The occupants of apartment No. 99 were well-known to neighbors, if not by name, then by loud music and late-night parties.
One such gathering at Camelot Village Apartments in Salem lasted well into the morning of May 13. The calm that finally settled over the building was short-lived.
Around noon, a panicked teenager called 911.
When Capt. Craig Bryant of the Salem Rescue Squad arrived a few minutes later, he found Joseph “Joey” Lawrence in an upstairs bedroom, lying sideways across a mattress on the floor.
The 18-year-old was not breathing, Bryant said. His heart had stopped, and his face had the bluish-gray tint of death.
On a nearby desktop, police found half of a narcotic wafer that was originally the size of a quarter.
Lawrence died that day from an overdose of methadone – a drug that can ease the pain of wrenched backs when prescribed by doctors, relieve the cravings of opioid addicts when dispensed by treatment clinics, and kill with deceptive power when abused by a growing number of people who, like the ones who gathered in apartment No. 99 on a spring night, were just looking for another way to get high.
Last year, Lawrence was one of 85 people in Western Virginia to die from a methadone overdose.
‘We’ve got an epidemic here’
The per-capita rate of fatal methadone overdoses in Western Virginia is at least twice the rate for New York City, according to figures from the state crime lab in Roanoke.
Deaths from the prescription drug, developed during World War II as an alternative to morphine, have increased by 600 percent in the past five years. As alarming as the methadone death count of 85 is, fatal overdoses from other prescription drugs have also been rising sharply, said Dr. William Massello of the state medical examiner’s office for Western Virginia.
Last year, there were 213 drug deaths in the western half of the state.
“My God, that’s three-and-a-half times what we used to have just eight years ago,” Massello said. “We’ve got an epidemic here, and it doesn’t seem to be going away.”
Fatal overdoses were up last year in four categories of opium-based prescription drugs:
– Eighty-five involved methadone, which is used by physicians as a painkiller and by treatment centers to get addicts off other opioids such as OxyContin and heroin.
– Forty-seven involved hydrocodone, a less-potent analgesic that is the active ingredient in Lortab and Vicodan.
– Forty-four involved oxycodone, an opium derivative found in OxyContin and Percocet.
– Twenty-one involved fentanyl, a painkiller that is administered in patches similar to a nicotine patch.
‘The issue is addiction’
Of all the drugs abused in the Roanoke Valley, methadone is perhaps the most controversial – and not just because it has caused so many deaths.
A proposed methadone clinic in Northwest Roanoke has generated widespread opposition from residents who fear it will bring crime to their neighborhood. A similar proposal in Southwest Roanoke County was withdrawn in the face of ardent community resistance.
Although the clinics dole out methadone under tight security, long-term patients are given take-home doses so they don’t have to visit the clinic every day.
Opponents worry that methadone will be sold on the street. However, virtually all of the methadone abuse and overdoses involve the pill or wafer form of the drug, which is prescribed by doctors as a painkiller, and not the liquid form, which is dispensed by the clinics, according to police and medical examiners.
Dr. Molly O’Dell, director of the Alleghany Health District, said the community should be more concerned about untreated addicts in its midst than the people who show up at clinics looking for help.
“That’s ridiculous,” O’Dell said of the often-cited argument that patients of methadone clinics pose a risk to nearby schools and neighborhoods. “People who are addicted are living close to the schools already, and they are living in the neighborhoods already.
“This community’s response to this whole issue is just abominable,” she said. “Let’s face it: The issue is addiction.”
Lethal cocktails
A 49-year-old man was found dead with a syringe in his hand. A longtime addict, he was known to inject oxycodone and fentanyl, and sometimes traded his prescription medication for cocaine to supplement his drug diet. His death was ruled an accidental overdose.
A 41-year-old man, seriously injured in an automobile accident, sank into depression over his mother’s death and the failure of pain medicine to relieve his severe headaches. He died next to an empty pill bottle. His death was ruled a suicide by methadone and fentanyl.
