On a beautiful, sunny April day, Chanda Lynn Germain sits talking with her brother, Zack Dahlbeck, on their back porch at home in Jamestown, New York. Chanda Lynn is wearing a tough leather jacket over a light blue gingham dress that matches Zack's plaid shirt. They also share the same platinum blonde hair and piercing blue eyes.
The scene seems almost idyllic. Though they are adults now— Chanda Lynn is 23; Zack, 25—it's not hard to imagine the childhood they describe, building forts in the woods and staying up until the early morning talking. Chanda Lynn—who was the only girl on the Jamestown junior high football team—proudly recalls beating up neighbor kids who teased Zack for being chubby.
But soon the conversation has shifted from childhood memories back to pills, syringes, overdoses, and death.
For the better part of two hours, the siblings have been talking about the epidemic that has seized hold of not just their own family, but Jamestown as a whole. The one-time furniture capital of the country, which lies nestled in rolling hills and green farmlands, finds itself engaged in a losing battle against opioids.
Suddenly, a Facebook alert pops up on Chanda Lynn's phone: "Somebody just died from a heroin overdose in Jamestown," she says.
This day, Zack reacts to the news somberly. But in the past, he says, he would have greeted the news with excitement.
"If I flip back into my junkie brain, 'Oh man, someone just died from pink bags, that's got to be great shit!'" he says, speculating that this latest overdose came from heroin laced with the powerful synthetic opioid fentanyl. Different batches of heroin are often sold in distinctively colored or marked bags, and when addicts know a certain batch is powerful, they seek it out.
The Centers for Disease Control and Prevention recently declared drug overdoses to be the leading cause of death for people under 50. And places like Jamestown—small towns across the American heartland and the Rust Belt—are those hardest hit.
Jamestown has a population of about 30,000; it is 86 percent white with a growing Latino population, mostly Puerto Rican. Most of the furniture factories—an industry dating back to 1815—closed by the 1990s, and few other jobs replaced those lost. Some manufacturing jobs remain, but they generally don't pay well. More than 29 percent of residents live below the poverty line. There is a shortage of physicians and a high number of people relying on Medicaid or lacking insurance, according to a recent county report.
The opioid epidemic runs generations-deep in Chanda Lynn and Zack's family. By the time they were teenagers, the siblings' mother and grandmother were already addicted to opioid painkillers.
"It's like I'm watching him die in slow motion."
Their mother, Jamie Lynn Dahlbeck, was first prescribed painkillers in 1991 while she was pregnant with Zack, for plantar warts on her feet. "My OB/GYN said: 'It will make you feel better. Don't worry, it won't hurt the baby,'" she recalls. In the years that followed, Jamie was prescribed more and stronger painkillers to help her deal with a congenital degenerative bone disease and wrist injuries she suffered from her job at a local hardware factory. She was also prescribed Klonopin and Ativan, benzodiazepines that are used to treat anxiety and insomnia. "Benzos" and opioids taken together can often be deadly, and white women specifically have been prescribed the dangerous combination at high rates.
"They used to hand them out like candy back then," says Jamie, now 43. "I knew I was dependent but I wouldn't look at myself in the mirror and say, 'I'm a drug addict.'"
When her prescription supply was running low, Jamie turned to her teenage son for help buying prescription opioids on the street. Zack did so, and began snorting Vicodin himself. "I figured what's good for mom can't be bad for me," he says. "And it was like our secret, something exclusive between me and mom, and I didn't have the best relationship with her so that was something."
When Chanda Lynn had her tonsils out at age 16, Jamie gave her a Percocet painkiller she had obtained from her own mother—Chanda Lynn's grandmother—who had been taking painkillers for more than two decades to treat migraines. Chanda Lynn knows many people who used painkillers after surgery, or even dabbled in them recreationally, and never became addicted. That wasn't the effect they had on Chanda Lynn though: As soon as she tried them, she wanted a supply of her own. "I had found my release," she says, "my escape."
When Chanda Lynn gave birth to a son four years ago, he came into the world dependent on opioids. For Chanda Lynn, the moment served as a wake-up call. She is now clean and an anti-drug activist and rising Internet star: Her poems and articles about opioid addiction are viewed on Facebook by hundreds of thousands of people.
