The Killer in Your Medicine Cabinet
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The Killer in Your Medicine Cabinet

A frequently prescribed painkiller found its way into the hands of two teen boys in a small California town. One night they went to sleep and never woke up. How could this have happened? And could it happen to your family?

A Parent's Nightmare

Homecoming was shaping up to be a lively event at Lassen High School, in the northeastern California town of Susanville, in Lassen County. On Friday, September 22, 2006, Alan Hoffman, 15, a lanky, handsome kid with dark hair, an irresistible grin, and a passion for skateboarding, attended the football game to cheer on the school's team, the Grizzlies. His redheaded little brother, Zach, 14, was there, too, as was his mother, Brenda Hoffman, 45, an administrative assistant at Lassen Community College. The family's father, Rod Hoffman, 41, a tow truck-company manager, was at home. Alan's 16th birthday was just two weeks away, and Rod was secretly trying to track down a used Acura, a gift he knew his son would love.

When Alan and Zach were toddlers the Hoffmans had moved from the suburban sprawl of Southern California's San Bernardino County to Susanville, population about 17,000. A former logging town, it had a quaint main street and picturesque surrounding countryside. This one-time trail stop for settlers heading to the Sacramento Valley was rich historically, though not economically. In 2004 the median family income of Lassen County was around $43,000, compared with $55,000 for California as a whole. The Hoffmans hadn't sought riches, though; they wanted a friendly town where their boys could play safely in the park and ride bicycles, far from San Bernardino's burgeoning gangs. To Brenda, life in Susanville was close to idyllic.

Between whoops as Lassen trounced the visiting team, Brenda talked to Rod via cell phone. He thought he'd found the perfect car, and they made plans to check it out the following weekend. Meanwhile, Alan socialized with his friends and Zach. When a streaker ran in front of the crowd, Alan yelled in mock outrage: "In front of my mother?" "It made me laugh," remembers Brenda.

After the game Alan went to the homecoming dance but used his cell phone to check in frequently with Brenda. The family rule was, wherever he went, he stayed in touch. Toward midnight on Friday Brenda drove down the hill from the family's log cabin-style house to the school to pick up Zach, Alan, and Alan's friend Stephen Draxler, 17, who sang in the school choir, was a valued member of the wrestling team, and played guitar. Zach went to his room while Alan grabbed some snacks, kissed Brenda goodnight, and told her he loved her. Then he and Stephen disappeared to the separate bunkhouse bedroom Alan had helped Rod build the previous summer.

At 11 a.m. the next day Zach was at a friend's and Rod was at work when Brenda returned home from a hair appointment. She looked in on Alan and Stephen, who were still in bed. Like most teens, Alan often slept late on weekends. "I figured they'd been up all night playing video games," says Brenda. She went shopping and returned around 5:30 p.m. to find the bunkhouse still silent. "Wake 'em, or they'll be up late again," she told Rod and Zach, who were also arriving home.

Hearing Rod cry out, she hurried to the bunkhouse. The two boys lay motionless. "We were yelling 'wake up! wake up! " recalls Brenda .Rod says he shouted, "Call 911!" but Brenda was shaking so hard she couldn't punch in the numbers. Zach had to make the call. Within minutes a fire truck arrived, followed by police cars and ambulances. Staffers who'd arrived at the house from the coroner's office pronounced the boys dead, estimating time of death as early Saturday morning -- hours before Brenda had looked in on them. Brenda screamed, "I want my son back!"

Who or what could have hurt the boys? The answer would send Susanville into shock and spur the town into action. It would also turn Brenda into an activist.

Mysterious Deaths

On Saturday evening no one yet knew what had killed Alan and Stephen. Detectives from the Susanville Police Department, Ryan Hibbs and Rodd Joseph, spent hours searching the bunkhouse as well as the Hoffmans' main house. "There were no signs of foul play, a struggle, or forced entry," says Hibbs, noting that Alan and Stephen were both unknown to local law enforcement. "There weren't any plastic bags with residue, medications, pills, pill bottles, or alcohol. There wasn't anything at the scene that would have led us to believe the deaths were drug-related.

The Hoffmans were not surprised. When Alan had been caught smoking pot at 14, Brenda and Rod had grounded him for three months. After that Brenda didn't take any chances. She routinely searched his room, even looking inside board games and shaking out tennis shoes. "Why don't you trust me?" Alan had complained. "I do trust you," Brenda always replied. "But I love you so much that I'm going to check up on you anyway." She never found any drugs.

