Heroin

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Sunday • 02.19.2017 • $3.00 • FINAL EDITION

A MASS KILLER

ST. LOUIS HEROIN DEATHS HIT NEW HIGH

DAVID CARSON • dcarson@post-dispatch.com

Ashley Johnston and Richard Skinner shoot heroin in the kitchen of Johnston’s home in St. Louis on Feb. 6. Both have used heroin off and on for years. Johnston, who is pregnant with her fourth child, is trying to kick her habit with methadone but recently missed a few methadone allotments because of car problems. Skinner said he used his stints in jail to get clean. Johnston and Skinner have one child together; that child is cared for by Johnston’s mother, who also cares for two other children she has.

IT DOESN’T DISCRIMINATE

Hundreds died last year: men, women, blacks, whites.

DEADLIER DOPE More fatalities when added fentanyl, lower prices are figured in

FATAL OPIOID OVERDOSES

BY JESSE BOGAN • St. Louis Post-Dispatch

St. Louis city

ST. LOUIS • After a long decline, Eric Bearden fi-

Other area counties

650

nally hit bottom in an abandoned building on South Grand Boulevard that thousands of people pass every day.

Bearden, 28, who once dreamed of being a chef, was victim No. 11 among a class of 256 fatal overdoses that quietly tore across the city of St. Louis in 2016.

One year later, a spent syringe lay discarded in the busy alley near where he died. Windows and doors have been boarded up, but the only thing that seems to have changed is the message posted in front of nearby Fanning Middle School.

“We do so they can,” the sign reads. “Every child deserves a champion.”

Heroin has made that much harder, as its death grip destroys more addicts, families and communities than ever in the region.

It has always been a hard-core and dangerous

600 550 500 450 400 350 300 250 200 150 100 50 0

2007

2008

2009

2010

2011

2012

2014

2015

2016

Source: National Council on Alcoholism and Drug Abuse; Post-Dispatch Note: 2015 and 2016 data are incomplete due to pending toxicology reports.

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JEFFERSON CITY • In his latest mission as Mis-

GOV. ERIC GREITENS Political newcomer relies heavily on social media while avoiding Capitol press corps to get his message out.

2013

souri’s governor, former Navy SEAL Eric Greitens is employing tactics taught in the military.

When it comes to interacting with the press, the political newcomer has been a disciplined operator, carefully picking his targets and keeping his distance from unanticipated questions that may impede his objective.

His stealthy approach is not uncommon behavior in this age of social media, when politicians routinely turn to Facebook and Twitter to spread their message directly to voters.

But now, after offering minimal opportunities for the press to ask him questions in his first six weeks in charge, the Republican chief executive is

Can we talk?

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A MASS KILLER

A6 • ST. LOUIS POST-DISPATCH

M 2 • SUNDAY • 02.19.2017

PHOTOS BY DAVID CARSON • dcarson@post-dispatch.com

Richard Skinner shoots heroin on Feb. 6 into a vein near a tattoo he got in prison years earlier. “Heroin is the only thing that ever stole my soul. I’m not me anymore,” he said.

USE OR NOT, IT’S A DANGER 2016 OPIOID DEATH RATE Per 100,000 people 80.4

St. Louis city 15.22 15

St. Louis County

11.8

St. Charles County Je erson County

28.0

Franklin County

28.5 7.4

Lincoln County Warren County

3.0 25.0

Madison County 13.1

St. Clair County

SOURCE: National Council on Alcoholism and Drug Abuse; Post-Dispatch NOTES: 2016 data are incomplete due to pending toxicology reports.

Warren County’s rate is based on most recent year for which data are available (2014).

OPIOID DEATHS IN ST. LOUIS There were 256 fatal opioid overdoses in St. Louis in 2016, a 94 percent annual increase. These deaths happened all over the city, most of them in homes. Others were more public — on a bus, in a car, in a store restroom.

Travis Garner, 3, goes high on the swings as his aunt Josie Martinez prepares to give Travis’s sister Amya Garner, 8 months, a push on Feb. 7 in St. Louis Square Park in south St. Louis. Before letting the children play in the park, she checks the playground for dirty syringes.

Block with two to four fatal overdoses Block with one fatal overdose

HEROIN • FROM A1

70

St. Louis city 64

44

55

VIDEOS AT STLTODAY.COM/WATCH “Heroin is the only thing that ever stole my soul. I’m not me any more.”

Watch Richard Skinner talk about his addiction and warns others about how the drug has ravaged his life.

She wants to keep her baby but knows the state could take the child.

Ashley Johnston is six months pregnant. Watch as she discusses her use of methadone and the struggle to kick her heroin habit.

drug. But today longtime addicts and new users are facing unprecedented risks.

Earlier this month, Ashley Johnston plunged a different syringe into her arm, her beating heart then pumping the dope through her pregnant body.

Johnston, 31, said two of her children had been born addicted to opioids. A third was not. She lost all of them to state custody.

Less than three months from another delivery date, Johnston suffers from a mental illness that public health advocates describe as substance use disorder.

“I am keeping it, and it’s going to live with me,” Johnston said of her unborn child. “It’s a boy.”

The region’s insatiable appetite for heroin has been well documented in the past decade, especially as the drug’s wrath moved out of the urban core and into the white suburbs.

Never has the drug been more deadly, nor this cheap. Purity levels have skyrocketed, while prices have plummeted on the street to $5 to $10 a dose.

And now, a lethal new twist has flooded the market: fentanyl. The cheap synthetic opioid is 50 times stronger than the real stuff. A little bit on the tongue can kill you.

Heroin historically has been mixed with inert substances such as baby powder and cornstarch to make it go further.

Now fentanyl is thrown in the mix.

A dealer with a conscience might sell fentanyl-laced heroin with a warning: “Be careful with that.” But, if anything, that only fuels appetites among buyers, driving much of the dramatic spike in the death toll.

More than 650 people died from opioid overdoses in the St.

Louis region in 2016, more than four times the number in 2007.

Toxicology results continue to come in.

Franklin County had 29, an 81 percent increase in one year. Jefferson County had 62, a 35 percent jump.

But while heroin is a growing crisis across the region, in the city of St. Louis it is an explosive epidemic.

The city logged 256 deaths, a whopping 94 percent leap from the previous year. Annual opioid deaths have catapulted ahead of homicides. The city’s opioid death rate of 80 overdoses per 100,000 people is more than twice the rate elsewhere in the region.

The typical victims are in the prime of their most productive years. And they are diverse. The city’s death pool included 183 males, 73 females; 138 Caucasian, 117 African-American and 1 Asian.

“We have a huge problem,” said Michael Graham, medical examiner for the city.

‘THIS IS A MARATHON’ These deaths happened all over the city, most of them in homes, including a scattering of addresses that saw more than one victim — such as an apartment building in the 2500 block of Hampton Avenue where three people overdosed.

Others died in the public sphere — on a bus, in a car, in a convenience store restroom, such as the 7-Eleven at 509 Bates Avenue.

“Those are the loved ones of family members of people and those are beautiful lives that are no longer with us,” said James Shroba, chief agent in charge of the Drug Enforcement Administration in St. Louis.

He said heroin plagued addicts worse than almost any

other drug. The success rate for treatment was already dismal.

Then fentanyl blew onto the scene.

“Just when you think you have seen it all,” he said.

Fentanyl, made in Asia, has long been a pain killer often given to humans in the form of a patch and intravenously after surgery. There are different forms, among them a tranquilizer for rhinos and elephants.

An illicit market for powdered fentanyl has taken root in the past few years. Officials said Mexican drug cartels added fentanyl to heroin before it was shipped across the border.

Meanwhile, the purity of heroin on its own has increased in the past decade in St. Louis from less than 10 percent to more than 50 percent, enough to compete with prescription drug abuse, according to the DEA. Of the 256 opioid overdoses in the city, more than half of the toxicology reports included fentanyl, mirroring a national upward trend.

One national estimate from a decade ago tallied $193 billion in damages to society from misuse of opioids and other illicit drugs each year.

Shroba said society couldn’t arrest its way out of the problem.

“We need everybody’s help, because this is a marathon,” he said.

NARCAN COUNTERPUNCH Paramedics are running harder than anyone else. While hundreds of addicts die, emergency responders revive scores more — often multiple times — with Narcan. The drug is sprayed up the nose or injected to reverse an overdose. Last year, the St. Louis Fire Department used it See HEROIN • Page A7

A MASS KILLER

02.19.2017 • SUNDAY • M 2

ST. LOUIS POST-DISPATCH • A7

USERS SEEK OUT DEADLIER BATCHES HEROIN • FROM A6

1,900 times, up from 1,200 in 2015.

Narcan is carried in city ambulances. A push to equip each firetruck with the drug has been delayed by a drug recall and training for firefighters. Police in south St. Louis, one of the worst areas for overdoses, plan to be part of a pilot program that equips officers with Narcan.

Other police, such as the St. Charles County Police Department, have already started.

There were 53 opioid deaths in St. Charles County in 2015. The count for 2016 was 44, with the month of December pending.

“We are going through Narcan faster than we can put it in cars,” Chief David Todd said.

Scott Gilmore, the medical director for the St. Louis Fire Department, senses the urgency, too. He rode with paramedics on a recent night. “It was incredible,” he said. “Probably one out of three calls were overdose calls.

That’s definitely an increase.”

A notable run was for a woman who had just buried a family member from an overdose.

PHOTOS BY DAVID CARSON • dcarson@post-dispatch.com Richard Skinner shoots a mix of heroin and meth in a quiet spot of a cemetery in south St. Louis on Thursday.

“Death ain’t nothing to me anymore,” said Skinner, who has been revived repeatedly by paramedics.

‘IT’S NUTS, MAN’ Heroin distorts reason. Even though a particular batch may have killed someone, addicts sometimes see opportunity.

They seek out the deadly batch.

“That’s how you know it’s a mental health condition,” said Brandon Costerison, of the National Council on Alcoholism and Drug Abuse in St. Louis.

“Who thinking clearly goes looking for the product that just killed someone? You don’t go looking for the car that just blew up randomly by trying to buy that model.”

Consider a cluster of fatal overdoses in the 3800 block of Louisiana Avenue last year. Terrell Whitehead, 27, lived there with his family. He went to Webster Groves High School through the desegregation program and still lived with his parents. People called him D.J. because he liked music so much.

He was next door on Jan. 7, 2016, when Cynthia McCoy, 48, died from an overdose. The experience scared him, but one week later, Whitehead died in his bathroom from the same thing.

Six months later, back next door, Nicholas Pope, 30, who had worked on towboats, died.

Curtis York, who owns Kuts

by Kurtis, a barbershop on the corner, said he had seen a frightening cycle of addiction come through the neighborhood. He said 15 of his customers had died from overdoses in the past five years. He told the familiar story about how most heroin addicts started by abusing prescription medications and painkillers.

When they can’t find pills, or want to chase a stronger high, they graduate to heroin, which is cheaper. First they snort it. Then they get over the stigma of the needle. When they hear about a potent supply, they come running. “They are going to get the stuff people are dying off of,” said York, 42. “It’s nuts, man.”

‘A REASON TO LIVE’ Heroin’s body count in St. Louis includes more than just city residents. Many victims are drawn in to feed their habit. In the process, some, like Bearden, die.

Bearden grew up in south St. Louis County and was a wellknown student at Oakville High School. He attended community college for a while and then moved to Denver to study culinary arts at a prestigious school.

He flunked out and returned to St. Louis, wandering homeless.

Addiction overpowered his life.

