Ritalin is methylphenidate.
“The Ritalin calmed me down and I liked that I was calm,” Collins says, “and then when I tried meth, I was super calm, I was focused.”
He started stealing and trading his food to buy more. He realized he was an addict at age 14.
“I could see the disappointment in my dad’s eyes,” Collins says. “He’d come home from work and he’d just walk past me to his room and stay in his room. He didn’t talk to me. It’s rough because we were close. It tore it all apart. My sister moved away to Idaho to get away from me. No one wanted anything to do with me. The only reason they let me stay until I was 18 was because the law, you know.”
Collins’ early introduction to drugs is no exception. Data from the Fresno County Department of Behavioral Health show more than 970 children under the age of 12 were treated for drug or alcohol addiction over the past year by Fresno County-contracted providers – around 9 percent of all cases.
Dawan Utecht, director of the Fresno County Department of Behavioral Health, also looks at those statistics as a mother of five teenagers. They tell her some students in their schools use drugs, but help is not seen as being readily available from school staff because drug use is punishable.
“When you have that zero tolerance policy, you encourage people to look the other way or not report it,” Utecht says. “I think that’s dangerous. Let’s set up a policy that says, ‘When you need help, we are here to help you.’ … Now, a lot can’t even ask for help without getting kicked out, and a lot of kids look at the school system as a supportive environment.”
Utecht says the message being sent to children now is: “Go to a teacher or guidance counselor, but not if you have this problem. If you have this problem, hide it. It will get you kicked out of school.’ … You can easily see how a kid can spiral.”
Is addiction criminal or an illness?
The passage of Proposition 47 in 2014, which reduced some drug possession felonies to misdemeanors, changed the way substance use disorders are addressed. Utecht calls it a “new frontier.”
Fresno Superior Court Judge Hilary Chittick is among those on the front lines coming up with new solutions. She presides over a new misdemeanor drug court established in Fresno.
“If we as a society are going to say we’re not going to deal with it as a felony,” Chittick asks, “what are we going to do? … There wasn’t a huge amount of treatment before, but certainly individuals had certain incentives to go to treatment because if they didn’t, they would get a felony.”
Linda Penner, retired Fresno County chief probation officer, is now chair of the Board of State and Community Corrections that is working to roll out promised state funding to local agencies to address changes caused by Proposition 47 and Assembly Bill 109, which has reduced the number of inmates in state prisons and increased the numbers in county jails.
Law enforcement officials hope that funding is put to good use. The majority of violent crime and property crime in Fresno is related to drug use, says Fresno Police Department Sgt. Mark Hudson, and now these people are spending less time in jail.
“When you see a spike or a series in property crimes, such as auto theft or residential burglary, you often find there is a meth user behind it,” Hudson says.
Still, Penner says: “We have to reckon with the fact that we can’t incarcerate our way out of these addictions. We have to treat these addictions.”
Utecht says something similar: “Jail is not the place to get treatment. It was not designed for that, and we should not rely on that.”
While many think of substance abuse as a choice, Utecht says, “it’s a physical problem and a physical illness.”
Petersen understands that illness well as he helps clients at Comprehensive Addiction Programs. He was once addicted to alcohol.
“I’ve had cancer before, and everyone wanted to help me,” Petersen says. “But in my alcoholism, I was not a person that drew the best side of me in that relationship, and so it’s very painful. … You lose who you are when you start.”
Getting people help
On July 1, the county roughly doubled the number of county-funded slots available in programs to treat substance use disorders, adding another 60 – spread between Comprehensive Addiction Programs, King of Kings, Fresno County Hispanic Commission, Mental Health Systems, Spirit of Woman, Turning Point of Central California and WestCare.
Officials hope more can be done after new funding is available, not expected until next year via Proposition 47 and a Medi-Cal redesign.
“We have this new population eligible to get Medi-Cal and are not in jail anymore, and now we found the existing service is not adequate,” Utecht explains. “We are working feverishly to get the redesign completed so we can submit a plan to the government. … There’s lots more people eligible for Medi-Cal and because we haven’t offered these services to the population before, we don’t know what the need will be.”
