I spent a large part of my academic career at a medical school, where I developed a consulting service at a Level-I trauma center with a county mission to care for patients who are indigent, homeless, and have mental illnesses. My work often involved helping patients with serious addictions.
Doing this work,Doing this work, I just assumed that my children would know what was going on with fentanyl and street drugs, particularly painkillers. The issue so saturated the media I assumed that, were I to bring the topic up with my sons, I would get an eye roll and a sigh.
In July 2022, I received a call from my 26-year-old son’s boss. My beloved son, Billy, was a successful construction manager and was living his dream, working on a major waterfront project in Seattle. His boss apologized for calling but said that, in four years of work, Billy had not only never missed a day of work, but he had also never been a minute late.
I sent a close friend to check on him and was on the phone when he discovered that Billy had not woken up from the night before when he had apparently taken a counterfeit M-30 pain pill that was spiked with fentanyl. He was dead.
Billy had lived with me for a year prior to his death after he broke up with a girlfriend. We found a house for him, and he was launched into his new life. He had been in the new house for three months when we lost him. For the year that Bill lived with me, I never saw any evidence of illegal drug use. I also never saw him intoxicated, but it would have been ridiculous of me to assume that he did not drink a lot at times; he just never did in my presence. There were no warnings of drug or alcohol problems in the year before he died. Early in his career, he was drug tested and would, in fact, become responsible for testing employees on his work sites.
The day Billy died, his mom, two brothers, and I came to an instant, unsaid agreement: We would use his death to prevent further fentanyl deaths in any way possible. This included what we published in his obituary, what was said at his memorial, featuring him in the Seattle newspaper with an article on “The Faces of Fentanyl,” and this piece for Psychology Today.
How do you talk to teenagers and adult children about this terrible societal risk that is only getting worse? Having had the darkest year imaginable, I am able to invoke what we have learned from motivational interviewing and harm reduction in psychology. Motivational interviewing (MI) involves the science of behavior change that is largely based on addictions. MI advises us not to confront, lecture, or shame people involved in destructive behaviors. It involves engaging in dialogue that provides useful information about the advantages and disadvantages of certain behaviors.
Harm reduction operates on the assumption that, with some addictive behaviors, if we are not able to change them instantly, then it is better to take a route that minimizes the harm such addictions will create.
With these psychological principles in mind, I will end with a letter that I published in the Seattle Times:
“If I somehow could talk to my son now, I would tell him that he was playing roulette with any drugs he gets on the street; most of them contain fentanyl. I would also tell him that if he sees friends who want to defy an early death and need to use street drugs, then they should at least test the drugs for fentanyl, never use them alone, and always have Narcan available. I never considered telling any of this to my son because I assumed he had read the papers or watched the news; I thought it would be obvious to him what a terrible risk it is to get drugs off the dark web or street. Apparently, I got that wrong.”
Sadly, I opted not to risk a sigh or an eye roll and communicate this to my son. Now, as his mother says, we will never see our beautiful child again.
References
Blume, A. W. (2012). Seeking the middle way: G. Alan Marlatt and harm reduction. Addiction Research & Theory, 20(3), 218–226. https://doi.org/10.3109/16066359.2012.657281
Motivational Interviewing: Helping People Change, 3rd Edition WR Miller and S Rollnick, Guilford Press, 2012