“It was a long period of time where he fell off,” said his brother, Andrew Bearden, 26 and an Air Force veteran. “He went through all the classes and all the therapies. He had his socalled sober moments. … There was nothing that would stop him from wanting more.”

His parents had no choice but to kick him out. One of the last times his brother heard from him, Eric Bearden said he once again sought to start over, get on track. “I was wanting to believe,” Andrew Bearden said.

After a short stint in jail, Eric Bearden died of acute fentanyl intoxication. His body was found Jan. 14, 2016, in an abandoned building in the 3400 block of South Grand.

Heroin has invaded more than St. Louis’ mean streets. It kills in stable neighborhoods, too.

Tom Athanas, 42, died from an overdose in 2009. He lived near Hampton and Chippewa avenues in a neighborhood known for its high count of Roman Catholics and police officers.

Athanas left behind three children. His mother used to lie about his cause of death, calling it a heart attack. “I was embar-

A discarded syringe lies in an alley behind a dilapidated apartment building on South Grand Boulevard in St. Louis on Feb. 9. A year earlier, heroin user Eric Bearden, 28, died of a heroin overdose inside the apartment building. The alley is still known for as a site for drug use.

rassed with my son,” said Carol Athanas, of the 3500 block of Regal Place. Sadly, she’s wiser to heroin now.

In 2016, the drug also claimed her grandson, Tommy, 29. He attended St. Mary’s High School and went on to work in construction, when he could hold a job.

His risky lifestyle was impossible to keep secret. The family estimated he’d been in an ambulance 30 times. One day he overdosed twice. “Tommy was so far gone, I don’t know if anybody could have helped him,” said Carol Athanas, who now speaks of addiction as a sickness.

There were glimmers of hope through her grandson’s addiction. He moved into his grandmother’s basement to make a clean start. It didn’t work.

He died there of heroin intoxication on June 21.

One of his brothers, Nick, also has used opioids. But he said he’s been clean since Feb. 9, 2015, the day he went to jail for stealing televisions.

Now, he stays busy as a laborer setting up equipment for events and being a father to 3-year-old Jameson, who ran around on a recent day, flashing the Vulcan salute from Star Trek.

“That person has a reason to live, and you have to find that,”

Nick said of addicts.

That message is needed along Regal Place.

A few blocks away, a man, 30, and a woman, 24, overdosed on Oxymorphone, a narcotic pain reliever, in the same small house within a span of three days in May. A new tenant said he had no idea.

‘TRAVIS, WAIT’ Heroin’s toll on St. Louis neighborhoods isn’t measured just in bodies. Even those who are physically untouched by the drug must confront its dangers. It is an obstacle to avoid, like a slow light at rush hour, but with grave implications.

Josie Martinez didn’t flinch when informed of two fatal overdoses in 2016 directly beside her home. She said police often came to the tiny, squalid apartments.

She said there was recently another fatal overdose right across the street.

Martinez said she could count on one hand the people she grew up with who were not on drugs.

She lives in the 7200 block of Minnesota, in far south St. Louis.

“In my 42 years in this neighborhood, we’ve lost them either to drug overdoses or being murdered or incarcerated because of the drugs.”

She said somebody would have

to hold a gun to her head for her to use. “Life is a blessing, and I know it is,” she said.

Especially now as she helps her niece care for two children, Amya, 8 months, and Travis, 3.

The grim nature of the neighborhood didn’t get in the way of going to the park on a recent sunny afternoon.

Martinez, pushing a stroller, intentionally avoided a few streets on the way to St. Louis Square Park on south Broadway.

“I always have him sit on a bench while I make sure there aren’t any syringes,” she said as they approached.

But Travis champed at the bit to play as Martinez quickly tried to scan the jungle gym for danger, high and low.

“Wait,” she told him, continuing the search. “Travis, wait.”

He couldn’t any longer. The little boy flew down a covered slide and tore through the rest of the equipment.

She remarked on his observance of a boundary line.

“He knows I won’t let him play in the leaves because I am scared of that,” Martinez said.

‘DEATH AIN’T NOTHING’ There is a bevy of needle tracks on Richard Skinner’s stout arms.

He estimated that he has known

120 people who died from overdoses, three for each year he’s been alive. Still, he uses. “Death ain’t nothing to me anymore,” said Skinner, 42. “Look at it. We are all born to die. It’s just a matter of when and where.”

He’s defied the odds, but after years of addiction he has little left beyond a deep-seated craving for getting high. It’s not just luck that he’s a survivor. He said he tried to be a responsible addict.

But when it came time to shoot up heroin on a recent night, Skinner checked his pockets and bags, realizing he had misplaced his syringe. Ashley Johnston, 31, with whom he has a daughter, offered a replacement. Both of them said they wished they’d never started using heroin.

“I just wanted to try it,” said Johnston, who has been to rehab numerous times and is still trying to break her habit with methadone. “Dumbest thing ever.”

She’s been using off and on for a decade, long enough to lose three children to the state and numerous friends to overdoses, including Terrence Pickard, 42, whom she described as her boyfriend. He died April 18 in an apartment in the 3900 block of Chippewa.

Skinner said he loved and hated heroin. He said it was the devil. “You end up with nothing,” said Skinner, who is homeless and has spent a lot of time behind bars.

He’s lost count of how many times he’s come close to dying.

He said he had to be revived a few weeks ago in a basement that he and Johnston had sneaked into.

“I told you don’t call the paramedics,” Skinner said.

“That’s not going to happen,” Johnston said. “You aren’t going to die on my watch.”

They recalled the incident while devouring the remnants of a leftover frozen pizza for dinner. Skinner washed it down with cola, struggling to keep his head up while high. Johnston, nearly seven months pregnant, drank milk.

“I am really doing it today because I have to be clean when I have the baby,” she said. “So today is the last day I can do it.”

Skinner said he spent $75 on heroin that day. He shared the treasure with Johnston and a few others, a kind gesture also laced with the security that they might help him out another day when he was having withdrawals.

Skinner has ridden the changes of the heroin market. He said that he usually bought from people he trusted and that he relied on experience to shield himself from a deadly dose.

He said he loved fentanyl when he tried it.

“You have to take baby steps,” he said. “If you are shooting up, shoot it a little bit.”

He compared getting high on heroin the first time to a giant egg of euphoria being cracked over the head, warm yolk running slowly down his neck, then the rest of the body.

“It felt so warm and awesome,” he said. “Just my mother’s comfort. I hadn’t felt that in so long.”

Skinner, now relaxed on a sofa, said he was on his last rounds of heroin. He said he might use methamphetamine to come off of it.

“I am trying to control it,” he said.

Eyes closed, he smiled.

“Like I can. I am lying to myself. Just for a little bit longer.”

Jesse Bogan • 314-340-8255

Richard Skinner and Ashley Johnston walk to Johnston’s home to wash his clothes and shoot heroin in St. Louis on Feb. 6. Johnston and Skinner together have a 12-year-old child who is cared for by Johnston’s mother. Johnston is pregnant with another man’s child.

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LIMITED STEP TOWARD A PRESCRIPTION DRUG DATABASE ADVANCES

PREVENTION VS. PRIVACY Medical professionals would submit a patient’s name to the Bureau of Narcotics and Dangerous Drugs

BY AUSTIN HUGUELET St. Louis Post-Dispatch

The bureau would grant access only if it determined a patient was a potential abuser

JEFFERSON CITY • After years

of fruitless debate, the Legislature this week took its first tentative step toward creating a statewide prescription drug database — but critics wondered whether the proposal would serve to block more effective measures.

The Missouri Senate gave initial approval Wednesday evening to a proposal offered by the very lawmaker most responsible for keeping the state the last one in the nation without such a database.

It wasn’t the measure many expected to pass, and opponents say it would impose limits on physicians not found in the other 49 states.

Under the plan from Sen. Rob Schaaf, R-St. Joseph, the state’s roughly 30,000 medical professionals wouldn’t have direct access to patient records. Instead, they would submit a patient’s name to the Bureau of Narcotics and Dangerous Drugs, which would grant access only if it determined the patient was a potential abuser.

All other states put the information at doctors’ fingertips as long as they have an authorized username and password. A group of Missouri counties, including St. Louis, St. Charles, Jackson and Ste. Genevieve, plan to

Proposal is panned by doctors group, and a competing measure is scheduled to be considered

A LEGACY OF ADDICTION

See DATABASE • Page A7

Bannon predicts ideological fight daily

PHOTOS BY DAVID CARSON • dcarson@post-dispatch.com

Sam Biermann (left) and Nick Athanas talk about Nick’s brother Tyler Athanas who died of a heroin overdose earlier Wednesday. Nick’s other brother, Tommy Athanas, died of a heroin overdose in the room behind Nick in 2016. Their father died of an overdose in 2009.

St. Louis family comes to grips with third fatal heroin overdose

BY JESSE BOGAN St. Louis Post-Dispatch

ST. LOUIS • In the emotional

throes of another sudden death, the family of 23-yearold Tyler J. Athanas couldn’t stomach the idea of a funeral.

Tyler was their third addict to die since 2009.

“I can’t believe it,” said his grandmother, Carol Athanas.

“He was my little buddy.”

Tyler lived with her in the 3500 block of Regal Place in south St. Louis. She said she last saw him Wednesday morning, when he retreated into his room for hours, which was common.

By early afternoon, he wasn’t responding. Tyler’s brother, Nick, rushed home and forced the door open and found him on the floor.

“Here I am fooling around and I have a dead grandson in his room,” Carol said.

Officials pronounced Tyler dead at the scene at 2:21 p.m. from an apparent overdose.

The Athanas family was part of a Post-Dispatch story on Sunday about the heroin epidemic. In 2016, more than 650 people died from opioid overdoses in the region, more than four times the number in 2007.

See HEROIN • Page A7

WASHINGTON POST

the Post-Dispatch after Parson, a former state senator from Bolivar, announced he was seeking an increase of nearly 25 percent in his operating budget in order to pay for mileage, out-of-state

OXON HILL, MD. • The reclusive mastermind behind President Donald Trump’s nationalist ideology and combative tactics made his public debut Thursday, delivering a fiery rebuke of the media and declaring that the new administration is in an unending battle for “deconstruction of the administrative state.”

Steve Bannon, the White House chief strategist and intellectual force behind Trump’s agenda, used his first speaking appearance since Trump took office to vow that the president would honor all of the hard-line pledges of his campaign.

Appearing at a gathering of conservative activists alongside White House chief of staff Reince Priebus, Bannon dismissed the idea that Trump might moderate his positions or seek consensus with political opponents. Rather, he said, the White House is digging in for a long period of conflict to transform Washington and upend the world order.

Also at the Conservative Political Action Conference on Thursday:

See REMODEL • Page A7

See CPAC • Page A8

Nick Athanas holds a family photograph taken before his father and brothers died of drug overdoses. His father, Tom (far right), died in 2009; the oldest brother, Tommy (far left), died in 2016; and Tyler (second from left) died Wednesday.

Remodeling of lieutenant governor’s office tops $50,000

BY KURT ERICKSON St. Louis Post-Dispatch

JEFFERSON CITY • Missouri’s No. 2 statewide official has approved more than $54,000 in remodeling and renovation to his office since he won the No-

vember election.

As the governor was cutting spending on a variety of programs because of a slowdown in revenue, Lt. Gov. Mike Parson charged taxpayers $8,474 to replace furniture in his new office on the second floor of the

Capitol.

That’s in addition to the more than $46,000 spent upgrading his suite of offices in the wake of former Lt. Gov. Peter Kinder’s departure.

The remodeling and redecorating costs were obtained by

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Bill is opposed by Missouri Medical Association DATABASE • FROM A1

launch a similar program in April. And the Centers for Disease Control and Prevention prescribe even more openness, recommending doctors allow physician assistants and nurse practitioners access to the list.

