Dustin Manning (with his mom, Lisa) fought addiction for years before dying of an overdose last spring.

Suti Stock Photo/Shutterstock.com (background); mukhina1/123RF.com (drugs); Courtesy of Family (Lisa Manning)

‘A Drug of Mass Destruction’

A deadly synthetic drug called fentanyl is making the opioid epidemic even more lethal

Every morning, Lisa Manning walks past the bedroom where her 18-year-old son, Dustin, died of an accidental overdose of the opioid drug fentanyl. Although it’s a constant reminder of the day last year when her husband, Greg, found Dustin slumped over on his bed, the Mannings can’t bear to move out of the house.

“Part of me thinks he’s still here, I guess,” she says. “I’d feel like we were leaving him if we moved so soon.”

Paramedics in Lawrenceville, Georgia, weren’t able to save Dustin on May 26, 2017. Less than an hour later, they received another call from a half mile away. Joe Abraham, 19, a childhood friend of Dustin’s, was unresponsive in his bedroom, dead from an unrelated fentanyl overdose.

Dustin and Joe weren’t close friends anymore, but the two recent high school graduates both became statistics in an opioid crisis that’s gripping the nation and shaking communities like Lawrenceville, a city of 30,000.

Every morning, Lisa Manning walks past the bedroom of her 18-year-old son, Dustin. He died there of an accidental overdose of the opioid drug fentanyl. It’s a constant reminder of the day last year when her husband, Greg, found Dustin slumped over on his bed. But the Mannings can’t bear to move out of the house.

“Part of me thinks he’s still here, I guess,” she says. “I’d feel like we were leaving him if we moved so soon.”

Paramedics in Lawrenceville, Georgia, weren’t able to save Dustin on May 26, 2017. Less than an hour later, they received another call from a half mile away. Joe Abraham, 19, a childhood friend of Dustin’s, was unresponsive in his bedroom. He had died from an unrelated fentanyl overdose.

Dustin and Joe weren’t close friends anymore, but the two recent high school graduates both became statistics in an opioid crisis that’s gripping the nation and shaking communities like Lawrenceville, a city of 30,000. 

“Everyone knew Dustin,” says Lisa Manning. “He was a baseball player. So when people saw these two kids dying from drugs, they knew it could just as easily be their sons.”

There were about 64,000 fatal drug overdoses in the U.S. in 2016, the highest total ever recorded. Most involved opioids, a class of highly addictive drugs that includes prescription painkillers like Oxycontin and illicit drugs like heroin. About one-third of the deaths involved fentanyl, the latest and most deadly opioid involved in the crisis.

“Everyone knew Dustin,” says Lisa Manning. “He was a baseball player. So when people saw these two kids dying from drugs, they knew it could just as easily be their sons.”

There were about 64,000 fatal drug overdoses in the U.S. in 2016, the highest total ever recorded. Most involved opioids, a class of highly addictive drugs that includes prescription painkillers like Oxycontin and illicit drugs like heroin. About one-third of the deaths involved fentanyl, a synthetic painkiller. It’s the latest and most deadly opioid involved in the crisis.

The Opioid Crisis At A Glance

What are opioids?
Opioids are a class of drugs that include doctor-prescribed pain relievers like Oxycontin and Vicodin, and illicit drugs like heroin.

What do opioids do?
Opioids act on the brain and nervous system to block pain signals and make people feel relaxed. (That’s why they’re often prescribed after surgery.)

Why are they dangerous?
Opioids are highly addictive. Many who abuse painkillers move on to heroin, which is cheaper and easier to obtain.

How bad is the crisis?
There were about 64,000 fatal drug overdoses in the U.S. in 2016, the highest total ever recorded. Most involved opioids.

What are opioids?
Opioids are a class of drugs that include doctor-prescribed pain relievers like Oxycontin and Vicodin, and illicit drugs like heroin.

What do opioids do?
Opioids act on the brain and nervous system to block pain signals and make people feel relaxed. (That’s why they’re often prescribed after surgery.)

Why are they dangerous?
Opioids are highly addictive. Many who abuse painkillers move on to heroin, which is cheaper and easier to obtain.

How bad is the crisis?
There were about 64,000 fatal drug overdoses in the U.S. in 2016, the highest total ever recorded. Most involved opioids.

