John Luciew Interview
John Luciew is a reporter for PennLive.com. He is also the author of numerous ripped-from-the-headlines fictional thrillers that mix politics, corporate power and pulse-pounding suspense.
His reporting on the opioid crisis is available here: https://www.pennlive.com/opioid-crisis/page/addicted_towns_of_pennsylvania.html
Could you briefly describe your background and your current feat that you’re covering?
We’re based in Harrisburg, Pennsylvania, which is the capital. We have really intensely covered the opioid epidemic for a good solid two years, including last year, where we spanned out across the state to the hardest hit towns and counties in terms of overdoses per capita to really get on the ground with reporters, photographers, videographers, and see what was happening in each of these addicted towns of Pennsylvania. I was the lead writer on that project.
When did that project begin?
We started it at the beginning of last year, 2017, and we sort of recorded it intensely over six or eight months. Then we published it in November of last year. We were on the ground with coroners, in hospitals, recovery centers talking to addicts, overdose victims, sort of the gamut. To get an idea of where this was happening, why it was so intense in certain areas, and it was particularly former blue collar manufacturing areas that were hardest hit in Pennsylvania, you know, the “r`ust belt” towns. But we also saw it in very wealthy suburban Philadelphia areas as well. It’s kind of like what Tolstoy wrote: “All happy families are the same but every unhappy family is unhappy in its own way.” So for each of the addicted towns, there was a different story of where they were at and why they were there, and also what they were trying to do about it.
That’s a very great way of putting it. What was the toughest article that you had to write as part of this project?
It has been tough in many different ways. One of the ways it’s tough is that when you’re just writing about overdoses, people have little sympathy for addicts. The feedback we were getting from readers was, “why do we care if some addict overdoses on heroin? That’s what they deserve.” There was that point. In other words, there was very little sympathy and very little insight into addiction as a disease. Many of our readers refuse to accept that somebody willingly taking an illegal drug that they don’t know whether it will kill them or not, is a disease. There’s that backlash. But, the series really uncovered that it’s not just the addicts that are at risk. It’s not even just the parents of addicts who are being affected. In one story, in Johnstown, Pennsylvania, right around Christmas, there was a young couple, both of them addicts, who had an infant baby. They scored a hot dose, probably with fentanyl, which seems to be the lethal substance that created that deadly spike in the epidemic. Fentanyl, which is more concentrated than actual real heroine. They overdosed and died. The baby was alive in the crib and it was in an apartment building where, you have to imagine, other people heard the baby crying for several days. The baby ended up dying of starvation and dehydration, and it was really a shock to the system for Johnstown, which is a proud, sort of former steel town that has taken its share of bumps but always prided itself on being a friendly neighborhood place where people took care of each other. To see this little baby who died alone after several days of probably crying out of hunger and starvation, it really was a shock to the system, showing how callous we had become with the epidemic that a baby could cry for a couple of days in an apartment building with other people around, and nobody would call 911. So, there was that. Anytime somebody overdoses with a friend or a girlfriend or boyfriend, and dies, people were dumping bodies rather than calling 911 because they don’t want to get busted for their drug use. We talked to funeral directors who have to bury the overdose victims to see what it’s like to go to someone’s funeral who died of an overdose. As it turns out, the funeral directors say that some of the overdose victims friends come high and have even found needles in the bathrooms. Here’s one of their friends who just died of an overdose, but that’s not enough to get them to stop. They’re shooting up, even in the bathroom of the funeral home for their friend. The interesting part is, a lot of these were sort of their “past their prime” towns. They were union towns, manufacturing towns, a lot of those jobs went away, and the jobs that replaced them never matched the salaries or the benefits. But people stayed because family was there, they had roots there, they didn’t want to leave, but there was this sense of less hope. A lot of experts who studied the epidemic describe the opioid crisis as part of a larger trend of depth of despair. In other words, jumps in suicides, other health issues that is causing a certain demographic, and it is sort of this white rural demographic, to have astronomically higher death rates all of a sudden. So, there’s a lot of factors that play in economics and demographics and where you live. Rural versus urban is all part of the equation of trying to figure out what’s going on.