But where doctors and medical experts see an essential tool in combating opioid addiction by making it harder to “doctor shop” — when addicts visit multiple doctors seeking similar prescriptions — Schaaf sees an invasion of privacy.

That’s why he has spent the last five regular legislative sessions thwarting attempts

by Sen. Dave Schatz, R-Sullivan, and Rep. Holly Rehder, R-Sikeston, to give medical professionals comprehensive access.

He has warned of hacks like the one in Virginia, which exposed 35 million records. He has offered studies showing the rise of heroin overdoses in other states with databases, though research published in the New England Journal of Medicine rejects the connection. He once even said people who overdose on drugs were “removing themselves from the gene pool.”

Then on Wednesday, he said he sensed time, term limits and counties were working against him. He bemoaned the gov-

ernor’s announcement making passage a priority in a Facebook Q&A last week. And in a move he compared to euthanizing a beloved pet, he urged colleagues to support his more limited plan while privacyminded senators remained a force in the chamber.

“I’m going to vote for this bill ... and I’m going to say to myself, ‘What did I just do?’” he said. “But I think this is the lesser of two evils because if you don’t pass something, we’re going to end up with something worse.”

At a Thursday news conference, he said his proposal would balance privacy and public health.

“We perfected a version of (a prescription drug monitoring database) that protects the liberty and privacy of Missouri citizens,” he said. “If (Schatz and Rehder) care about what they say they care about — saving lives — this is PDMP that can do that.”

Opponents weren’t buying it.

“This makes things worse and not better,” said St. Louis County Councilman Sam Page, a physician who pushed for the county’s database initiative. “This system is cumbersome, unprecedented and makes it more difficult for doctors to treat patients with complex and dangerous problems.

“I have no idea what Rob’s trying to do other than put as many hoops between doctors and this information as possible.”

The Missouri Medical Association panned the result, calling Schaaf’s effort a “fake PDMP.” Rehder stressed that Schaaf’s measure ignored the will of the state’s largest counties, which contain nearly half its population.

“This is about local control,” she said.

“It’s not for me to tell people how to keep their citizens safe sitting here in the state Capitol.”

The Senate perfected the measure Wednesday night by a solid vote of 20 to 13, with 8 Republicans and 5 Democrats dissenting.

In the days before the vote, Schaaf seemed to extend debate on other legislation far beyond serious discussion, prompting speculation he was doing so to force a favorable vote on his bill.

“Politics is like playing chess,” Schaaf said. “If you’re good, you advance your legislation. I’m using the tools available to me to achieve my goal which is to protect the privacy of the people of Missouri.”

Regardless, Rehder, whose own legislation has twice commanded majorities in the House, confirmed Thursday she would

Lesson opens eyes for police helping LGBT crime victims

remain ardently opposed to Schaaf’s bill.

“I appreciate his willingness to try and compromise,” Rehder said Thursday morning, “but this to me is a medical tool and it’s important for doctors to be able to see their patient’s history without an additional barrier to helping people who are sick. Without that taken care of, I can’t support his bill.”

Schatz isn’t giving up either.

He read aloud a long list of his bill’s supporters Wednesday night, including doctors, law enforcement associations and pharmaceutical companies such as Mallinckrodt Pharmaceuticals, which makes the highly abused painkiller oxycodone.

His bill is scheduled for debate in upcoming weeks and he said the Senate can pass both bills and the let House or governor decide.

But the St. Joseph senator has no intention of letting that happen. “I fully intend to filibuster if they don’t want to compromise with me,” he said. “I’d just as soon not have a PDMP. Would they rather have a database that protects privacy or no database at all?”

Austin Huguelet • 573-556-6184 @ahuguelet on Twitter ahuguelet@post-dispatch.com

Fatal overdose is third in same St. Louis family HEROIN • FROM A1

ROBERT COHEN • rcohen@post-dispatch.com

St. Louis Police Chief Sam Dotson introduces Jessica Meyers, of the Crime Victim Advocacy Center of St. Louis, as she teaches the command staff Thursday at police headquarters about working with LGBT victims of violence.

BY CHRISTINE BYERS St. Louis Post-Dispatch

ST. LOUIS • When a crime

victim advocate asks police officers to write down the three things that matter most to them, the most common responses are: Job. Spouse. Children.

Then Jessica Meyers pairs the officers up and tells them to have a conversation without mentioning those topics. That’s how she starts an hourlong training program meant to show officers how gay, lesbian, transgender or bisexual crime victims may feel when talking to them.

“It really appeals to police officers because they love to interrogate each other,” said Meyers, the director of Advocacy Services for the Crime Victim Advocacy Center of St. Louis. “But they soon find out that a simple question such as, ‘What did you do this past weekend,’ can force someone to make a choice: tell the truth and out themselves, lie or become evasive.

“It shows them what it’s like to be closeted about something for fear of being outed.”

The training that some officers went through Thursday is a far cry from the department’s first documented gay

sensitivity training in 1950, Meyers said.

The 1950 version included a reading from the book of Leviticus and the use of terms such as “sexual perversion.”

Back then, most police encounters happened during raids at gay bars because homosexuality was illegal, she said.

Police Chief Sam Dotson could not recall how much training on the topic has taken place since then, and he acknowledged that Meyers’ training was “long overdue.”

Those early roots have led LGBT victims of crime, such as domestic violence in same-sex partner relationships, to mistrust police and believe officers won’t help.

They have also led some aggressors to use those stereotypes of officers to silence their victims, Meyers said.

Gay and transgender people are often victims of human trafficking, hate crimes and homelessness and are not as likely to call police when they are victims of domestic violence, she said.

“A man might tell his male partner a police officer isn’t going to do anything for them because they don’t believe a man can be beaten by another man,” Meyers told a group of commanders at police head-

quarters.

The topic has become particularly relevant as President Donald Trump on Wednesday rescinded the Obama administration directive to let transgender students use the bathroom that matches their gender identity. The issue has put the unique issues that the gay and transgender community faces again in the spotlight, Meyers said.

And earlier this month, a gay police officer drew national attention after he said in a lawsuit against the St. Louis County police department that he was told to “tone down” his “gayness” if he wanted a promotion.

Dotson said the training Meyers is running for the St. Louis police department has been in the works for months.

It’s funded by the nonprofit Meyers works for.

“I want our officers to have an awareness and understanding about how to communicate better at a time of crisis,” Dotson said. “I think this has been an enlightening and eye-opening experience for a lot of them.”

About 30 officers in St. Louis and about 20 commanders have undergone the training, and there are plans to train the entire 1,200-member department

by June.

The nonprofit offers its services to every police department, but so far the city’s force is the only one to undergo the training, which also asks officers to write down thoughts and beliefs about gay and transgender people to be read and discussed aloud in class.

A lot of time in Meyers’ first class with officers Wednesday was devoted to whether homosexuality was a choice, and how officers’ own religious beliefs affect their decisions.

“I’m not asking you to set aside your religious beliefs.

I’m asking you to treat people with respect, because that is accepted by every religion,” Meyers said she told them.

Capt. Angela Coonce serves as the department’s liaison to the gay and transgender community.

She said the department is looking internally to change policies and protocols to better serve gay and transgender residents.

The department requires officers to search people of their same gender, but now, the department will give transgender people a choice.

Christine Byers • 314-340-8087 @christinedbyers on Twitter cbyers@post-dispatch.com

The city’s death rate is by far the highest, with 80 fatalities per 100,000 residents.

The report mentioned 256 opioid deaths in the city in 2016, which was a dramatic annual spike blamed partly on the prevalence of fentanyl, a powerful synthetic opioid that hit the street market in recent years.

But in the past week, 10 more cases were added to the city’s tab in 2016, as toxicology reports continue to flow in for the final part of December.

T h e At h a n a s fa m i ly showed how heroin doesn’t Tyler kill only on the mean streets Athanas of St. Louis.

Carol’s 42-year-old son Tom died in his home across the street on Regal Place in 2009. She was initially embarrassed by the overdose and tried to hide it from friends and neighbors. She said she learned to describe addiction as a sickness such as cancer and arthritis that has plagued their family.

Tom left behind three sons: Tommy, Nick and Tyler. Tommy, 29, died from an overdose in his grandmother’s basement in June.

Then Tyler died Wednesday in the bedroom.

Later that night, Carol motioned toward Nick.

“He’s all we have left,” she said.

Nick, 27, has struggled with his own addictions. He said he’d been clean of opioids since he went to jail on Feb. 9, 2015. He said living behind bars allowed him time to sift through a lot of mental muck and grab hold of something worth surviving for: his 3-year-old son.

“You have to endure the pain to enjoy the pleasurable things,” he said Wednesday night, seated near a decoration in the living room that said: Live. Laugh. Love.

He questioned whether he’d been too hard on his younger brother, Tyler.

Nick said Tyler had been using drugs since he was 15 and dropped out of Lindbergh High School. He said Tyler had been to rehab and frequently went to Alcoholics Anonymous meetings but struggled to find work and stay positive.

Nick said Tyler suffered from anxiety and had been selling anti-anxiety medications for heroin. Family said emergency responders found heroin, a needle and spoon, and dozens of orange medicine containers of pills squirreled away in his bedroom.

Tyler’s room also had a large cage for his beloved dog and a watering bowl near it that said “Ruff Life” on the side.

An idealistic quotation posted on his Facebook page says: “Ever wonder how different your life would be if that one thing never happened.”

Tyler found his father dead in 2009.

Carol found Tommy. Nick found Tyler.

On Wednesday night, Nick took breaks to answer incoming calls about the latest death.

“Not my first rodeo,” he said.

Jesse Bogan • 314-340-8255 @jessebogan on Twitter jbogan@post-dispatch.com

Spokesman defends work, says office hadn’t been updated in ‘at least 12 years’ REMODEL • FROM A1

travel expenses and for an additional employee.

That request comes as Gov. Eric Greitens and lawmakers are reviewing a $27.6 billion spending plan for the coming fiscal year that reduces funding for higher education and could reduce health care to 20,000 elderly and disabled Missourians.

And it comes after Greitens and his predecessor, Democratic Gov. Jay Nixon, pared $200 million in spending in the current budget because tax revenues aren’t growing as quickly as projected.

Parson spokesman Tyler Habiger de-

fended the office work, saying it hadn’t been updated during Kinder’s tenure.

“It should be noted that there has been no refurbishment work done on the lieutenant governor’s Parson office in at least 12 years,” Habiger told the Post-Dispatch.

According to the Office of Administration, which oversees maintenance and operations in the Capitol complex, the work in Parson’s office included the replacement of damaged hardwood flooring and repair of cracked plaster in the walls.

Workers also removed old wiring, replaced old carpeting and cabinets and in-

stalled a new sink and refrigerator in the office’s kitchen.

The new furniture includes a leather couch in the waiting room.

Although there was turnover in five of the six statewide offices in November, only the lieutenant governor had work done to his office during the transition period, said Office of Administration spokeswoman Ryan Burns.

The lieutenant governor, with a salary of about $86,600, is the lowest-paid of Missouri’s statewide elected officials and has the smallest staff.

Parson is seeking a $125,000 increase in his $463,000 annual budget. Of that, he wants $35,000 in his budget for travel

expenses, including money to reimburse him for mileage when he drives his personal vehicle on state business.

He also is seeking $10,000 for out-ofstate travel. Parson told members of a House budget committee it could be used to pay for trips to meet with other lieutenant governors.

