The questions never stop going through Colleen Ronnei’s mind. Where did she and her husband go wrong in raising their son Luke? What could they have done differently? Did some decision they made — maybe something that seemed inconsequential — cost him his life?
Ronnei’s son, Luke, died in January 2016 of a heroin overdose. He was 20.
His life didn’t end in a dark urban alley or a rat-infested drug house. When he died, Luke Ronnei was a college student at home for winter break in Chanhassen, a well-to-do Minneapolis suburb. “He was a great kid,” Ronnei said. “People would never, ever have imagined that for him.”
A Changing Opioid Epidemic
Heroin use among young people ages 18 to 25, though still relatively rare, has doubled over the last 10 years, according to the Centers for Disease Control and Prevention (CDC). Overall, its use has increased the most among groups not historically known for abusing it: women, the upper middle class and those with private insurance.
Overdose deaths for all opioids, prescription and illicit, have more than quadrupled since 1999. And there has been an explosion in deaths from fentanyl, a synthetic opioid often added to heroin without its buyers’ knowledge.
Jim Johnson, director of the state office of drug control policy in West Virginia, said that law enforcement used to see just a small cross-section of society addicted to opioids. That has changed.
“It’s now ‘us,’” he said. “What we’re looking at now is the 18-year-old kid who had his wisdom teeth taken out, the 28-year-old mother who used to go jog five miles every morning and had a moderate knee sprain, the laborer who hurt his back and got hooked on these opioids.”
In fact, almost half of all opioid deaths today involve a prescription opioid, according to the CDC. And according to a 2013 study, about three out of four new heroin users report abusing prescription opioids before using heroin. African Americans are less likely to make that transition, because they have historically been prescribed fewer painkillers.
A Trip to the Oral Surgeon
When he was a junior in high school, Luke Ronnei had his impacted wisdom teeth removed. He left the oral surgeon’s office with a prescription for a 30-day supply of the opioid Vicodin, a combination of acetaminophen (Tylenol) and hydrocodone. After the surgery, Luke developed dry sockets, an extremely painful condition that his oral surgeon believed warranted another four to five weeks of Vicodin, his mother said.
“I was kind of like, is this really necessary?” Colleen Ronnei, 55, recalled. She believes that was the beginning of her son’s eventual path to heroin.
“If we had had any sense of how much that was rewiring his brain, we would have never allowed that,” she noted.
Like many high school students, Luke was already a pot smoker. He believed it helped his depression and anxiety. But during his senior year, he was arrested for buying marijuana.
The lawyer his parents hired advised them to put Luke into treatment. Otherwise, the judge would not go easy on him, and the criminal charge could remain on his record forever, the lawyer said. Luke’s psychiatrist, on the other hand, told them unequivocally: Don’t do it.
“You send that kid to treatment, and with his personality, he’ll make friends with every kid in that room,” Ronnei said the psychiatrist warned. “And he will come out far worse.”
A Powerful — and Deceptive — Marketing Campaign
The changes in the landscape of opioid addiction nationwide began in the 1990s. Among the catalysts: In 1996, Purdue Pharma introduced OxyContin, a time-release form of the powerful opioid oxycodone. The company promoted it aggressively, not only for the acute pain of cancer or end-of-life palliative care, but for more chronic pain like back pain, arthritis or fibromyalgia, according to an Oct. 30 article in The New Yorker.
“Purdue had conducted no clinical studies on how addictive or prone to abuse the drug might be,” the article said. “But the FDA [Food and Drug Administration], in an unusual step, approved a package insert for OxyContin which announced that the drug was safer than rival painkillers, because the patented delayed-absorption mechanism ‘is believed to reduce the abuse liability.’”
Unlike other prescription opioids, however, the oxycodone in OxyContin was not mixed with aspirin (as in Percodan) or Tylenol (as in Percocet). Oxycodone was the sole active ingredient, The New Yorker noted. It didn’t take long for people to learn they could defeat the time-release aspect by crushing the tablets into powder they could snort, or dissolving them in liquid they could inject, the magazine said. That way, users experienced the drug’s effects in one powerful — and potentially deadly — jolt.
“Nearly two decades ago, we were encouraged to be more aggressive about treating pain [with opioids], often without enough training and support to do so safely,” said then-U.S. Surgeon General Vivek H. Murthy in an August 2016 letter to fellow health care professionals. “The results have been devastating.”
Purdue, along with three of its executives, pleaded guilty in federal court in 2007 to charges that it misled regulators, doctors and patients about OxyContin’s addiction risk, The New York Times reported. It continues to face lawsuits from states and cities, including New Jersey and Alaska as of Oct. 31, The Wall Street Journal reported. Other opioid manufacturers have been the subject of legal action as well.
