Dopesick - Beth Macy Page 0,69
up. “There’s just something so fundamentally soul-sucking about heroin,” Wolthuis said.
He said he was still “just waiting for something to fall from the sky” in the Jesse Bolstridge case. The timeline between the point of sale and his death was not airtight: Too much time elapsed between the time Jesse’s best friend, Dennis Painter, bought the heroin and the moment Jessie died, some eighteen hours later, and there were too many people with Jesse in the interim and too many other unknowns.
Metcalf and Lutz believe Dennis bought the heroin from a local user-dealer originally supplied by people in the Jones/Shaw ring, but such death cases are hard to prove in the fluid realm where most overdoses occur, and resources are limited. “We don’t have the capacity to try everyone involved in a ring of hundreds of people,” Wolthuis said. “But we do try to cut the heart out of the monster.”
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Kristi Fernandez was already scared when a homesick Jesse begged to come home for the weekend from an Asheville sober house in May 2013 against his counselor’s advice. She worried that weekend, too, when he disappeared for hours at a stretch with Dennis. She liked Dennis—and still has pictures of the two of them together playing in the sandbox at their preschool, Grasshopper Green—but she knew full well that Dennis had been in and out of drug rehab for heroin. And as far as she knew, Jesse’s problem hadn’t progressed to that.
When Jesse returned to Asheville that Sunday night, he tested positive for marijuana and, per the contract he signed when entering the program, counselors booted him out. He had loved living there, telling his Facebook friends a month earlier: “I’m grateful to have such a big support group, I love all of my family & friends. They’re the best.”
And: “So glad to be sober on this date. 93 days!”
Those same supportive counselors advised Kristi not to welcome Jesse home after his dismissal, but she took him in anyway. “I don’t regret that,” she says. “I was not going to leave my eighteen-year-old son in a different state with nowhere to live.”
And unlike Jamie Waldrop, the Roanoke mother and surgeon’s wife, Kristi could not afford to spend thousands sending her son immediately to another rehab, or flying with him to make sure the transfer stuck. Kristi had already sent Jesse to a rehab in Jacksonville once, in January 2013, a ten-week treatment regimen that began with intensive counseling and medical detox, during which Jesse briefly took buprenorphine (more commonly known by the brand name Suboxone), a partial-opioid agonist designed to stem cravings. Jesse still owed $25,000 for that earlier rehab stint, even though he was on his mother’s insurance, paying $25 a week that he had autodeducted from his checking account.
He was weaned off Suboxone after three weeks, a not-uncommon practice that would become increasingly controversial as the treatment became more prominent. As National Institute on Drug Abuse (NIDA) director Nora Volkow told me in January 2016: “To be clear, the evidence supports long-term maintenance with these medicines in the context of behavioral treatment and recovery support, not short-term detoxification programs aimed at abstinence.”
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NIDA, the Institute of Medicine, the World Health Organization, and the White House drug czar’s office would all agree that indefinite (and maybe even lifelong) maintenance treatment is superior to abstinence-based rehab for opioid-use disorder. And even Hazelden, the Betty Ford–affiliated center that originated the concept of the twenty-eight-day rehab, changed its stance on medication-assisted treatment, or MAT, offering Suboxone to some patients in 2012.
But the rehab Jesse went to was aimed at abstinence, as most were, then and now.
“The whole system needs revamped,” said Tracey Helton Mitchell, a recovering heroin user, author, and activist. “In the United States, we are very attached to our twelve-step rehabs, which are not affordable, not standardized from one place to another, and not necessarily effective” for the opioid-addicted.
Clearly, more recent data supports ongoing MAT, but there is a catch: “One of the reasons people stay so hopeless about the epidemic is that, in any given episode, they only see a small proportion of people get into remission,” Harvard researcher John Kelly told me.
“What happens is, it takes about eight years on average, after people start treatment, to get one year of sobriety…and four to five different episodes of treatment” for that sobriety to stick.
And many people simply don’t have eight years.
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After being kicked out of the sober-living house in Asheville, Jesse moved back home and took a construction job with