During his tenure, Kinder also asked for taxpayers to pick up his mileage costs, but he also reduced spending in his office to offset the additional expense. His requests were turned down. ​Kurt Erickson • 573-556-6181 @KurtEricksonPD on Twitter kerickson@post-dispatch.com

DROME

e per rths

3.0 7.0 12 26.37

SOULARD SOIREE

DAVID CARSON P-D

STLSUNDAY • B1 SUNDAY • 02.26.2017 • $3.00 • FINAL EDITION

MISSOURI’S HEROIN EPIDEMIC

THE TINIEST VICTIMS

BY NANCY CAMBRIA St. Louis Post-Dispatch

The tiny babies typically arrive at Jill Bundschuh’s foster home in Rock Hill around her family’s dinner time.

Social workers bring them on short notice, with maybe some formula and a few diapers. There are no extra onesies. No swaddling blankets. No car seats.

The paperwork is usually sparse beyond a name and maybe a few clues about the baby’s first few days or weeks of life. Bundschuh knows from experience to quickly read the hospital notes before the caseworker leaves with the file.

Even when there is no medical history, this relatively new foster parent knows what to expect in

More babies in withdrawal Rate of births to addicted women is climbing in St. Louis region

A burdened system Foster care placements increase; judges must weigh reunification

See FOSTER CARE • Page A8

MISSOURI INFANTS BORN WITH NEONATAL MISSOURI INFANTS ABSTINENCE SYNDROME BORN WITH NAS 600

400

200

ROBERT COHEN • rcohen@post-dispatch.com 0

’06 ’07 ’08 ’09 ’10 ’11 ’12 ’13 ’14 ’15 ’16

SOURCE: Hospital Industry Data Institute

Darren Beckham Williams feeds his 10-month-old grandson, Aaron, on Friday at the family home in Florissant. Beckham Williams and his wife, Donna, have cared for Aaron, their son’s child, since he was 10 days old. The baby had tested positive for opioids at birth. Neither of Aaron’s parents have attended required drug testing, so his grandparents have started adoption proceedings. “They’re drug addicts,” Donna Beckham Williams said of her son and his girlfriend. “They stick together, and that’s the hard part with getting them help.”

As Confluence students lag, charter is warily renewed

YNDROME

NAS rate per 1,000 births  0

BY KRISTEN TAKETA  0.1 to 3.0St. Louis Post-Dispatch  3.1 to 7.0  7.1 to 12 Of the more than 10,400 chil 12 to 26.37 dren who attend charter schools

in St. Louis, few perform worse as a group than the 2,800 who attend Confluence Academies.

The network of five schools on 5.21 four campuses has lagged far behind state averages on Missouri standardized exams throughout its 14-year history.

That kind of persistent fail6 ure is supposed to be at odds with the very concept of char5.73 ter schools. The independently run, publicly funded schools are 4.52 founded on the idea that, if they fail in their promise to provide a 1.25 2.23 better alternative to traditional public schools, they should be 2.75 3.0 closed.

And yet on Tuesday, Missouri’s 4.03 Board of Education said it had no choice but to grant the schools a fresh five-year license to operate.

See CONFLUENCE • Page A14

OSCARS PREVIEW

State education board scolds academies’ leaders for failing their 2,800 pupils but lacks power to deny five-year renewal

GAGA FOR ‘LA LA LAND’ A&E • SECTION D

Tweets breathe new life into Super Hornet program • E1

It’s a toss-up

TODAY

51°/37° CHANCE OF RAIN

TOMORROW

LAURIE SKRIVAN • lskrivan@post-dispatch.com

Language arts teacher Tashia Harris helps sophomore Ventricle Fortson, 16, compare her test scores to state proficiency standards Wednesday during class at Confluence Preparatory Academy in St. Louis. Confluence has five schools on four campuses.

Clear your clutter by clearing your mind • H1

58°/52°

Cardinals welcome their latest Cuban import • C1

WEATHER A15

Wheels are in motion on bike lane debate • B1

PARTLY SUNNY

POST-DISPATCH WEATHERBIRD ®

2 M Vol. 139, No. 57 ©2017

“DIVINELY, DANGEROUSLY

DECADENT.”

FABULOUS FOX THEATRE • MARCH 7-19

314-534-1111 or MetroTix.com

A8 • ST. LOUIS POST-DISPATCH

MISSOURI’S HEROIN EPIDEMIC

M 1 • SUNDAY • 02.26.2017

“We are in desperate need of more foster parents for the first time in a decade and a half.”

Melanie Scheetz, executive director of the Foster and Adoptive Care Coalition of St. Louis

ROBERT COHEN • rcohen@post-dispatch.com

Donna Beckham Williams bounces her grandson Aaron, 10 months, while warming a bottle for him in her Florissant home Friday. Beckham Williams said a day after Aaron’s birth last year, she got a panicked call from her son begging her to take him because Aaron had tested positive for opioids and was being sent to foster care.

Foster care system is overloaded FOSTER CARE • FROM A1

INFANTS BORN WITH NEONATAL ABSTINENCE SYNDROME

host foster parents at their first social MISSOURI INFANTS eventWITH in the governor’s BORN NAS mansion.

NAS rate per the long night ahead.

600 The governor has proposed in his 1,000 births preliminary state budget a $2.7 milThe baby will constantly fidget. lion increase in direct foster care There can be sudden tremors in the  0 funding to serve the increasing numarms and legs. The buttocks might  0.1 to 3.0 ber of children in state custody and bleed from open sores caused by  3.1 to 7.0 another $1.2 million increase for runny diarrhea. The sucking reflex is  7.1 to 12 400adoption resource centers. Those off, so feeding can frustrate the baby.  12 to 26.37 centers, including Foster and AdopLullabies and cuddling rarely tive Care Coalition in St. Louis, resoothe the child who arches his or cruit foster parents and run programs her back and cries in a high pitch. to quickly find permanent relative So Bundschuh will find a quiet spot TOP 10 COUNTIES placements for children recently enaway from the bedrooms where her 200 Iron......... 26.37 tered in foster care. husband and three boys are sleeping.

Polk ..........17.15 She will rock the baby in her arms St. Louis (city)..

MAKING DECISIONS with his or her body vertical. Being ................ 15.21 cradled agitates the baby.

The ultimate decision to separate a Madison....15.11 Mostly she will pace with the baby child from a parent and place him or Pulaski.... 14.65 through the dark house — because in 0 her in foster care lies with the prePhelps......12.96 ’06 ’07 ’08family ’09 ’10 court ’11 ’12 ’13 ’14 ’15in’16each her experience babies withdrawing siding judge Shannon ..12.92 from heroin or methadone or morof Missouri’s circuit courts. In St. Oregon.....12.24 SOURCE: Hospital Industry Data Institute Between phine or other opioids may be conLouis, that’s Robin Vannoy.

Dent......... 12.12 soled by movement. foster care custody cases last week Howell.......11.71 Bundschuh has cared for four bain her courtroom, she said reunificabies in opioid withdrawal since she tion with the parent is almost always SOURCE: Hospital Industry Data Institute | Post-Dispatch and her husband became licensed the goal with newborns and infants foster parents in Missouri two years when a parent is facing a substance ing because I’m constantly checking Children’s Medical Center’s Fosterago. The most recent arrival came in abuse issue. their breathing,” she said. “I didn’t go ing Healthy Children medical clinic late January — a newborn preemie.

That means children may stay in through that with my own. With my see nearly all the children who enter The previous baby was agitated for the foster care system longer and paown kids, it’s not so stressful.” foster care in St. Louis and St. Louis six months, a fairly typical course for rental rights will not be terminated as County. About a third of some 900 full withdrawal. quickly — all with the understandTHE NUMBERS CLIMB children they’ve served since open“There would be two to three ing that addicts typically fail several NAS rate per times before they may be able to stop ing5.21 two years ago have been opioid hours every night where he just Last year more than7.09 650 people died 1,000 births using drugs. addicted. screamed; he was very hard to calm,” from opioid 3.96 overdoses in the St. 2.97 2.8  0 “I she said.

The National Institute on Drug Louis region, more 9.42 than four times 7.19was totally unprepared,” said  0.1 to 3.0 Abuse estimates up to 60 percent of Donna Erickson, medical coordinaBundschuh made no special rethe number in 2007. Last week, the 6.37chronicled 2.94the toll 1.33 tor. 6.02 “I am friends with social quest to care for these cases when Post-Dispatch  work3.1 to 7.0 recovering drug addicts will relapse.

8.33 6.39 on the reers in the NICU, and we’ve had7.1one she signed on to be a foster parent. those fatalities are taking to 12 With heroin, those rates are higher.

2.14 families or two parents overdose in the bathNonetheless, she has wound up on gion’s 2.71 and communities.  12 to 26.37 Many opioid addiction cases in2.2 5.03 2.01also measured room while they are visiting.

But I the front lines of Missouri’s opioid volving children never reach VanBut is 4.79 the epidemic 10.62 5.58 of Missouri hos4.24 rooms truly epidemic, which is sending children noy’s courtroom or the Children’s in delivery 3.47 had no clue about its prevalence until I started 6.82 working here.” at an alarming rate to a state foster Division because grandparents step pitals, which have seen 2.12 more than 8.77 foster care is intended to Though care system that is straining to serve in. When a child is unexpectedly a fivefold3.76 increase4.4in the number of 4.04 be3.66 a haven10.8 for a6.54 child, the transithem. born drug-addicted, a hospital typiinfants born with symptoms of6.92 opi2.12the past 10 years, tion into state custody, and15.21 the risk It’s not just newborns — though cally calls the Children’s Division. oid withdrawal in 6.38 3.61 1.14 multiple placements or re-entry the system is seeing far more of The baby can go into foster care after according to the Missouri Hospital 5.2 of2.84 6.31 9.71 into foster care when a parent fails them. It’s also older siblings who discharge with a judge’s order.

Association. St. Louis 9.73 stood out1.0with 8.68 stop using drugs and neglects the need care after Children’s Division But caseworkers can also opt to one of the highest rates in the state, 7.9 to6.1 child, are considered highly trauinvestigators find severe neglect inTOP a 10 surpassed by just two counties in rudivert a custody hearing and keep 4.43 9.86 COUNTIESral south-central4.94 7.06 12.96 6.94 8.72 matic events. household disrupted by opioid adthe child with the mother through a Missouri.

14.65 Iron...........26.37 8.73of research An increasing body diction and the often unsafe parental system of “Team Decision Making” The number of children going into 3.51 26.37 Polk ........... 17.15 3.85 8.3 began 9.14climb 12.12 children struggle finds foster with behaviors that go with it. meetings. They identify family supfoster care in Missouri to 17.15 15.11 St. Louis (city)... lifelong health and behavioral issues 5.73 “We are in desperate need of more ports to ensure the child’s safety as in 2012, following years of a general 6.32 6.6 ..................15.21 3.28 because of the trauma of the initial foster parents for the first time inMadison..... a well as the mother’s willingness to decline.

Last year 7,505 children en9.68 15.11 6.39 4.32 4.01 abuse and12.92 neglect as well decade and a half,” said Melanie tered foster 5.54as the toxic4.52 get treatment and parenting classes, Pulaski......14.65 3.82care. That is a leap from stress from their years in foster care Scheetz, executive director of the therapy and other programs.