The Ease of Access of Opioids
Even teens and young adults who are not prescribed opioids can get hooked by raiding the medicine cabinet at their parents’ house, or Grandma’s or the home of a friend. Others get opioids from classmates who offer to sell a few pills.
Depending on various factors, including a history of addiction in the family, a person can become addicted after only a few uses, according to the National Institute on Drug Abuse.
Addiction to prescription opioids often then leads to the use of illicit drugs like heroin, which are much cheaper and easier to obtain.
“On the black market, a pain medication like oxycodone is a dollar a milligram,” and a person with an addiction might need 180 mg a day, said Dr. Joseph Lee, medical director for youth services at the Hazelden Betty Ford Foundation.
When Luke Ronnei attended treatment after his marijuana arrest, he was the only person there for pot use. The other 13 young people in the group had come straight from inpatient heroin treatment, his mother said. A few months later, Luke was talking with one of the young men he befriended there. The man, who said he was in recovery from heroin, told Luke he had a THC-based drug that would provide a great high. (THC is the active ingredient in marijuana.)
It was actually black tar heroin, something Luke had not seen before. Its caramel color was unfamiliar to him, his mother said.
“So he went back to his dorm room and he said to his roommate, ’You gotta smoke this stuff, this stuff is crazy!’ and his roommate was like, ’Dude, that’s heroin,’” Ronnei said.
By Christmas of his freshman year, Luke was addicted, his mother said.
The Search for Treatments
David Rosenbloom, professor of public health at the Boston University School of Public Health, said there are effective treatments for opioid disorders. But they too often go unused.
“I think this is particularly important for parents of kids who may be getting into trouble with opioids,” he said. “The parents are desperately looking for treatment outside the normal medical system, because the normal medical system is not yet prepared to treat kids appropriately with medications and support.”
One treatment is Suboxone, a drug that works to lessen the cravings for opioids and treat brutal withdrawal symptoms.
But Suboxone has been subjected to restrictions that have made it hard for doctors to treat patients with it, Rosenbloom said. For example: physicians must complete an eight-hour training program before using Suboxone with patients. And some insurers have made its use subject to prior authorization.
“In my view, [training] ought to be a required part of every residency training program in pediatrics,” Rosenbloom said. “And parents really need to know that these medications are out there, and know that if they’ve got a kid who’s getting in trouble with opioids, that ought to be the first line of defense.”
Another drug is naloxone, or Vivitrol, but “there has been scant science to prove the drug’s efficacy,” The New York Times wrote on June 11.
Signs of Hope — Then Tragedy
Luke Ronnei tried both treatments, his mother said. With Suboxone, Colleen Ronnei said, they felt that Luke was “back.” They could start thinking about his future again.
He transferred to a different college for sophomore year. Things seemed to be going well. Over winter break, Luke joined a group of friends on a trip to Australia and had the time of his life.
He returned to Minneapolis on Jan. 6, 2016. That night, Luke went out with two friends, one of whom showed up again later at the house. Colleen Ronnei had a bad feeling.
“I said, ‘I know something’s not OK, Luke. I can tell.’ He said, “Mom, I love you, I’m OK, everything’s gonna be OK.’”
The next morning, when his parents went to wake him for a doctor’s appointment, Luke wasn’t breathing. Paramedics could not revive him.
What to Look For
Experts said parents can help prevent abuse by keeping opioids out of medicine cabinets. Don’t hang on to leftover pills for a rainy day.
Signs of heroin use, according to Ronnei, may include Q-tips without the cotton, stray pieces of cotton, small orange syringe caps, bits of balloon, pieces of wax paper or plastic wrap, or water bottle caps. Young people may hide things inside socks. They may tuck needles into the inner band of a baseball cap.
Teens are prone to mood swings and emotional outbursts, so it may be difficult to determine what certain behaviors indicate. But pay attention to the following potential signs of addiction, the Hazelden Betty Ford Foundation said:
- increased secrecy
- suspicious-sounding excuses or lying
- difficulty thinking or concentrating
- increased lateness or absences
- paranoia, irritability, anxiety, fidgeting
- mood changes
- significant weight loss or gain
- loss of interest in usual activities
- decline in school performance
- changes in friend group
Colleen Ronnei said she never imagined her son would get involved with heroin. He was well-educated, and they had talked about the many risks.
“No matter what you think you know about your kid, they may make choices that they don’t even know they’re making,” she said.
It’s not the “super-sketchy” kids who are using these dangerous drugs, she said. “It’s your kids.”