Last Day Revisited: The Opioid Crisis

3: And Now, We Rewind the Tape

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[0:33] Stephanie Wittels Wachs: If you are just joining us for the first time, this episode will make much more sense if you go back to Episode 1 and listen from the beginning. That is my personal and professional recommendation. I hope you enjoy the show.


[0:55] Doreen Cordova: I saw him. just sitting in there. Head back, kind of mouth open. I just said to him ‘what’s going on?’ And he’s like ‘nothing ma, nothing’ and I’m like ‘Stef, are you using heroin?’ And he said ‘you don’t want to know.’ And I said, ‘I already know.’ 


[1:15] Stephanie Wittels Wachs: From the moment you find out that your person is using opioids, you start bracing yourself for disaster. You develop a palpable fear around normal, everyday things. You fear the doorbell. You fear the telephone. 


[1:37] Doreen Cordova: I got a call at eleven thirty at night from his dad crying that he died. I didn’t understand. I was sleeping and I thought maybe I was dreaming. 


[1:53] Stephanie Wittels Wachs: This is Doreen Cordova. We met her son Stefano in our last episode, when we walked through his last day. 


[2:01] Doreen Cordova: I said, “you need to hang up and take a deep breath and call me back because I don’t understand what you’re saying to me.” He kept telling me that he died. And so he called me back and said he couldn’t get Jess on the phone. And I had to make some calls. And it was the worst day of my life.  


[2:31] Stephanie Wittels Wachs: Those calls Doreen made? One was to Jess. Stefano’s sister, and my behind-the-scenes partner on this show.

[2:40] Jessica Cordova Kramer: The moment I found out he had died, it was 1 o’clock in the morning. My stepmother was the first person in our immediate family to find out and she called my father, my father called my mother, and no one could reach me cause I was sleeping and my phone was off. So my mother called my in-laws who live close by and they drove over in the middle of the night and came into our house. And I was deep asleep and I heard my father-in-law call for us. And the first thing I thought was, ‘my god, something happened to my mother-in-law.’ And then I heard her voice and I said ‘is everything okay?’ and they said ‘No. Stefano Jr. is dead.’ And I kind of collapsed. And I said ‘I was expecting this,’ or ‘I was waiting for this.’ 

[3:30] Stephanie Wittels Wachs: I’m Stephanie Wittels Wachs, and this is Last Day. When your person dies of an overdose, the very first thing that happens – before the denial and the grief fog and the keening – is that you hear the news that they’ve died. And time stops. Your world collapses. You’re changed. In an instant. In one moment, reality is as you know it, and in the next, it’s not. And then, naturally, you rewind the tape. You replay scenes from various stages of your lives together. You ask yourself, over and over again: What could I have done differently? Yesterday, last week. Last year. In college, high school, childhood. Did you put too much responsibility on them? 


[4:37] Stefano Cordova Sr.: I went to my son and I said, ‘Listen, I know you’re only 16. I know you can drive, I need you to take over all my chef teams.’  


[4:48] Stephanie Wittels Wachs: Stefano, who we met in the last episode, was, in fact, Stefano Cordova Junior. This is senior. When Stefano Junior was growing up, his dad was working as a corporate chef, catering big events – golf tournaments, tennis matches. And Senior would sometimes ask Junior to step in. Was that it? 


[5:13] Stefano Cordova Sr.: 15, 16, 17-year-old kid, you know, working the U.S. Open, where you have to deal with the top cream of the people in the world.

[5:24] Stephanie Wittels Wachs: Or maybe it was kind of the opposite. Maybe he wasn’t involved in his son’s life enough. 


[5:32] Stefano Cordova Sr.: Plus my job was very demanding in terms of travel and not spending too much time with the family. Actually I overworked. That’s one of my biggest regret that I overwork at that time


[5:44] Stephanie Wittels Wachs: Or maybe it was the divorce, when Stefano was 14.


[5:49] Stefano Cordova Sr.: And you know he started to get in trouble here and there and so forth. I started to feel the distance and the fear of losing him.