Meanwhile Zack had graduated from prescription painkillers to heroin, a not uncommon progression of addiction. Multiple stints in rehab in Pennsylvania, Illinois, and New York did little to get him clean.
"I got high within 24 hours of being home," he says. "Rehab wasn't this awesome spiritual experience you were hoping for. There's no halo, you don't even glow. You're disappointed and you're angry and you're resentful. So you take it out on yourself, because that's what addicts do."
Sitting on his porch, he swears he is clean and determined to stay that way without going to rehab. His sister doesn't believe him. She wants to, but she just can't.
Six weeks later, Zack overdoses on heroin. Paramedics revive him with a shot of Narcan, an overdose-reversing drug. This marked the sixth time he'd been revived through Narcan.
Chanda Lynn says this time is the last straw, she's given up trying to help her brother get off heroin.
"It's so rare that a family member can help your own family member," she says. "So it's just a matter of sitting back and having hope, and taking precautions to make sure I don't enable him."
Here, she pauses for a moment.
"It's like I'm watching him die in slow motion."
The opioid epidemic was launched in the mid-1990s with the heavy marketing and prescribing of painkillers. New York passed the I-STOP law in 2012 to address opioid abuse, which included the creation of a registry meant to prevent "doctor shopping" wherein people fill prescriptions with multiple doctors.
That law, coupled with increased scrutiny from the federal government, has made prescription opioids harder to get in Jamestown. So, as in many other towns, heroin became cheaper and easier to obtain than painkillers. Savvy drug dealers quickly recognized this market opportunity, and soon dealers from Philadelphia, Buffalo, and New York City were coming into Jamestown to sell heroin.
"I wasn't going to buy pills from Bettie Jane for $8 each anymore," Zack says. "I'd rather get a strange powder from a Puerto Rican dude who doesn't know my name."
It's not the first time dealers have flocked to Jamestown. In the 1990s a Brooklyn drug dealer named Nushawn Williams knowingly infected scores of local women with HIV by having unprotected sex with them. At the time, crack and powder cocaine were the illegal drugs of choice. Now dealers from bigger cities are plying Jamestown with heroin.
"It's supply and demand," says Robert Samuelson, commander of the Jamestown Police Department's administration and support services division. "People are coming from Buffalo, Pennsylvania, you name it."
Samuelson says the town has experienced previously unseen gun violence including drive-by shootings, as well as a spike in property crimes linked to heroin.
"We didn't see heroin coming until late 2011, and then it started showing up in possession and overdoses," he says. "In the '80s heroin was considered what junkies use, the low-lifes you never saw. Now we have businessmen overdosing."
In 2012 Jamestown formed a metropolitan drug task force focused on the heroin influx. That same year, the task force seized 119 bags of heroin. In 2013 it seized 826 bags; in 2014, it seized 5,110 bags, which equates to 18 ounces; in 2015, it seized 31.6 ounces. In 2016 police confiscated 1,100 bags, though locals say the drug was as prevalent as ever.
The task force teamed up with state and federal authorities in 2014 for its Operation Horseback drug bust, in which 47 people were indicted and $60,000 worth of heroin (and quite a few firearms) were captured. But those dealers didn't end up doing much jail time. While Samuelson refuses to consider a decriminalization approach with safe injection sites similar to those proposed by Ithaca and Seattle, he does support a larger public health approach. Since 2015 all Jamestown officers carry Narcan.
"We're not going to arrest our way out of this problem," Samuelson says.
Even though many opioid addicts have switched from painkillers to heroin as their drug of choice, Jamestown locals say black market prescription painkillers are still easy to get. There are always relatives, friends, neighbors who can lend a helping hand.
Zack describes one pill dealer, an older woman "with knick knacks and the 'Learn, Live, Laugh' wall-hanging" in her apartment: "She would ask, 'Have you eaten?' and feed you pork chops" after making a deal.
