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<p>One of the beauties of naloxone is that it allows someone overdosing another chance at life, someone like Brittany Russ, who now is focusing on a heroin-free future.

By Taylor Sisk

Brittany Russ speaks of death in the past tense. “The day that we died,” she begins, recounting the memory of overdosing on heroin as her sister, Rachel, lay unconscious just a few feet away.

A sheriff’s deputy revived Brittany Russ with naloxone after she overdosed on heroin. Photo credit: Taylor Sisk

“We both died, and then they woke us back up,” she said of the early-morning hours of Sept. 13 when a Pitt County Sheriff’s Office deputy arrived at Genesis Mobile Home Community, just outside Greenville, and found Brittany and Rachel in a back bedroom, neither breathing, heroin packaging and paraphernalia strewn about.

The deputy administered naloxone to both young women. Naloxone is a drug that very abruptly reverses the effects of heroin overdose. More law enforcement officers around the state are carrying the drug and have reversed hundreds of overdoses.

Four days later, at 5:15 a.m., Rachel again overdosed. Brittany was at her dealer’s house at the time. She got word, and rushed over. This time, help had arrived too late.

Enough

“I didn’t have a good childhood,” Brittany Russ said. Her parents split up. She, her mom and brother and sister moved around a lot. Sometimes ends didn’t meet. There was little supervision.

“My mom was an alcoholic and she worked all the time,” Brittany said, “and my brother did heroin in front of me since I was 9.”

On Sept. 17, at 5:15 a.m., Rachel Russ, 20, died from an overdose of heroin. Photo courtesy Brittany Russ

Heroin came to define her life. “I was numb to everything. I didn’t care about anything but getting it…. I did anything and everything I could to get my hands on it.”

She sampled weed, prescription painkillers and crack. But heroin ruled.

“It made me chill,” she said, “and it took all the pain away” – the pain she’d felt for so long she couldn’t remember when it was otherwise: depression, despair, no future worth imagining. No way out, unless …

“You do heroin once,” she said, “and you’re good all day.”

Until it’s the day your sister, 20, two years your elder – your confidant, fashion consultant, momma to your 2-year-old niece – is dead and not coming back.

Brittany decided she’d had enough. She’s done with heroin today and, she hopes, tomorrow.

But it’s taken a collaborative effort to pull her out of what Chris Smith of the Community Care Plan of Eastern Carolina – part of the Community Care of North Carolina network – called a “toxic environment.”

That effort began with Brittany’s determination to get out – an unspoken but unmistakable cry for help – and a drive within Smith and the Pitt County Sheriff’s Office’s Melissia Larson to rally their collective resources to help get her out.

Smith serves as a coordinator with CCNC’s Chronic Pain Initiative. Among the program’s objectives are reducing opioid-related overdoses and addressing substance abuse issues.

Larson is a grants administrator for the sheriff’s department and an advocate for those in need of mental health and substance abuse services.

Smith believes the kind of partnership they’ve now forged can work in any of the 27 largely rural eastern North Carolina counties she covers.

“I think it’s very feasible in any county where there is an openness to collaboration across disciplines,” she said.

‘Sick, sick, sick’

Rachel had been clean for a year, Brittany said, and had gone to live with their dad in Florida. Brittany went down in hopes of staying with him as well. She traveled by train, throwing up the entire ride, she recalled with a shudder, dope sick – “Sick, sick, sick.”

She stood on her dad’s street holding her suitcases in arms blighted by bruises. He couldn’t let her in, couldn’t risk further instability in his home. Brittany got it. “He already had too much on his plate.”

“So I took a train back to North Carolina the next day. And I just kept doing what I was doing.”

Rachel returned as well.

Rachel and Brittany Russ overdosed on the same night at Genesis Mobile Home Community in Pitt County. Photo credit: Taylor Sisk

Brittany had attempted to get help several times. When she was 17, she tried to get into a rehab facility, but it only accepted adults. “They told me I couldn’t get help because I wasn’t 18 yet. And I said, ‘So there’s an age limit on heroin addiction? OK.’”

It had been a jolting journey to 17.

“They put me in therapeutic foster care because I was so bad,” Brittany said of her early-teen years. “I didn’t care. I hated my mom. I didn’t think she cared.”

She became acquainted with the juvenile justice system, gathering four felony charges, and was well known to the local authorities. She had a history, Larson said, of “addictive behaviors: shoplifting and being unruly.”

She got sent to Chatham Youth Development Center in Siler City at 14 for stealing a car – stole it, alone, in Jacksonville and headed to the beach.

No one could question her intrepid nature. It just wasn’t properly focused.

