Opinion: With fentanyl, addiction struggles become Russian roulette – Des Moines Register

Third in an occasional series
Mary O’Keefe and her son Michael tooled around England, Scotland and Ireland in 2019 for 3½ weeks, a bucket list trip for the 31-year-old. To add historical context to their daytime explorations, Michael would knock on O’Keefe’s hotel room door at night, laptop in hand, so they could watch the British series “Downton Abbey” together.
Michael loved history and clearly had creative ways of engaging with it. A voracious reader and state debate champion, he was smart and full of curiosity, but equally interested in fishing and camping, and capable of quirky, humorous banter with strangers. The only child of a now-37-year marriage, Michael got plenty of attention and amply showed his gratitude, according to O’Keefe.
Even though she and Michael had been seeing each other daily since he joined her in a business venture in 2018, he’d still bring a bouquet of flowers. And though she had retired as chief marketing officer for Principal Financial Group, and his job was to fill the orders for the skin care product company she’d bought, he’d put his humor toward marketing The Happy Cow Udder Balm at out-of-state trade shows.
 “Do you use our product?” he’d ask people, and when they’d answer no, he’d come back with, “Oh, I heard you say, ‘Not yet!’”
He had it all. But he was also addicted to drugs.
On his birthday, Nov. 1, 2019, three weeks after the trip to Europe, O’Keefe was unable to reach Michael and went to the house he owned in Beaverdale. There she found him unresponsive and called police. The subsequent autopsy found heroin and fentanyl in his system. Fentanyl poisoning had caused his death.
It’s coming up on three years, but the grieving O’Keefe, a 2014 Iowa Women’s Hall of Fame inductee for being“as comfortable at high corporate board meetings, as she is in rolling up her sleeves and working with young people,”has avoided sharing much about Michael’s illness. It didn’t help that a detective she first interacted with after his death was condescending and judgmental, seeming to suggest that that’s what you get with addicts.
So when people ask how Michael died, sometimes she says from fentanyl and other times she says by accident. Both are true, but neither is the whole story. She knows this much: He didn’t set out to die.  They had gone for a walk together the day before and he was fine. She has since learned how fentanyl is being mixed in with drugs sold on the street, so buying them that way, even if they’re labeled as prescription drugs, can become a game of Russian roulette. “There’s no way to know what you’re taking is fatal,” she says. “This is killing our beautiful, smart, talented young people.”
Michael first smoked pot at 18 and got into harder drugs during college, but he later sought and got residential treatment for his addiction. He went to a Hazelden Betty Ford center in Minnesota, “did well for a year and a half, then relapsed,” his mother says. “In this world of addiction, there will be multiple relapses.”
He also attended regular counseling sessions, and O’Keefe and her husband, Jeff, went through family treatment programs with him. Michael had attention deficit disorder, which O’Keefe has learned is a risk factor for addiction. He was disorganized and could be stubborn, and his parents discovered that in high school, though he’d walk into class with completed homework in hand, he might not turn it in. He also suffered from arthritis and migraines.
But the biggest lesson O’Keefe has learned is the lethal power of fentanyl, a synthetic opioid originally used in medically prescribed painkillers. It can be cut into different powders and sold as prescription drugs such as Adderall or Percocet, or illegal ones like heroin. Once global manufacturers got wise to its profit-making possibilities, they started sending it here by mail from China, and later moving it across the southern border from Mexican through drug cartels. Distributors can buy it for a few thousand dollars, then mix or package it, and sell it for millions.
More:Rekha Basu: A mother’s failed struggle to save her son prompts her to push more open talk about addiction
More:Rekha Basu: A record 470 Iowans died of overdoses last year. Some Iowans helped keep the drugs coming.
The first significant wave of fentanyl deaths was in 2017 and 2018; they have escalated at an alarming rate. Iowa Public Safety Commissioner Steven Bayens has said that the Iowa Division of Criminal Investigation’s crime lab analyzed 17,163 fentanyl pills disguised as prescription drugs in 2021. But in the first six months of this year the DCI crime labs examined 70,556 fentanyl pills. A majority were disguised as prescription drugs.
Brooke Anderson lives in Shelby County in western Iowa and doesn’t know O’Keefe. But she’s also a mother who lost a son to the abundance of fentanyl in Iowa. She even uses the same analogy as O’Keefe, about the Russian roulette game it represents.