Mexican Drug Cartels

A synthetic painkiller, fentanyl is so powerful that ingesting an amount equal to a few grains of salt can be fatal. Fentanyl is cheap and made entirely in a lab, and Mexican drug cartels obtain it easily over the internet from China. They add it into heroin, cocaine, and methamphetamine (commonly known as “meth”) that’s smuggled into the United States to increase the drugs’ potency. Dealers also use fentanyl to make fake prescription pills, like the counterfeit Vicodin that killed pop singer Prince in 2016 and the tainted Xanax that killed rapper Lil Peep in November.

Fentanyl is so powerful that ingesting an amount equal to a few grains of salt can be fatal. Fentanyl is cheap and made entirely in a lab. Mexican drug cartels obtain it easily over the internet from China. They add it into heroin, cocaine, and methamphetamine (commonly known as “meth”) to increase the drugs’ potency. Those drugs get smuggled into the United States. Dealers also use fentanyl to make fake prescription pills, like the counterfeit Vicodin that killed pop singer Prince in 2016 and the tainted Xanax that killed rapper Lil Peep in November.

Overdoses are now the leading cause of death for Americans under 50.

In most cases, drug users have no idea that what they’re taking has fentanyl in it. That’s a primary reason why overdoses have eclipsed car accidents as the leading cause of death for Americans under 50. And the victims are getting younger. In 2015, nearly 800 teens died of overdoses, about a 20 percent increase from the previous year, according to the Centers for Disease Control and Prevention.

The current crisis has its roots in the late 1990s, when powerful new painkillers like Oxycontin went on the market. They were supposed to help patients, such as people with cancer, deal with intense pain. But doctors overprescribed them and some patients became addicted.

As Americans’ use of prescription opioids skyrocketed (see chart, below), a black market developed around the drugs for recreational use. The federal government began cracking down around 2010, but by then thousands of users were dependent on the drugs.

Many of those who were addicted to pills soon found a cheaper alternative
in heroin. Now fentanyl—50 times more powerful than heroin and 100 times stronger than morphine—is being mixed into these drugs, greatly increasing the risk of fatal overdoses.

“It’s the most dangerous drug I’ve ever investigated,” says Major John Merrigan, an 18-year veteran of the Vermont State Police. “It’s a drug of mass destruction.”

As Americans’ use of prescription opioids skyrocketed, a black market developed around the drugs for recreational use. The federal government began cracking down around 2010. But by then thousands of users were dependent on the drugs.

Many of those who were addicted to pills soon found a cheaper alternative in heroin. Fentanyl is 50 times more powerful than heroin and 100 times stronger than morphine. It’s now being mixed into these drugs, greatly increasing the risk of fatal overdoses.

“It’s the most dangerous drug I’ve ever investigated,” says Major John Merrigan, an 18-year veteran of the Vermont State Police. “It’s a drug of mass destruction.”

A Health Emergency

The Northeast has been one of the hardest hit regions. Fentanyl killed more than 2,000 people in Pennsylvania in 2016 and a similar number in Massachusetts. New Hampshire and Vermont have also been devastated by the drug.

But the problem isn’t limited to the East Coast. In Milwaukee, where overdose deaths are almost triple those of homicides, 11 people died of fentanyl overdoses in a four-day period in October, including a 16-year-old boy found inside a parked car.

And in the Dayton, Ohio, area, 365 people died of overdoses from January through May 2017, nearly matching the total for the entire previous year. Dayton officials compared the effects of the opioid crisis in the city to a “mass casualty event,” such as a pandemic or terrorist attack. 

The Northeast has been one of the hardest hit regions. Fentanyl killed more than 2,000 people in Pennsylvania in 2016 and a similar number in Massachusetts. New Hampshire and Vermont have also been devastated by the drug.

But the problem isn’t limited to the East Coast. In Milwaukee, overdose deaths are almost triple those of homicides. There, 11 people died of fentanyl overdoses in a four-day period in October. That included a 16-year-old boy found inside a parked car.

And in the Dayton, Ohio, area, 365 people died of overdoses from January through May 2017. That nearly matched the total for the entire previous year. Dayton officials compared the effects of the opioid crisis in the city to a “mass casualty event,” such as a pandemic or terrorist attack.

Todd Williamson Archive/Getty Images

Pop singer Prince died of an accidental overdose of fentanyl in 2016.

The epidemic is forcing agencies not used to dealing with drug addiction to confront the problem. Schools and colleges are trying to help students get off drugs (see “New Subject on Campus: Opioids,” below), and some child welfare services are at a breaking point, as kids are being orphaned or removed from their addicted parents’ care at a shocking pace.

