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FATAL COMBINATION | FENTANYL, PANDEMIC DRIVE OVERDOSE DEATHS

'Completely overwhelmed': Fentanyl, pandemic fuel record opioid overdose deaths

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Margaret with Aidan's shoes and coat

Margaret Sweet keeps her son Aidan's shoes and coat in her home on Madison's West Side. Aidan Sweet, a 17-year-old West High School student, died in August 2020 from an overdose involving fentanyl, a dangerous opioid. COVID-19 isolation and an increased presence of fentanyl in other drugs have spurred record opioid overdoses in Wisconsin.

As a student at West High School in Madison, Aidan Sweet started buying opioid pills on the street, saying they calmed his anxiety and helped him sleep, his parents said.

Aidan Sweet

Sweet

When the COVID-19 pandemic began in March 2020, he met with a behavioral health therapist, but the sessions were online.

Amid the isolation from shutdowns and stress related to family and the violent death of a friend, the 17-year-old “was trying to find ways to numb the pain,” said his father, Jim Sweet, and he continued using.

“The world turned upside down,” his mother, Margaret Sweet, added.

On Aug. 21, 2020, Aidan died of an accidental overdose involving the dangerous opioid fentanyl.

Lily photo and mementos

Mementos from Lily Kolb's life are displayed in the home of her mother, Lorre Kolb, on Madison's East Side. 

COVID-19’s disruption of regular life and an increased presence of fentanyl in other types of illicit drugs, often with users not knowing, have spurred record levels of fatal opioid overdoses around the country, including in Wisconsin, officials say. The state had 1,227 opioid overdose deaths in 2020, 32% more than in any previous year. The preliminary total for 2021, as of Tuesday, was 1,237, a figure that may grow.

Wisconsin’s rate of opioid overdose deaths is highest among people ages 18 to 44, more than twice as high among men than women and nearly double the state average among Black people and Native Americans.

Wisconsin’s effort to control the problem — from addressing health disparities and reducing the risk of overdoses to expanding addiction treatment and supporting recovery — is being enhanced by the first proceeds this year of the state’s $420 million in opioid settlement funds expected over 18 years.

A new state Department of Health Services plan calls for beefing up substance abuse education in schools, improving overdose activity alerts to warn the public of increased risk and making the overdose-reversal drug naloxone, or Narcan, more widely available, among other steps. The state also plans to boost distribution of newly legalized fentanyl test strips to help users identify the deadly opioid frequently found in other drugs, including heroin, cocaine, methamphetamine, other types of opioid pills and even marijuana.

Snapshot of Margaret and Aidan

Margaret Sweet said her son Aidan liked to tell jokes. "He was such a people pleaser," she said.

“Investments are needed across the continuum of care in order for Wisconsin to reduce the dangers of opioids and their impact on our communities,” Paul Krupski, opioid initiatives director for the state health department, said in a statement after the agency held a dozen listening sessions early this year.

Addiction experts welcome the renewed push to curb the opioid overdose epidemic, but say the complex crisis has been neglected during the pandemic, making it even more difficult to overcome.

“Our services are completely overwhelmed by the need,” said Skye Boughman, clinical supervisor for outpatient treatment at Arc Community Services in Madison, which provides addiction treatment for low-income women. “We know that people are dying on waiting lists.”

Aidan with Jim

Jim Sweet, a football coach at West High School, coached his son Aidan. 

Fentanyl “is in just about everything, but people think they’re taking something else,” said Dr. Ritu Bhatnagar, co-medical director of NewStart, UnityPoint Health-Meriter’s addiction treatment program in Madison. Even a small amount of fentanyl “will suppress their respiratory drive and be lethal,” she said.

Fentanyl and other synthetic opioids, involved in 86% of Wisconsin’s opioid overdose deaths in 2020 and 90% in 2021, make addiction treatment more challenging, said Kevin Florek, CEO of Tellurian Behavioral Health in Monona. During detox, people using fentanyl tend to have worse symptoms, such as stomach pain, and comfort medications don’t work as well, Florek said.

The presence of fentanyl in so many overdoses is not surprising. It is up to 50 times stronger than heroin and 100 times stronger than morphine.

“It’s more addictive, and it’s even more difficult to get through the withdrawal process,” Florek said.

Recovery coaches

Among numerous efforts to address opioid overdoses in the Madison area is a recovery coach program at Safe Communities Madison and Dane County. With more than $500,000 in county funding this year, 18 recovery coaches support people who have survived overdoses or otherwise want help, with focuses on emergency room patients, pregnant women, people in or leaving jail and marginalized groups.

Wisconsin opioid overdose death rates by county

Since October 2020, peer support specialists from the nonprofit have been embedded at UW Health clinics in DeForest and Monona, helping patients being treated by doctors for addiction, said Tanya Kraege, recovery coach manager.

Safe Communities also helps lead the Ending Deaths from Despair Coalition, announced in May 2021 by Dane County Executive Joe Parisi. The group aims to reduce suicides and overdoses through efforts such as directing people to the county’s Behavioral Health Resource Center, which opened in November 2020.

