Chad Sabora and Robert Riley Are Fighting 'the Perfect Storm' of Opioid Addiction in South City 

click to enlarge Chad Sabora and Robert Riley II, co-founders of the Missouri Network for Opiate Reform and Recovery, stand outside their outreach center on Broadway.

STL-PHOTO

Chad Sabora and Robert Riley II, co-founders of the Missouri Network for Opiate Reform and Recovery, stand outside their outreach center on Broadway.

Chad Sabora parks his Ford SUV in front of the former beauty parlor at 4022 South Broadway, unlocks the building's front door and disappears inside. He reappears a moment later with a sidewalk sign. Chalked on it are the words "Free Narcan Here."

The last rays of a late September sun filter through the building's ground-floor windows as Sabora sits down behind a desk, pops open a Red Bull and fires up his laptop.

Then he waits.

As co-founder of the Missouri Network for Opiate Reform and Recovery, Sabora spends a lot of his time waiting in this storefront.

The network's outreach center is one of the few places in the St. Louis region where people addicted to prescription opioid painkillers, such as OxyContin and more powerful opioids including heroin and fentanyl, can walk in off the street to obtain life-saving doses of Narcan.

Narcan stifles the effects of opioids and reverses an overdose. Sabora hands out Narcan to whoever shows up to get it, but only after visitors get a tutorial on how to use it effectively, as well as an impassioned lecture on the importance of getting into recovery.

On this warm Friday night, Sabora does not have to wait long.

Evan Reuscher, 28, walks through the door of the center, accompanied by a female friend. Reuscher explains he had almost died the night before at his house in Des Peres while doing a "speedball," a cocktail of methamphetamine and heroin. Two friends saved his life, he says.

"They gave me CPR," he says.

Sabora leads Reuscher and his friend into a small kitchen area.

"How many times have you overdosed?" Sabora asks.

"Uh, thirteen," Reuscher replies.

Sabora reaches for a cardboard box full of glass vials of Narcan. Sabora shows Reuscher and his friend how to aim a syringe into the vial and remove it quickly.

"With a twist," Sabora says.

Pantomiming with his arms, Sabora says, "Then you inject it into the arms, legs or butt."

"Arms, legs or butt," Reuscher repeats.

Sabora glares at him in a no-nonsense way, then hands him business cards to give to friends who are using.

Sabora makes a pitch for a Hep C and HIV testing, set up for the next day at the center. He follows with a second pitch, for a no-cost addiction treatment program in Colorado where Reuscher could go to detox and get clean.

"You work during the day, go to treatment at night," Sabora says.

Reuscher stays silent.

Slightly annoyed, Sabora says, "We will buy you a plane ticket to get you there if you can't afford it."

"OK," Reuscher says.

Reuscher acknowledges he almost died the night before, but the thought of dying while doing drugs does not really scare him, he says.

Reuscher's been using powerful painkillers since he was at least thirteen, when he began relying on them to help him heal from a football injury, he says. He notes that he only "dabbled" in heroin. Methamphetamine is his main drug of choice, he says.

Reuscher uses heroin because "people kept bringing it around," he says. "And it got really cheap, too. I hadn't fucked with it for a while, and the price just cut in half."

Reuscher has been through more than ten treatment programs, he says. So why hasn't he kicked the stuff yet?

Reuscher ponders the question for a beat.

"I haven't hit that point where enough is enough," he says.

click to enlarge Robert Riley talks to Michelle Charbonnier, a volunteer counselor at the outreach center. - STL-PHOTO
  • STL-PHOTO
  • Robert Riley talks to Michelle Charbonnier, a volunteer counselor at the outreach center.

America's opioid crisis is scything a widening swath through the St. Louis region. It is killing hundreds of men and women in their twenties and thirties, causing thousands more to suffer near-fatal overdoses and throwing countless families into turmoil.

It is a drug plague unlike any before it. For starters, the primary gateway for opiate addiction is not some shadowy dealer operating outside the law, but the family medicine cabinet. More than 80 percent of people hooked on heroin began with addictions to prescription painkillers.

The opioid crisis' roots reach back to the 1990s. That's when big pharmaceutical companies began flooding the consumer market with vast quantities of narcotics as the medical community came around to the notion that too many people suffering severe and chronic pain were being under-treated.

Big Pharma saw an immense money-making opportunity. It launched a decades-long push to market long-lasting, powerful opiate painkillers to both physicians and consumers.

