Both my sons died of opioid ODs

I am an anesthesiologist who administers fentanyl daily to patients. I’ve also heartbreakingly lost both of my adult sons to accidental opioid overdoses.

The typical warning signs of teen drug use are falling grades, loss of friends, or a decline in appearance. Those things never happened to my kids. My boys both excelled at sports and school and got along well with others. Each sons’ pathway into use was different and not simultaneous. What happened to each was slow and insidious. Pure evil, really.

The first signs of drug use are subtle. First, you might find a few pills either in a pocket wrapped in foil or dropped in the bathroom. They soon develop an increasing preoccupation with money, followed by missing cash. You know you took $100 out of the bank, but yet you only seem to have $60 in your wallet. They frequently go missing for extended periods of time where they are unreachable by their cellphone via calls, texts, or tracking.

Another clue is that they start falling asleep a lot. I’m not talking about sleepiness because your teen stayed up late studying. This is falling asleep eating at the dinner table or standing at the refrigerator looking for a snack. It’s called dipping out, and it becomes more exaggerated if they progress to intravenous opioids. The opioids provide a degree of muscle rigidity that holds them slightly upright, but very far tilted. Anyone sober would wake up and jerk themselves upright. An impaired person will fall ohso slowly right into their dinner plate, taking slow, deep, noisy breaths.

Start paying attention to bathroom habits. All opioids and heroin cause constipation, so if a bottle of stool softener or laxatives suddenly find their way to your kid’s bathroom, ask questions. IV drugs can cause urinary retention, and users might fall unconscious on the toilet because they can’t pass urine. They know they have to go, but they can’t, and fall asleep sitting there.

If they happen to take too much heroin or highly potent fentanyl, they are likely to be quickly unconscious and not breathing on the bathroom floor as soon as they inject. With fentanyl, this rapid suffocation can happen in as little as 90 to 120 seconds.

It’s important to question any curious items you find in your teen’s bedroom or in their belongings. Heroin is sold in postage-stamp-sized waxed paper envelopes that have an ink stamp brand from the drug dealer on the outside. The drug is typically sold in a bundle of 10 envelopes, each in tiny zip-top plastic bags, held together by colored elastic bands. Syringes used to inject drugs have bright orange plastic caps.

I would find remnants of these items in the trash bins or in odd places, but never the syringe. None of this caught my eye early on because I didn’t know what they represented. The metal teaspoons from our kitchen, which were used to heat and liquefy heroin, seemed to be dwindling, and we thought they were inadvertently being thrown in the trash. The ones left had swirls of white residue that had to be scrubbed off.

My sons’ behavior became increasingly secretive, isolated, and highly erratic. At times they would be agitated, restless, pacing, answering frequent short text messages on their cellphone, and if you looked closely their pupils were huge. They would step outside to walk the dog, and then be back inside scurrying off to be alone. This was code for “I feel sick and I’m withdrawing,” then “I just scored some drugs.” Initially, they would become exuberant, often dancing and joking like they were your new best friend.

They didn’t feel sick anymore because they were now high, their pupils small. Itching or scratching the skin is also a side effect of opioids.

Writing this all down it seems like, “HOW COULD YOU NOT KNOW!” Yes, I am yelling this. Yet, these isolated findings happened over months, years. Just before the IV usage began is when it became clear there was a problem. My boys never fit the profile of opioid user. Now, the message is clear. A heroin addict is not just a marginalized individual sitting on a street corner, but may be the popular high-school quarterback with straight A’s. The bottom line is that many things are easy to rationalize as odd adolescent behaviors.

Most teens simply can’t envision that a tainted Percocet pill that they try at a friend’s party can render them breathless, blue, and dead. Make your messages absolutely, lovingly clear.

To all the mothers who have suffered my same loss, I stand with you in grief, but also in celebration of the lives we cherished with our beloved children.

I cannot bear to remove my sons’ old voicemail messages from my phone. I still get to hear them say, “Hey mom…”