[5:58] Stephanie Wittels Wachs: Stefano Senior did talk to Stefano Junior about using drugs. He’d seen addiction take over his friends as a kid in Italy. 


[6:08] Stefano Cordova Sr.: When I grew up in Rome I know I left all my friends — same age —  with you know smoking a couple of joints here. By the time I came back a few years later everybody was on heroin and cocaine and so forth. And two years later I would say 99 percent had died.


[6:26] Stephanie Wittels Wachs: And yet, Stefano went from smoking weed in high school and college, to using Oxy in his 20s, and then onto heroin, when he started to run out of money.


[6:38] Stefano Cordova Sr.: Later on, when he told me that he was using heroin because he was almost broke and heroin is cheap and five dollars to get a bag, I said ‘there is only one thing that you can do and that’s move in with me.’


[6:49] Stephanie Wittels Wachs: Move home, he means.


[6:52] Stefano Cordova Sr.: I didn’t mind if he lived with me for the rest of his life. You know, I enjoyed him.


[6:56] Stephanie Wittels Wachs: Stefano Senior and Doreen, Stefano’s mom, they helped Stefano through a series of rehabs. When Stefano Junior was living in Florida, before moving out to Boston, his dad would come with him to NA meetings and sit outside waiting for him to literally fend off the dealers who stalk the meetings. Because they know that’s where people struggling with addiction are. That’s where the business is. Stefano tried taking responsibility for managing his son’s finances for a while. Junior asked for this, by the way – handed over his savings, and told him to keep them safe. Because he knew that if it was in his hands, he’d spend it on drugs. 


[7:39] Stefano Cordova Sr.: And then I got a call from him that he was in trouble with money, that you know, he almost got arrested


[7:46] Stephanie Wittels Wachs: Again, dad said, come home. Again, Stefano said no, no, I’m good, dad, I’m getting it together. And Stefano Senior basically thought that was bullshit. But he gave the money back.


[8:02] Stefano Cordova Sr.: ‘I can’t live with the risk that you’re going to commit a crime, or go to jail or whatever it is, or you know get hurt in one way or the other, because you have no money to pay for the rent or to pay for whatever to sustain yourself.’ So I just released the money to him again. And It probably kept him safe for a few years. Kept him safe.


[8:29] Stephanie Wittels Wachs: In the months before Stefano Junior died, he and his dad had entered a new phase of their relationship. 


[8:35] Stefano Cordova Sr.: A grown up relationship I had with him the last four months. I never had that kind of grown up — where you know he was actually guiding me — and all of a sudden, this. And was very unexpected for me and I cherish the last few months because it went from him dependent on me to having the wonderful one-to-one relationship with him.


[9:00] Stephanie Wittels Wachs: And also, Junior had been struggling. He was trying to stick with rehab and therapy, getting a Vivitrol shot, but also using. And hiding that from his parents. 


[9:12] Stefano Cordova Sr.: His word was always ‘Don’t tell my father, don’t tell my father, because my father’s gonna come here and kidnap me and take me back with him.’


[9:20] Stephanie Wittels Wachs: And Stefano senior says yeah, you’re damn right. He would have, if he’d known. But he didn’t. 


[9:32] Stefano Cordova Sr.: That hurts. That hurts me a lot. Because especially the last few months we got so close and he would call me almost every day. You know, ‘look how I’m doing, I’m getting all these accounts, I’m being so successful.’ I was so proud of him but I still you know I keep telling him ‘if you stay in Boston, you’re gonna die.’ He says ‘no no no pa, I’m clean.’ I said ‘No no no. Nobody’s clean from heroin.’ But you know he was happy. So I didn’t want to force him, but if I knew that a few weeks before he died he had overdosed and nobody told me and I still regret, I still regret it.


[10:18] Stephanie Wittels Wachs: I get these regrets. I really do. I have these regrets about Harris. Not that I wanted to kidnap him and lock him in my basement. I mean, I live in Texas and I don’t have a basement, but you know, something like that. Maybe an attic. My attic. Or his attic. Or maybe not even an attic at all. Just moving in with him, into his guest room – he had a very comfortable bed in there – and just hanging out there, with him. As long as it took. Indefinitely. Forever. Being a five-foot-tall bodyguard to my 30 yr old brother. In theory, solid plan. It sounds like a plan. Be there for your person. Thick and thin. 


