The children killed by fentanyl

Published by UnHerd (13th March, 2024)

“I never thought this would happen to Reese, but you have to get it through to people that it can happen to anyone.” Grief and sadness envelops Wendy Chisholm as we talk in her snow-dusted suburban house in the hills above Vancouver. She is telling me about her “lovely, easy-going, thoughtful” teenage daughter, whose face beams out from a photo on the fridge in the kitchen. She takes me upstairs to show me the sports-mad girl’s room. It is filled with trophies, pictures of Reese in her soccer kit and with a black belt from taekwondo, her name picked out in yellow thread.

Reese died from a toxic drug overdose nearly two years ago. She was just 15 when her father went to wake her one summer morning and found her dead in bed. “Many days, I still don’t believe this has happened,” says Wendy, too devastated to return to her job with a car finance firm. “I feel like I’m sleepwalking through life. There are no words to adequately describe this. I just feel this deep sense of loss: my daughter has gone. She deserved so much better. I miss her every day, every moment.”

A talented athlete — she earned the prized black belt aged 11 — Reese started struggling when she became a teenager. This coincided with Covid, which cancelled all sport and social activities just as she was transitioning from her cosy middle school to a much bigger high school. She did not adapt well to online classes, felt lonely, then began hanging around outdoors with some new friends and smoking weed in a nearby park. One day she fell sick — and when Wendy took her to the doctor, her daughter confided to her mother that she had been taking “Dillies”, an opioid painkiller more potent than heroin.

By the time of her death, Reese had already gone through the cruel cycle of experimentation, addiction, treatment and then relapse. “She was the last child you would expect to pass in this way,” says Wendy. “She lived in a good community, had a stable family, went to a good school, excelled at sport.” Yet Reese’s story is far from unique in this prosperous corner of Canada. Here, health authorities have revealed an astonishing fact: fatal overdoses from illicit drugs are now the leading cause of death for young people aged 10-18 in British Columbia, overtaking motoring accidents and suicide. And the vast majority of the fatalities here involve fentanyl, a highly-potent opioid that is often cut into other drugs by dealers.

There are many reasons why people use such illicit substances — from blotting out trauma through to boredom, experimentation and peer pressure. But, as Wendy says so poignantly, “You don’t get to make mistakes with fentanyl.”

I first saw how fentanyl carved through societies when reporting from Dayton, Ohio in 2017. A police officer told me he had never seen an overdose victim before the start of that decade, yet in our four hours together we witnessed a dozen such incidents on his patch. At the end of our patrol we found a pair of middle-aged users slumped like corpses in their car outside a dealer’s house, the impact of fentanyl so instant that one syringe lay between the woman’s legs and another on the dashboard. She was brought back to life; her partner was less lucky.

Fentanyl, long used by doctors as a legal painkiller, is liked by dealers since it is many times more potent than morphine so they can smuggle in small quantities yet drive up profits per kilo tenfold. Counterfeit pills are made by the Mexican cartels with chemicals imported from Wuhan in China. It gives a powerful hit, so some users actively seek it out, while laced into other drugs from cocaine to crystal meth it delivers more kick and can foster addiction. But the fluctuations in purity make it potentially deadly. When I asked one former user what it is like to overdose on fentanyl, he said he had no idea since it happens so fast — then you either wake up or die. The risks are so unpredictable that in one US case, two teenage girls at a party split what they thought to be a prescription opioid pill; one died, the other survived.

Meanwhile, the Taliban’s clampdown on heroin production in Afghanistan has meant similar synthetic drugs are arriving in Europe such as nitazenes, which can be many times stronger than fentanyl. “It’s terrifying since it feels like we are looking down the barrel of the catastrophe seen in the US and Canada but no one is doing anything about it,” said Steve Rolles, senior policy analyst at the UK-based Transform Drug Policy Foundation.

In the US, where drug fatalities keep on rising grimly, fentanyl has driven the surge in accidental overdoses, despite falling illicit drug use by middle- and high-school students. An average of 22 adolescents aged between 14 and 18 died each week in 2022 as street drugs become deadlier, the third largest cause of paediatric deaths after firearm-related injuries and motoring accidents. But over the border, in Western Canada, it is now the leading cause of death for all ages — from children aged 10 right up to adults of 60, according to federal health officials.

Across the country, 5% of all overdose hospitalisations are children and teenagers. In Vancouver, the epicentre of this crisis, the toll of frighteningly young fentanyl deaths includes Logan Williams, a 16-year-old actor who starred in several television shows. “It was not an overdose but a poisoning,” said his mother Marlyse, 52, sales manager for a dental products firm.