It was about 8:30 p.m. Saturday by the time Alan and Stephen were zipped into black body bags so they could be taken to the medical examiner's office. An autopsy would be necessary to determine the cause of death. "God made a mistake when He said it was Alan's time to go," says Rod. "I don't want to lose faith, but I don't understand why He had to take my little boy. Alan was so high on life." Brenda didn't sleep that night. "We were in shock," she says.

Early Sunday morning kids began appearing at the Hoffmans' house, their car windows painted RIP. Says Zach, who felt many did not comprehend the finality of the boys' deaths: "I think most were hoping Alan would appear and say, 'What's up, guys?' But that never happened."

The first boy to arrive, a friend of Alan's, had already contacted police to tell them what he now told Brenda: Flipping open his cell phone, he showed her the kind of souvenir photographs that some kids nowadays take of their activities -- legal and not. These photos were of large white tablets scored into four sections: methadone pills that the boy said a teenage girl from another high school had either sold or given away at the game. Other kids showed Brenda photos they'd also snapped of the discs, about the size of two stacked quarters. The youngsters claimed that the girl had obtained the drugs from a teen boy, Brenda says.

It eventually became clear that Alan and Stephen, who may or may not have known what the drug was or what its effect might be, had taken some amount of it at the game, fallen asleep Saturday night and not awakened. They may have been told that the pills can create feelings of euphoria, but likely didn't know that, in higher dosages, they can also cause extreme drowsiness, an irregular heartbeat, suppression of the part of the brain that maintains breathing -- and even death.

Brenda says she had warned Alan about cocaine, marijuana, and heroin but never thought to mention methadone. Like many parents, she believed it was a liquid dispensed at clinics to help heroin addicts stay clean. She didn't know that starting in the late 1990s it began to be prescribed in pill form to relieve discomforts ranging from the ache of arthritis to the severe pain of cancer. Annual amounts of methadone sold to pharmacies for filling prescriptions jumped from nearly 400,000 grams per year in 1997 to nearly 5 million in 2005, says the Drug Enforcement Administration.

Stephen's mother, Deborah Draxler, and her former companion, Dave Wilson, both Susanville residents, had also cautioned Stephen about drugs. Wilson, a carpenter, was a big part of the boy's life, he says, adding that he had been present at Stephen's birth and considered himself his dad. "Stephen had grand expectations," says Wilson. "He should not have died from a pill in the middle of the night."

Later that Sunday Alan and Stephen's friends organized an impromptu memorial service at the local skateboard park. Teens wore T-shirts printed with the likenesses of their dead friends, and Zach and Rod spoke.

When Ignorance Kills

Susanville teens didn't own up to just the Hoffmans about the methadone. They also phoned the police department to tell officers about the pills that had been handed out at the football game. Since some tablets were likely still circulating, Hibbs, Joseph, and Police Chief Jeff Atkinson called in frightened kids for questioning and eventually determined that about twenty 40-milligram pills had been distributed on Friday. Some had been consumed, but a few were unaccounted for.

"Very candid" is how Hibbs describes most of the teens he questioned that weekend and during a visit to Lassen High School on Monday. "We reassured them that our main concern was accounting for the whereabouts of all the pills and getting hold of them -- not bringing charges," Hibbs says. "That said, had anyone lied to us, charges would have been brought."

The authorities cannot reveal information about the juveniles involved in this case. It appears, however, that a teenage boy stole the legally prescribed pills from his ailing grandmother and gave them to the girl, who seems to have then handed them out, perhaps selling some for $1 or $2 each. On Tuesday Detectives Joseph and Hibbs arrested the two teens. Because there was no proof at that point that methadone was the cause of death, they were charged with furnishing a controlled substance and placed in a juvenile detention facility.

The boy's grandmother has not been prosecuted in this matter. "She had every legal right to possess the pills," says Lassen County District Attorney Robert M. Burns. "If she had furnished them, that would totally change the picture."