[11:07] Stephanie Wittels Wachs: In reality, it’s bonkers. And impossible. For me and for most people with lives, jobs, families, mortgages, how do you DO that, like, logistically? When Harris checked into rehab for the first time, I had a one-month-old baby at home who I was literally nursing from my body. By the time he checked into the last rehab, his final rehab, that baby was 12 months old. My family lived in Houston, Texas, nearly 2,000 miles away from L.A. You can’t, really, shut down your life to save theirs. But it doesn’t stop you from wishing you could. For Doreen, Stefano Junior’s mom, her regrets, and questions, and what-ifs go even further. 


[12:07] Doreen Cordova: When he was born, he was exhausted. 


[12:10] Stephanie Wittels Wachs: Yes, to birth. 


[12:12] Doreen Cordova: It was an emergency C-section because his heartbeat was lost. He was a bigger baby than my first. And so they thought a C-section was best. He had huge shoulders. And so when I got to hold him, I was drowsy. He was sound asleep and then we looked at each other. I held them for hours and I just will never forget the feeling, you know the feeling of holding your child, and the bonding, and just the dreams and you just want to be there for them. This was before I had any idea about any issues with you know drugs or you know use a baby, but I mean he was introduced to medication before — you know, in the womb. So that of course I feel even guilty about that piece. Are C-section babies more vulnerable to issues?


[13:16] Stephanie Wittels Wachs: I need to jump in here and just note that there is no evidence that babies born via C-section are more prone to opioid addiction. But this is how crazed you get. You examine everything.


[13:31] Doreen Cordova: You know, he was really good baby. 


[13:34] Stephanie Wittels Wachs: Pretty decent teenager, too, actually. 


[13:36] Doreen Cordova: He confessed to me about everything in life. ‘I colored out of the line. I failed the test,’ which he never failed a test.


[13:47] Stephanie Wittels Wachs: I love that she has to clarify that in fact this is a bad example because he NEVER failed a test, but anyway… 


[13:55] Doreen Cordova: Or ‘I did something wrong.’ He would confess things to me. ‘Oh, I got a speeding ticket’ or ‘a girl I was dating, we broke up.’ So he wasn’t a person who didn’t talk to me. 


[14:13] Stephanie Wittels Wachs: Reading the tea leaves — did we not talk enough? No, we talked. Did we not confront the addiction directly? No. Doreen is a planner, and when she found out Stefano was using heroin, she sat him down and said look, we need a plan. 


[14:34] Doreen Cordova: Let’s figure out what’s your plan to get better. And I woke up that morning and he wrote me a letter and it said the plan. And then he has a list of things — he’s gonna find a sponsor. Get a job. He went on to say eat healthy, ride a bike. And he bought a bike then he was riding every day. He was so amazing.


[15:01] Stephanie Wittels Wachs: If only a bike ride was the answer. Except a bike ride can’t rewire your brain. When we come back, we turn from self-flagellation to science. Stick with us. 


[17:43] Stephanie Wittels Wachs: We’re back. I’m Stephanie Wittels Wachs. And this is Last Day. So my mom is part of a support group in Texas for people who lost their loved ones to overdoses. She started the group, actually. After Harris died, this therapist tried to send her to a suicide support group, and she was like, um, this is sad, but this isn’t really the same thing. So she started her own group. She’s been doing it for three and a half years now. At first, there were maybe five people who showed up? Now, there’s usually a crowd. I went with her recently. Good times, lemme tell ya. 


[18:27] Woman at meeting: I used to have these — not even dreams they were, I was awake — but these dreams where he died. Like all the time. All the time. 


[18:38] Man at meeting: It’s like I went to his funeral numerous times before it actually occurred. 


[18:42] Woman at meeting: When the word heroin came out of his mouth, we knew that this wasn’t going to end well. 


[18:51] Stephanie Wittels Wachs: When my kids were really little, I would tiptoe into their rooms at night to check that they were okay. Put my hand right in front of their tiny mouths, make sure they were still breathing. For parents of people who are struggling with addiction, you’re doing that when your kid is 25.