Such transactions happen mostly beyond the reach of law enforcement, and the drug task force does not keep a tally of prescription drug seizures or arrests, which usually only result in misdemeanor charges, Samuelson says.
Because Jamestown is a working-class town, built mostly on industrial jobs, many residents have suffered workplace injuries or simply the physical stress of jobs that entail repetitive motions and heavy lifting. A 2013 state assessment of health in Chautauqua County found there were 397 work-related hospitalizations for every 100,000 employed people between 2009 and 2011, compared to 171 for the state as a whole.
Among Jamestown residents middle-aged or older, it is common to rely on prescription painkillers as a way to get their bodies through the day and continue working.
On Foote Avenue in Jamestown, on a hillside just above the Chadakoin River, a historic quaint pink building houses the Chautauqua Pain Medicine Institute. Right next to it sits Family Medical Health Services, a clinic where Germain and her grandmother, Adrian Smith, were prescribed painkillers. Many residents over the years have gone to these centers for prescriptions to manage their chronic pain. Chanda Lynn and Adrian both wonder why a town of 30,000 needs two adjacent clinics offering pain medicine, which can also be prescribed by doctors at the medical center just up the hill. (Representatives at both clinics did not respond to multiple interview requests.)
It took Adrian three decades of painkiller use to realize the extent of her addiction. When her regular doctor only downplayed her fears and offered no advice on getting clean, Adrian turned to her granddaughter for help. Chanda Lynn bought Suboxone (the brand name for buprenorphine, a prescription opioid medication used to treat opioid addiction) on the street, and helped her grandmother use decreasing amounts to wean herself off painkillers without going through withdrawal.
Suboxone, methadone, and the opioid blocker Vivitrol (naltrexone) are widely considered best practices for treatment of opioid addiction. But many people have difficulty obtaining treatment with these medications, which are highly regulated and may not be covered by insurance or Medicaid. (These drugs also make it onto the black market, and stories abound of people becoming addicted to and overdosing on Suboxone and methadone; Vivitrol blocks opioid receptors and is not an opioid itself, so it does not pose that risk.)
Chanda Lynn says she was prescribed Vicodin for back pain while she was pregnant with her son. She thought the prescription was irresponsible but, already struggling with addiction, she found herself unable to stop using painkillers. "Every day I'd lay in bed and I'd pray over my stomach, Please protect him from withdrawal, please protect him from addiction," she says.
The 2013 state report showed that, from 2008 to 2010, 157 of every 100,000 babies in Chautauqua County were born with indicators of drug exposure in utero, compared to 64 out of 100,000 statewide.
Chanda Lynn says a urine test during pregnancy indicated she was abusing prescription drugs, and Child Protective Services visited the day of the birth, when her son was diagnosed as opioid-dependent through a urine test and observation. (Her son was able to become non-dependent without any major treatment, and Chanda Lynn was allowed to keep the baby.) But she says she herself was never referred to counseling or treatment.
She continued to use painkillers after giving birth. "I had to stay high so that I could take care of my son. I couldn't change his diapers or feed him if I was in the bathtub for four days in withdrawal, I couldn't detox because I had no one to take my son," she says. "I see a lot of women stuck in this situation."
Chanda Lynn finally took an opportunity to leave her son with a relative and go through detox. She's been clean ever since. Her daughter was born in February of 2016 without ever having been exposed to opioids.
Children present just one of many barriers that make it hard for people to get treatment for opioid addiction, says Rick Huber, head of the Mental Health Association of Chautauqua County (MHA), which provides peer support and treatment referrals including for county drug court participants.
Housed in a cavernous former industrial space, MHA has the welcoming feeling of a clubhouse. Group therapy and peer support groups run nearly around the clock, and participants play pool and wander in and out of huge garage doors that are left open in warm weather, next to the swift-flowing Chadakoin River where ducks swim.
MHA has the distinct feeling of a movement, with Huber acting as the leader in its crusade for awareness, harm reduction, and de-stigmatization around substance abuse and mental illness. When the county organized its first forum to discuss the opioid epidemic, Huber demanded that regular residents be allowed to testify about their experience. He prevailed, and brought in busloads of MHA members, all of them sporting tie-dyed T-shirts.
