Sept 24, 2021 –  I had a long conversation with one of his patients, Zachary, 31, who asked to be identified only by his first name, to protect his career.

Zachary’s addiction trajectory is pretty typical. In his late teens, he began using prescription opioids like Vicodin and anti-anxiety drugs like Xanax.

As public health experts became alarmed at the increasing number of opioid overdose deaths, and the enormity of the crisis was becoming clear, prescription opioids became harder to find.

“All of a sudden, everyone had switched from prescription stuff to heroin,” Zachary said. “It was so much cheaper.”

But as drug cartels realized it was easier and cheaper to produce fentanyl, heroin became scarce.

Zachary told me he has lost count of how many times he has overdosed and been revived with Narcan; he has used it to revive friends many times.

In his mid-20s, he had already spent four years on probation ordered by drug court, though he’d never really stopped shooting heroin and cocaine. One day, he and his girlfriend scored what they thought was heroin.

He dozed off, and when he woke up, his girlfriend, who was seven months pregnant, was sitting on the floor cross-legged, her arms propped on the coffee table. When he asked if she wanted some ice cream and she didn’t respond, he touched her shoulder. “She just dropped,” he said. He revived her briefly with Narcan and called 911. She died at the hospital. The baby could not be saved.

“Turned out, it was straight fentanyl,” Zachary said.


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