[19:14] Woman at meeting: Even when Travis was at home, when it was sleeping, I’d run upstairs to his room in the morning and make sure he’s OK. And I just I would go over and listen to make sure I can still hear him breathing. And I don’t know how many times the thought crossed my mind. 


[19:33] Stephanie Wittels Wachs: And those late nights, and in the days too, you’re just wondering, how the FUCK did this happen? And also, honestly, at least for me, what the FUCK is wrong with him? Why, why, WHY did he DO THIS? And sometimes, you get an answer.  


[20:01] Man at meeting: I had a heart-to-heart with my son about four years before he died. I woke him up at 5 in the morning, 4 in the morning, which is the time I get up, and I just said there’s no distractions. It’s just him and I. I got some insight the first time into the torment he was under and he just looked me in the eye and said, ‘you have no idea how I feel inside.’ He said the demons inside me are just tearing me apart. And I looked at him and I could see into his soul at that moment and I got this overwhelming feeling like, ‘Oh my God, what’s going on in him? I probably have no way to take that pain away from him.’ I’ve just realized it’s almost like seeing the devil. It really brought the hairs on my neck to stand up because I realized he had no power over it. And it was in control of his life and he knew it was in control of his life and he couldn’t stop what he was doing.


[21:02] Stephanie Wittels Wachs: I had this idea of what the meeting would be like. Lots of tears and tissue boxes. Pure sorrow. What I didn’t expect was the anger — the palpable anger — that these parents felt. Not at their children, but at the system. The anger was front and center. 


[21:30] Woman at meeting: The government doesn’t want to hear my story. They don’t want to hear my story. How do you change that? I don’t know. I mean Sam Snodgrass writes extensively about this stuff, he knows what to do. Nobody asked him to be on the committee. They should have asked him to be on the committee, he was a heroin addict. Yeah. He also has a PhD in pharmacology. He knows what doesn’t work and what could work. And you know he’s been there. 


[21:54] Stephanie Wittels Wachs: When I told my mom I was doing a podcast about the opioid crisis, the first thing she said — well, after asking me why she wasn’t hosting the show — is that I needed to touch base with Sam Snodgrass. So when a second person brought him up at the meeting, I knew I had to talk to this guy. 


[22:16] Sam Snodgrass: I started shooting heroin back in 1976 when I was 20 years old and a sophomore at the University of Arkansas at Little Rock. And I loved it. But for the next 13 years I just used occasionally.


[22:28] Stephanie Wittels Wachs: That is Sam Snodgrass. He’s a behavioral pharmacologist with a doctorate in biopsychology. Simply put, he studies how drugs affect our brains and our behavior. And for Sam, that love did not immediately tip over into crisis. Despite his occasional use of heroin, he was, in fact, doing pretty well.  


[22:56] Sam Snodgrass: Whenever I had spring break, summer break whatever, I’d come back to Little Rock, I’d shoot dilaudid and light up with my friends, and then go back to Georgia and forget it. After I finished my PhD I was awarded a National Institute on Drug Abuse postdoctoral fellowship in Pharmacology and Toxicology. That’s a three-year fellowship and I came back to the Pharmacology Toxicology Department at the University of Arkansas for Medical Sciences. And while I was there and doing research with these drugs with these substances, there was a bottle of powdered methadone hydrochloride, it was rolling around the drawer.  


[23:33] Stephanie Wittels Wachs: Methadone, for the lay people here.


[23:36] Sam Snodgrass: I watched that bottle of methadone hydrochloride roll around until April of 1989. One day I thought ‘Oh well, I wonder what that methadone would feel like.’ That was not my one of my better ideas. I got into that methadone and I started shooting that methadone every day and then I started shooting it two or three times a day. Then I started increasing my dose and the whole time I was doing this I kept telling myself you know, ‘when I want to I’ll stop, when I finish this bottle I’m done, I’ll stop’ and I really believed that right up until the time I couldn’t stop. And I tried, I tried as hard as I could. I tried with everything that I was to stop and I couldn’t. 