Purdue Pharma, the maker of an extremely profitable painkiller called OxyContin — which soon acquired the nickname "Hillbilly Heroin" because of its skyrocketing popularity in Appalachia — mounted marketing campaigns that convinced physicians that OxyContin was both safe and non-addictive. As subsequent litigation shows, those claims were absurdly wrong on both counts.

Because of a set of tightly reinforcing factors — the lack of readily available treatment programs, the cheapness and enhanced purity of today's heroin and the proliferation of fentanyl, a synthetic opioid 50 times more powerful than heroin — the opiate drug crisis is far deadlier and harder to treat than its predecessors. And it shows no signs of slowing down. Both St. Louis and St. Louis County set records for accidental overdose deaths in 2016, and they are on track to set new records by the end of 2017.

Opiate overdoses are killing people all across the St. Louis metro area, from Section 8 apartments in north St. Louis to McMansions in west county to trailer parks in Jefferson County.

More than 700 people in the St. Louis region died from overdose deaths in the St. Louis area last year, with 250 in St. Louis city alone. What is especially disturbing is that fentanyl-only deaths eclipsed heroin-only deaths last year for the first time, according to James Shroba, special agent in charge of the St. Louis Drug Enforcement Administration office.

"Combine the two together, that's a staggering number of people that are losing their lives," Shroba says.

Enter Sabora and Robert Riley, who nearly two years ago opened the Missouri Network Outreach Center as a place where anyone affected by the opiate crisis — be they active users, people in recovery or their family members — can find support and learn ways to survive opiate addiction.

"Anybody at any point in substance abuse disorder can come in, whether they are actively using, whether they want help, whether they are in recovery," Sabora says. "I can tell you that everybody who comes here, we do our best to make sure they survive their addiction. We do a lot of work in harm reduction. That's our main focus."

The recovery center is located deep in south St. Louis, just past the point where Jefferson Avenue intersects Broadway. Surrounded by a neighborhood known for drug-dealing hot spots, the center also stands near several drug rehab facilities.

"We specifically chose that spot to be able to reach the using public," says Riley.

Since its opening in December 2015, the recovery center and its unpaid staff have become a beacon of hope and a source of new ideas during a time with a shortage of both.

In late August, after persistent lobbying by Sabora and Riley in Jefferson City, Missouri's 911 Good Samaritan Law took effect. The new law provides legal protection to people who call 911 "in good faith" in overdose cases, allowing witnesses to dial 911 for help without fear of arrest.

In June 2016, then-St. Louis Mayor Francis Slay signed a similar bill that would prevent police from arresting addicts who report a drug-related medical emergency in the city. It was believed to be the first municipal ordinance of its kind in the U.S. Alderwoman Cara Spencer sponsored the measure, again after lobbying by Sabora and Riley.

Sabora and Riley were also instrumental in starting a program at the St. Louis city jail that launched last month. It ensures that inmates addicted to opiates are given doses of Narcan when they leave the jail in the event they start using again and suffer an overdose.

The center receives no government funding. Its budget comes entirely from private fundraising, such as poker runs sponsored by motorcycle clubs whose members have received help there.

The center provides a wide range of services, including weekly family support group meetings, recovery meetings for current and former users, and tai chi and kung fu classes. Drug addicts who are homeless are encouraged to drop by the center for free "blessings bags," which are filled with soap, toothpaste and toothbrushes, snack food and other items that are donated by the mothers of addicts in recovery or those who've passed away.

For Sabora and Riley, the opiate crisis cuts especially close to home. Both men are themselves recovering heroin addicts who know how hard it is to break free of opiate dependency. They met on a closed Facebook page for recovery users, then became administrators of the page because of their penchant for answering group members' questions.

"And they were questions like, 'How long does withdrawal sickness last? Who hires felons?'" recalls Riley, who spent a stint in a federal prison in Arkansas on drug charges and today works as a certified drug treatment counselor.

One day a young woman asked via the page if Sabora and Riley could come over to her house for the weekend and help her kick her heroin habit.

"So we took turns," Sabora says. "We took eight-hour shifts for three days to help her."

Not long after that experience, Sabora and Riley decided to start an outreach center to keep as many people alive as possible and then shepherd them through recovery.

"There are 5,000 people getting high right now in the city," Sabora says. "How can we save them from death?"

Here's what scares the hell out of Sabora and others fighting the opiate crisis: A few years ago the progression for opiate users went like this — they would get hooked on prescription opiates, prescribed either for themselves or someone else. And then, once the prescription ran out, they would switch to heroin, which would be mixed with fentanyl or other substances.

