‘It Takes Time,’ Fentanyl Stops Clock
By Matthew Rodriguez
My little sister Myla Marquez is among the overdose deaths of 2021. Our brother Charlie found her dead on her bedroom floor on April 13, 2021.
The coroner’s report listed her cause of death as a fentanyl-related overdose. The circumstances that led to her death were pieced together from diary entries, text messages, social media and fragmented memories. They are also the bits and pieces which inform this story, because my grief demanded details. Sure, curiosity killed the cat – but he died knowing.
“My mind and head hurt. I need sleep. This is really, really bad. Anxiety is bad.” – March 13, 2021
My hometown of Farmersville is nestled in the foothills of the Sequoia Nevada Mountains. Their rocky silhouettes form a constant backdrop dominating the eastern skyline. At dawn, the sun rises over the peaks. It illuminates railroad tracks that crisscross groves of oranges and walnuts, vegetable patches, and dairies that spread below, across California’s Central Valley.
Just before dawn, Myla’s phone chimed loudly on the kitchen table. She stood at the sink rinsing hair dye from her eyebrows under the cold faucet water. She quickly toweled her face dry. She twisted her wet curls into a towel turban and then silenced the alert on her phone before the grandparents or Charlie would wake.
The alert marked day three since she last slept. A feeling of unease was settling in the pit of her stomach.
“I have patterns to unlearn, new behaviors to embody and wounds to heal,” the quote reads on her phone’s lock screen. “I am unlearning generations of harm and remembering love. It takes time.”
She scoffed at the words. She’s been manic for several hours, and now her eyebrows were a deep shade of emerald. The latest regiment of anti-depressants and mood-stabilizers treating her bipolar disorder were only making things worse. Mostly, she scoffed because she was tired of being tired.
“It takes time,” she wrote in her diary and walked quietly back to her bedroom to roll a joint.
In Los Angeles, I covered my face with a pillow and screamed, clawing at the physical pain in my chest. Now, I know what it feels like to have your heart broken, I thought. There is now a before and a mysterious after.
March 2, 2021 SMS Message
Jane Doe: Are these the ones with fentanyl in them??
Myla: Yea, these have fentanyl. I know that for sure.
Fentanyl’s role as a potent additive to other narcotics in the illicit market is multifaceted. Unlike pharmaceuticals, illicit fentanyl is not diverted from a legitimate market but produced in black market operations that are difficult to detect. Overdose deaths from fentanyl have been on the rise since 2013.
“Since 2016, it’s been the substance that has really been driving the overdose crisis,” said Emily Einstein Ph.D who works at the National Institute of Drug Abuse in the science policy branch. “And we’ve seen further increases that are associated with a period of time during the pandemic when we also have data to indicate that people were using fentanyl more frequently as using it in combination with other substances more frequently as well.”
Shipments of fentanyl’s precursor chemicals (chemicals used in heroin, cocaine and amphetamines are called drug precursors) are shipped from China into Mexico where it is produced and cut with other narcotics before being smuggled across the U.S border for distribution.
Pure fentanyl is too potent to replace heroin or Oxycontin - just 2-3 milligrams can kill. Rather, adding fentanyl to heroin, cocaine, or counterfeit pills boosts potency and increases the likelihood of addiction. People using these drugs are often unaware of their opioid tolerance. One pill can kill.
According to Mary Brennan, head of the Special Narcotics Prosecutor’s Office for New York City, fentanyl’s extreme potency and high demand of steady addicts in the drug market are keys to understanding the considerable profit of fentanyl as an additive.
“It’s the tragedy of it all, my guess is now everybody is affected by it,” Brennan said. “It’s cheaper than heroin and the purer it is, the more profit it stretches.”
How much profit is worth a human life? Not such an easy question.
“Imagine one kilogram, or ‘brick’ of pure heroin yielding 30-50 thousand bags for distribution. Fentanyl will stretch that to yield around 90-150 thousand bags” Brennan said. “By the time we get to the street level and sold as ‘dime bags’ for $10 each, you’re looking at $1 million per brick and you begin to see the why. Don’t get any ideas, Matthew!”