A 34-year-old woman was found sitting up in bed, a needle in her arm. She had ripped apart a fentanyl patch and injected the liquid while placing a second patch on her arm. Her death was ruled an accidental overdose.
Those deaths are just a sampling of 23 case studies examined by toxicologists George Behonick and James Kuhlman and forensic scientist Tara Valouch of the state crime lab in Roanoke. Their study, published last year in the Journal of Analytical Toxicology, focused on abuse of fentanyl.
It also reinforced what authorities have known for some time: When the body of an overdose victim is wheeled into the lab for an autopsy, the results often show a toxic mixture of prescription medicine, street drugs and alcohol.
The problem is so bad that when Massello compiles his annual list of fatal drug overdoses, he often will list a single death under two categories of drugs if, for example, lethal amounts of cocaine and methadone are found in the victim’s bloodstream.
Abusers find as many ways to get high as they do drugs to choose from: They swallow handfuls of pills; they grind them up and snort the powder; they dissolve crushed tablets in water and inject the mix into their veins; they use adhesive tape to line their legs and arms with fentanyl patches.
They even burn the patches and inhale the smoky fumes through a straw in a practice called chasing the dragon.
A deceptively deadly drug
So why does methadone play a role in so many of the deaths?
The drug has a much longer half-life than other opioids, and can linger in a user’s system for days until it reaches a lethal level, according to Dr. Marty Wunsch, an associate professor of addiction studies at the Edward Via Virginia College of Osteopathic Medicine in Blacksburg.
In other words, someone can take methadone on Friday and Saturday and then overdose on Sunday from what he or she thought was a small dose.
And because the drug does not cause the same euphoria as other opioids, some users take too much and then die waiting to get high.
Most of the deaths are accidental. Methadone is especially dangerous with first-time and occasional users with no tolerance for the drug. Young people seem especially vulnerable. “It doesn’t take a lot to kill you,” Massello said.
Police do not believe many addicts use methadone exclusively. The drug is cheaper than brand names such as OxyContin, so some people might resort to it when times are tight. Methadone is also used sporadically by some addicts simply to avoid withdrawal symptoms while they take a break from other opioids.
Massello said he was aware of just one death in Western Virginia involving methadone from a clinic.
An isolated case?
In September 2002, a patient of the Life Center of Galax in Tazewell County died in the Russell County Jail of a methadone and cocaine overdose, according to the state agency that investigated the incident. Records of the probe were obtained by The Roanoke Times under the Virginia Freedom of Information Act.
The man, who is not identified in the records, apparently took methadone from his brother, who was also a patient at the clinic and was allowed to have a take-home dose.
A short time later, the man received his allotted dose at the clinic, and was leaving with family members when his earlier drug use was discovered. The man became disoriented, and family members who feared he was overdosing began to drive him to the hospital.
On the way, the car was stopped by a Virginia state trooper, who charged the driver with DUI and the passengers with being drunk in public. The victim was taken to the Russell County Jail, where he later died.
An investigation by the state Department of Mental Health, Mental Retardation and Substance Abuse Services determined that clinic officials did not conduct the required weekly drug tests on the man, according to the documents. The clinic’s license was renewed last month after no additional problems were reported.
The death seems an aberration; a study by the U.S. Substance Abuse and Mental Health Services Administration recently concluded that most methadone deaths nationally are not linked to treatment centers.
Deceiving the doctors
Every day, about 1,000 recovering addicts get a dose of methadone from Western Virginia’s two clinics in Galax and Tazewell County. The clinics are operated by the Life Center, which is owned by same company that has proposed a third location in Northwest Roanoke.
Virginia State Police First Sgt. Bill Purcell, who supervises investigations of prescription drug abuse, said the methadone that is being abused in the region does not seem to be coming from the clinics.