Dane County had 1,173 emergency medical services calls for suspected opioid overdoses in 2020 and 1,200 last year, up from 966 in 2019, according to Eric Anderson, a data analyst with Dane County Emergency Management.

In response to the increase in opioid calls, Fitch-Rona EMS ambulances in May 2021 started carrying Narcan kits that include information on seeking treatment. Medics leave the kits with loved ones or roommates of people who overdose from opioids, in a program patterned after one in Baltimore, said Jeff Dostalek, deputy chief of the agency that serves Fitchburg and Verona.

Margaret with framed photos

After her son died from an overdose involving fentanyl, Margaret Sweet set up the Aidan Sweet Isintu Foundation to help other parents and children wrestling with substance abuse. "It's a terrible crisis," she said.

“If we have to go back 15 times to the same house to give 15 boxes of Narcan, I don’t care, because that’s 16 times somebody might call and get help,” Dostalek said.

Test strips

Public Health Madison and Dane County provides clean syringes and collects used ones at two syringe services sites, formerly known as needle exchanges, to reduce the risk of infectious diseases among injection drug users.

Workers at the sites also hand out Narcan and fentanyl test strips to reduce the risk of overdoses, and encourage clients to seek treatment, said Julia Olsen, a supervisor for the city-county health department. The need is increasing, she said.

“Things have gotten worse for (people with drug addiction) while we were all-hands-on-deck for the pandemic,” Olsen said.

Fentanyl test strips didn’t become legal in Wisconsin until March, when a new law clarified they aren’t drug paraphernalia. Since 2019, however, Vivent Health has been distributing them at its 10 offices around the state, with approval.

The single-use strips of paper can be dipped into water containing a small sample from a pill, powder or injectable drug. Within minutes, lines on the strips show the presence or absence of fentanyl. The goal is to help drug users make informed decisions.

Vivent, a four-state organization formerly known locally as the AIDS Resource Center of Wisconsin, handed out 46,000 of the strips last year, including nearly 4,000 from its Madison office. Among the 10% of recipients who reported results, nearly 60% said they used drugs with a friend — instead of alone — after drugs tested positive for fentanyl, which can help reduce overdoses. More than half said they used a smaller amount than planned. In Madison, 67% of drugs testing positive for fentanyl were identified as heroin, and 33% were cocaine.

Lorre profile

Lorre Kolb said her daughter, Lily, who died from an overdose involving fentanyl in April 2021, had made an appointment with her doctor to start addiction treatment the next day. "When someone's willing to do treatment, it needs to be immediate," she said.

Legalizing the strips is encouraging more people to use them, said Kristen Grimes, Vivent’s director of prevention services.

“The people we serve do not want to die,” Grimes said. “They want to use safer strategies to reduce their risk of an overdose.”

Treatment clinics

In September 2020, just as the first major peak of COVID-19 transmission began, Dr. Michael Repplinger opened Monarch Health, an addiction treatment clinic in Downtown Madison.

An emergency room doctor at UW Hospital who also works at ERs in Darlington and Portage, Repplinger said he was prescribing initial doses of the addiction treatment medication buprenorphine, or Suboxone, to ER patients who had overdosed to help them avoid withdrawal and cravings. But he said he couldn’t find clinics to send them to for follow-up care.

Lorre with Lily's artwork

Lorre Kolb displays her late daughter Lily's paintings in her home. Lily wanted to be a tattoo artist.

So he opened Monarch, which treats about 120 patients a week with Suboxone or naltrexone, also known as Vivitrol, another addiction treatment medication. The clinic also provides counseling to help people become sober.

Nearly all of the patients are on Medicaid, many are jobless or homeless, and some are in and out of jail, Repplinger said.

“Trying to get them to prioritize addiction care above some of these other issues, rightfully so, is difficult,” he said. “But there’s clearly a need.”

Dr. Christopher Harkin also sees growing demand at Addiction Services and Pharmacotherapy, which he and another doctor opened on Madison’s South Side in 2018. It’s one of four methadone clinics in the city and 24 in Wisconsin. They mostly provide methadone, the first medication approved for addiction treatment, along with counseling.

Lorre with Lily photo album

Lily Kolb attended East High School and Horizon High School, for students in recovery from substance abuse disorders.

Methadone clinics, also called opioid treatment programs, are tightly regulated, which includes a limit of 50 patients per counselor. The cap will be raised to 55 in October, but Harkin said he wishes it would go even higher so he could enroll more patients.

“The biggest issue is access,” he said.

Restoring Roots

In April, the Dane County Sheriff’s Office started letting jail inmates continue taking buprenorphine if they were already on it. The jail had already provided Vivitrol injections for inmates who had gone through withdrawal. Sheriff Kalvin Barrett said he wants to expand the buprenorphine program to inmates with addiction who haven’t started the medication once a long-delayed jail expansion and renovation is done.

Many addiction patients try inpatient treatment, or rehab, which typically lasts 28 days, but that’s not long enough for some people, said Julia Schwab, president of Restoring Roots in Middleton. The nonprofit aims to build a 50-unit recovery housing complex in the Madison area to provide longer-term support, including for people leaving inpatient treatment.

