House of Hope
Battling the Devastation of America's Opioid Crisis
When Brayleigh was born on Jan. 10, 2018, in Lawrence, Massachusetts, her body was completely rigid. Her tiny head didn't tilt backwards, her arms could hardly move and her chin was cramped against her breast. She emitted high-pitched, shrill cries. Her tiny body was in the throes of withdrawal.
The first few days in this world were an ordeal for this baby girl. The doctors gave her morphine to stop the shakes and her mother would cradle the naked newborn against her skin to soothe her. Brayleigh remained in intensive care for three weeks -- because she had spent several months ingesting heroin through her umbilical cord.
Since then, over a year has passed, and on a recent day in February, Brayleigh is playing in the living room of a white rambler in Salem, New Hampshire. Now she's a cheerful girl with pigtails.
"What did I do to her back then?" says Jenn Mosher, the mother of little Brayleigh. Jenn, 34, is sitting on a couch in the living room, a shy woman with long blonde hair who knows precisely how it feels to go through withdrawal. With tears in her eyes, she recalls the first few days after her daughter's birth: "I massaged her body to relax her muscles," she says. Even today, she's still afraid that Brayleigh might develop behavioral problems in the future.
Roughly every 15 minutes, a baby is born in the United States with withdrawal symptoms -- and the number of newborns with "neonatal abstinence syndrome" has increased fivefold within a decade. This is one of the most appalling consequences of the opioid epidemic that is wreaking havoc across the country. Over 11 million people abuse prescription painkillers, and some 8.7 million children in the U.S. have at least one parent who is addicted.
Toys are strewn on the living room floor next to Brayleigh and surrounding her in the living room and kitchen are five men and women, chatting and joking. Here in the hinterlands, they've found refuge from the latest American drug crisis. Dozens of former addicts go in and out of the house in Salem on a regular basis, including many mothers and their children. The O'Learys' home is their shelter.
Lydia and Jim O'Leary grew up in this small town. The young couple has four children of their own, and over the past 15 years this family's Christian faith has moved them to take in roughly 150 people in need -- essentially doing what they can to take up some of the slack left by a government that has failed for years to get the problem under control.
Viewed from a distance, this exceptional project appears to be set in the heart of an intact and orderly world. Stately trees line the streets of this quiet Salem neighborhood and SUVs are parked in the driveways of single-story homes. But New Hampshire -- this sparsely populated state with its bucolic woods and lakes -- is, along with Ohio and West Virginia, one of the epicenters of the opioid crisis.
A Vast Calamity
It's been nearly 20 years since this devastating drug epidemic erupted in America. Around the turn of the millennium, pharmaceutical companies began to inundate the market with painkillers that initially appeared harmless, with doctors prescribing them following dental treatments and to alleviate back pain. The opioid OxyContin, marketed by Purdue Pharma, was especially popular and praised as a miracle panacea. In reality, though, its molecular structure resembles that of heroin.
The calamity that the pharmaceutical company has unleashed upon the country is vast, and cities, municipalities and states have filed myriad lawsuits against both the pharmaceutical companies that produce the drugs and the retailers, like Walmart, that sell them. OxyContin maker Purdue is reportedly even considering filing for bankruptcy in a bid to escape the looming legal proceedings against it. There are already some 2,000 lawsuits that have been filed against companies like Purdue, and the first trial is scheduled to begin in May in Oklahoma.
For decades, pharmaceutical companies in the U.S. virtually had a free hand with their aggressive advertising campaigns. Up until a few years ago, doctors in so-called "pill mills" would issue large quantities of prescriptions for Oxys in exchange for cash. A flourishing black market developed on the streets, where one pill would cost about $80. Pain pill addiction, though, was an expensive habit, so many pain-pill patients switched to heroin, which cost just $10 per dose.
The crisis has become worse and worse in recent years and -- following the initial surge in prescriptions and the secondary diversion to heroin -- experts are now warning of a third wave: The market is now dominated by the highly potent synthetic opioid fentanyl, which is up to 50 times more potent than heroin. A tragic record was set in 2017, with over 70,000 people dying of overdoses in the U.S., outstripping fatalities from car accidents or gunshot wounds. Roughly 2.1 million Americans are addicted to opioids, and millions of children are growing up in broken homes. And because the government has failed to effectively combat the problem, private initiatives like the O'Learys' home have become vital.
"How can we love people in our community best?" That's the question that they asked themselves at the start of their adventure, says Lydia O'Leary in her house in Salem as she pulls a loaf of banana bread out of the oven for her guests. She and her 42-year-old husband, Jim, who works as a plumber, dedicate their time and money almost exclusively to combating the opioid crisis in their neighborhood.