Grief Invades Dreams
“It does not do to dwell on dreams and forget to live,” J.K Rowling writes in Harry Potter and the Sorcerer’s Stone, alluding to the curiosity of dreams that blur the lines between reality and fiction. I’ve never been one to dwell on my own dreams whose details elude me shortly after waking. This changed with a dream that came to me a few weeks after Myla died. It was so vivid and uncanny that all I could do was bow in humility as something unknowably bigger than me passed through my subconscious.
Our laughter settled into a comfortable silence walking through billowing fields of wheat that surrounded us in every direction. Twilight’s dreamy pinks and purples deepened to evening’s shades of blue and purple.
“Myla, you know what happened, right?” I asked.
“Yes, I know I’m dead,” my sister replied looking at her feet. “I’m sorry.”
“Have you seen mom?” I asked her next.
Myla shook her head, gazing out at the endless fields swaying in the breeze.
“No,” she answered. “I know it’s possible, but I haven’t figured out how yet.”
A short but vivid dream... I know that grief is powerful. It pulls back the curtains covering a transcendent aspect of reality; an abstract concept of what things could be other than what we assume things to be: something stranger, more slippery, more possible.
Must our world be only one thing, or can it be many?
My sister was called a miracle baby. Our mother gave birth to her while paralyzed on the entire left side of her body after an accident she had three years prior. She was doted on, wanting for nothing, while our mother watched powerless to intervene.
When I reflect on this time as an adult the same age now as my mother was, I can’t find the words, and hope I never do.
As my sister matured, she became a young woman who was easy to laugh with and befriend. Whip smart, she attended a university prep charter high school. She dreamed of going to medical school. Always lurking just underneath the surface of her personality, however, was a deep and existential anguish.
During her senior year, she was diagnosed with anxiety and prescribed Xanax, a fast acting tranquilizer used to control anxiety and panic disorders.
After Myla graduated, she decided to put off college for a year. She took a waitress job at a local diner, where she quickly made friends with her coworkers.
“Now on Clonazepam and Seroquel, panic and mood stabilizer. This is the beginning. But I’m very tired.” – January 16, 2021
Her anxiety only worsened while she began to experiment with drugs and drink heavily. Sociable as she could be, my sister was also deeply emotionally insecure. This aspect of her personality showed itself in her relationships with boys. She usually ended with her heart broken.
She was always attracted to people whom she thought she could fix in some way. When she started dating Edgar, I noticed my sister’s condition declining. The tell-tale signs of an abusive relationship were obvious. She was being drained financially and emotionally. She was withdrawn and spiritually abused.
Her first D.U.I was costly. Her second one was even more expensive and required a court-ordered ankle monitor. Just before the country locked down for COVID-19, she became pregnant and miscarried, and she only told Edgar.
They both knew it was likely the drug use that caused the miscarriage. Edgar broke up with her, shortly after she lost his baby.
“Life just sucks. I’ve wasted so much money. I’m too much, that’s always the issue. Everyone would get over it.” – April 5, 2021
The new decade has changed all our lives, but the isolation of quarantine only worsened Myla’s depression. It gave way to intense periods of manic episodes and mood swings that were diagnosed as bipolar disorder by the end of the year.
Laid off, heartbroken, stuck at home, unemployment assistance used for nonsensical fees associated with her D.U.I charge, my sister had nowhere to go but up.
Dr. Emily Einstein, chief of science policy at the National Institute on Drug Abuse (NIDA) says abuse and addiction are intertwined, tending to inform and exacerbate each other in complex ways.
“Substance abuse disorder is a psychiatric condition, and they frequently co-occur with other psychiatric conditions,” Einstein said. “A lot of these disorders have similar risk and protective factors that can be biological, social or environmental. They certainly exacerbate each other.”