Was there anything you came across in the course of your reporting for this project that changed your perspective on the opioid crisis?
You do get a sense of how hard it is to quit, that because of the way the opioid interacts with the brain chemistry in the chemical balance of the brain, that it actually just diminishes the brain’s own natural ability to create that euphoric feeling, whatever that chemical is that the brain produces naturally. Once you introduce the opioids to it, you get less and less of your own chemical response. That’s why they always say that the addict is chasing the first high, because that first high was the opioids plus your brain at its maximum capacity of creating its own dopamine or whatever that chemical is that creates the euphoria. If you’re a hardcore addict, you have degraded your brain chemistry so far that it’s almost impossible to just do what they call the “cold turkey abstinence withdrawal,” where you’re required to give up all of the chemical substances. That is, according to a lot of the people I’ve talked to, the least successful path to recovery, whereas the chemical assisted treatment, whether it’s suboxone or some of the other synthetic opioids that they give people to slowly taper them down, is a more successful path to being able to stay off the opioid. Then you talk to another school of thought where there is also underlying trauma and anxiety that people are self-medicating with the opioids. In other words, the relief of the opioid is that you’re just totally taken away from all of your earthly cares. One of the addicts described it. She first watched her boyfriend shoot up, and as soon as that needle plunged into his arm, to see him totally relax and fall deeper into the chair, and to sort of see the weight of the world lift off of him, was very appealing to somebody who has a lot of anxiety or who is carrying around whatever trauma that somebody might have, self-doubts. To see that total relief from all of those troubles was a very powerful advertising for her to try it. She did try it, and then was on it for years and years and lost her daughter in the process, and now is actually to the point in her recovery where she is helping others with the recovery. The counties are sort of economically challenged, so there’s a lot of empty building spaces and storefronts. In some counties that have been hardest hit, they’re actually creating what they are calling “recovery communities.” Halfway houses, three-quarters houses where people in the midst of recovery can live in a group setting with other recovering addicts and have the support. There’s plenty of space for AA and NA meetings and that kind of thing, and there’s a sense of, “okay, we’re in this together.” But of course the recovery is fragile and a lot of friends don’t make it the whole way, and every time there’s an ambulance call, everybody is wondering who could it be. The most vulnerable time for anybody taking an opioid is if you withdraw from it for some time, and then you go back to your regular dose. That can be the lethal dose, and that’s because your body doesn’t have the same tolerance. Somebody who falters in their recovery often makes the fatal mistake because of that. It’s hard. There’s no easy answers for the solution, for the people who are addicted, to get off of this stuff. Methadone, suboxone, and certain other chemical assisted treatments seem to be the most effective.
In the course of your reporting, what kinds of interview subjects were the most helpful in eliminating the opioid crisis in Pennsylvania?