"We All Yearn for Beauty"
Lydia O'Leary, 37, studied music and sociology at college, but now she's primarily a homemaker. She's a warm-hearted woman clad in jeans and a cardigan sweater, her hair dyed eggplant-purple. Her own four children, who she home-schools, are bustling around the kitchen. The O'Learys' project began in the early 2000s, when Lydia's brother ran into trouble after their parents' divorce. His sister took him in, and he was soon followed by others who needed help: a family that lived in a van, a homeless girl and a recently divorced man. Instead of asking a lot of questions, the O'Learys rolled up their sleeves and got to work.
"Anyone can fall prey to addiction," says O'Leary. "We all yearn for beauty, a sense of purpose and unconditional love. Some seek fulfillment in a relationship, in a job, others in children or even in drugs." She says that as long as someone fails to recognize that they're complete within themselves, they'll always be plagued by a sense of emptiness in their lives. "God," says O'Leary, "loves everyone."
Jenn Mosher, Brayleigh's mother, is sitting on the couch and nodding timidly. Sometimes, she says, she has a hard time believing the kind of life that she used to lead.
Mosher grew up in New Hampshire. "There wasn't much going on here, except for my parents fighting all the time," she says. She drank heavily to forget her problems until she got pregnant the first time and gave birth to a boy by caesarean section. "After the operation, I could barely walk. Every step was torture." Her doctor prescribed the painkiller Percocet. Mosher didn't think anything of it, exhausted as she was because of the baby. "With the pills, though, I felt like supermom."
She became addicted and began buying pills on the street. When she couldn't get a hold of any pain pills one day, she met a friend who was shooting heroin, so she gave it a try. "It was awesome," she says. Mosher soon left her son with her mother and moved into a car with her friend. They started begging on roadsides and spent their days shooting up.
It wasn't until she was in her fourth month that she realized she was pregnant again. She was distraught. "I don't want it!", she screamed. She thought about having an abortion, and even considered suicide. But then she decided to keep it and made a new cardboard sign for panhandling: "Seven months pregnant. In a terrible situation. Everything helps! God bless you."
Nobody helped Jenn Mosher until a friend of the O'Learys' pulled her off the streets. Had she been less fortunate, her child might have ended up in an institution. In many states, children are still separated from their addicted mothers and placed in the care of foster parents or in homes. A number of doctors, researchers and social workers are warning of a damaged generation that will need massive support.
Barry Lester, a researcher at the prestigious Brown Center for the Study of Children at Risk in Providence, Rhode Island, is unsure what's most damaging for the children -- the withdrawal symptoms themselves or the trauma from how society treats them. The first large-scale study of children with neonatal abstinence syndrome has only been underway since 2014 and no results are yet forthcoming.
Lester recalls the 1990s, when crack cocaine was the drug of choice and the addicts were often black. "There were horror stories about heart defects and brain damage," he says. At the time, he launched a 16-year longitudinal study of 1,400 children of cocaine users. He says that the babies were damaged not only by the drugs, but also because they were taken away from their mothers. It could turn out to be a similar story this time around. According to the New York Times, in 24 states and in the nation's capital women can be prosecuted for using illegal substances during pregnancy.
But when it comes to treating addicted mothers, the government's approach is much less hands-on. In the state of New Hampshire, where the O'Learys live, it takes up to 60 days after birth before a child and family social worker visits the mother and her infant, and after four meetings the case is generally closed. Sometimes this leads to accidents, with intoxicated parents who no longer receive help occasionally smothering their infants or forgetting to feed them.
In Boston, 55 kilometers from the house in Salem, a man who is intimately familiar with the crisis met with DER SPIEGEL for an interview in a conference room of the Grayken Center for Addiction. Until 2017, Michael Botticelli served as the director of the Obama administration's Office of National Drug Control Policy.
A Safe Place and a Job
Botticelli says pharmaceutical companies in the U.S. were allowed to market their drugs in a "truly inappropriate way." One of his colleagues collaborated on a new Harvard study that shows that the more often doctors received gifts and other incentives from pharmaceutical representatives, the more opioids they prescribed. He adds that politicians have been excessively influenced "in exchange for sympathetic legislation."
In his position as the nation's drugs czar under Obama, Botticelli campaigned for addicts to be given access to treatment. Under the Affordable Care Act, commonly known as Obamacare, addiction treatment is listed as one of the 10 essential health benefits, something Botticelli is proud of. Drug addicts who live in a state that has implemented Obamacare now have an easier time getting healthy again, though far from everyone benefits from such services.
What does he think of the Trump administration's response to the crisis? "Largely inefficient," says Botticelli and his voice starts to quake with emotion. "He says he favors treatments, but at the same time he wants to appeal Obamacare," Botticelli points out, adding that the president proposed slashing the budget of his former drug agency by 95 percent. "You can't say that you support treatment and then act like that."