Three months later, in December, results of the toxicology report confirmed that Alan and Stephen had died of acute methadone intoxication. There was no alcohol or other drugs in their systems. As a result of the police investigation, Hibbs estimates that each boy took two to three 40-milligram tablets. Since new users are often given starting doses as low as 2.5 milligrams, according to manufacturer Roxane Laboratories, that means Stephen and Alan may have consumed as much as 48 times the recommended amount. Methadone has a relatively mild effect, and Hibbs says the two boys probably took repeated doses to try to produce a more intense reaction. The medication built up and led to their deaths.

Looking back at the way the boys' overdoses occurred, Rod reiterates the opinions of some experts on teen drug use, who note that kids don't recognize the danger of abusing other people's prescriptions or of taking random doses or combinations of pharmaceuticals. "Kids think that if a pill is prescribed by a doctor, it's safe," says Rod.

"A cloud of depression hung over the town for months," recalls Letha Martin, chief probation officer for Lassen County, who works regularly with teens and whose department aided the police in tracking down the pills. "We found hundreds of kids who admitted to stealing methadone, other painkillers, and tranquilizers from relatives at one time or another." Generally, the youngsters admitted to taking from half a pill to a whole one.

Alan's and Stephen's deaths made some teens cautious. After attending a skate park memorial, a boy who had sipped wine there dropped by Martin's office, complaining of light-headedness. "We took him to the hospital, where he tested positive for methadone," says Martin, who surmises that "somebody laced the wine." Whether this was the case has not been proven.

A Town Grieves

Instead of planning Alan's 16th birthday party, Brenda and Rod, in a daze of disbelief, were planning his funeral. They also worried that Zach, who'd gone to school the Monday after the tragedy, was too stoic. "I needed to go because a lot of people were struggling," says Zach, who has a sweet face and dimples. "It helped them to see me not crying."

Responds Brenda, "He thinks he has to be strong. He says, 'I'm not going to cry.' I say, 'It's okay to cry.' He lost a very important part of his life."

In the days following Alan's funeral his friends kept arriving in the Hoffmans' yard. "They would talk or just sit out there. If we had to go to town, we would put out an ice chest with sodas," Brenda says.

Rod marveled at Brenda's ability to communicate with the teens and also found the visits therapeutic. "Otherwise I'd have been sitting on my bed staring into space," he says. Nevertheless he agonizes over what he might have done differently. Should he have kept the family in Southern California? "You don't know," he says, spreading his hands helplessly. "You do the best you can. Which we did."

Crusaders Are Born

Christine Boyd's son, Lane Morrow, then 17, knew Alan and Stephen from school. Although Boyd, then 38, didn't know the Hoffmans or Deborah Draxler, she drove Lane to the first skate park memorial and wept with the other mourners. Boyd is a correctional officer at High Desert State Prison, one of two correctional facilities near Susanville that have provided jobs in the area. She was saddened to see prisoners whose lives had been ruined by drugs and wanted an explanation for this terrible tragedy in a town where she, like the Hoffmans, had moved in part to protect her son.

Several days after the funeral, as Boyd researched methadone on the Internet, NOPE Task Force popped up. NOPE is an acronym for Narcotic Overdose Prevention & Education, a nonprofit organization of government agencies, community leaders and parents headquartered in Palm Beach, Florida, where the group originated. Boyd e-mailed and spoke with the group's executive director, Karen H. Perry, and decided to start a local chapter.

Boyd reached out to law enforcement and schools, and in October, about 30 people showed up for a meeting. Brenda, who was present, jumped on board and spoke at succeeding meetings, despite her anguish. "Every time I think about what I'm going to say, I relive every moment of that night," she says. "But education is empowerment. We teach them about sex, driving, alcohol. Now we must also say, 'Prescription drugs can kill you.'"

Over the next months donations came in to NOPE of Lassen County from the Susanville Indian Rancheria Tribal Business Council, local Rotary clubs, correctional officers' groups, and others. At a meeting in March Brenda sat onstage with Zach, who squeezed her hand. She spoke of the rush of unconditional love she'd experienced when Alan was born and the profound pain she and Rod felt over his death. Later Zach told her, "You made me cry."

At the next NOPE event, in May, Zach braved the crowd himself, telling the audience how hard it was to be one of the pallbearers who carried Alan to his grave. Hearing Zach touched his father's heart. "Seeing him up there was one of the proudest moments of my life," Rod says.