[24:18] Stephanie Wittels Wachs: Okay, so how — when you say that you tried, what does that look like? 


[24:22] Sam Snodgrass: Yeah. It’s called failure. In your head you’re saying ‘I’m not going to use. I’m not gonna use.’ And then you use. It was the most mystifying thing to me in my life, why I couldn’t control my own behavior. I mean, come on, I’d always been able to accomplish what I set out to accomplish in my life. I can remember — there’s so many times, so many times — I’m just driving up to an A.T.M., and all the time I’m driving up to this A.T.M. I’m telling myself ‘I can’t do this, I can’t do this, I can’t make my house payment, I can’t freaking make my car payment, I can’t do this’ — sliding my card in the A.T.M., punching the numbers, all the time cursing myself for doing this. Getting the money and then going to shooting the dilaudid. 


[25:16] Stephanie Wittels Wachs: What is this word you’re saying. It’s dilaudid — what is it?


[25:20] Sam Snodgrass: Dilaudid is hydromorphone. It’s very similar to heroin. It produces a very similar effect. It just doesn’t last as long as heroin. We would say it doesn’t have the legs that heroin has, but it produces one incredible rush when you shoot it. 


[25:37] Stephanie Wittels Wachs: At what point did you decide that you needed to get help in some way? What did that look like? And were you ‘successful’ quote, unquote?

[25:47] Sam Snodgrass: [Laughter]


[25:49] Stephanie Wittels Wachs: [00:38:43] I love the laughter. I love the laughter. Let me explain to you. 


[25:55] Sam Snodgrass: Oh well I mean there’s just no–you don’t understand.


[25:57] Stephanie Wittels Wachs: I don’t.


[25:59] Sam Snodgrass: I go to the methadone clinic and I stabilized on that methadone, and I led a pretty good life. I went and started teaching out of University of Arkansas at Little Rock. I got strung out on methadone. And yet here I was using methadone to stabilize an addiction. Whether a drug produces addiction or stabilizes an addiction is not an inherent property of the drug, but it’s rather in how we use it. I did well when I was on the methadone clinic, but I screwed up and got my ass kicked out. Every now and then I would take a benzo — benzodiazepine — I think it was Xanax. And they had a zero tolerance policy. 


[26:36] Sam Snodgrass: And one time when I went into get my methadone, they decided to give me urine screen and it popped up with a benzo and they kicked me out. I said when I got through with that, I was going to quit. I was gonna stop. I was done with it. No more. Of course I didn’t stop. I started shooting oxy 80s. I don’t remember this, but I was told that I was going into class and I’m trying to teach and nodding out at my desk, nodding out standing up. Anyway I got kicked out of UA Law in the spring semester 2009. 


[27:08] Sam Snodgrass: After that I lost my home, my car, I lost everything. I was homeless, penniless kind of thing. I was sleeping on the ground in homeless shelters. The last about three months of my addiction I was living with this family, they were very good to me. They tried to help me. I was sleeping on the floor, but heck, they slept on for half time, didn’t matter. The grandmother was selling dilaudid, roxies, methadone — whatever she could out the front door. This is literal. Her son-in-law and grandsons were selling crack out the back door and it was just 24 hours a day chaos in that house. It was just almost impossible to be able to live there. But again, it was a roof over my head and they were good to me. They fed me. I didn’t pay rent. And I’d been there for about three months and I didn’t have anywhere to go. The only thing I could think to do was go to a detox and to try and get my tolerance down. I wasn’t thinking about quitting. I was going to go to detox and just you know get my tolerance down to where when I went back out on the streets it would be better for me–wouldn’t cost as much. 


[28:11] Stephanie Wittels Wachs: The lower your tolerance, the less you need to get high, the less it costs to get high. 


[28:18] Sam Snodgrass: Anyway I went to this detox and I was sick as I could be, but this detox place had it worked out to where I could go to a place called Hoover, which was your basic 12-step religious-based rehab. Luckily it was only about eight blocks from the rehab so I could walk. I didn’t have car. I hadn’t had a car in years. And I can’t say that Hoover did much for me except it gave me a place to stay out of the weather the first December in Arkansas. I had no money, I had no friends left — I’d burned every bridge that you could possibly burn. Nobody knew if I was alive or dead and nobody really cared.

