HUNTINGTON, W.Va. — The white car had stopped in the middle of the highway. The driver was slumped behind the wheel, her breaths faint and few.
Her head was bobbing, chin to chest; her pupils were the size of pinpoint. The car was strewn with syringes. Paramedics inserted a needle of naloxone, an opioid antidote, into her left arm — the one with fewer scars. A minute passed. Two. At last, Taylor Wilson’s eyes flickered opened below the bright ambulance lights.
Taylor’s overdose was the first of 28 that would be reported in this small city on the Ohio River in the span of five hours on Aug. 15, 2016. Frantic calls flooded in to 911: Heroin users were passed out on dining room floors and in convenience store bathrooms. “People are coming here and dying,” one caller said. The horror of that afternoon made national news: CNN, Fox News, Associated Press, the Los Angeles Times.
Then the reporters left. Taylor’s story, though, was just beginning.
Her parents, John and Leigh Ann Wilson, would spend the next 41 days trying to get help for their blue-eyed bookworm, who had recently turned 21. They drove door to door in search of inpatient treatment beds to isolate Taylor from her heroin world. They sought out medicine to curb her cravings. They even wrestled with whether to have their daughter involuntarily committed to a hospital.
As longtime health care professionals, the Wilsons thought they knew how to navigate the system. Leigh Ann had worked for years as a paramedic before becoming a home health worker; John was the lead residential therapist at an Ohio facility for troubled adolescent boys. They both had a sense of the hard road ahead.
But for 41 days, they ran into roadblocks far greater than they’d ever imagined.
On the 42nd, a beautiful Sunday in late September, Taylor Wilson overdosed again. This time, no one was able to call 911 in time.
Leigh Ann and John Wilson play back those 42 days in a constant loop. They remember the clinics with lengthy waiting lists; the treatment centers that wouldn’t take Medicaid; the doctors who discouraged Taylor from inpatient treatment, saying she could do without it. They wonder, more than anything, why it’s so hard to get addiction treatment in the state with the nation’s highest drug death rate — 818 deaths last year, most of them from opioids.
Here in Huntington, population 49,000, health officials estimate a staggering 1 in 4 residents is dependent on opioids, from squalling newborns shaking with withdrawal symptoms to powerful lawyers immobilized by addiction. It’s so bad that the mayor carries around a naloxone injector in case he encounters an overdose victim. The city has tried setting up a needle exchange, hiring a drug czar, even suing the drug companies that brought pain pills to the state of West Virginia. None of those tactics have stopped the epidemic.
“There doesn’t seem to be enough emphasis on what we’re losing,” John Wilson said, fighting the tears falling down his face.
His daughter had been a Girl Scout. She’d loved to ride horses. He thought she even had the potential to play soccer in college. Taylor loved words — reading others’ and writing her own — so much that she wanted to become a librarian.
Now she was in the throes of an addiction she could not shake, and no one seemed able to offer any more help than a syringe full of naloxone.
“This pain has gone too far,” John Wilson said.
‘You’re going to get her back in a pine box’
The overdose that left Taylor slumped behind the wheel of her white Kia Soul was her third in a year.
Her dad had found her after her first, back in the summer of 2015. He’d heard a loud thump in the lower level of his house. Taylor was unconscious. After her second, in March of last year, Leigh Ann had received an anonymous call saying Taylor had recently entered cardiac arrest and almost died.
“If you don’t pick your daughter up,” the caller said, “you’re going to get her back in a pine box.”
Leigh Ann placed Taylor on leave from her college classes at Marshall University in Huntington and her job at the Wendy’s drive-through window. She made countless calls before she found a bed at Karen’s Place, an all-women’s Christian treatment center in a lakefront lodge just across the Kentucky state line. The Wilsons scraped together $4,000 for a 28-day inpatient program that included counseling, spiritual mentoring, and Narcotics Anonymous meetings. Patients were only allowed receive visitors every two weeks and make 15 minutes’ worth of phone calls every seven days, much to Taylor’s frustration.
With 12 days left, Taylor checked herself out. She soon got back together with her boyfriend, who had a long rap sheet of drug possession offenses and was also addicted.
The following month, Taylor turned 21. She celebrated her birthday with a new hairdo, paid for by her mother — and later that day, with heroin.
A shortage of treatment beds
Her addiction, like so many others, had started with prescription pain pills. But as lawmakers cracked down on pill mills, drug users across the state and the nation turned to heroin. Taylor did, too. It was more convenient to get, and often cheaper. It was also more deadly, especially when spiked with synthetic opioids like fentanyl or an elephant tranquilizer known as carfentanil, so potent that a dose the size of two salt grains could kill.
Spiked batches of heroin had the potential to ravage a whole town. One day last summer, there were 17 overdoses in Akron, Ohio. Another day, there were 10 in Columbus, Ohio. The cluster in Huntington was one of the worst. Two of the 28 drug users who overdosed on that day died. And many who survived got no treatment beyond the jolt of naloxone to revive them.