The hours Rod spent driving on his job after Alan's death gave him time to think, he says, and to cry. He has since moved to a store-management job, which means less time alone. "A lot of parents say, 'It wouldn't happen to my kid,'" he says. "I was one of them."

Early this year the boy who stole the methadone and the girl who distributed it were convicted in juvenile court on charges of involuntary manslaughter, furnishing methadone, and conspiracy to furnish the drug. Because of the teens' ages, the authorities are unable to comment further.

On Alan's birthday in October 2006, his friends took balloons to his grave. For his 2007 birthday they left a skateboard. In March 2007 the Hoffmans filed a wrongful-death claim; doing so gave them the right to pursue a lawsuit against the Lassen Union School District for failing to provide protection and supervision to Alan and other students at the football game. The school rejected the claim, and at press time the Hoffmans were considering proceeding with the suit.

"It's not about the money," says Brenda. "We want the school to watch over the students more carefully by, for example, having more personnel present at events."

One Friday night shortly after Alan died, Brenda noticed the quiet in the house. "I thought, 'This is crazy, because Alan wouldn't be here anyway. He'd be at the football game,'" she recalls. "But you know what? It's a different quiet." Then there's the pain that wells up unexpectedly. "Certain songs. The sound of a skateboard. 'Hey, Mom, watch me do this trick.' That's not something I'll hear him say again. Everything changes. But his room is just like it was. I go there and I can still smell him."

Methadone Death Tally

A growing number of accidental deaths are being attributed to methadone. The Department of Justice's National Drug Intelligence Center reports that between 1999 and 2004 the number of poisoning deaths to which methadone contributed annually nearly quintupled, from 786 to 3,849. By 2004, says the Centers for Disease Control and Prevention (CDC), the largest increase in methadone deaths was in the 15 to 24 age group, which experienced an elevenfold rise since 1999.

"Methadone stays in your blood a long time, longer than the painkilling effects," explains Leonard Paulozzi, MD, MPH, a medical epidemiologist for the CDC. "If you take too much or overlap the doses, you can have a fatal effect."

Hospitals are on the front line of this crisis. According to the Drug Abuse Warning Network, a national agency that monitors drug deaths and drug-related emergency room visits, of 598,542 ER visits in 2005 that involved nonmedical use of prescription and over-the-counter drugs, 41,216 were for methadone ingestion.

Bruce Goldberger, PhD, a forensic toxicologist for the state of Florida, whose lab helps investigate the causes of death for many cases each year, believes that methadone-related fatalities are underreported and even these numbers may be low. Methadone is "one of our [lab's] top drug findings," he says.

Protect Your Children Now

In early 2007 the White House announced that some teens are increasingly turning to prescription drugs to get high. For example, youngsters may abuse pain relievers such as methadone, oxycodone, and hydrocodone that they obtain or steal from relatives and friends. Government and parents' groups are figuring out how to stem this tide. Here's what you need to know:

Parent education. You are your kids' best defense against abuse of all drugs -- legal and illegal. According to a 2007 press release from the Office of National Drug Control Policy, teens who reported lower illicit drug use also claimed their parents monitored their behavior. Check out www.theantidrug.com, the Web site of the White House Office of National Drug Control Policy, where you'll learn which drugs are likely to harm your child, as well as how to recognize illicit drug use, communicate with your child about the dangers, and get help if you need it.

Warnings. In 2006 the FDA alerted healthcare providers to deaths and life-threatening side effects in those taking methadone. At the request of the White House Drug Policy Office, during February and March 2008 pharmacies nationwide distributed warnings about commonly abused prescriptions, including painkillers, tranquilizers, and sedatives.

Safety at home. If you have prescription medicines that are likely to be misused, inspect or count them regularly and consider storing them in a secure spot where another person cannot easily access them.

Random checks. The White House has announced new grants to be made available for drug testing in schools. Parents can go to www.whitehousedrugpolicy.gov for the publication "What You Need to Know About Starting a Student Drug-Testing Program."

Formulation changes. Some people who abuse prescription painkillers crush and dissolve the pills so they can inject them, says Dr. Paulozzi of the CDC. He suggests that such drugs be reformulated to include substances that block the active ingredients when the tablets are altered in this fashion and injected.

For advice on talking to your teen about drinking and drugs, visit www.lhj.com/teentalk.

 

Originally published in Ladies' Home Journal, May 2008.

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