I really think that there is no one subject. I think you have to see it from all angles to really appreciate it. You have to see it from the parents’ perspective. They will tell you, you can love someone who is addicted to opioids, but they cannot love you back. They lose that capacity because their whole entire drive of their existence is their next high. You can love them, but they do not have the capacity to love you, and all you can do is hold on until they try to get through this and get into recovery, and that’s a process that they have to lead. In other words, as a parent loving somebody, you can tear your hair out and say, “you have to do this, you have to do that.” But, until they are ready and until they get to whatever bottom is for them, there’s no way of leading them. They have to come to it themselves. Then there’s the coroners who are dealing with this. One of the more interesting ones was the 911 operators who are answering the overdose calls. A lot of times it’s parents calling, finding a son or daughter who has overdosed and maybe even already dead. They played some of the 911 calls for us, and actually we included some of the calls in the series, and it’s just this gut-wrenching wailing and screaming of so much despair, of “I could not save my son or daughter from this.” A lot of times, by the time they find them, they’re gone. Or if there is a slight pulse, the 911 operator is instructing them in real time before that ambulance even gets there. These calls are just gut-wrenching, and it affects the 911 operator who is fielding all of this. Every day, day in and day out, to the tune of dozens of days in some of the bigger counties. It takes its toll on so many different levels that you wouldn’t even think about to tell you the truth. To really get a full 360 profile, you can’t just talk to a couple of people in town and leave. You almost have to sort of try to get everybody at every different layer. The one thing I will say, everybody was willing to talk. In other words, nobody in these towns, especially in the hard-hit towns, was willing to pretend that this wasn’t a problem. They’ve all admitted that they have a huge problem, and they’re willing to talk about it. The parents themselves have their own support groups. I sat in on a couple. And the addicts, the recovering addicts, are very transparent. The one thing is, except for this very tiny rural town that had a deep problem, it’s one of those places where everybody knows everybody, pretty much everybody except that rural town had gotten past the stigma of this, and they were ready to deal with it head on, with no pretense and no pretending or minimizing that this doesn’t exist at the lethal level that it’s at now.
Given your unique vantage point of looking at so many different parts of Pennsylvania, what is your impression of the current status of the opioid crisis in the state: Would you say things are starting to turn around or are there still bumps and challenges on the road ahead?
I think there remain daunting challenges. Now, the one thing that they have gotten control of is the prescription side of the epidemic. In other words, it’s now not as easy to get your opioids prescribed to you. The unique thing is that in these severely addicted towns of Pennsylvania that we visited, many were awash in opioids already. Prescription opioids. Think about it. These are manufacturing towns, aging towns, demographics are older, these are people that work 20-30 years in physical labor, so they have their fair aches and pains. Medicine cabinets in these places were already filled with opioids. That made it easier for sons, daughters, granddaughters, grandsons, to get access to prescribed opioids in their father’s or grandfather’s medicine cabinet. Take those to the party and it becomes this gateway drug. Underage drinking, marijuana, and then opioids. A lot of the gateway is started with prescription opioids that comes from some family member’s medicine cabinet. That’s the way it has started in a lot of these places. When you can no longer get your hands on prescription opioids, that’s when you turn to the street heroin and obviously the street fentanyl. They have reigned in the prescription opioid, and they are trying to reign in the lethal fentanyl that, a lot of times, was literally coming mail order from China and Mexico. In other words, you could order it mail order from places. It was the most lethal because it’s chemically produced, and obviously these dealers are not pharmacists so they’re parcing it out into little dime bags, not knowing exactly how lethal it is. But the worst thing of all of this, I’ve heard this in more than one town, is when there would be a wave of overdoses. When authorities would know that there was a new brand of opioid that was on the streets and was killing people, and they would see the bag that was at the death scene or the overdose scene, and it would have a stamp on it, they would put that stamp out on TV or on the internet and say something like, “this is the brand that is causing all of the overdoses right now.” For an addict, who is always looking for a better high, that was actually advertising for them. They wanted that bag because that was the good stuff. Real hardcore addicts, when they hear about a new strain of opioid that has been causing overdoses, they’re going to go out and try to get that because they think that’s the good stuff, the strong stuff that is going to get them up to that first high that they’re always chasing. It really is such a pressing subject the deeper you get into it because you realize how hardcore these addicts are. And listening to recovering ones who had to go through six or seven overdoses or near deaths before they ever got the message to try to actually clean up, mainly through chemical assisted treatment, to get away from the street opioid and that kind of thing. It’s a one soul at a time job to try to stop it. And, the other side of the coin. We have such an intractable problem of people who are already hooked, you want to stop new people from getting hooked. So, a lot of the schools in some of the hardest hit opioid towns are trying new curriculum, mainly in their health classes, that is designed to make kids more resilient so that they are less susceptible to the seduction of opioids. They’re less susceptible to wanting to erase all of their feelings. It is designed to make them less anxious, it’s a carefully scientifically put together curriculum that they are onto that is designed around creating more resilience in young people so that they don’t have those psychological drives that make them more susceptible to want to have to erase all those feelings that they have inside of them with these opioids that basically just numb you out and put you in a sort of “La La Land” where nothing matters.