“We’ve gone from having 2,500 children in care three years ago to having 5,500 kids in care,” Marilyn Moores, a juvenile court judge in Indianapolis, told NPR. “It has just exploded our systems.”

In October, President Trump declared the opioid epidemic a health emergency, and Attorney General Jeff Sessions assigned 90 federal agents to a new field office to help combat the illicit opioid trade. Last month, Trump also called for reducing the number of opioid prescriptions, tightening drug enforcement on the Mexican border, and enacting tougher penalties for drug dealers, including the death penalty.

However, the budget proposal Trump submitted in February has earned mixed reviews. It provides $3 billion more this year and an extra $10 billion in 2019 to combat the crisis, but it slashes other programs—such as Obamacare—that help patients pay for treatment.

Some states are taking action on their own. In Florida, where overdoses have risen dramatically in recent years, a new law—passed partly in response to the death of 10-year-old Alton Banks of an accidental fentanyl overdose—took effect in October. It allows prosecutors to bring murder charges against anyone who sells fentanyl that causes an overdose death.

The epidemic is forcing agencies not used to dealing with drug addiction to confront the problem. Schools and colleges are trying to help students get off drugs. Some child welfare services are at a breaking point. The cause? Kids are being orphaned or removed from their addicted parents’ care at a shocking pace.

“We’ve gone from having 2,500 children in care three years ago to having 5,500 kids in care,” Marilyn Moores, a juvenile court judge in Indianapolis, told NPR. “It has just exploded our systems.” 

In October, President Trump declared the opioid epidemic a health emergency. Attorney General Jeff Sessions then assigned 90 federal agents to a new field office to help combat the illicit opioid trade. Last month, Trump also called for reducing the number of opioid prescriptions, tightening drug enforcement on the Mexican border, and enacting tougher penalties for drug dealers, including the death penalty.

However, the budget proposal Trump submitted in February has earned mixed reviews. It provides $3 billion more this year and an extra $10 billion in 2019 to combat the crisis. But it slashes other programs—such as Obamacare—that help patients pay for treatment.

Some states are taking action on their own. In Florida, overdoses have risen dramatically in recent years. The state enacted a new law, passed partly in response to the death of 10-year-old Alton Banks of an accidental fentanyl overdose. It allows prosecutors to bring murder charges against anyone who sells fentanyl that causes an overdose death. The law took effect in October.

‘He’s Watching Over Us’

The current focus on combating opioids came too late for the Mannings. Dustin’s descent into addiction began when he tried alcohol at age 12. By 15, he was using marijuana and abusing prescription opioids—stolen from the medicine cabinets of family and friends—and other drugs, like meth.

Despite his addiction, Dustin remained a popular teenager. He was a star catcher on Mountain View High School’s baseball team, and teachers and coaches raved about him.

“People used to say that he was the type of kid who would look you in the eye,” says Lisa Manning. “He was always very respectful.” 

The current focus on combating opioids came too late for the Mannings. Dustin’s descent into addiction began when he tried alcohol at age 12. By 15, he was using marijuana and abusing prescription opioids. He stole them from the medicine cabinets of family and friends. Dustin also began using other drugs, like meth.

Despite his addiction, Dustin remained a popular teenager. He was a star catcher on Mountain View High School’s baseball team, and teachers and coaches raved about him.

“People used to say that he was the type of kid who would look you in the eye,” says Lisa Manning. “He was always very respectful.”

Lisa Manning made the gut-wrenching decision to call the police on Dustin for abusing drugs.

In 2015, when Dustin was 16, his parents discovered he was an addict and sent him to rehab. For the next two years, he struggled with staying off drugs. He was in and out of recovery programs, relapsed twice, and was arrested after his mother made the gut-wrenching decision to call the police on him for using drugs.

“It was a horrible two years,” she says. “We were dealing with Dustin relapsing, being in rehab. It was very hard.”

But by May 2017, Dustin appeared to be embracing recovery. He had just turned 18, earned his high school diploma, and attended the prom with his girlfriend, Cameron. Clean for several months, he seemed optimistic about his future.

“We thought, ‘He’s going to do this,’” says Lisa Manning. “He was really growing up. He talked about learning a trade. He was doing great, then…”

No one knows why or how Dustin got the meth he snorted the night he died. But his parents are convinced he had no idea the drug was laced with fentanyl.