2.81 Phelps.......6,432 12.96 in 2013.

4.84 1.25 Mothers who seek prenatal treat2.23 6.3 Louis 4.9 without adoption or reunification Foster and Adoptive Care Coalition In the 1.92 past five years, St. Shannon ... 12.92 with family. of St. Louis. “We need them for both ment for addiction also tend not to Oregon......County 12.24 saw a 29 percent7.8jump in the 11.71 12.24 3.42 9.44 “Very often from the time the child newborns and older children.” lose children to foster care if they number of children entering foster Dent...........12.12 5.51 3.0 8.29 5.48 2.75 2.09 leaves the NICU to the time we see Scheetz said foster parents needHowell........ to show progress in their recovery and a 11.71peaking at 521 children last year. care, them at the clinic, they may have4.03 albe trained about dealing with trauma strong support network.

In St. Louis city, entries increased by

INFANTS BORN WITH NEONATAL ABSTINENCE SYNDROME

in these children: more than a third. Jefferson County SOURCE: Hospital Industry Data Institute | Post-Dispatch “We had a case where two kids saw a 20 percent increase; St. were found in Fairground Park beCharles County, 14 percent. hind a bridge because their mother The state lacks data to directly tie was turning tricks for drugs. It’s just the spike in foster care to opioids. devastating for these families.”

But data from the St. Louis Family Bundschuh received no special Court show the link. training on how to care for babies in Of the 46 children who have endrug withdrawal after being exposed tered foster care in the city this year, to opioids in the womb or given mor17 — or 39 percent — were due to phine in the hospital to taper the drugs, either involving drug exposymptoms of their withdrawal. She’s sure to newborns or issues of abuse learned on her own. or neglect because of substance Along with the risk of burnout abuse by parents. One of the cases and frustration with an inconsolinvolved the fatal shooting death of able baby, there is constant worry. a 6-year-old girl by a younger sibling She knows, for example, that babies while the mother and her boyfriend in withdrawal are at a higher risk for slept after smoking drugs, accordseizures or sudden infant death syning to court records. The three living drome, or SIDS. If something hapsiblings, ages 3, 4 and 9, went into pens, she could be legally liable. foster care.

“The first week is very exhaustClinicians at Cardinal Glennon

ready been moved a couple of times when they have withdrawal issues,” said Maggie McVey-Vogt, a clinical nurse at the foster care medical clinic. “And the new foster parents have little or no knowledge about what they are looking at with these babies.”

The Missouri Department of Social Services would not acknowledge or speculate if the increase in foster care placements is due to opioids, citing a lack of statistics. Nor would the department make a Children’s Division official available for an interview about the increase.

Yet Gov. Eric Greitens campaigned heavily in rural areas on a platform that pledged to deal aggressively with the opioid crisis. His wife, Sheena, is a well-known advocate for foster parents. The couple chose to

But some addicts burn through their safety nets. In those cases, Vannoy, on the recommendation of the Children’s Division, often places the child in foster care. The ideal placement is with a relative.

In most cases that relative is a grandparent.

Sometimes those grandparents — still joyful about the birth of a grandchild — abruptly learn that their child is a drug addict.

‘THERE WAS NO TIME’ Donna Beckham Williams, 46, of Florissant, said a day after her grandchild Aaron’s birth last year, she got a panicked call from her son begging her to take him because Aaron had tested positive for opioids See FOSTER CARE • Page A9

02.26.2017 • SUNDAY • M 1

MISSOURI’S HEROIN EPIDEMIC

ST. LOUIS POST-DISPATCH • A9

PHOTOS BY DAVID CARSON • dcarson@post-dispatch.com

Four-month-old Camden is held in a car seat by his mother Amanda Davis as she waits for the bus Thursday to take her back to a Queen of Peace maternity home in the College Hill neighborhood of St. Louis. Davis was downtown for testing to show she is still clean of drugs.

Surprise pregnancy leads to help Heroin addict is sent to nonprofit offering therapy, parenting classes

BY JESSE BOGAN St. Louis Post-Dispatch

ST. LOUIS • Lying in bed at BarnesJewish Hospital in May, Amanda Davis was sickened by what she saw pop up on the ultrasound: a baby’s beating heart.

She immediately turned away.

“I was horrified,” she recalled.

“What if I can’t kick?”

Homeless, with one bag of belongings left on her heroin death march, she’d ridden a bus to the hospital to get help in the psychiatric ward because she’d relapsed. She had no idea that she was 18 weeks pregnant.

“I was no longer just hurting myself,” said Davis, 35. “Now, I’d be hurting an infant that’s living inside me.”

But her addiction had hurt others.

She had already lost parental rights to her 14-year-old daughter.

Her 8-year-old son has been in foster care since running for help from a Schnucks bathroom at Gravois and Hampton avenues. He had seen his mother overdose.

“He really didn’t have any reaction,” Davis said. “I hate to admit it.

He’s seen it several times.”

The boy also found his grandmother dead from an overdose. She retired from the Veterans Administration in St. Louis, where she worked in an office. She suffered from arthritis and eventually became dependent on pain medications that became less effective. Davis, a former department manager at Walmart in south St. Louis County before she lost everything to drugs, said she had introduced her mother to heroin.

“The brain thinks of heroin like water. I am dying of thirst,” she said.

“Your brain is screaming for the drug.”

Davis’ latest pregnancy calmed that voice.

Barnes-Jewish referred her to Queen of Peace Center, a Catholic Charities agency serving women with addiction and their children and families. About 750 indigent women show up each year on the front doorstep at 325 North Newstead Avenue,

Many newborns are reunited with their parents FOSTER CARE • FROM A8

and was being sent to foster care. Not long after, she was shocked to learn both her son and his girlfriend were using heroin. She waited an agonizing week to get foster care custody of her grandchild, who had been placed with a stranger in a foster home.

“I had to go right into mommy mode because there was no time,” she said.

Beckham Williams has been caring for Aaron for 10 months. Additionally, she baby-sits her daughter’s infant twins during the week and cares for her blind, elderly uncle. Her son and his girlfriend have made no ef-

Amanda Davis tickles her son, Camden, in their private room Thursday at a Queen of Peace maternity home. Davis entered the program after she was pregnant. It helped her find prenatal care and quit using heroin. Davis has two other children.

behind the Cathedral Basilica of St. Louis in the Central West End. Some 10 percent of them are pregnant and addicted to heroin.

A Post-Dispatch story about the heroin epidemic in St. Louis caused a stir last weekend by showing and telling the story of a pregnant woman shooting up. She had already lost three children to state custody because of her lifestyle.

She is one of hundreds of Missouri mothers who are increasingly in a similar situation. Nearly 600 babies were born addicted to opioids in 2016, a 500 percent spike in the past decade, according to the Missouri Hospital Association.

Queen of Peace was created in 1985 as an alternative to incarcerating mothers and putting children in state custody during the crack epidemic.

“Our model is designed to help provide support to the whole family so that the cycle of addiction can be broken, so that those babies who are born to moms who are substance using don’t end up having to come back here 20 years later for treatment of their own,” said Chief Executive Officer Lara Pennington.

She said most of the women haven’t had access to prenatal care.

Or if they do know they are pregnant and continue to use drugs, shame and fear are often barriers to seeking proper health care.

“The system now is less punitive and more rehabilitative,” Pennington said.

The nonprofit, which has a $8.5 million budget mainly supported by government contracts, says about 95 percent of the babies in the program are born drug-free — not including controlled doses of Subutex, a narcotic used to ease a mother off heroin. Newborn babies are weaned off the medication with morphine.

“I felt so bad for him knowing that I am putting him through this,” Davis said of her youngest son Camden, who was born Oct. 7. “But it was better than heroin withdrawals.”

Today, she and Camden live in a Queen of Peace maternity home in the College Hill neighborhood with about 10 other women. During the day, they go to the central office for group therapy, life skills training and meetings with case managers who ensure they stay on top of require-

ments with the Division of Family Services and medical appointments.

“When you are on the street, you don’t call doctors and make appointments,” said Davis, who also suffers from anxiety, Crohn’s disease and a chronic inflammatory disease that attacks her bones. “That’s just not something you would do.”

Nor do you typically seek ways to be a better parent.

“This lady has saved my life, especially with my kids,” Davis said of the leader of a parenting class she likes.

There is a 6 p.m. curfew at the maternity home. Davis is expected to shop and cook on her own. She hopes to have access to her own apartment soon, one that is in the Queen of Peace network of support.

She does mandatory drug testing.

“I am the master of peeing in a cup,” she said. “But the more you have, and they are negative, the better it looks.”

The better the chance of keeping Camden. And maybe getting her other kids back.

fort to regain custody of their child and don’t show up for required drug testing and other meetings set up by the Children’s Division, she said.

“They’re drug addicts,” she said.

“They stick together, and that’s the hard part with getting them help.”

Many newborns who enter foster care with opioid issues are reunited with parents within several months, Scheetz said.

Bundschuh, the foster parent, said all of the babies she’s nursed through withdrawal went back to their mothers while still infants.

She remains in contact with two of the families and sees one of her former foster babies weekly. She knows, despite the bonds she made with those babies, they need permanent homes. But given the reach of heroin in families and the risk of relapse, she and others in the foster parent community worry some babies are being placed with relatives too quickly.

“The system is so big on trying to quickly move them to families that a lot of foster parents don’t feel are safe or ideal,” she said. “Sometimes, those babies end up back in foster care, causing them more disruptions.”

Last Wednesday, though, those worries were not present in one case on Vannoy’s foster care docket.

An 11-month-old babbled and bounced on a maternal cousin’s knee while clutching a burp cloth. The infant had been placed with the relative at 2 months after being placed in another foster home after birth.

Court testimony said the newborn had tested positive for cocaine, heroin and fentanyl, a potent synthetic opioid that is often responsible for fatal overdoses.

Various court and caseworkers testified the young mother sitting in the courtroom had tested clean on all of her drug tests. She had

taken required therapy and parenting classes, passed a psychological evaluation and obtained housing and employment. The baby had received therapy through day care and been through various developmental screenings.

Vannoy ruled the mother could have unsupervised overnight visits with her baby. If all goes well, mother and baby will spend three months together this summer on a trial basis.

“I have to say that it’s unusual to get someone so young like you to cooperate and do everything you needed to do,” Vannoy told the mother.

The mother beamed. After the hearing, the judge held the toddler in the folds of her black robe and spoke to her in a high, delighted voice.

“You made my day today.”

Jesse Bogan • 314-340-8255 @jessebogan on Twitter jbogan@post-dispatch.com

Nancy Cambria • 314-340-8238 @nanecam on Twitter ncambria@post-dispatch.com

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Bombs keep falling in Syria

Proven treatment is out there for heroin addicts But most can’t get — or don’t want — medication

‘The American strikes did nothing for us,’ besieged civilian says

BY LOUISA LOVELUCK AND ZAKARIA ZAKARIA Washington Post

BEIRUT • Residents of the

Syrian town devastated by a chemical weapons attack Tuesday said warplanes had returned to bomb them Saturday, despite a U.S. missile barrage and warnings of possible further response.

At least 86 people in the northwestern town of Khan Sheikhoun were killed Tuesday in a chemical attack that left hundreds choking, convulsing or foaming at the mouth. Eyewitnesses and a monitoring group, the Syrian Observatory for Human Rights, said Saturday that fresh attacks on the area — now a virtual ghost town — had killed one woman and wounded several others.

Photographs from the site

See SYRIA • Page A12

DAVID CARSON • dcarson@post-dispatch.com

After kissing the tips of her fingers, Vanessa Riley reaches out to touch the box containing the ashes of Dante Bonzano, father to her three children, as she goes to bed Thursday. Riley keeps the ashes next to a box of Bonzano’s personal items because she says she hasn’t gotten used to the idea he is gone. Bonzano had been on Vivitrol to help control his addiction to heroin but died Feb. 8 of an apparent overdose.

Critics say there isn’t a standardized method of care for the growing opioid crisis.