But now, in a trend helping power the record-setting number of overdose deaths, users are going straight to fentanyl, Sabora says.

"Fentanyl has a stronger rush — you get that warm feeling in your stomach when you use it," he says.

Fentanyl offers the prospect of a more intense high but one with a shorter half-life — conditions guaranteed to raise future body counts.

"But now that's all the young kids want," Sabora says.

click to enlarge Chad Sabora lost his job as a Cook County prosecutor after being arrested for heroin possession. - STL-PHOTO
  • STL-PHOTO
  • Chad Sabora lost his job as a Cook County prosecutor after being arrested for heroin possession.

I had come to the recovery center looking for answers.

For years I had watched in dismay as the opiate crisis continued to worsen. Something had gone wrong in the American Dream, and it was clear the nation's insatiable hunger for opiates was somehow connected to it. What was unclear was if it was a cause of something bigger or was itself a consequence. Or maybe it was both.

Last month, the New York Times reported that drug overdoses killed about 64,000 people in the United States in 2016 — a 22 percent jump from the year before.

America's opioid death toll is more than double the number in 2005, and nearly quadruple the number in 2000, "when accidental falls killed more Americans than opioid overdoses," according to the Times.

Drug overdoses are now the leading cause of death for Americans under age 50, surpassing the death toll from gun violence, car accidents and even HIV at its peak in the mid-1990s. Some experts believe the true number of overdose deaths is seriously under-reported and that over the next decade upwards of one million Americans will die from drug overdoses, the vast majority opioid-related.

I also had a deeply personal interest in the crisis.

Sixteen years ago my younger brother Joe, a hospital nurse at the time, became hooked on opiate-based painkillers, mainly Vicodin and Percocet. His drug problems eventually would cost him his job and his career, and they sent him down a spiral of shame that I believe he never recovered from.

Since childhood, Joe had suffered from anxiety and depression, though those mental health problems weren't properly diagnosed until late in his life. Not long after he went into treatment for his opioid addiction, I asked him why he turned to the painkillers in spite of the risks.

We were seated at the time at a table at the Kaldi's coffeehouse in Clayton. Joe and I would meet there regularly to talk about life, our childhoods, other stuff. Occasionally, we'd talk about his recovery.

Then one day I asked him the question I had always wanted to ask him.

"So what'd you get out of it, the drugs?"

"I don't know," Joe said. "I guess it just made me stop feeling things for a while."

Joe eventually got off opiates after a two-year struggle and became extremely proud of his sobriety. But the depression and anxiety that dogged him only got worse. He took his life on February 13, 2008.

For Sabora, anxiety also played a role in his addiction.

"My whole life I felt that there was something inside me that was incomplete. I felt like an outsider even with my own friends," he says. "I had really low self-esteem, which I overcompensated for with a superiority complex. I would use my money or my intelligence to create this wall around me. I felt if people got to know the real me, they would not like that person."

When he tried drugs like heroin, it felt as if someone had pushed a switch.

"I felt complete," he says. "When I was taking opiates, pain pills, they made me feel good, like I was 'better.' They made me feel complete."

He sees that time and again with the addicts he treats. "We have no real tools to give kids when they are growing up to deal with life stressors and coping skills," Sabora says.

And America is awash in pills, especially opiate painkillers. The U.S. comprises five percent of the world's population but consumes 95 percent of the world's opiates.

The nation's all-purpose answer for any mental health problem is "just take a pill," Sabora says. "Then there's all this news media about heroin, heroin, heroin. It's making people who are apt to be experimental and rebellious try it. That's what made me try crack in the 1990s. All the news stories about crack."

Sabora grew up in the Chicago suburbs. As a teenager he dabbled in a wide range of drugs, but held it together enough to get through college and law school and then get hired as a Cook County prosecutor.

But grief caused by the sudden deaths of his mother and father led him to abuse narcotic pain pills, which in turn led him to heroin. Chicago police arrested him in February 2008 for heroin possession, costing him his job as a prosecutor. The criminal case against him was eventually dismissed, but he continued to abuse drugs until the money he inherited from his parents dried up.

After three years — and six failed stints in rehab — Sabora had lost his house, his law license and his fiancee. Finally, in June 2011, Sabora decided to get clean. He took a train to the Gateway Clinic in Caseyville, Illinois, located a few miles east of St. Louis.

"I walked in there as high as a kite," he recalls.

Gateway was a natural place for a new start. His father, a recovering heroin addict, had helped start the drug treatment center.