Anderson contacted me while I was working on this piece. Her son, 23-year-old Devin Anderson, was found unresponsive this Feb. 24 in the family home by his 14-year-old brother while Anderson was taking another son to a wrestling workout.  Devin was known for his contagious laughter, his kindness, sense of humor and smile, she says.
But despite all his friendships, his solid earnings doing construction work, his love of the Hawkeyes, the Dallas Cowboys and “escape room” adventures with friends, Anderson said he was a bit of a “lost soul” at times. So when she found out last year that he had a drug problem, she made him move back home from his own place and took him under her wing. He admitted he struggled at times with anxiety and sleeplessness. She got him to see a psychiatrist, and it seemed he was doing well again.
Devin had confided in her that he was getting Percocet pills from a friend, but it didn’t alarm her much because she assumed it was gotten by prescription. After his death, “I found out these were not prescription pills but M-30s, blue pills sold on the streets by dealers, that have fentanyl in them.” In fact, the pill that killed him didn’t even have Percocet in it. And because his tolerance was low from not using any drugs for six months, his body probably couldn’t survive it.
For that reason, “a lot of people who have accidentally overdosed or been poisoned by fentanyl have just relapsed and have a low tolerance, or are using a the drug for the first time and have no idea fentanyl is in it,” she said.
Five Iowans ranging in age from 19 to 28 were arrested in late June on federal indictments for conspiracy to distribute fentanyl, after an investigation into overdoses, including Devin’s, in Cass and Shelby counties. Three people related to the case subsequently pleaded guilty to conspiracy to distribute a controlled substance, one of them on state charges, and three are scheduled for trial Nov. 7.
Anderson would like to see the dealers responsible for providing drugs that resulted in deaths face homicide charges, but Iowa law doesn’t provide for that.
Another set of Iowa parents, Deric and Kathy Kidd, are mourning their son Sebastian, who died of fentanyl poisoning in July 2021. He too thought he was taking Percocet. It took just half a pill to kill him.
“He was deceived to death by whoever sold him that counterfeit pill,” Deric Kidd said at a news conference with Gov. Kim Reynolds in July. He listed physical and emotional trauma, depression, anxiety pain from surgeries and peer pressure as among the reasons young people are seeking those opioids.
Nationally, synthetic-opioid-related deaths other than methadone, primarily fentanyl, rose to 56,516 in 2020, according to the U.S. Centers for Disease Control and Prevention.
“If some illness was killing our kids at the rate this is, people would be really up in arms,” says O’Keefe. She wants to see it addressed by making it unprofitable, quipping, “Killing your customers isn’t a long-term strategy.”
Noting that only a fraction of cars and trucks coming in from the southern border are scanned and searched for illegal drugs, she wants to see such safeguards increased. She also wants fentanyl test strips legalized that can detect the presence of fentanyl in pills, powder or injectables. 
And she’s calling for greater funding of treatment programs for drug addiction and mental health so that addicts don’t have to be arrested and jailed before they can get help. If arrest are made, she says the first step should be to mandate treatment. “It will bring them back to themselves a bit. … Get them into programs that tell them it’s changing their brain. Kids don’t believe that. They can’t see around the corner.”
Those are all reasonable measures that state and federal elected officials should be advocating. Many more beds also need to be available for that time when, as O’Keefe says, someone’s child “is ready and saying, ‘I’m tired of living like this.’“
O’Keefe says she has spoken to many parents about the risks but she wants to reach children before they ever get involved with substances, contending that programs offered in sixth grade aren’t early enough. In fact she’s ready to go into schools and talk to children herself. Among other things, she’d tell them, “Don’t do this. You don’t always think what the outcome is. You’re not thinking about your mom.”
For any school that would like to have her come speak, her email address is: maryform75@gmail.com.
Michael’s 4-year-old German Shepherd, Nox, is now his mother’s, and goes to work with her every day. Asked how she gets through a bad day — which is generally every day — without her son, she said, “I talk to his dog. I’ve gotten counseling. I walk. There’s no fix to outliving you child.”
This isn’t the same world many of us came of age in, in which even if you were just playing around with drugs for fun, you generally knew what you were getting. With fentanyl in the mix, and half a pill sold under the wrong name capable of instantly killing someone, all bets are off.
Please, talk to your own kids and help spread awareness about fentanyl, especially to those who might be vulnerable. These stories underscore the risk of not knowing enough about what’s at stake.
“It’s a lonely, lonely path for the parent, and losing a child to this is so isolating and sad,” said O’Keefe, succumbing to tears. “I just miss my beautiful son.”

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