There’s still confusion about what treatment even is and how long it should last.

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ST. LOUIS • Dante Bonzano had a reputation for being one of the best concrete finishers and bricklayers around. He often worked knee-to-knee with his father, who trained him from a young age to be a devout Jehovah’s Witness and work 12-hour days.

The proud father used to say everything the boy touched turned to gold. But that didn’t turn out to be true.

By the time he was a grown man, Bonzano was often in reach of a can of Bud or a syringe. His life passed in and out of Missouri’s prison system.

Then came an opportunity that eludes most heroin addicts — a form of treatment that has See TREATMENT • Page A10

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In June 2015, Dante Bonzano, then 33, removes vegetation in an overgrown backyard in St. John. Bonzano was helping prepare a vacant home for rental. In May 2016, Bonzano fell from a roof and was prescribed painkillers. He soon spiraled out of control.

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the 2016 election, Diane Redmond felt compelled to get involved in activism, but she wasn’t sure how.

“I felt frustrated because I have a limited income and I didn’t think I could help financially,” said Redmond, a graphic designer who lives in St. Louis. “What I did have was time I could sacrifice and energy I could spare, despite working two jobs.”

She eventually helped organize the Women’s March on St. Louis in January and continues to encourage

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PHOTOS BY DAVID CARSON • dcarson@post-dispatch.com

People line up Monday outside the St. Louis Metro Treatment Center in Breckenridge Hills at 5 a.m. to get their daily dose of methadone, a highly regulated drug that limits the urge to use heroin. The clinic opens its doors at 5:15. Many in line were on their way to work. “I get up every day at 3:30 in the morning and am usually at work by 6,” one man said.

No standardized method of care TREATMENT • FROM A1

been proven effective.

Bonzano was deemed an ideal candidate for a small program in Missouri that treats heroin addicts with a monthly Vivitrol injection as they leave prison and go back to their communities. At $1,000 a pop, the drug is supposed to shield the brain from getting high.

In other words, it works on the premise that the best way to fight drug addiction is with more drugs.

That flies in the face of popular notions about kicking the habit through sheer willpower. For decades, the prevailing response to opioid dependency has largely been the same as for alcohol and cocaine addiction: abstinence, followed by support, such as a 12-step program.

But a commanding body of research suggests that’s not working for the tens of thousands of people who die each year from the opioid epidemic, including hundreds in the St. Louis region.

“Detox is not treatment,” said Rachel Winograd, director of a $20 million federal grant in Missouri aimed at improving response efforts between emergency rooms, drug treatment centers, mental health clinics, primary care doctors and emergency responders. “We are setting people up to fail if we let them out the door with nothing to help keep their cravings at bay.”

What does work, according to evidence-based research, is medication-assisted treatment.

The most well-known — methadone — isn’t new.

Often dispersed on the fringes of society, methadone has been used since the 1960s, and was pushed by the government to treat heroin addicts coming back from the Vietnam War. A correct dosage stimulates opioid receptors in the brain of severe addicts, limiting withdrawal symptoms and the urge to use.

More than 70 percent of people respond to treatment — a figure that dwarfs recovery rates for those without medical support.

And yet medication-assisted treatment is missing nearly 80 percent of opioid addicts.

Some don’t think they need help. But public health experts say the shortfall is also caused by a dire lack of coordination in the system. They say there isn’t a standardized method of care for the growing crisis. There’s still confusion about what treatment even is and how long it should last.

If addicts do want help, they often aren’t aware of the most effective options, nor can they immediately get access to care. On any given day in Missouri, 2,500 people — rich and poor — are on a waiting list for drug treatment.

“Someone who is put on a wait list today may be in jail or in an emergency room tomorrow,” said Mark Stringer, director of the Missouri Department of Mental Health. “Every single name on a waiting list is a potential tragedy.”

Part of the problem, experts say, is that too few medical treatment options are on the table.

Methadone and naltrexone,

Vanessa Riley sits in the living room of her home in St. Louis with one of her children resting in her lap last month.“I thought we were all going to save him,” she said of her children’s father, Dante Bonzano, who died of an apparent overdose in February.

which comes in a daily pill and the extended-release Vivitrol shot, are two of only three drugs approved by the FDA to treat opioid addiction. The other is buprenorphine.

Access to the three drugs is severely limited by an addict’s ability to pay, with state and federal funding running far short of the need for subsidized treatment.

But even for patients with financial means, finding a doctor or program to administer medication-assisted treatment is difficult.

Few physicians prescribe medicine for addicts and many are apprehensive to get involved.

Patients with substance-use disorders often have co-occurring conditions. Their entire lives might be in flux. There are mental, physiological and genetic obstacles to overcome.

And even as drugs such as Vivitrol offer promise, they’re not a panacea. Experts say far more work is needed to not only develop new treatment drugs, but to better understand how to best use the few already on the market. For instance, long-term outcomes from Vivitrol are unknown.

Keeping patients on the drugs is also a challenge. Many — perhaps bending to the notion they have kicked their addictions — ditch treatment, only to relapse.

Bonzano is a tragic testament to the limitations of Vivitrol treatment.

On Feb. 8, he was found dead in his work truck.

Vanessa Riley, the mother of Bonzano’s three children, remembers the hope she felt when, at first, Bonzano responded to treatment. That initial success was the subject of a previous Post-Dispatch story. But it proved to be short-lived.

“I thought we were all going to save him,” she said. “I think that’s what every family thinks — if you love them enough and go through enough. For a minute, it works. It’s like a Band-Aid on a gaping wound.”

ANGELS ON A PIN Percy Menzies is president of

Assisted Recovery Centers of America, or ARCA, which has multiple clinics in the St. Louis area and Farmington. Clients are mainly referred by state agencies.

He said effectively serving those clients — and the thousands more addicts who are cut off from services — requires a sea change, one that dramatically increases access to medicationassisted treatment.

He envisions walk-in clinics, as accessible as urgent care centers, to “humanize” care for opioid addicts.

“Imagine if 2,500 patients with chest pains, symptoms of stroke, symptoms of the Zika virus infection could not find a place to seek treatment?” Menzies said. “We simply don’t even have a rudimentary infrastructure in place to treat addictive disorders as a chronic condition.”

Instead, he said, society is slow to accept the very concept of using drugs to battle drug dependency.

“Here we are so driven by ideological differences that we are like theologians fighting over how many angels can dance on the head of a pin,” Menzies said.

Research suggests that less than 10 percent of heroin addicts remain clean after detoxing without medication.

But Joe Brennan, 54, who helped found Heroin Anonymous in St. Louis, said he’s confident 12-step programs work if you follow the guidelines of the social-support program.

He was skeptical of medication success stories, having seen many people’s initial hopes be destroyed by relapse and death.

“Medication-assisted treatment is fine, but you have to stop sooner or later,” he said. “Throw them a life jacket, please, but who wants to swim with a life jacket?”

He distrusts pharmaceutical companies.

“At $1,000 a shot,” he said of Vivitrol, “I want to be an administrator of that, too. This is all being fueled by big money.”

Brennan didn’t have statistics to back up Heroin Anonymous.

He estimated that maybe four of

the 15 to 20 people who first came to the meetings in 2011 are clean.

Another four or so died.

“Give me the broken ones, the ones the doctors can’t fix, and I’ve seen it happen,” he said.

“They get jobs, and they don’t break into cars. They have relationships and babies. They have homes and pay taxes.”

One success story was his daughter, a former high school cheerleader who became an addict at 15. He said abstinence didn’t immediately take, but she recently celebrated five years sobriety.

“There are a lot of gruesome details, but the ending is pretty sweet,” he said.

Advocates of medication-assisted treatment don’t refute the fact that it’s possible to recover from opioid addiction through an abstinence approach, such as a months-long therapeutic community program. They just see much better odds when medicines are also in the picture.

That’s a point that Adam Bisaga, professor of psychiatry at Columbia University, has attempted to get across through multiple studies.

Testifying at a congressional hearing in 2015, when 90 people were dying a day, he said: “Medication-assisted treatment is the best way to reduce the number of overdose deaths on a large scale.”

BEFORE SUNRISE One recent morning, a few hours before sunrise, cars and trucks were already parked in front of St. Louis Metro Treatment Center at 9733 St. Charles Rock Road.

Sandwiched between an Aldi supermarket and thrift store in tiny Breckenridge Hills, the nondescript clinic has a sign up that reads only: SLMTC. But people who need methadone know what it is. Two dozen addicts were lined up at the door, trying to beat the rush, when it finally opened at 5:15 a.m.

“I get up every day at 3:30 in the morning and am usually at work by 6,” said a 37-year-old concrete finisher from Lincoln County, who, like the other peo-

ple at the front, didn’t want to be identified. They had too much to lose.

The man added that he was in his seventh year of making the hour-and-a-half roundtrip daily commute. Once there, he drinks the liquid medicine in seconds.

“I want to get off of it, but it’s not easy when you have responsibilities,” he said.

Skip a day, and patients say they feel 10 times sicker than having the flu. Methadone can be abused, which is why it’s highly regulated.

Doses are generally dispensed in person, one day at a time. Eventually, some patients are trusted to pick up a week of treatment all at once. There aren’t many clinics; Missouri has just three state-funded ones.

The clinic on the Rock Road is privately run. Many patients paid the $17 daily dosage fee out of pocket. Patients came from all over, with all kinds of backgrounds. A woman with a baby in her arms. A man dressed in a security guard uniform.

A few arrived in nice cars, others by taxi, including a factory worker from Alton. “We need more methadone in Illinois,” said Derek Bultema, 31.

The inconvenience of getting the medicine seemed to be worth it.

Tiffany Taylor, 33, entered the clinic with her husband and her children, each carrying an iPad. “You found $200 to get high,” she said. “You can find $17 to come here.”

G o ve r n m e n t - s p o n s o r e d methadone clinics in the area are booked, including “The Center” in East St. Louis.

One customer there said he had been on methadone for two decades. He’s now allowed a week’s supply of methadone to take home in a locked box.

“This gives you a minor euphoric buzz, but it doesn’t last,” said the man, who did not want to be identified. “So I see it as taking medicine, like I have diabetes, because it helped my life so much. It stabilized my whole situation.”

He has a steady maintenance job. He’s been married a long time. They have two children, including one who is on the way to a private college. Neither knows he is a recovering heroin addict.

A FIGHTING CHANCE One night several years ago, a drug addict dropped to her knees and prayed for help. She had just told an angry group of people she tried to rip off that they couldn’t kill somebody who was already dead.

“I knew some things were going on,” said Shannon Governick, 46, of Valley Park. “I needed help.”

A psychiatrist ended up treating her bipolar disorder and prescribed buprenorphine to help her fight off heroin. Her doctor, Luis Giuffra, helps run a clinic in Ladue that doesn’t have immediate openings for new clients.

“We are big advocates of science,” he said. “Too much of addiction treatment is based on bias and personal opinion. Sadly, See TREATMENT • Page A11

THE STRUGGLE TO GET CLEAN

04.09.2017 • SUNDAY • M 1

ST. LOUIS POST-DISPATCH • A11

MEDICATION-ASSISTED TREATMENTS Opium, heroin and morphine are derived from the poppy flower, grown in places such as Afghanistan and Mexico.

To understand how opioid addiction is treated, it helps to understand how opioids act on the body.

Once consumed, opioids bind to receptors in the brain, nervous system and digestive tract. These receptors are involved in how the body perceives pain and can activate the body’s reward system that controls feelings of pleasure and euphoria. Drugs used to treat addiction work at the receptor level. The treatment drugs fall into two categories: Opioids (agonists) bind to receptors in the brain, nervous system and digestive tract, blocking pain and causing euphoria.