Larson took notice of Brittany’s file after Rachel’s death. She saw promise – Brittany seemed to do well in structured environments – and an opportunity.

She contacted Smith. Could they make some calls? Pool their resources?

Smith was all for it.

Sheriff Neil Elks was likewise immediately receptive.

“He said, ‘We have to do everything within our powers to help this young woman,’” Larson said.

His deputies had witnessed that “toxic environment” in which the girls lived, the criminal behaviors that surrounded them, and knew how difficult it would be for Brittany to get out if she didn’t get help, fast.

Death was now a very real threat. And the other likely option, prison, “is not a therapeutic place,” Larson noted.

On Sept. 18, the day after Rachel’s death and the day before her funeral, Smith went to the trailer where Brittany lived with her mom and said, “This is your shot. Right now.”

Brittany packed her things.

‘Three-way parenting’

They first went to the emergency department at Vidant Medical Center. The sheriff’s office then asked a magistrate to issue an involuntary commitment order. While those steps may seem counterintuitive given that Brittany was receptive, Smith said it was the only way to get her immediately into detox.

Chris Smith with the Community Care Plan of Eastern Carolina helped rally resources at a critical moment. Photo credit: Taylor Sisk

Walking into the ED with a plan in place, she said, made all the difference.

The ED established that Brittany was medically stable, clearing her for a week of detox at Vidant Beaufort Hospital in Washington, 30 minutes away.

Meanwhile, Smith and Larson found a place for Brittany at the Family Tree House, a halfway house, where she can stay for up to a year. She likes it there. She feels supported.

“It’s sort of a three-way parenting thing that we’re doing,” Smith said.

Brittany is now in a program that uses Suboxone, a drug that has been shown to reduce cravings and improve the chances that someone addicted to opiates stays clean. She’s also attending 90 Narcotics Anonymous meetings in 90 days and group therapy three times a week.

A model

Putting a plan in place that sticks, Smith said, is often “like nailing Jell-O to the wall.” It may initially appear secure, but initial appearances can deceive.

First, you need to build a solid foundation.

“What you need is having the right people at the right table at the right time,” Larson said. “It takes resources, and it takes the passion.”

Evidence of success goes a long way – particularly in rural areas, where resources are generally scarce – and with Brittany and Rachel, Smith said, “in essence, we have a control group: ‘This is what happens when we don’t intervene, and this is what can happen when we do.’”

They now have a window into what resources are needed and what the outcomes can be, Larson said.

Melissia Larson said the Pitt County Sheriff’s Office saw an opportunity to help save Brittany’s life. Photo credit: Taylor Sisk

Critical to success, she said, are law enforcement officers, social workers and program coordinators who take the initiative to learn what resources are available in the community, and then someone to follow up.

“Deputies are talking with family members on the scene and telling them about resources available to them,” Larson said. “But who is following up?

“You need a vested [partner] to come in and do the follow up.”

“We’re trying to pull everyone’s expertise into the situation in order to make everyone’s job easier,” Smith said.

“I would love to be able to make a case for increased collaboration between systems of care” – hospitals, substance abuse and mental health treatment programs and law enforcement – “to improve patient outcomes,” she said.

“And, oh yeah, at very little cost to the system, because everybody is only doing what they already do, they’re just doing it better and smarter.”

This effort requires case management, for which Smith’s employer, Community Care of North Carolina, has provided a model for Medicaid agencies around the country. But under the Medicaid reform plan passed this fall by the General Assembly, CCNC’s future is uncertain.

A statistic

Brittany loves where she’s now arrived. “I just feel like … I don’t now how to explain it. Just better.”

She wants to take things slow.

Brittany says she feels good about where she is today. Photo credit: Taylor Sisk

She’d love to one day be a police officer – “I like cops. I mean, when they arrested me I didn’t like them. But I like them now.” – but that’s not possible due to her charges.

Maybe something related though. “I like helping people.”

What she needs now more than anything, she said, is “consistency. … I just like how everything is going right now. I don’t want it changing. I’ve got to adjust to this before I can realize something else.”

“Everything is so new,” Smith said. “I don’t know that she even knows enough yet to know what she needs.”

One goal is clear: “I don’t want to be the next statistic.”

“She was well on her way,” Larson said.

Today, she imagines a future. She says of her niece, Luna, “She’s the best baby in the world…. I want to take care of her so bad.”

She’s newly engaged, to a guy who’s supportive of her recovery.

Brittany says somebody should write a book about what she’s experienced. But, Smith advised her, she’s got some scripting yet to do.

Her support team hopes and trusts that script will culminate in the resolution of chapter one of a very long and giving life.

“People change,” Brittany said. Sometimes it requires encouragement.

[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]

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