According to the toxicology report, an amount of fentanyl equivalent to three grains of salt killed him within 20 seconds. “He was slumped over,” his mom recalls. “He didn’t even have a chance to lay down.”

In 2015, when Dustin was 16, his parents discovered he was an addict and sent him to rehab. For the next two years, he struggled with staying off drugs. He was in and out of recovery programs and relapsed twice. After his mother made the gut-wrenching decision to call the police on him for using drugs, he was arrested.

“It was a horrible two years,” she says. “We were dealing with Dustin relapsing, being in rehab. It was very hard.”

But by May 2017, Dustin appeared to be embracing recovery. He had just turned 18, earned his high school diploma, and attended the prom with his girlfriend, Cameron. Clean for several months, he seemed optimistic about his future.

“We thought, ‘He’s going to do this,’” says Lisa Manning. “He was really growing up. He talked about learning a trade. He was doing great, then…”

No one knows why or how Dustin got the meth he snorted the night he died. But his parents are convinced he had no idea the drug was laced with fentanyl.

According to the toxicology report, an amount of fentanyl equivalent to three grains of salt killed him within 20 seconds. “He was slumped over,” his mom recalls. “He didn’t even have a chance to lay down.”

His death has spurred his family to take action. Dustin’s older sister, Danielle, a junior at the University of Georgia, is now studying to become an adolescent addiction specialist.  

And Lisa Manning is dedicating her life to fighting addiction. She’s forming a nonprofit organization, Mission Recovery, that will provide treatment services to addicted minors. She’s also spoken at schools, churches, and to community groups in Georgia and surrounding states about the dangers of fentanyl and warned that it could be hidden in any illicitly obtained drug.

She tries to reassure herself that she did all she could to try to save her son. And she hopes that other parents don’t have to go through what her family has had to endure over the past few years. 

“I feel that Dustin is behind this effort, he’s watching over us,” she says, “and I want people to know that this stuff is in everything. It’s Russian roulette. You’re risking your life trying drugs once.”

His death has spurred his family to take action. Dustin’s older sister, Danielle, is a junior at the University of Georgia. She’s now studying to become an adolescent addiction specialist.

And Lisa Manning is dedicating her life to fighting addiction. She’s forming a nonprofit organization, Mission Recovery. It will provide treatment services to addicted minors. She’s also spoken at schools, churches, and to community groups in Georgia and surrounding states about the dangers of fentanyl and warned that it could be hidden in any illicitly obtained drug. 

She tries to reassure herself that she did all she could to try to save her son. And she hopes that other parents don’t have to go through what her family has had to endure over the past few years.

“I feel that Dustin is behind this effort, he’s watching over us,” she says, “and I want people to know that this stuff is in everything. It’s Russian roulette. You’re risking your life trying drugs once.”

New Subject on Campus: Opioids

How colleges in the U.S. are responding to the epidemic

Courtesy Haven

Student residents of Drexel University’s special housing for recovering addicts

Last May, four students at Johns Hopkins University in Baltimore were hospitalized after overdosing on opioids. Furman University in South Carolina lost a student the day before his graduation last spring when he overdosed on fentanyl. Around the same time, a sophomore at the University of North Carolina at Chapel Hill was found dead in his bedroom. In his system were traces of the opioids he had tried desperately to kick.

Because of these and other incidents, states have urged colleges to take action. New York and Colorado are earmarking millions of dollars to their public colleges for prevention education and research. Maryland now requires colleges and universities to offer arriving students a drug-prevention class on the risks of opioid use, and New Jersey last year announced a $1 million increase for “recovery dorms”—living areas that cater to students battling substance abuse—on public campuses in the state.

It’s not uncommon for stores near universities to stock free overdose reversal kits of naloxone, a drug that blocks the effects of opioids. And many schools now provide overdose-prevention training sessions for residence hall assistants, campus police officers, and health care workers.

There is little data on the extent of the problem among college students. But a 2016 national survey by the University of Michigan found that 7 percent of college students said they had misused opioid painkillers.

Colleges are struggling to help people like Julie Linneman, a sophomore at Villanova University in Pennsylvania. She got her first prescription pills in high school from the boy with the locker next to hers. In college, she moved on to cheaper heroin.

After a stint at a rehab center, she’s continuing her education and relying on support from other recovering student addicts in the Philadelphia area, who gather at the Haven at Drexel, Drexel University’s housing for students in recovery. “Sometimes,” Linneman says, “you just need to be around other students who know what you have gone through.”

Kyle Spencer