Over the course of your reporting, what the most memorable experience you had, whether it was something you observed or something you heard someone say, that stuck with you?
I think it was being with one of the coroners. Here we are, doing this big exposé on opioids, and, at least the stuff that I read going into this before I started my reporting, no one really described exactly how you die from an opioid overdose. So, the coroner, who was in one of the hardest hit counties, and really saw the first wave of fentanyl coming through, saw this wave of overdose deaths due to the fentanyl, but the initial chemical screen, the tox screen that they were using on victims, where they would either pull some blood or urine and just run a tox screen, it wasn’t even showing the fentanyl. In other words, it wasn’t registering under that initial tox screen as an opioid overdose. In the autopsy, and I witnessed one on a victim, the first cut is the chest cut, where you open the chest and you take out the ribs and you look at the chest cavity and the heart and the lungs and everything. He would show me explicitly that opioid death is unmistakable. What happens is you literally relax to death. The opioid, it’s in your system, and it relaxes not only your voluntary muscles but also your involuntary muscles in the chest that cause you to breathe. So, what happens is the lungs no longer expand, they fill up with fluid and they turn a bright, dark purple. As soon as you do that autopsy with that opened chest, you see these swollen purplish lungs of the victim and that’s the tell-tale sign of an opioid overdose. He was seeing this time and again but the tox screen that they were doing at the time wasn’t detailed enough to show the fentanyl because that was when the market had changed and there wasn’t enough heroin, so people were going to fentanyl and that was the more lethal one that was causing all of these deaths. They didn’t know it at the time until they got a more expensive drug test to test for a deeper, wider array of all of these toxins, and then they finally pieced everything together. But seeing the actual way you die of an opioid overdose, I think, sticks with you. Then hearing from near-death experiences and knowing that they nearly had that experience where they stopped breathing and relaxed to death and were brought back, maybe by a friend who was shooting up with them, hearing that same story again and again, just shows how close you can come. You never know which high is your last with opioids, especially when your supply is on the street and you don’t know if it’s fentanyl or carfentanil or how strong it is. Those purple lungs stick with me in my mind.
Media coverage, particularly, is just something that pops up on the news. It’ll be like some soundbite and a lot of those tend to focus on the statistics like overdose deaths or the economic cost of the crisis. How can we sort of do more of what you’ve done, which is present a more personal narrative that people can relate to?
You have to be careful with “personal” too. We’ve ran other stories of parents who lost kids and that kind of thing, or of babies born addicted and other recovery people. People can dismiss a lot of things as, “okay, that’s somebody else’s problem, but that wouldn’t happen to me.” But I think what was different with this series, it shows how entire communities were crumbling under the weight of this. Everything from the firefighters, who have narcan with them, because a lot of times they’re not fighting fires anymore, they’re helping revive the overdoses. When there’s no ambulance, they send a firetruck and that firefighter has to be prepared to revive that overdose victim with narcan or naloxone. That’s the antidote for the opioid overdose. A lot of people have relatives in some of these towns, Pennsylvania is a state where a lot of people might move around but a lot of Pennsylvanians were born in Pennsylvania, so there’s a lot of roots here, they could really see how it wasn’t just the family that was affected, it wasn’t just an addict’s sob story. This was entire towns and entire communities just crumbling because of this, and not just the opioids. The economic situation that opened the door for the opioids, how dealers thought, “instead of the competition in the urban centers, why don’t I go out to some of these rural towns where I can make more money and have an abundant supply of addicts? I can set up shop in a house that I can pay rent for cents on the dollar because real estate is so cheap.” In other words, literally, the drug selling community saw an easy start-up. It’s almost like a real business, looking at it and saying, “why would I want to do this? This is silly when I can go out to this rural town where I have less competition, I can charge more and make more and my overhead is much less.” People are looking at it like business ventures. Cops are getting wise to this, all of these cops have