Dane County has several sober living houses, including four places listed on a new state registry, which operate on a smaller scale than what Restoring Roots envisions. With $500,000 in last year’s county budget, the nonprofit aims to invest $13 million to $15 million to set up a staffed facility to serve up to 70 clients at a time, Schwab said.

“A person suffering with addiction needs time for the brain to heal,” said Charles Tubbs, a board member of Restoring Roots, director of Dane County Emergency Management and former chief of the Wisconsin State Capitol Police. “They need love, understanding and compassion, as well as people holding them accountable.”

Tubbs has personal insight on the topic. He lost his son, Charles Jr., also known as CJ, of Madison, to an overdose of fentanyl and marijuana in May 2019. Like many people wrestling with addiction, CJ, 32, was frequently in jail and didn’t get treatment soon enough, his father said.

“We all know that jail is not going to solve this problem,” Tubbs said.

Lorre with scarf

A scarf made by Lily Kolb is among the artwork kept by her mother, Lorre. Lily died at 20 from an overdose involving fentanyl in April 2021.

A day too late

Lorre Kolb remembers when her teenage daughter, Lily, told her she had overdosed on heroin and been revived by Narcan. Soon, Lily showed Kolb how to use Narcan so she could rescue her if she overdosed again.

“It was really a kick in the gut,” said Kolb, who retired last year as a public information specialist for UW-Extension. “It’s not a world I ever thought I would live in.”

Lily Kolb

Kolb

In March 2021, Lily, who had been living in a car with her boyfriend, moved back in with Kolb in Madison. On that March 29, a Monday, she set up an appointment with her doctor to start addiction treatment that Friday. But the day before the appointment, she died from an overdose of meth and fentanyl, according to her death certificate.

Lily, 20, had given birth to a son the year before. The boy is in foster care.

Kolb wonders if the outcome might have been different if Lily could have started treatment the day she called. “We need places where, when someone says they want to try to get sober, we can take them there right then,” she said.

Liliana "Lily" Kolb died at the age of 20 from an overdose involving fentanyl on April 1, 2021, just before she was to start treatment. Her mother, Lorre Kolb, recalls her daughter's struggles with addiction.

Lily started using marijuana around eighth grade and likely tried other drugs before turning to heroin about a year before she died, Kolb said. A painter who wanted to be a tattoo artist, Lily was loving but often felt unlovable, her mom said.

“She would make you prove every day that you loved her,” she said.

Kolb adopted Lily at age 5 after taking her in through foster care at age 3. Her biological parents struggled with substance abuse.

Despite the challenges, Kolb cherishes the time they had together. “She was such a gift,” she said.

Lorre with urn and mementos

Lorre Kolb, beside mementos of her daughter Lily and an urn containing her remains, said she was a "very complex person" who struggled with substance abuse and trying to feel loved.

Turning to pills

Aidan Sweet started using marijuana in middle school and later bought Percocet, or oxycodone, pills on the street, his parents said.

His father, who coached Aidan and other students in football at West, points to the August 2019 homicide of Shay Watson in Fitchburg as a trigger for opioid abuse in Aidan and others. Myjee T. Sanders, who was 15 at the time he shot and killed the 17-year-old Watson during a marijuana robbery, was sentenced last year to 20 years in prison.

Young Aidan photos

Aidan Sweet, who went to St. James School and Toki and Cherokee Heights middle schools, traveled to more than 20 countries, including to South Africa, his mother's native country.

The death of Watson, who played football at Verona High School, hit friends around the Madison area hard, said Jim Sweet, a UW-Madison history professor. “Their immediate move was to go to pills,” he said.

After his parents divorced in 2018, Aidan lived with his mother, Margaret Sweet, a Delta Air Lines customer service representative at the Dane County Regional Airport. In the fall of 2019, when she found marijuana in Aidan’s car, she took his car away and cut off his phone, hoping the moves would deter substance use.

The family, including Aidan’s older sister, went to group therapy, which helped address Aidan’s anxiety and depression, his parents said. But as 2020 began, his substance abuse increased, his father said. By the time the Sweets believed Aidan needed inpatient treatment, they said COVID-19 had shut that option down.

Margaret on stairs

Margaret Sweet said she didn't know her son Aidan was using opioid pills until June 2020, when she found some in his bedroom. Two months later, he died from an overdose involving fentanyl.

Online sessions seemed to help. But in June 2020, Margaret found empty Percocet packets on the floor of Aidan’s bedroom. He said they helped him sleep.

They found a new therapist whom Aidan seemed to like. One day in August, however, he didn’t show up for an appointment. The next morning, his mother found him slumped over on his bed, dead from an overdose of fentanyl and marijuana, according to his death certificate.

Margaret Sweet, originally from South Africa, started the Aidan Sweet Isintu Foundation, incorporating the Zulu word for “humanity.” The nonprofit helps parents and children who struggle with substance abuse, offering free rides to treatment.

She said people need to talk more about substance abuse, especially with fentanyl killing so many people like her son.

“People are so afraid to talk about it because of the stigma,” she said. “But if you talk about it, you could save someone’s life.”

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