When Jesse returned to Asheville that Sunday night, he tested positive for marijuana and, per the contract he signed when entering the program, counselors booted him out. He had loved living there, telling his Facebook friends a month earlier: “I’m grateful to have such a big support group, I love all of my family & friends. They’re the best.”
And: “So glad to be sober on this date. 93 days!”
Those same supportive counselors advised Kristi not to welcome Jesse home after his dismissal, but she took him in anyway. “I don’t regret that,” she says. “I was not going to leave my eighteen-year-old son in a different state with nowhere to live.”
And unlike Jamie Waldrop, the Roanoke mother and surgeon’s wife, Kristi could not afford to spend thousands sending her son immediately to another rehab, or flying with him to make sure the transfer stuck. Kristi had already sent Jesse to a rehab in Jacksonville once, in January 2013, a ten-week treatment regimen that began with intensive counseling and medical detox, during which Jesse briefly took buprenorphine (more commonly known by the brand name Suboxone), a partial-opioid agonist designed to stem cravings. Jesse still owed $25,000 for that earlier rehab stint, even though he was on his mother’s insurance, paying $25 a week that he had autodeducted from his checking account.
He was weaned off Suboxone after three weeks, a not-uncommon practice that would become increasingly controversial as the treatment became more prominent. As National Institute on Drug Abuse (NIDA) director Nora Volkow told me in January 2016: “To be clear, the evidence supports long-term maintenance with these medicines in the context of behavioral treatment and recovery support, not short-term detoxification programs aimed at abstinence.”
*
NIDA, the Institute of Medicine, the World Health Organization, and the White House drug czar’s office would all agree that indefinite (and maybe even lifelong) maintenance treatment is superior to abstinence-based rehab for opioid-use disorder. And even Hazelden, the Betty Ford–affiliated center that originated the concept of the twenty-eight-day rehab, changed its stance on medication-assisted treatment, or MAT, offering Suboxone to some patients in 2012.
But the rehab Jesse went to was aimed at abstinence, as most were, then and now.
“The whole system needs revamped,” said Tracey Helton Mitchell, a recovering heroin user, author, and activist. “In the United States, we are very attached to our twelve-step rehabs, which are not affordable, not standardized from one place to another, and not necessarily effective” for the opioid-addicted.
Clearly, more recent data supports ongoing MAT, but there is a catch: “One of the reasons people stay so hopeless about the epidemic is that, in any given episode, they only see a small proportion of people get into remission,” Harvard researcher John Kelly told me.
“What happens is, it takes about eight years on average, after people start treatment, to get one year of sobriety…and four to five different episodes of treatment” for that sobriety to stick.
And many people simply don’t have eight years.
*
After being kicked out of the sober-living house in Asheville, Jesse moved back home and took a construction job with his father, commuting ninety miles one way to the D.C. suburbs, where they worked on a government contract and Jesse earned $1,000 a week.
He was a good worker. He was pleasant to be around. And he lived rent-free with his mom. And so Kristi was stymied, later that summer, when the overdraft notices from Jesse’s bank started piling up.
“I can’t stop,” he finally admitted to his mom. He was spending $200 a day on black-market opiates, he told her, and asked for help returning to rehab in Florida. He was so high then that she refused to allow him to come home, to protect his younger sisters. But she arranged for him to stay in a nearby town with her sister, who made him hamburgers that night and let him sleep on her couch. He used what she believed was the last of his money to buy an airline ticket to Jacksonville. He was forty-eight hours away from a do-over, the insurance and admissions paperwork already arranged.
And yet Kristi still didn’t comprehend the depth of her son’s addiction. “I hate to even say it, but I thought he was going back to rehab for ‘just pills.’” Jesse still looked like a linebacker, after all. He was handsome and tanned. He hadn’t missed a day of work at his construction job. “They’d leave at four a.m., and that’s not easy work,” she said. He had plans to start community college in January 2014, then transfer to a four-year university. His goal was to become a phys-ed teacher, coach, or sports medicine trainer. He hungered still for the football field.
The idea that her son was shooting up heroin hadn’t crossed her mind, she said, then corrected herself: The truth was, the thought had crossed her mind; she just hadn’t let it roost. Despite evidence to the contrary. Despite having already padlocked her bedroom door, to keep Jesse from stealing money for drugs.
Only later would she learn about the spent syringes found on the Porta-John floor at the construction site where Jesse worked. Only later would she understand that Jesse lied about his dismissal from a warehouse job a year earlier. He swore he had nothing to do with the syringes his boss found in the bathroom, and Kristi believed him. How could someone who looked that robust be addicted to heroin?
It was late September 2013, and news of Jones’s heroin ring hadn’t yet appeared in the local press, though several arrests had already been made, and federal agents were working with local police from seven counties to target the leaders of what they were privately calling one of the largest heroin rings in the state. The region’s pill problem had become a full-fledged heroin epidemic in the span of just a few months.
But the only ones to know about it—other than the addicted—were a handful of cops.
*
That Friday night, two days before Jesse was scheduled to fly to a Jacksonville treatment center for his do-over, Dennis was deep in the throes of dopesickness when he and Jesse stole insulin needles from Jesse’s grandmother and bought heroin.
“I was puking,” Dennis recalled of their last day together. “I told him, I was like, ‘I gotta gotta get this dope.’”
“I’m not trying to do dope,” said Jesse, who’d spent the summer injecting black-market Roxys. But the pills had worn off, and he, too, had been throwing up off and on all day. He tried eating his two favorite foods—McDonald’s chicken nuggets and macaroni and cheese—but couldn’t keep them down.
As soon as Dennis made the buy, Jesse relented, deciding it would be his final hurrah before returning to rehab. They hosted a going-away party at a friend’s house. Late that night, a mutual friend broke down crying when she saw Jesse shoot up in front of people; he’d never before been so open about his heroin use, she told me.
But Jesse assured his friends that he liked the rehab he was returning to. Even though he missed his mom and twin teenage sisters, Jesse said, he liked being with people his age going through the same struggle as he was. He hugged Dennis’s girlfriend, Courtney Fletcher, and told her, “I promise, I’m gonna be OK.”
*
The next morning, as several friends left to go four-wheeling, Jesse came out of the spare bedroom complaining of a headache. Courtney offered him Tylenol from her purse, but Jesse declined and returned to the bedroom, she said.