“You hear about all of the overdoses, but where are they getting it?” Purcell said.
Most of the time, he said, they get it from doctors.
By Purcell’s estimate, “99.9 percent” of physicians have no idea when the drug they prescribe falls into the wrong hands.
Some drug abusers feign ailments or injuries to get their drug of choice. Others with a legitimate medical need – or perhaps an embellished one – are not satisfied with a single prescription.
“They will go to the second, third, fourth or even 10th doctor to get the same medication,” said Landon Gibbs, who held Purcell’s job before becoming the assistant director for law enforcement liaison and education for Purdue Pharma, the company that makes OxyContin. Forged prescriptions passed at pharmacies are another problem, said Gibbs, who trains local police on the problem.
Internet drug sales are also becoming widespread, the White House announced earlier this month as it unveiled a national strategy to combat prescription drug abuse.
In some cases, federal authorities say, the doctor is the dealer.
Five physicians in far Southwest Virginia have been convicted in recent years of prescribing excessive amounts of painkillers to their drug-abusing patients.
A sixth case in Roanoke, involving Dr. Cecil Byron Knox, has been more complicated. A federal jury last year acquitted Knox of about half the charges he faced, and was unable to reach a verdict on the remaining counts. Prosecutors plan to try him a second time, although no trial date has been scheduled.
From patients to partyers
Another source that feeds the prescription drug pipeline is the medicine cabinets of law-abiding patients, who have no idea that family members are pilfering their pills.
That apparently is how Lawrence obtained the methadone that killed him. One of his friends, 15-year-old Kenneth “Jake” Shelton, has admitted selling Lawrence some methadone he took from his mother, who was prescribed the drug for back pain.
After taking the methadone back to his Salem apartment, Lawrence shared it with at least one other teen. Patrick Buckland of West Virginia survived an overdose at the apartment in May, police have said.
Last month, a judge in Salem Juvenile and Domestic Relations Court sentenced Shelton to probation on a drug distribution charge. Assistant Commonwealth’s Attorney Aaron Lavinder said Shelton’s mother had no idea her drugs were being sold.
Shelton declined through his attorney to talk about the case; his mother also declined to comment.
A son, not a statistic
The night before he died, Joey Lawrence made a promise to his father.
“He was telling me how his life had changed and how proud he was going to make me,” Darrell Lawrence wrote in a statement that was introduced in court the day Shelton was sentenced.
Although Joey Lawrence had his problems – he dropped out of Salem High School and began to experiment with drugs far stronger than marijuana – the 18-year-old did not appear to be on the downward spiral that often marks an overdose victim’s last days of life.
He was scheduled to start work the following week at McDonald’s, his father said, and was excited about getting an old car running again for the commute.
Darrell Lawrence, who said he is still too upset over his son’s death to be interviewed for this story, wrote in the statement that he talked to his son late into the night of May 12.
He got up early the next day and went to work. Around noon, a co-worker told him that fire trucks and rescue squads were parked outside his apartment. He rushed home to find rescue workers trying to revive his son and Buckland.
Both teens were taken to Lewis-Gale Medical Center in Salem. Buckland walked away; Lawrence was pronounced dead on arrival.
“This was the start of the hell I live, every second of every day,” Darrell Lawrence wrote in the statement.
“I do not feel I will ever get over this. My whole life has been changed by Joey’s death. I spend much of every day wondering what kind of man he would have become.”
Along with his written statement to Judge Philip Trompeter, Lawrence provided a photograph of his son.
“I, Darrell Lawrence, father and friend of Joseph ‘Joey’ Lawrence, desire that my son be recognized by his name and the picture enclosed,” he wrote.
“I do not want him to be remembered as a case number, a victim, or, God forbid, a drug abuser.”
Those who knew Lawrence will be able to remember him for the way he lived.
But for those at the medical examiner’s office, who determined the way he died, Lawrence was but one number in a death count that shows no signs of subsiding.