She scrolls through pictures and videos of her son as she tells me about his short life, often wiping away tears. The images of Logan are heart-breaking: smiling at the camera as a young child; filming on the set of The Flash television series; laughing happily as he leaps off a boat into water while on a holiday in Switzerland. “There are no words to describe the emptiness in my heart. Nothing makes it feel better. Nothing.”

Later she drives me to the city’s Downtown Eastside, lined with dozens of citizens who live, use drugs and often die on the streets. “Look at them — it’s so sad,” she says as we drive past the disturbing scenes of misery. “Each one of them is someone’s child, living like this.” She points at one man, spread-eagled on the pavement in pouring rain with an orange towel draped over his head. “Look — you can’t even tell if he is dead or alive.” Then, she adds quietly: “This could have been Logan’s fate, spending years like this… I will never know since he didn’t get the chance to grow up.”

Marlyse calls herself a conservative, accuses China of deliberately targeting North America with fentanyl and wants harsher laws for people selling toxic drugs, such as the dealer who not only killed her son but also five other people under the age of 20. “This is drug-induced homicide in my opinion since drug dealers are no longer dealing drugs, they are dealing death,” she said, adding that almost nine in 10 street drugs sold in Vancouver contain fentanyl. One couple she knows through a grief group she helps run lost their 13-year-old son, who took what he thought was a Xanax pill. “In the morning when they went to wake him up for school, he was dead in his bed.”

Yet, as Marlyse says, these are urgent health issues confronting the nation’s youth. She is open to ideas such as vending machines offering test strips and clean drugs, comparing their society’s hesitant response to the drug epidemic with how officials and politicians reacted so fast and firmly to Covid. “The death toll keeps on rising and I don’t have all the answers on how to fix it or even know if it is fixable. I can only tell you that addiction can hit any family: rich, poor, black, white, two-parent households, single parent… it doesn’t matter. Fentanyl is a game changer. It can be one pill, one time and the result is death. Our youth must be the number-one priority in this pandemic with a multi-faceted approach from education and fighting the stigma through to science-based, long-term treatment.”

Logan died while waiting to get into treatment, compounding the tragedy. Above all, like every bereaved parent to whom I spoke, she wants to end the stigma around drug use that drives people to hide problems. “I know of grandparents who come to our grief group and they’ve never told anyone else how their grandkids died since they’re so ashamed,” she said.

Debra Bailey lost her 21-year-old daughter, Ola, two days before Christmas. She had hidden her heroin addiction from family and friends. Debra is a leading member of Moms Stop The Harm, a group of families pushing for an end to the failed war on drugs with evidence-based reform, prevention and treatment policies. She argues that the state should provide safe drugs. “The only way to save lives is to replace the fentanyl with a safer supply for people with substance abuse issues, then maybe they can get a handle on their problems. We can’t stop the fentanyl and the cartels are not going to make it safe.”

This corner of Canada is already pushing such harm-reduction policies. Possession of small quantities of drugs for personal use was decriminalised last year following the introduction of safe consumption rooms and drug-testing facilities — in stark contrast with Britain, which accounts for almost one-third of overdose deaths in Europe yet remains hooked on prohibition. Many of the Canadian advances have followed court rulings, such as the recent verdict in a case taken by nurses that banning the use of illicit drugs in public places infringed on the constitutional rights of users.

Now, the debate is over state supply of safe drugs after two members of the Drug User Liberation Front were arrested for running a “compassion club” that offered “rigorously tested cocaine, heroin, and methamphetamine, at cost, to users”. But there is pushback on the Right with Conservative leader Pierre Poilievre, ahead in the polls before next year’s federal election, arguing safe supply of opioids leads to addictive drugs trickling into the community, fuelling problems rather than treatment and recovery. Police also claim that some opiate pills obtained through harm-reduction programmes have been sold on by criminal gangs.

Backers of the “compassion club” counter that, during the 13 months of its operation, there were no overdoses among 43 participants, who were able to stabilise their lives. But even the most radical drug campaigners accept the need for controls on use by children, as shown with legalisation of cannabis in 2018 designed to restrict access for young people. A recent health study of British Columbia adolescents, however, found an increase in younger children using drugs at 12 — the same age as Logan Williams when he started smoking cannabis. “We are failing this generation of kids and we are not brave enough to change what we are doing,” says Emily Jenkins, a nursing professor and expert on mental health and substance use at the University of British Columbia.