A social worker for 38 years, Huber says there have been major improvements in recent years in the approach of public officials, the availability of treatment, and the growing awareness of the general public regarding opioids. But there is much more that needs to be done, he says, especially with the epidemic still escalating. He estimates there are currently 2,500 active heroin users in Jamestown; he meets new ones almost every day.
"It's all about customer service," Huber says. "If you have a dealer's number, you can call at 2 a.m. and they'll deliver and front you money. If you want to get in treatment, you have to call between 9 and 5 Monday through Friday and then you might get an appointment three weeks later if your insurance covers it. Until treatment becomes as user-friendly as dealers, we will never be able to compete."
Andy O'Brien is in charge of chemical dependency programs at WCA, Jamestown's hospital. WCA is in the process of opening a new 20-bed long-term residential treatment facility, where people can stay for a year. It currently operates a 15-bed short-term treatment facility, and refers people to other treatment programs in the county. WCA also recently opened a program to help people stabilize during and after going through withdrawal. The program has been serving an average of six people a day, according to O'Brien—more than hospital staff had predicted.
O'Brien says that, contrary to common belief, there are usually treatment beds available in Jamestown or the county. But people don't know where to look, and they end up making countless phone calls only to be told they've called the wrong place.
"There should be no wrong door," O'Brien says. "My job is to get people help right away, to be able to say come in right now."
Insurance companies also make it difficult, with countless pre-authorization hoops to jump through and an endless maze of health-care coverage policies to navigate. But a state law now says insurance companies must reimburse at least 14 days of in-patient and residential treatment and withdrawal services including methadone and Suboxone without pre-authorization. O'Brien says that change came about as a result of coordination and pressure from health-care providers and grassroots groups.
"When you come back, the communities aren't willing or ready to accept you. So you go back to the addict community that accepts you."
The county recently launched an online dashboard where people can view available beds, rather than having to call multiple treatment centers. O'Brien says this was also a direct result of community and provider organizing. He is also hoping more outpatient treatment options can be offered, and he notes that the Affordable Care Act has made treatment accessible to more people, though this may change with the Trump administration's and Congress' attempts to dismantle the Act.
The county is also trying to prevent opioid addiction early, with educational programs about opioids starting in kindergarten in local schools. And the county provides safe disposal sites and free lockboxes for prescription medicine, to try to keep it from filtering onto the streets.
While Chanda Lynn is glad to see health-care institutions and public agencies taking action, she believes the real change must come from someplace much deeper: the way our society looks at users. Addicts are often doomed to relapse when they return to a society where they face stigma and lack of opportunity, she says.
"When you come back, the communities aren't willing or ready to accept you. There are no jobs and you have felonies so you can't get a house or a car," she says. "So you go back to the addict community that accepts you."
People from around the country contact Chanda Lynn for advice and information. She writes for the website Kill the Heroin Epidemic Nationwide, she speaks at events around the Midwest, and she's organizing a "Save Jamestown" rally for the fall. "I'm so incredibly proud of her," says her mother Jamie, who quit prescription opioids and benzos in 2010 with help from a methadone program.
Chanda Lynn has decided her addiction stemmed in part from a lack of purpose in her life, from being expected to "go work 9-5, go to the factory like my mother," with no outlet for her creativity. "I was homesick for a place I had never been, this existential longing to be somewhere else."
She recalls one memory from her childhood, which she considers the moment she realized she could actually make a concrete impact on the world. Standing on the side of the road one day, a young Chanda Lynn broke off a small tree branch and heaved it into the air. She did the same with a rock. Each time, she grew more aware, she says, of her ability to shape the planet she was born into. She says it's that same desire to leave a trace that's motivating her today. Only now it's an opioid epidemic, not a branch, she's trying to break.
"I want to be a Tasmanian devil, I want to be that tornado effect," Chanda Lynn says. "Even if it's one small ripple in western New York, that will change someone and they will change someone else, and they will change someone else."
This story was supported by the Social Justice News Nexus at the Medill School of Journalism, Media, Integrated Marketing Communications at Northwestern University.