[28:57] Sam Snodgrass: Now, after 28 days in Hoover you could leave what they call the campus, which was really just an old church building that flooded when it rained. But you could leave the campus and, luckily, University of Arkansas for Medical Sciences, UAMS, was about 10 blocks from Hoover. And so what I did was when I was able to leave I went to the library at UAMS and I started reading about opioid addiction. I started reading about what I they had learned about the changes within the brain that produce opioid addiction. And it clicked. I finally understood why I couldn’t stop. I finally understood why I fought myself like I did and kept losing. This is an acquired disease of brain structure and function. They say knowledge is power. It was this knowledge that — nothing I got out that damn rehab — it was this knowledge I think which has helped me to not use up until this point. 


[30:00] Stephanie Wittels Wachs: Ok, this is important. This is so important. Sam kept “fighting himself and losing” because he had a disease. An acquired disease of brain structure and function. And knowing that literally changed his life. 


[30:22] Sam Snodgrass: This is a chronic illness. Right now, my addiction is in remission. I am not cured. I am not recovered. I’m not even in recovery. My addiction is in remission. I can’t promise you that next week or next month or next year I won’t be using again. This can come back. It can have a recurrence of this disorder anytime. There is no such thing really as addiction, just as there’s no such thing really as cancer — there are many different forms of cancer, each with a specific form of treatment. The same thing with addiction. There are different forms of addiction and each one has its own specific form of treatment. This is not a one-size-fits-all kind of thing. Because again this is not about willpower, it’s not about being a good or bad person, it’s not about wanting to quit. If we could quit when we want to quit there wouldn’t be a problem. This is about having people get their lives back and understanding that these medications are not a crutch. 


[31:24] Stephanie Wittels Wachs: He’s talking about medications like buprenorphine, suboxone and methadone. Medications that are often used to help people stay sober. It’s called Medically Assisted Treatment or M.A.T., and it’s backed by a thing called science.

[31:42] Sam Snodgrass: This is where these medications are so important, and to try and get rid of the stigma around them, because they reduce all cause mortality. Particularly, overdose deaths decrease by 50 to 75 percent with people who are taking medication. We could save so many lives if we could just get rid of this stupid idea that these medications aren’t as good as going to AA or NA. Abstinence–based methods, they may work very well for other forms of — I’ll say alcohol use or meth or coke — I don’t know and I don’t really care.

[32:20] Sam Snodgrass: What I care about right now is that most of the people dying in this country are dying because of opioid overdose and we have medications that would keep them alive. And yet we restrict access to them, we stigmatize them, and we tell people, ‘Oh no, don’t use those medications. Go to some rehab that will put you through abstinence-based treatment.” When you come out of jail, when come out of detox, when you come out of prison, you have no tolerance. Your tolerance is gone. It’s zip, it’s done. And you could use what you think is a safe dose. And it may not be. 


[32:59] Stephanie Wittels Wachs: This is why my brother’s dead. This is exactly why. Because he would relapse every single day that he got out of rehab, three times. 


[33:09] Sam Snodgrass: Yes, of course.


[33:10] Stephanie Wittels Wachs: He relapsed that day. 


[33:11] Sam Snodgrass: The problem is that no one’s ever told us that this is an acquired disease of brain structure and function. And that tolerance is a sign, a signal, that you are actually changing the structure of your brain on a cellular molecular level. Since we don’t know that, we don’t understand that, we’ve always been told as a matter of willpower, it’s a choice, we can stop if we want to. But really, what drives us is this craving that the opioids produce. Let’s say that somebody is starving for food. What are they going to be thinking about? They’re going to be thinking about food. And they’re going to be craving food. And the longer they go, the more they starve, the more they crave for food.