Sabora acknowledges that substance abuse runs in families, and that as the son and grandson of addicts, he was at the mercy of a genetic lottery. Now married with a young son and another child on the way, he thinks about the challenges he and his wife are likely to face raising their kids.

"Yeah, it scares me," he says, noting that one person in five has an addictive personality. "My dad did an amazing job of raising me. He couldn't have done anything to stop me from using. And I know the same about my son. The best thing we can do to educate our next generation is empathy, and understanding it's a mental-health issue."

click to enlarge 01-cover_67_.jpg

Like so many human-made catastrophes before it, America's opioids crisis began innocently, with the best of intentions.

The match that lit the fuse, so to speak, was a one-paragraph letter published January 10, 1980, in the New England Journal of Medicine.

The letter's headline: "Addiction Rare in Patients Treated With Narcotics."

Its authors, physicians Jane Porter and Hershel Jick, stated they had examined the files of nearly 40,000 patients. Almost 12,000 had received at least one narcotic preparation, but only four cases were found "of reasonably well documented addiction in patients who had a history of addiction. The addiction was considered major in only one instance."

Then, in one of the most consequential sentences written in American history, Porter and Jick wrote: "We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction."

The Porter and Jick letter "launched the pain revolution of the mid-1990s," says Brandon Costerison, who studies opiate abuse for the National Council on Alcoholism and Drug Abuse St. Louis Area.

At the time, Purdue Pharma was seeking to sell a powerful time-release tablet made from oxycodone called OxyContin. The company used the Porter and Jick letter to show that opioids aren't addictive, Costerison says.

"I don't think they fully understood," he says. "But it was used as justification. Purdue wanted a way to market oxycodone and make a bunch of money off it. So combining the development of oxycodone, supposedly a time-release tablet, along with this letter saying this brand-new drug is really, really safe, those two combined is what really led to the ramp-up in prescribing."

In May 2007, three current and former Purdue Pharma executives pleaded guilty in federal court to criminal charges that they had misled federal regulators, doctors and patients about OxyContin's addiction risks and potential for abuse. Its parent company also agreed to pay $600 million in fines and other payments, then one of the biggest amounts ever paid by a drug company to resolve criminal and civil complaints related to the painkiller's "misbranding."

 In 2016, Forbes magazine ranked the Sackler family, which owns Purdue Pharma, the nineteenth wealthiest family in America, with an estimated worth of about $13 billion, thanks to $35 billion in sales of OxyContin since it was released in 1996, according to journalist Sam Quinones, the author of Dreamland: The True Tale of America's Opioid Epidemic.

Last June, Missouri Attorney General Josh Hawley filed a lawsuit against Purdue Pharma and two of the other largest makers of opioid painkillers. In the lawsuit, Hawley accused them of violating Missouri's consumer protection laws.

Filed in St. Louis, which has the highest overdose death rate in Missouri, the lawsuit calls opioid abuse a statewide epidemic that is a "direct result of a carefully crafted campaign of deception" that "fraudulently misrepresented" the dangers posed by the drugs the companies make and sell, deceiving doctors and patients.

Hawley, a Republican, said he chose the companies because he is "confident about the evidence we have about their fraud" and because they comprise "the lion's share" of the opiate-based painkiller market.

As the 1990s progressed, another trend emerged: The American Pain Society designated pain as the fifth "vital sign" that doctors should use to detect or monitor medical problems. Pain control became a measure of patient satisfaction, which was often linked tied to a physician's compensation under the guidelines of the health insurance giants that were posting enormous profits.

Critics of the health insurance industry complain of the "Toyotazation" of medicine, because doctors under contract to these big insurers lost much of their autonomy and were forced to meet production quotas that limited the time they could spend with patients.

Insurance companies would pay for primary-care office visits and for pain pill prescriptions, while balking at alternative medical treatments or extensive physical therapy.

"'But we'll give you a bottle of Percocet for ten bucks,'" Costerison says.

The next major turning point in America's opioid crisis began about ten years ago, as states like Colorado and Washington legalized medical and recreational cannabis. With profits from illegal pot sales fading fast, the Mexican drug cartels went all-in on heroin.

"Why would Mexican drug cartels keep growing marijuana if you got to ship bales of it over, and it can't compete what's grown domestically?" Costerison says. "It just doesn't make any sense. So a lot of these cartels tore up their marijuana fields and started planting opium poppies. So they were able to use the same trade routes as for marijuana."