this tracker that can check a license plate that tells you what toll did it go through or did it get a parking ticket, so you can kind of see where this person is coming from. The movement of the drugs in and out of places, that’s when they’re most vulnerable to being arrested, when the opioids are coming in through the car because cops are being more vigilant about checking license plates and running them through the system to see where they’ve come or where they’ve been. Certainly if they get an idea that it’s coming in from Detroit or Philadelphia or other places where the drugs are coming from in their small little town, they’re going to be more suspicious. The one thing is, it’s not like the crack epidemic where people were standing on corners and selling drugs out of crack houses or crack dealers. We’re in a cell-phone age, and the one thing about opioids is that it’s a personal business between your dealer and your addict. It’s all done by text messages and by phone and it’s so one on one, where you’re either going over to their home or they’re coming over to yours. It’s harder to have that open air drug market that used to be easier for cops to monitor and bust. Also, addicts, if they overdose, they’re less likely to give up their supplier because they don’t want to burn their bridge so there’s less ratting down the line. And, law enforcement is treating the victims as victims, not criminals. That’s the one thing. They have not criminalized being the addict in this crisis, unlike past crises where you would be arrested as a crack user. You’re not really arrested as an opioid user or a heroin user. You’re not criminalized for your addiction. But, in some ways, that makes it harder for law enforcement to work their way up the line and hit the big fish dealer that is supplying all of this stuff. There’s so many sides to this thing.
If somebody gave you a magic wand to change any policy in order to more effectively alleviate the opioid crisis in Pennsylvania, which policy would you zero in on?
The one thing that’s a big problem: There’s no uniformity in terms of best practice, in terms of treatment and recovery. In other words, because there’s such a split in the recovery community between chemical assisted treatment, which actually is more effective, and the school of thought where you need to be total abstinence from any substance and you work your recovery much like they do in AA or group therapy, it’s hard enough as it is because of the brain chemistry issue with opioids to get clean. Because there’s no best practice solution of what is the most successful way to get off of this stuff, so that there’s a clear path, there’s a lot of spinning the wheels in terms of if you get to that point of when you want to get off of this stuff, finding the best route and the best provider and the best, most cost-effective way to do that. We need to have somebody come up with a clear path, like, “this is the scientifically proven, research-driven way that this the best chance of getting off. This is how we’re going to pay for it, all you have to do is show up and start your recovery.” Right now we don’t have that. We don’t have a clearly focused path in terms of recovery. There’s so many different providers and so many different people out there, and honestly people trying to make a buck out of this thing too. It’s really confusing, and it’s really that much harder to find the right way to do this and the best scientific, data-driven, and also most cost-effective way to try to get clean.
In addition to the reporting that you and your team have done, what additional resources would you recommend to members of the public who would like to know more about the opioid crisis?
I would think that in most communities that are battling this, there has been seminars where the coroner, I know, has done it. There are groups who are helping addicts, they have outreach and that kind of thing. I think the best thing is to see what’s in your community and what’s going on and going in and seeing. Some of these recovering communities, they have addicts that are running their own coffee houses. They’re actually the employees but they’re also coming there to hang out and basically just smoke and drink caffeine rather than other things. If you notice, a lot of recovering addicts replace their drug or alcohol with caffeine and cigarettes. But actually break the barrier and meet some people who are on the front lines of this thing. I think that’s the best way for people to really get an idea of the scale of this thing, not necessarily reading about it, but actually seeing what’s out there in your community in terms of people discussing it, people confronting it, groups, churches, everybody seems to be involved on some level. You can actually go out and talk to people and see it, you don’t have to get it secondhand. There’s enough going on in every community where people can find out more on their own.