Jenkins argues there is insufficient evidence-based guidance for schools, so many still preach abstinence instead of harm-reduction advice. She adds, though, that deaths are concentrated among children with difficult life circumstances, many of whom have been through the child welfare system. “There is some experimentation and some are doing drugs for fun. But in Canada we rank in the bottom third of industrialised nations for child poverty with nearly one in five kids not having access to basic necessities of life. When paired with wider social problems such as family breakdowns, housing problems and racism, you can imagine some feel a deep sense of hopelessness.”

The crisis ranges widely across the community. As I leave the professor’s office, she introduces me to her research manager, who tells me that her twin 19-year-old daughters had three friends who died from drug overdoses. “The youngest was 15. One had come here alone at 14 from China. It is terrifying,” she said.

But why are such significant numbers of children using powerful drugs at these young ages? The anthropologist Danya Fast has spent 15 years talking to young Vancouvans about it. She has followed about 20 youngsters closely and half of them have died from overdoses. “I’ve heard so many times they started using at 11, 12, 13,” she said. “These are our most vulnerable kids, experiencing instability and tensions many of us will never experience in our lives. But they are also still kids.”

Fast, an assistant professor at UBC’s department of medicine, has just published The Best Place: Addiction, Intervention, and Living and Dying Young in Vancouver. She says self-medication is part of the story of their substance abuse — but it is not just about blocking out trauma. For many, it is also a search for fun and meaning in life. “It fills the time, alleviates their boredom, opens up possibilities when there aren’t a lot around for them. Boredom for these young people is almost painful, a deeply confusing state of mind. But drugs are the one thing they can have, for a few moments at least.”

She believes society should do everything possible to keep these children alive. “There needs to be room for more youth self-determination on drugs — and that’s scary,” she says. “But do we really want to hold on to the idea that young people don’t use drugs and abstinence is the only way forward when it is so clearly failing? We need to give them places to go for fun and meaning but also for non-judgemental help, where they can talk openly about drug use if they want. Then they might live to make that decision to try treatment. Eventually they might be ready to detox, to slow down. But if we just offer abstinence and treatment, they think older people don’t listen to them and disengage. Then they can end up using fentanyl in a basement somewhere in the most risky situations.”

Guy Felicella proves addicts can escape even the most crushing circumstances. He grew up in a comfortable middle-class household with a father who ran hair salons and owned race horses — but behind the front door there was alcoholism, domestic violence and a lack of love, fuelling feelings of isolation, resentment and sadness. He played around at school, was written off as a “dumb” kid, then ran away aged 12 and began using cannabis and LSD. “I felt like ending my life but then I found something wonderful — I found drugs and they gave me the ability to numb myself and to forget,” he says. “When you live in an unpredictable house, it gives you something predictable since I knew what would happen if I took drugs.”

This was the start of two dark decades of addiction, homelessness and prison, with 55 convictions related to drug use. “It was physically, medically and mentally draining. You sleep rough, you live rough, the health consequences are terrible. You are always on alert — from other users, from the police — trying to protect yourself while the public look at you like you are discarded rubbish, incorrigible, a loser criminal scumbag.”

Guy didn’t overdose until 2012, after fentanyl arrived on the scene. Then it happened six times until, in February 2013, he woke up to a nurse telling him that she loved him as a fellow human being. “I burst into tears because I knew that I was going to die if I did not manage to stop. I’d tried more than 50 times. But this time I managed to get off drugs — although I didn’t feel better until I had loads of therapy to understand the issues in my head.”

Now he is happily married with three children and speaks to schools about his experiences, arguing that drug users are not inherently bad people. “Just Say No has never worked — you must have proper education. But I don’t tell kids how to run their lives. They’d laugh at me if I did. All I can do is tell them the story of my life and say that if you do fall down the hole, there is hope because you can make a comeback at any age when you accept reality.”

Guy is a reminder that most people addicted to drugs do stop using them. He argues passionately that, however unpalatable the idea might sound, the crisis will intensify and fatalities keep mounting unless we regulate supply of drugs. “It will still not be safe to take them but at least users will know exactly what they are consuming,” he says, adding that in his view this issue exposes wider societal problems. “We live in a world that creates addiction: they want you to gamble, they want you to use technology, they want you to buy processed food. Our society is all about getting people hooked on things — but then we blame them when they use drugs and end up losing their lives.”

As Wendy Chisholm tells me, engulfed in her terrible grief, the best answer to this problem would be to stop the flow of toxic drugs, but history has proved this to be impossible. “I think this issue is like a freight train that no one really knows how to stop,” she says. Then she drives off to briefly spend time with her daughter. “I visit her grave every day — sometimes for 10 minutes, sometimes for an hour, maybe to rearrange the flowers or just to talk to her,” she says, wistfully. “It’s the only way I can care for my daughter nowadays.”

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