[33:56] Sam Snodgrass: Now, If they have to, are they going to steal to get money to buy food? The answer to that would be yes. Because survival is not a choice. You will do what you have to do to survive. We can be starving — if you give us a choice between heroin or food we’re gonna take that heroin. That doesn’t make us bad people. No, it is a completely normal, rational response to the starvation that we’re feeling. This is why we do the things we do in our addiction — we’re not bad people. But we’re in an unwinnable situation. We have no power over our addiction. So robbing a drugstore really isn’t that great an idea, but we’re out of options, and we know it’s a horrible thing to do.

[34:44] Sam Snodgrass: And if we had a choice we wouldn’t be doing these things. But again the starvation drives us to do these things. If we had more options, if we had more power over our addiction, then we could express that power. But it’s very difficult because we have such an entrenched system of beliefs and stigmatized beliefs, misinformed beliefs about opioid addiction in this country that the Congress — instead of really looking at this as a health problem or a health condition — still has this belief that we should arrest our way out of this problem. If this worked we wouldn’t be where we’re at. It doesn’t work. 


[35:28] Stephanie Wittels Wachs: But, there are things he believes do work.


[35:33] Sam Snodgrass: Harm reduction is two things — harm reduction is programs like overdose training and naloxone distribution, syringe exchange programs. It’s medications to treat opioid addiction — methadone and buprenorphine. It would be Overdose Prevention Sites, if we could ever get them set up in this country. The purpose of the programs is to reduce the harms, is to keep people alive long enough to help them to get their life back together. You get people coming into the syringe exchange, you get people coming in for naloxone, and you start making connections with people who have no connections, whose families have abandoned them, who have been marginalized and thrown the refuse of society. But they’re people. And if you treat them like people, then you can help bring them in and you can help them make changes in their lives, which will better them and better society. 


[36:30] Stephanie Wittels Wachs: These days, Sam works at a buprenorphine clinic. He spends his days educating people struggling with opioid use disorder about the effects of opioids and why he believes medically assisted treatment, like buprenorphine, is so critical in the recovery — or remission — process. That’s on paper. But he does so much more than that.


[37:02] Sam Snodgrass: I try and make them feel wanted. I try and make them feel valued. I try and make them understand that they are not bad people. We’ve all done bad things, but that doesn’t make us bad people. And I want them to understand that these things that they carry around full of guilt, full of shame — I want them to understand that, yes, they were bad things, don’t ever forget you did them, but don’t live in that area because you really didn’t have an option at that point but to do those things. But now you do have an option. You’re here. You can get on this buprenorphine and you can not do those things again and you can be the person you were meant to be. 


[37:50] Stephanie Wittels Wachs: How do you respond to somebody that tells you ‘my son, my husband, my daughter, my best friend — whomever — my brother, my sister, has this addiction and I want to help them. And I don’t know what to do. What do I do?’


[38:05] Sam Snodgrass: Well, my suggestion would be to try and find somebody who is board certified in addiction medicine if you can, or at least try and find a buprenorphine provider within your area. If you want to keep the person you love alive, get them on a medication. If somebody has Parkinson’s or multiple sclerosis, they get physical therapy, they get medications, they get motorized wheelchairs. Now, if you take those services away from those people, wouldn’t they be powerless over their disease? I know people say, ‘oh well, you did this to yourself. You know you’re the one that put the first drug in –’ and yeah, yeah, okay. We did. But the point is you can do — you don’t understand. Nobody understands what it’s like to have an opioid addiction until you’re in one. And by then it’s a little late. We know how to keep people alive. We’re just not doing it. 


[39:07] Stephanie Wittels Wachs: Are there things that you can point to that makes people prone to an opioid addiction or is a genetic? I have little kids, you know, how do I know? Like, well, how do I look out for this? What are the risk factors?


[39:22] Sam Snodgrass: Being human. 


[39:25] Stephanie Wittels Wachs: OK. Thank you. 


[39:28] Sam Snodgrass: That is the short answer: being human.

[39:30] Stephanie Wittels Wachs: That was your shortest answer yet.


[39:35] Sam Snodgrass: If you have a child, you have a loved one, or you, or whatever — you take some pain pills, or for some reason try some heroin or whatever, and it makes you feel better then you’ve ever felt before, you had better not do anymore.