Antagonists bind without triggering effects, blocking opioids.

AGONIST

ANTAGONIST

Opioid

Opioid

Opioid

Naloxone Opioid

Opioid

Opioid receptors

Opioid receptors

METHADONE — AGONIST Methadone has been used for decades to treat people who are addicted to heroin and narcoticIN pain medicines. It is TREATMENTS U.S. designed to help people to recover from Number of clients receiving methadonewith or buprenorphine at clinics with their addiction, ideally in conjunction and withoutand Opioid Treatment counseling social support.Programs.

It is highlyOnly facilities with federally approved are allowed tothrough dispense methadone. regulatedOTPs and administered 350,000 clinics.

Buprenorphine Methadone Year introduced in the U.S. • 1960s 300,000 How does It work? Methadone lessens the painful symptoms of withdrawal and 250,000 blocks the euphoric effects of opioids, including 200,000 painkillers such as oxycodone and hydrocodone. Methadone is offered in150,000 pill, liquidand wafer forms and is taken ASSOCIATED PRESS once a day. It’s a controlled substance that A methadone dispenser 100,000 has a potential for abuse. at a clinic in Virginia

PHOTOS BY DAVID CARSON • dcarson@post-dispatch.com

Mike Donnelly gives his friend Robin Clements, a recovering heroin addict, a ride to the methadone clinic in Breckenridge Hills in February. “If it wasn’t for Mike, I don’t know what I’d be doing. I’d probably be dead,” said Clements, who met Donnelly through a Narcotics Anonymous meeting. In March, Clements relapsed and stopped going to the methadone clinic after eight months of sobriety. “I just got to stop doing this to myself,” she said this month. “I don’t want to die. Pretty much everyone in my family is dead because of this.”

‘I want to give myself the best odds’ TREATMENT • FROM A10

50,000

BUPRENORPHINE — PARTIAL 0 2004 2006 AGONIST

2008

2010

SOURCES: methadone National Survey oftreatment, Substance Abuse Treatment Services, National Institutes of Health, National Unlike which Institute on Drug Abuse, Food and Drug Administration, Harm Reduction Coalition must be performed in a highly structured clinic, buprenorphine can be prescribed or dispensed in physicians’ offices. But only 3 percent of primary care physicians have been cleared to prescribe the drug, which is commonly sold as Suboxone and Subutex.

Year introduced • 2002 How does it work? Buprenorphine is similar to methadone. Like opioids, it produces effects such as euphoria. With The generic pill form buprenorphine, however, that effect is of buprenorphine and weaker than with heroin and methadone. naloxone, which is also sold under the brand name of Suboxone

NALOXONE — ANTAGONIST

Naloxone, commonly marketed as Narcan, is usually administered by first responders after an addict has overdosed.

The medication is often given by intranasal spray or injection.

Year introduced • 1960s How does it work? It blocks opioid receptor sites, reversing the toxic effects of the overdose. Naloxone is also added to buprenorphine (Suboxone) to decrease the likelihood of abuse.

Suboxone sublingual film

NALTREXONE — ANTAGONIST Naltrexone is sold in two forms: a daily pill, and a monthly injection, called Vivitrol. Detox is required before use.

When was it developed? The drug was developed in the 1960s, with FDA approval of Vivitrol in 2010.

How does it work? The drug, which is an antagonist, blocks the euphoric and sedative effects of drugs such as heroin, morphineand codeine. Research has shown that naltrexone, which blocks people from getting high, helps prevent relapse and curtail craving.

SOURCE: Substance Abuse and Mental Health Services Administration

Opioid

Naltrexone, as a generic daily pill

Naloxone Opioid

Opioid

Opioid receptors

Opioid receptors

PHOTOS BY DAVID CARSON • dcarson@post-dispatch.com

A nurse prepares a monthly Vivitrol shot for a client at Assisted Recovery Centers of America in St. Louis last month.

most people doing treatment don’t have the skills to read, or even find, the scientific literature.”

About 50 percent of opioid addicts respond to buprenorphine, but only 3 percent of primary care doctors have been cleared to prescribe it, and they are limited in the number of patients they can treat. Meanwhile, there are less restrictions to prescribe addictive pain medicines.

Like methadone, buprenorphine is a controlled substance that’s been around for years.

Typically sold under the label Suboxone or Subutex, buprenorphine typically comes in a daily pill or a film that dissolves in the mouth like a breath mint strip.

“When I started taking that my mental and physical desire to use heroin was completely lifted,” Governick said. “I had to do other things with it in combination, but because of Suboxone I had a fighting chance. I am 11 years sober now.”

The former Laclede’s Landing bartender said she is disabled but is a teacher at her church.

“It makes me sad that some people are not being told or given Suboxone,” she said. “I know as a living proof how much that helps you if you are serious about getting sober. Every day I am so grateful that I am alive. Not just alive but actually living.”

Governick doesn’t want to risk coming off Suboxone, despite pressure from a few 12step support groups she has attended in the past that preached abstinence from all drugs.

About 80 percent to 90 percent of opioid addicts successfully treated with methadone or buprenorphine relapse if they come off the medication, said R. Jeffrey Goldsmith, a doctor in Cincinnati and board president of the American Society of Addiction Medicine.

“If you are the doctor, why would you want to stop prescribing it?” he said. “I think of this as a long-term problem.”

Patients often insist they can stop.

“I am willing to try it after telling them the research statistics several times,” he said. “I am

happy to have somebody prove me wrong and succeed.”

SOBER HOMES Harris House. Hilljack House.

Oxford House. Recovery House.

They are the region’s “sober homes,” each with a slightly different flavor of transitional housing and treatment for people trying to beat drug and alcohol addiction.

Recovery House has seven homes.

The network’s manager, John Stuckey, 32, has himself been on Vivitrol for over four years. He said success involves more than medication. It requires a structured daily routine, going to counseling, being part of a social support group and around other sober people who hold you accountable.

“Like any disease, I want to give myself the best odds,” said Stuckey, a former manager at a country club in Lake Saint Louis. “I am trying to get the percentages in my favor.”

Jesse Williams, a former baseball standout from Farmington, is one of eight addicts at a Recovery House home in Dutchtown. He said the approach is working for him.

“I didn’t believe it was possible before I came here,” said Williams, 26, who has been on Vivitrol for a year.

Vivitrol isn’t addictive. There isn’t a street market for it. But your body has to be clean of opioids for about a week to get started. Detox is hard. There’s concern that patients might be at a higher risk of overdose should they relapse, because their tolerance is gone.

But some of the housemates swore by it. At a recent weekly group meeting, they went around the room, talking about their routines, new jobs and making sure they were current on their monthly Vivitrol injections.

Williams and others at the sober house weren’t sure how long they would be on Vivitrol.

They hadn’t read the studies, including one published in 2016 in the New England Journal of Medicine, that warn of the dangers of suspending treatment.

Of 153 people monitored on extended-release naltrexone, which is Vivitrol, over six months, 43 percent of them relapsed compared to 64 percent of 155 people on traditional treatment. One year after the injections stopped, both groups had similar relapse rates.

Joshua Lee, a doctor at NYU School of Medicine who led the study, said there needs to be more options.

“There are eight different ways to lower blood pressure,” he said. “There are three very

good medications for opioid misuse. Wouldn’t it be better to have 10?”

A STEPPINGSTONE Sean Laux, 52, on his sixth journey to stay clean, has long been aware of the recovery mantra: Change your people, places and things. But this time around, he said, he was trying harder.

“I never went as far as moving out of the house,” said Laux, who is married and has grown children.

Nor had he tried Vivitrol before. He recently celebrated 100 days of sobriety and worked his way up to a management position at Recovery House. He didn’t want to jinx his success by going home.

He is from south St. Louis and was close friends with Bonzano, the bricklayer who died in February.

“Him dying was another brick in the wall of loved ones I’ve lost to this heroin disease,” Laux. “It was almost like the last straw.”

Bonzano suffered from anxiety and depression. Every effort at sobriety failed.

At first, Vivitrol seemed like a godsend. After seven monthly doses he was proud to be clean and extolled the benefits of the treatment to others.

It turned out that Bonzano’s run at sobriety wasn’t sustainable, though. Life got in the way of his continued treatment.

In May 2016, the same month he graduated from St. Louis drug court, Bonzano fell from a roof. He shattered his heel and fractured his pelvis. He had to take a break from doing the one thing he was very good at.

To cheer him up, old pals showed up at the hospital with beer. Fed up, Riley — the mother of his children — walked out.

Bonzano, prescribed painkillers, spiraled deeply out of control.

Not allowed in the house, he was found parked in his work truck, around the corner from where his family lives on Walsh Street. Officials said what friends and relatives suspected: The case was being handled as a possible drug overdose.

It’s unclear when he stopped taking Vivitrol.

But today, Riley can show you family photos of Bonzano and point to the ones where he was taking the treatment. The signs are in his facial expressions.

Back then, Vivitrol brought hope that there was a way out of a decade of addiction hell.

“It’s something you use like a steppingstone in the right direction, if that’s where you choose to go,” Riley said.

Jesse Bogan • 314-340-8255 @jessebogan on Twitter jbogan@post-dispatch.com

TREATMENTS IN U.S. Number of clients receiving methadone or buprenorphine at clinics with and without Opioid Treatment Programs. Only facilities with federally approved OTPs are allowed to dispense methadone.

350,000 Buprenorphine

Methadone

300,000 250,000 200,000 150,000 100,000 50,000 0

2004

2006

2008

2010

SOURCES: National Survey of Substance Abuse Treatment Services, National Institutes of Health, National Institute on Drug Abuse, Food and Drug Administration, Harm Reduction Coalition

VIDEO • ROBIN CLEMENTS Robin Clements talks about her struggle with heroin addiction and her efforts to get clean. Hear her describe her history of drug use that began when she was 11 years old. stltoday.com/watch

A group of recovering addicts meets last month to discuss the week’s successes and challenges at a “sober home” in south St. Louis. Many of the men were addicted to heroin. They are trying to stay clean and support each other by living together and holding each other accountable. Sean Laux (center, in white sweatshirt) was friends with Dante Bonzano, who died in February of an apparent overdose. Laux, 52, recently celebrated 100 days of sobriety. He is on his sixth journey to stay clean.

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COACHED TO RECOVERY Ex-addicts bridge gap for folks who overdose, visiting hospitals and connecting them to care

BY MICHELE MUNZ • St. Louis Post-Dispatch

Recovery coach Kael Maness talks with Brittany Wilkinson, 29, at a Starbucks in St. Louis last month.

Maness met Wilkinson after she had overdosed on opioids and helped get her treatment. Wilkinson says she had used for nine years. Maness abused drugs for 15 years before getting clean.

Emergency room staff at St. Louis area hospitals are getting to know Kael Maness. When he walks in, they just say, “Room 10.”

The room number changes, but the scenario is usually the same: The room holds a patient brought back to life after a heroin overdose. Maness, 32, introduces himself and explains he works for a drug treatment program. He’s in recovery after abusing drugs for 15 years. He’s been sent to help.

“I’m not a (expletive) psychologist. I’m just an addict they’ve given an opportunity to,” Maness says. “I’m going to help you.”

Maness will point to a bright spot on his biceps among the sleeve of tattoos on his arm. It’s sky blue

DAVID CARSON • dcarson@post-dispatch.com

See ADDICTION • Page A4

Ruins from sunken city in Egypt are headed to St. Louis

Tigers handle Vanderbilt Blowout makes Mizzou eligible for bowl game SPORTS • B1

Art Museum will be first in North America to show artifacts of ancient Mediterranean society

BY MIKE FAULK St. Louis Post-Dispatch

For centuries it was the main port of call for trade in ancient Egypt, home to the heroes of Greek legend and a place where titles and power were bestowed on new pharaohs.