Fresno’s misdemeanor drug court, established last September, also is helping connect people with services. Before entering the courtroom, people meet privately with substance abuse specialists.
“As a result of that, a very high percentage accept treatment, almost 100 percent,” Chittick says.
Utecht explains the new system this way: “We went from having a shotgun marriage to having to seduce people. When they were in felony drug court, it was, ‘OK, go to jail or get treatment.’ When hammers go away, you try to get people to agree voluntarily.”
Other changes: Offenders are now cited to appear in drug court in 30 days vs. the normal 90 days, in an effort to connect them with treatment more quickly, and if they fail to appear, they can be booked on a warrant.
Chittick wants to see health care providers do more to help those addicted to drugs and alcohol.
“Does your doctor ask you about an overdose? Do they follow up with you the way they would as a diabetic?” Chittick asks. “Have they changed any of their activities, any of their focus, over the past year since Prop. 47 to better address addiction?”
Surgeon General Murthy is urging health care professionals to go to TurnTheTideRx.org, which lists a three-part pledge: “1. Educate ourselves to treat pain safely and effectively. 2. Screen our patients for opioid use disorder and provide or connect them with evidence-based treatment. 3. Talk about and treat addiction as a chronic illness, not a moral failing.”
Fresno County Public Health Officer Dr. Ken Bird also is sharing this message as a member of the Central Valley Opioid Safety Coalition. And for those with a prescription medication, Bird says, it’s important to dispose of any unused pills in a timely manner to prevent children from gaining access to the drugs.
In a July 28 Valley Voices column in The Bee, Bird called prescription painkiller abuse one of the fastest-growing public health concerns in the U.S. and said deaths due to prescription painkiller overdoses – an average of 46 every day – now outnumber deaths from vehicle accidents in the country.
Jackson Smith’s family is speaking up in hopes of preventing more deaths. International Overdose Awareness Day on Aug. 31 encouraged more stories and education.
“Back in my day, you didn’t talk about it, but there’s no shame in it,” Pamela Smith says. “It’s an addiction. It doesn’t make them a bad person.”
Collins went to his first drug rehabilitation program at age 14, but nothing worked until he went to Comprehensive Addiction Programs in Fresno when he was 18. He underwent a detox program and lived at the nonprofit’s residential facility for a month and a half while participating in group and individual therapy sessions, and helped out by working as a prep cook and washing dishes. Collins says the work “felt good.”
“I said, ‘I want to be like my dad. I want to be a hard worker.’ And that’s what I was. I was a hard worker.”
After leaving CAP, he lived with Petersen for several months and got the guidance needed to keep changing his life for the better.
“I did more in that four months than I’ve done in the whole time I was alive,” Collins says. “I got my GED, my driver’s license, a job, friends. So, yeah, it was a lot. The big thing is I had goals and I would work on them every night.”
He started at Fresno City College this summer and plans to eventually transfer to Fresno State, where he is thinking of majoring in occupational safety and health. Collins works for a security company, doing things like oil checks and safety memos, and says he likes making “everything safe.”
“When people see drug addicts and homeless people, they think, ‘Oh, they are just a waste of life,’ and stuff like that. But you know, we’re people. We just lost our way,” Collins says. “We’re sick, we have a disease of addiction, and the sad thing is sometimes we don’t make it out of our addiction. We die.”
During Smith’s memorial service, his stepmother read a eulogy with a few lines from an unknown author: “The prettiest smiles hide the deepest secrets. The prettiest eyes have cried the most tears. And the kindest hearts have felt the most pain.’ That’s really so much him. We just didn’t know all the craziness that was going on inside of him.”
His family says they don’t want him to have died in vain.
“He can’t come back, even though God knows we’d love that to happen, we can’t make that happen,” Mary Dougherty says. “But we can help so that this city can be a cleaner place for our grandchildren and our other children and other people’s children, because we care about them.”