[39:48] Stephanie Wittels Wachs: So really, I mean, truly, it can happen to anybody. 


[39:52] Sam Snodgrass: Yeah, I think that’s the point. 


[39:55] Stephanie Wittels Wachs: Are there any statistics, Sam, about how many people are in your boat versus how many people — I don’t even know how to phrase this question. How many people can beat this thing, and how many people can’t?


[40:10] Sam Snodgrass: OK. Again, I haven’t beat it. 


[40:12] Stephanie Wittels Wachs: All right, all right. I know, it’s — see, this is such a flaw in the way that we talk about it. It’s so ingrained.


[40:18] Sam Snodgrass: Yeah. It’s been a little over seven years, something like that, since I’ve used, but again, I haven’t beat this.


[40:30] Stephanie Wittels Wachs: There may not be a way to beat it, but there are ways to treat it, to manage the symptoms like any other medical disease. To take that first step towards remission, like Sam did. And over the course of the season, we’re going to explore many of the methods and treatment options that Sam mentioned. But it’s not easy. And it’s not one-size-fits-all. It’s trial and error. For many, for most, a lot of error. Which doesn’t make us “bad.” It makes us human. When Doreen, Stefano Sr., and Jess wonder how this could have happened, and what they could have done differently, the short answer is: Nothing. 


[41:41] Stephanie Wittels Wachs: Stefano died from a disease. Period. This wasn’t a choice. This was not a choice. Like Sam says, it’s not a life that anyone chooses. It’s certainly not the life Stefano chose. Not the life he wanted. He wanted that promotion at work. He wanted to start a family with Paige. He wanted to be an old man…for Halloween, at least. A few days after he died, his costume arrived.


[42:31] Jessica Cordova Kramer: I remember when we were cleaning out his apartment, the doorbell rang and a Fedex package arrived for him and it was his Halloween costume, which he was planning to wear a week later. He was going to be an old man. So it was some sort of mask. I couldn’t bring myself to look at it. 


[42:51] Stephanie Wittels Wachs: If you’re a member of our shitty club for people who’ve lost people to opioids — you probably have a vivid image of what an overdose looks like. Maybe you’ve seen it before. Maybe you’ve played the scene in your head a hundred times. Maybe it’s the thing that keeps you up at night. And if you’re not part of the club, you’ve definitely seen it portrayed on TV and in movies. 


[43:16] Stephanie Wittels Wachs: After Stefano overdosed, his wife Paige found his body in their bathroom. She called 911. The operator told her to administer CPR until the EMTs arrived. When they finally did arrive, Paige recalls that it was all business.


[43:38] Paige Cordova: They walked in and they were just like so rude they were just, like, yeah, I don’t see anything. Like they don’t see any breath.


[43:47] Stephanie Wittels Wachs: Paige had just lost her husband. They were out on another job. A job that can be exhausting, unrelenting, demoralizing, and kinda like they’re trapped in the movie Groundhog Day starring Bill Murray, but way less funny. 


[44:05] Karen Host: Sometimes we’ll go for the same patient three or four or five times a day. And I think that it’s frustrating for our crews at times because, you know, they just see this cycle where they go and they grab them, they do everything they can for them, they wake them back up, they get to the hospital and then they walk back out. 


[44:24] Stephanie Wittels Wachs: Next episode, we look at things from their perspective. 


[44:34] Stephanie Wittels Wachs: Last Day is a production of Lemonada Media. It’s produced by Justine Daum. Kat Aaron is our consulting producer. Jessica Cordova Kramer is our Executive Producer. Mix and sound design was done by Joe Plourde. Kegan Zema is our editor. Our music is by Hannis Brown. And I’m Stephanie Wittels Wachs. 


[44:55] Stephanie Wittels Wachs: You can find us online @lemonadamedia. That’s Lemonada like L-E-M-O-N-A-D-A. If you liked what you heard today, tell your family and friends to listen and subscribe. Rate and review us on Apple, Spotify, or wherever you get your podcasts. And check out our show notes for a deeper dive into what you’ve heard today and how to connect with the Last Day Community. See you next week.

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