The heroin the cartels began bringing to the U.S. was much purer and therefore more deadly. Black tar heroin of the 1980s had a purity of between three and six percent. Today's heroin, in contrast, has a purity level of 55 percent.

And then the cartels began bringing in fentanyl, made in China, to the U.S. Fentanyl is 50 times stronger than heroin, but it costs 95 percent less.

As a business strategy, "It makes perfect sense, you know," Costerison says.

Seated behind his desk, contemplating the Red Bull in front of him, Sabora reflects on the vicious cycle he's seeing, an accelerating conveyor belt that's sending young people to early graves in ever-growing numbers.

"It's a perfect storm," he says. "You couldn't have scripted this better."

What will it take to end America's opioid crisis, or at least make a meaningful dent in it?

Everyone who studies the problem agrees that America's medical community needs to get out of the mindset of over-prescribing opiates. And that's starting to happen, says Costerison, of NCADA St. Louis.

Experts also agree that America needs to spend many billions of dollars more on effective treatment programs, to cut down on the long waiting periods — ranging from a month to more than five months — between when addicts choose to get clean and when they can get beds in treatment centers.

Prescription drug-monitoring databases have been set up in every state, including Missouri, which this year became the last in the nation to do so (even as critics note its database is far from comprehensive). But it will likely take years for them to make a significant impact on the rate of overdose deaths. As long as there is no uniform, national database, then illicit drug users would still be free to go from one state to another to find physicians willing to prescribe them painkillers, according to the DEA's Shroba.

"The DEA's position is that there needs to be a national system," Shroba says. "It needs to be legislated by the federal government and not run by the federal government. .... So that doctors coast to coast can see what's being prescribed because that'll eliminate doctor shopping."

Physicians also need to be better educated about addiction and have greater freedom to prescribe medication therapies, which help impede the cravings that pull opioid addicts into relapse.

Problem is, while literally anyone with an M.D. behind their name can prescribe opioids, physicians who endorse medication-assisted therapies must take eight hours of special education classes.

Even if they take the required classes, physicians are limited by a federal law that requires them to obtain a waiver from the DEA to prescribe buprenorphine or buprenorphine-naloxone. And once they get the waiver, there's another hurdle — the physicians can't treat more than 30 patients in the first year, and no more than 100 patients per year going forward.

The result: a huge bottleneck in providing access to treatment, a bottleneck that Congress could end at any time, but won't, Riley says.

"It's all political," he says.

While drugs like buprenorphine have an 85 percent effectiveness rate, programs modeled on twelve-step programs reject medication therapies. Riley believes that's a huge mistake.

"We're still treating this based on 1937 methods," Riley says. "Yet this is 2017 and we know far more about the science of the addictive brain than we knew in 1937. Then we still treated it as a moral failing, as a choice. Today we know, we know through science, that this disorder of the brain, that the brain actually sets a higher value for the release of [the neurotransmitter] dopamine than it sets a value for going to work in the morning or being honest with my parents."

There is another reason the abstinence-only model is being blamed for a rising death toll. After only a few days off opioids, especially powerful narcotics like heroin and fentanyl, an addict's tolerance drops sharply, according to Costerison.

"Their tolerance is gone and they're at a much higher risk for an overdose if they relapse," Costerison says. "The same thing happens if someone is locked up in jail for the weekend. They get out. Then they have a very high chance for an overdose."

Finally, America needs to move away from its current system of drug enforcement, which sets a premium on shutting down dealers and incarcerating addicts. By focusing on the supply side, America's "War on Drugs" does nothing to deal with the demand.

What America needs to do is adopt the strategy adopted by Portugal, Sabora says, which decriminalized drug use but made treatment programs easily accessible.

"The bulk of the blame lies on our failed drug policy in the United States," Sabora says. Since Portugal decriminalized drugs, he says, "and people are getting treatment instead of jail, their rate of addiction has gone down."

Shroba, the DEA special agent in charge of the St. Louis area, pushes back against Sabora's suggestions.

"We are the Drug Enforcement Administration, not the Drug Treatment Administration," Shroba says. "And so while we want to help people in that regard, if we don't interdict the supply, if we don't interdict the most dangerous drug traffickers out there, does anyone think that will make our streets safer or limit the availability?"

Shroba called it unrealistic to stop going after the suppliers of illegal drugs, especially the most addictive and powerful.

"Because then we're going to have increased availability," he says, "which means we'd have an escalating number rising exponentially, each and every day of individuals trying to seek treatment because we're not restricting the supply."

click to enlarge Chad Sabora helped his wife kick heroin. Now she's pregnant with their second child. - STL-PHOTO
  • STL-PHOTO
  • Chad Sabora helped his wife kick heroin. Now she's pregnant with their second child.