After his election, Trump pledged to allocate funding to combat the crisis. Speaking in Washington on Oct. 26, 2017, he declared the opioid epidemic a national public health emergency. "Such beautiful, beautiful babies," Trump lamented as he referred to the growing ranks of America's opioid orphans. But not much has happened.
The funds that Trump earmarked for fighting the opioid epidemic had mostly already been allocated under the Obama administration, says Botticelli, adding that the drug crisis doesn't appear to be a priority for Trump. Botticelli is afraid that Trump's drug policy will take no steps toward getting to the roots of the crisis. The president has called for the death penalty for smugglers and dealers, but he doesn't care much about ways of reducing the demand in the country through prevention and sustainable rehab programs.
"The opioid crisis emerged over a period of 15 to 20 years. It's not going to disappear overnight," Botticelli says. During his travels through the U.S. as part of the Obama administration, he would ask people: "What do you feel is the biggest barrier to your recovery?" The answer was often: "A safe place to live and a job."
At 6 p.m. on a recent Friday evening in Salem, around 30 men, women and children are streaming into the house, their arms loaded with bowls of salad and hot dogs. It's no different from every Friday when the O'Learys invite everyone to drop by for a religious service. Lydia O'Leary has set up chairs in the living room while she takes a seat at the keyboard and sings as the visitors praise Jesus with raised arms or listen quietly. These evening gatherings are an opportunity for everyone to share their personal drug stories. There are tales of men who were so high that they beat others within an inch of their lives or sped their cars through people's front yards. And there is a story of a woman who sold her body for drugs.
Among the praying adults, a five-year-old boy named Michael is playing on the floor. He has short brown hair, blue eyes, and somehow looks a bit older than his age. A big and strong boy, Michael can hardly sit still and has a hard time channeling his energy. Sometimes he'll snatch toys away from other children before running wildly around the room bumping into things.
His mother, Melissa Small, 27, stands up, a blue-eyed woman with freckles and hair tied up in a ponytail. These days she works in a beauty parlor. She silently passes around her smartphone, which displays photos of an emaciated woman living in a makeshift shelter of plastic tarps next to some railroad tracks in New Hampshire. She's the woman in the photos. As an adolescent, Small suffered from a spinal curvature and took the painkiller hydrocodone. Years later, she tells the group, she met her boyfriend and they both became addicted to heroin, shooting two grams a day, even when she was pregnant. "I thought the child would die anyway."
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"But Michael is perfect," she says, adding "though maybe a little hyper." Later that evening, though, Small disciplines him because he refuses to settle down and they head home early. She's giving O'Leary a big goodbye hug when Michael breaks loose once again. "Jesus loves you," the boys proudly says to the praying visitors.
With the help of the O'Learys, Melissa Small has made a stable life for herself. When the pregnant Small and her boyfriend rang the doorbell of the house in Salem in 2013, the O'Learys had no idea that they were bringing the opioid crisis into their home for the first time. "I thought they were a couple of homeless people. I knew nothing about opioids," says O'Leary, as she tells Small's story the next day. The couple moved in. "We noticed that they often fell asleep during a conversation and their speech was strangely slurred." Before long, money was missing from the church collection.
The Next Step
It was only when Michael's birth was approaching that she admitted her addiction. O'Leary drove her to a methadone clinic and the child was born shortly thereafter. While O'Leary would massage the baby's stiff arms at night, Small struggled with her addiction in her room -- and one day she slipped away and simply abandoned her child. "That was our introduction to the opioid crisis," O'Leary says dryly.
Roughly a dozen mothers -- some with their children, some without -- have lived in her home since then. They all go through the same program: "First, they hand over their smartphones. Then I tell them: You're going to follow me now with everything that I do. You're going to learn what a normal life looks like. We'll go to bed at a normal time, and we'll get up at a normal time. We'll talk about positive things, and you're going to work on your problems." She drives everyone to their therapy, says O'Leary. The main thing is to promote physical, emotional and spiritual healing, so she creates experiences for her guests. When somebody in the house has a birthday, the others rush to their bedside and sing. When somebody gets off methadone, O'Leary drives everyone to the seaside.
Jenn Mosher, the mother of Brayleigh, is thinking about the next step. She is feeling more stable and the others in the house constantly praise her for the wonderful way she interacts with her daughter.
Her dream now is to live with her two children in an apartment and look after them. In a few weeks, she's going to apply for an internship at a hospital. Afterwards, her 12-year-old son wants to move in with her -- the same boy that Mosher left with her mother in another state when she was an addict.
The O'Learys have invited the boy to stay at their house in Salem as an initial step. Here they'll have a safe environment to slowly learn what it's like to be a family.
Translated from the German by Paul Cohen