According to NIDA’s research, while bipolar disorder often runs in families, no one hereditary gene has been identified as a cause.
Still, I think of my stepfather and his unpredictable, sometimes violent mood swings, wondering of possible similarities with my sister. I think of my brother, because the anger in the father is also palpable in the son.
My grandmother often refers to my stepfather as “Jekyll and Hyde,” the titular character in the classic tale “The Strange Case of Dr. Jekyll and Mr. Hyde”.
In the story, respected physician Dr. Jekyll develops a serum to repress his evil urges. Instead, he transforms into Hyde, a creature without compassion or remorse. Commonly understood as an allegory for good vs. evil and the duality of human nature, the late-Victorian period of the novella’s publication also coincides with the earliest case studies on a phenomenon now known as bipolar disorder.
Myla’s bedroom is painted an ugly pastel orange, chosen by my grandfather, a shade I found revolting when the bedroom was mine. It was revolting as ever when I entered it the day after she died to collect the diaries, documents, pill bottles, and prescriptions, from all the nooks and crannies I knew well – all of it.
The truth that is avoided and rationalized by lack of proof is that my sister committed suicide during those early dawn hours. Myla was not a novice but an addict familiar with opioids, dosages, and purity levels.
There are moments when I feel this truth is an unfair burden, but I don’t have the heart to tell my brother or stepfather.
The trajectory of my sister’s life is merely a drop in the ocean of thousands of similar stories, a truth bore out by thousands just like it. The pandemic has both masked and amplified the problem as rising death rates are linked to anxiety and isolation.
There is a multi-system failure of regulation. The crisis demands an urgent, unified, and comprehensive response. The crisis has historical roots in the White House war on drugs during the Nixon Administration.
“You want to know what this [war on drugs] was really all about? The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people,” said John Ehrlichman, assistant to the president for domestic affairs under President Richard Nixon according to the Vera Institute. “You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”
Care, treatment, and prevention are critical. Over-reliance on opioid medication is emblematic of a health care system that incentivizes quick, simple answers to complex physical and mental health needs. The current status quo ensures addiction will remain a constant long-term threat to public health that won’t respond to short-term fixes or short-term funding.
Underlying all of this – structural factors such as economic opportunity, social cohesion, racial disadvantage, and quality of life that are at the root of addiction in the U.S.
These do not typically figure into the mandate of healthcare, yet they are fundamental to public health. As long as these issues go unaddressed, addiction will remain a constant long-term threat to public health that is unresponsive to short-term fixes or short-term funding.
What I’ve learned about life and death through grief can fill a book one day, but the future feels stolen from me. Over time, I’ll learn how to live and grow outside the void, but without the agency of choice. No semblance of my life before my sister died is the same, good grades, my relationship, friendships, the color in the world, even my apartment that has left me essentially homeless - all of it is gone.
This story does not ask for pity, but asks readers to look for the parts that mirror their loved ones or themselves who may be struggling with addiction before their lives are also changed. Death has irrevocably steered the course of my life into uncharted territory, as I try to make sense of a paradox: learning to be OK with never being OK again. It’s the only way forward. And if our lives are subject to change at any moment, there are still more changes ahead. Let me open my eyes and be glad that I got here.
Capturing the full scale of opioid addiction in the U.S is beyond this story’s capacity. Years of ineffective drug policy, rising poverty, addiction, healthcare access, the greed of unchecked capitalism, mental health, and foreign and domestic policy are all interwoven in complex ways. This crisis is national, but the impact is personal.
According to the United States Center for Disease Control (CDC), over 100,000 Americans died of a drug overdose in 2021 for the first time in the history of our nation. From this figure, 64,000 deaths were caused by fentanyl, a synthetic opioid 50-100 times more potent than heroin. A potent additive to increase addiction and profits, fentanyl is the next deadly wave in a decades-long opioid epidemic ravaging communities across the nation – a darker aspect of Americana with no end in sight.