Sabora and his wife, Brittany, live in a house in Lemay, a few miles south of the outreach center.

I am seated on the couch in the front room while Sabora keeps an eye on their one-year-old son Jayce, a black-haired ball of energy who pinballs around the room between taking breaks watching Teletubbies on the big-screen TV.

I can't help myself. I have to ask the obvious question.

"Ten years ago," I say, "when you were still using, did you think you'd have all of this" — meaning the house, the marriage, the son.

"I thought I would be dead," Sabora says.

Sabora recalls how his father, a drug counselor, and his mother died in 2005 and 2006, respectively. His father, a former heroin addict, died after 35 years of sobriety.

His father's biggest fear was that "he would pass that heroin gene onto his kids," Sabora says. "So I did two things after my parents died. I shot every dime they left me into my arm. And two, I made my dad's worst fear come true after death."

Sabora admits it's hard to watch opiate addicts he's helped into recovery go through treatment programs, work hard to stay clean, only to relapse. Optimism can be hard to come by.

"One hundred thousand people died last year, once it's all said and done," he says. "So I don't know how I can be optimistic ... But I'm optimistic that when people come to our offices, they're going to have a better chance."

I glance over at Jayce, who's watching Teletubbies in rapt silence. I ask Sabora if he's worried that Jayce someday might get hooked on drugs. After all, both Sabora and his wife are in recovery for heroin abuse.

"Do you think by the time he's a teenager, we'll have this opioid thing fixed?" I say.

Sabora shakes his head.

"I don't think it'll be opiates anymore," he says. "I think it'll be synthetics."

As for drugs and his son, "I've got to talk to him about it. He's got to make his choices," he says. "It's like a peanut allergy. We won't know he's a drug addict until one day he tries drugs. We know most kids are going to try drugs. If something happens to him, at least I know we'll have the resources to help him."

Brittany Sabora, who got off heroin with her future husband's help, is pregnant with the couple's second child. A Christian, she credits her higher power, God, for helping her stay clean.

Of her children, she says, "Realistically, yeah, they have a great chance of becoming an addict." But, she says, she and her husband both know that doesn't have to be a death sentence. "You have the choice to pick up, and when you do, here's where you can go when you're done," she says, explaining what she'll say to them. "They didn't teach me that when I was growing up.

"I thought I was doomed to be a junkie the rest of my life. Until I learned there is recovery."

About a week after I first meet Evan Reuscher, the Des Peres man who came to the recovery center for Narcan, I give him a call.

When I first met Reuscher, I had only spoken to him for a few minutes, but I took an immediate liking to him. At 28, he was young enough to be my son. He seemed intelligent and thoughtful.

I wanted to see if he was OK.

I call him on the phone. He answers and tells me, yes, he is OK, even though he had overdosed on fentanyl twice in the six days since I had last spoken to him. The last time was just the night before. Fortunately, a friend he was with gave him a dose of Narcan and he survived, he says.

Critics of free Narcan programs argue that the overdose medication instills a sense of recklessness in opiate addicts.

Sabora is acutely aware of those criticisms, but pushes back hard against them. The opiate epidemic is so bad right now that what matters most is survival, he says.

"So we really try to push basic survival principles to people using right now," he says. "Of course if you want to get to treatment, we will help you. But if you're not ready, then carry Narcan, never use alone, split up times of using so you don't overdose at the same time. Those are the principles that keep me alive."

As for Reuscher, I struggle to understand the world from his point of view.

"How do you look at your life right now?" I ask. "Do you think you're on borrowed time?"

"I don't think so," he says. "That's the thing. I was talking to somebody about it, the way it affects people around me, when they see it, and they have to bring me back, and all that kind of stuff. And obviously it scares the shit out of them."

But for some reason he does not share those fears, Reuscher says.

"I don't know why," he says. "I think that in itself scares me."

"How about your parents?" I ask. "Obviously, they got to be scared."

"I mean, scared to death," he says."Scared shitless."

We talk for a few minutes more. I think of my late brother Joe. My brain kicks into dad mode. I have three sons. I'm scared for them, I'm scared for Reuscher. Isn't he afraid of dying?

"Where my thought processes go is a mess," Reuscher says, "'cause it basically makes me not give a fuck as far as being more reckless and things like that."

We end the conversation a few minutes later.

"Stay safe, OK?" I say.

"OK," he says. "I will."

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