The Egyptians called it Thonis. The Greeks called it Heracleion. But for all the ancient texts mentioning it, for more than 1,000 years there were no artifacts, nor any sign on land of the ancient metropolis.

That changed 17 years ago, when French explorer Franck Goddio found its astoundingly well-preserved ruins in shallow waters just miles off the Egyptian coast. Next year, the same artifacts of religious, commercial and daily antiquity that were the talk of ancient Mediterranean civilization will make their North American premiere in St. Louis.

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The “Head of Serapis” is seen underwater in Canopus, Egypt. The piece dates to the second century B.C. and was found with almost 300 other artifacts 17 years ago. An exhibit of the ancient exhibit artifacts will open at the St. Louis Art Museum in March.

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“Black stone queen” dates to the Ptolemaic Period. The upcoming exhibit will include statues as tall as 17 feet.

This piece is titled, “A ram of Amun engraved on both sides of a limestone plaque.”

“Statuette of Osiris with golden eyes” commemorates one of Egypt’s most important myths involving the god.

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with the date 5-12-14. That’s how long he’s been clean.

“Once they know I’m an addict, they open up,” he said.

“I know how to talk to them.

They’re my people. They’re me.”

Over a year ago, health providers came up with a plan to try to stop a barrage of heroin overdoses landing in emergency rooms. It is now a regionwide project that involves sending “recovery coaches” like Maness to hospitals as living proof that addicts can get better.

Each month, about 75 patients agree to meet with a coach.

The recovery coaches quickly connect patients to outpatient addiction treatment programs.

And emergency room doctors can administer drugs that can ease withdrawal symptoms right away and provide patients a short prescription until they get into treatment — a new approach in treating addiction.

Patients landing in emergency rooms after nearly losing their lives are likely to be the next casualties in the epidemic. They have angered their friends and family. They have lost hope.

“We might be the last person fighting for them,” Maness said, “the last person in their corner.”

Danyell McMiller, 42, a father of four, began using drugs a dozen years ago to cope with his younger brother’s death. The only future he saw for himself was on a street corner.

Maness met him in the emergency room at Barnes-Jewish Hospital one Friday in April and tried to convince him he could get better.

“It seemed way out of reach,” McMiller said, “like being the president.”

McMiller had to wait for his 8 a.m. appointment the following Monday at the Preferred Family Healthcare treatment clinic on Delmar Boulevard in St. Louis.

“I’m glad you showed up,” Maness told him as the two sat together recently in the clinic’s art room, where McMiller painted a picture for his sisterin-law’s birthday.

McMiller hadn’t used heroin in four months.

He was quick to respond: “I’m glad you showed up.”

PHOTOS BY DAVID CARSON • dcarson@post-dispatch.com

Recovery coach Kael Maness jokes with Brittany Wilkinson last month as they part ways after meeting in St. Louis to see how she was doing in her recovery. “Once they know I’m an addict, they open up,” Maness says of working with people who have overdosed. “I know how to talk to them.

They’re my people. They’re me.”

recognize it is key in getting patients to the door of a treatment program.

Doctors had to get over fears of people seeking emergency care in order to get a prescription, Poirier said. Barnes-Jewish, which only had four doctors able to prescribe, will have 20 more by the end of this month, he said. “It’s a culture change.”

A statewide program is educating health providers on the importance of medication assisted treatment and providing the training for free.

Dr. Randall Williams, the new director of Missouri’s health department, lauds the approach.

“If someone comes in for an overdose, or they have a serious addiction, the brain is not thinking about anything else but doing it again,” Randall said. “If you can get (buprenorphine) in their system … it gives you an itty-bitty window to get hope in them.”

ALL THANKS TO YOU Friends bring them. Sometimes they get left in the driveway. Or they arrive by ambulance after paramedics rescued them with Narcan, the antidote that reverses an overdose.

Every day, five to 10 people who have overdosed on opioids such as painkillers and heroin come through the doors where Dr. Robert Poirier works at Barnes-Jewish Hospital, the city’s busiest emergency department.

But no emergency department is immune to the epidemic, which took the lives of 650 people in the St. Louis region in 2016, more than four times the number of opioid deaths in 2007.

Doctors knew they had to do something other than sending patients back onto the streets.

Patients would get a list of drug treatment programs, but it could be three weeks to three months — especially without insurance — to get into one.

More than a year ago, participants in the Behavioral Health Network of Greater St. Louis asked: “How can we work together to get this under control?” Poirier said. The network is a consortium of health providers, leaders, advocates and consumers who work together to address barriers to mental health services.

The network found a model in Rhode Island, where a drug treatment program sent a peer to meet patients in emergency rooms.

It also found research — a 2015 study from Yale that showed patients given medication in emergency rooms to reduce withdrawal symptoms were twice as likely than others to be in a treatment program 30 days later.

Yale New Haven Hospital emergency doctors initiate medication, connect patients to treatment and give them Narcan to take home.

Combining both approaches, project EPICC — Engaging Patients in Care Coordination — began a test run in December at Barnes-Jewish Hospital with a $500,000 state grant.

Two recovery coaches were on call to meet with a patient at any time and connect them to free care at two addiction treatment programs.

The project has exploded.

Nine hospitals in the city and St. Louis, St. Charles and Jefferson counties now participate. Five coaches working with five treatment programs are on call.

The effort received another

Kael Maness shows off a tattoo on his arm last month. The date refers to when he was able to stop using opioids. He has since earned his drug counseling certification.

“If someone comes in for an overdose … the brain is not thinking about anything else but doing it again. If you can get (buprenorphine) in their system … it gives you an itty-bitty window to get hope in them.”

Dr. Randall Williams, the new director of Missouri’s health department

$550,000 grant for next year, which pays for the coaches as well as administrative costs to track outcomes. Treatment for Missouri residents referred through the project is covered through a statewide budget of $5 million a year for the next two years.

“Getting people into a situation that they did not know was possible for them has at least saved dozens of lives,” said Mike Bloodworth, program director at Preferred Family Healthcare and Maness’ boss. “That’s the best, hearing people say, ‘I would be dead now without this.’”

As Maness recently walked to his car in the parking lot of a treatment center in St. Louis, a man on the sidewalk yelled at him through a chain link fence, “Kael! Hey!” Maness remembered helping the man get treatment and into a sober living house. The man said he was walking home from work. Maness asked how long he had been clean.

“One hundred and seventeen days!” he said, beaming. “All thanks to you, man!”

I DON’T HAVE A HOME Maness grew up in Arkansas, under the shadow of an abusive and alcoholic father, he said. At age 12, his parents divorced, and his mom eventually moved the family to Fenton, where he attended Rockwood Summit High School.

His mom remarried, which he hated. He stayed away from home, hanging out with his older sister’s friends. He felt a void, and he filled it with danger and drugs.

A talented drummer, Maness played with the well-known punk band Opposites Attack.

The lifestyle fueled his addiction. He was smoking K2, synthetic marijuana, and taking painkillers.

Two times, Maness tried to stop. He relapsed the first time after 70 days straight. His thenfiancée had brought him a bottle

of whiskey. “It’s good to have you back,” she told him.

After the second time, he got a job driving a truck for FedEx and cut ties with old friends. But he gave in to the voice telling him he could handle one drink. He was fired after passing out in his truck with a K2 pipe in his hand.

Maness, who was living with his mom, pretended to continue leaving for work. But one day, she found him passed out in her living room. She warned him he would have to leave if it happened again. It happened again.

His car became his home. He and a friend used heroin, stealing and strong-arming people for cash. He broke into his parents’ house, even stealing from his little brother’s piggy bank.

On Christmas Eve, a cop banged on his car window and told him he had to go home. “I don’t have a home,” Maness answered.

The officer insisted he had to take him somewhere, so Maness directed him to his mom’s house. As they pulled up, Maness could see his family in the driveway, hugging and saying their goodbyes for the night.

“Can you please just keep going?” he asked. “Drop me at the end of the block?”

The officer obliged, and Maness ended up back at his car.

Maness would eventually make his way to his sister’s house, asking for gas money.

“You look like you’re going to die,” she told him. “Why don’t you go back to treatment again?”

ITTY-BITTY WINDOW Dr. Corey Waller told emergency physicians at a recent symposium at Washington University School of Medicine on the opioid crisis that humans need three things to survive: food, water and dopamine.

Dopamine is the “feel-good” chemical in the brain. It’s what gets us out of bed in the morning.

When we feel the worst, do-

pamine levels in the brain hover at 40 nanograms per deciliter, Waller said. Sex and favorite foods can boost levels up to 94 nanograms. Heroin jolts levels to more than 900 nanograms. The spikes cause the body to stop producing dopamine naturally, Waller said. “It kills the nerves in the happy part of the brain.”

Going without the drug is like going days without food or water. One will eventually do anything to get it, he said. “Motivation to get that drug is through the roof.”

Medications such as buprenorphine and methadone can block the euphoric effects of illegal drugs while also normalizing brain chemistry, which can take months.

Methadone can only be administered through a methadone clinic, but doctors can prescribe buprenorphine after completing training and earning a federal waiver.

Yet only eight emergency departments in the country have doctors treating addicts with buprenorphine, Waller said.

The slow adoption of medication-assisted therapy is partly due to misconceptions that the drugs are just substitutes for the illegal versions. Yet evidence shows they are a safe way to overcome addiction, and reduce the need for expensive inpatient detoxification facilities with long wait lists.

Doctors have long treated opioid addiction as a moral failure rather than a disease, Waller said. Medication is used to treat chronic diseases such as depression and diabetes, and addiction should be no different.

“This is a preventable and treatable disease,” Waller told the auditorium full of physicians. “We have a real ability to help, and it’s only us standing in the way.”

Not all hospitals participating in project EPICC have emergency physicians trained to prescribe buprenorphine, but that is quickly changing. More

RECOVERY SALESPERSON Until his sister said it, treatment hadn’t seemed like an option, Maness said. They found a spot in the third inpatient facility they called.

After the two-week program, Maness moved into a sober living house in south St. Louis, where he lived for nearly two years. For 10 months, he took medications to help him with withdrawal.

He got jobs doing peer support work at different treatment centers before ending up at Preferred Family Healthcare.

He earned his drug counseling certification.

When the job as recovery coach became available, Bloodworth knew Maness would be perfect. “He’s like a recovery salesperson,” he said, “and that can be a tough sell.”

Five days before McMiller met Maness in the emergency room, McMiller had shown up high at his brother’s house. His brother yelled that McMiller must not care.

But he did. He loved his brother. He loved his children, his life. Seeing his older brother with tears in his eyes was a wake-up call.

“I thought I was only hurting myself. I thought that no one cared … but that was not the truth,” McMiller said. Maness convinced him to show up for treatment. There, McMiller learned to stop blaming himself for his younger brother’s death.

“Hurting myself wasn’t justifying anything,” McMiller said.

“There’s nothing I could’ve done, nothing at all. So get yourself together, and live.”

Maness recently bought a house in south St. Louis County.

He’s working on a college degree. Instead of filling the void in his life with drugs, he said, he’s filling it with helping others.

“I have a life today I didn’t know I wanted,” Maness said.

He understands addiction is a disease, one that often isn’t treated because of the crime, hurt and shame that comes along with it.

“But people change” he said.

“It happens all the time. I see it every day.”

Michele Munz • 314-340-8263 @michelemunz on Twitter mmunz@post-dispatch.com