That’s a familiar problem. West Virginia officials estimate 150,000 residents — 8 percent of its population — needed substance abuse treatment in 2016. Just a fifth received help from treatment providers belonging to the state’s top behavioral health association. And only 156 detox beds were available across the entire state.
“There are not enough resources available,” said Kim Miller, director of corporate development at the Prestera Center, West Virginia’s largest behavioral health service provider. “There’s a workforce shortage. If we could pay people better, we could have a more robust workforce — more docs, more psychiatrists, more counselors — and more treatment.”
‘It has to stop here’
After her third overdose, when her car stopped on the bridge in the middle of traffic, Taylor called her mom from St. Mary’s Medical Center. The paramedics had brought her there, and she needed a ride home.
In the emergency room, Leigh Ann found Taylor sitting in a hospital gown, chatting about her car, her job, her boyfriend, as if everything were normal. It was too much for her mother. “It has to stop here,” she thought to herself.
At wit’s end, Leigh Ann asked John if they should involuntary commit Taylor to a psychiatric hospital by way of a legal document known as a mental hygiene order. John knew such an order would have repercussions; their daughter could lose her ability to own a gun or hold government jobs requiring security clearance. But Leigh Ann reasoned that such consequences wouldn’t matter if they had to bury Taylor.
And, since Taylor right then didn’t get the gravity of her addiction, they feared her release from St. Mary’s could amount to a death sentence.
“I had to do something to try and save my angel,” John said.
He agreed to try for a commitment order.
Natalia Bronshtein/STAT West Virginia Health Statistics Center, Vital Statistics System, Drug Overdose Database
A judge met with Taylor in the hospital and presented two options: comply with your parents, avoiding a messy court hearing, or defend your competency in court. Taylor chose the former.
Before dawn on Aug. 16, a police officer transported Taylor in handcuffs to Charleston’s Highland Hospital for detox. The lead psychiatrist there diagnosed Taylor with addiction and depression.
But she thought Taylor had a shot at recovery if she could break out of a codependent cycle of using drugs with her boyfriend. Leigh Ann worried that Taylor’s first call from the detox center was to her boyfriend — but drove out there regardless to bring her clean clothes.
Leigh Ann thought Taylor, once detoxed, should enter a residential recovery program. Four years earlier, Leigh Ann had admitted herself to Prestera’s inpatient treatment center for alcoholism and depression. Knowing her daughter, she doubted anything less would cut it.
Highland’s psychiatrist, however, decided Taylor should be released after seven days with a recommendation for intensive outpatient counseling. That isn’t uncommon: It’s hard for providers to get insurers to pay for more than a week to 10 days of inpatient treatment. A Highland Hospital spokesperson declined to discuss Taylor, citing privacy regulations, but said in a statement that “each patient’s treatment is based on that patient’s clinical needs.”
Leigh Ann disagreed. Taylor had already overdosed at least three times. Her relationship with her boyfriend fueled and reinforced her addiction. Leigh Ann knew deep down that outpatient counseling wouldn’t be enough for her daughter.
‘Most of the people on that list will die’
Days after her discharge, Taylor received even more bad news: She had contracted hepatitis C, likely as the result of sharing needles with her boyfriend. It could be treated, but she’d have to stay away from needles. She believed medication-assisted treatment was necessary to help her withstand withdrawals.
“It’s the only way I’ll make it,” Taylor told her mother.
Evidence suggests that the combination of counseling and prescription drugs to reduce cravings can be more effective than abstinence or 12-step programs. But West Virginia lawmakers, concerned users might trade one addiction for another, have restricted the availability of medication. The demand for treatment has far outstripped supply.
Taylor put her name on Prestera’s waiting list for Suboxone, an opioid-based drug to reduce withdrawal symptoms. No one told her how long she might have to wait, but she’d heard it could be months.
“There aren’t enough resources to accommodate the addiction problem in the heroin capital of the U.S.,” Taylor later wrote to a reporter. “If no one changes it this whole city will go under.”
While she waited for treatment, Taylor had agreed to live at her father’s house, located in a secluded part of Barboursville, the quiet suburb outside Huntington where both John and Leigh Ann had settled after their divorce years earlier.
She had two conditions: access to library books and the ability to write back to her friend John Stiltner II, a recovering heroin addict who’d sent her a letter during her hospital stay. John Wilson had strict rules — no computer, no cellphone, and no car — but agreed to those conditions if he could read Taylor’s letters before she mailed them.
Taylor’s recent overdose weighed on her father’s mind. During her stay at Highland, he’d picked up her Kia Soul from the impound lot, where the police had written “N-E-E-D-L-E-S” on the windshield as a safety precaution. Driving home, he had felt overcome with emotions — anger, confusion, embarrassment, and sadness — but cleaned out the syringes to keep his daughter safe. John had Taylor wipe the letters off the windshield.
“You have to straighten yourself up,” he told her, “or I’ll lose you.”
In late August, John decided to keep his long-standing plans for a vacation. He couldn’t trust Taylor at home alone, so he asked her to stay with her mother. The day Leigh Ann picked up Taylor, their daughter seemed giddy and her eyes looked dilated.
Leigh Ann wondered if, despite all their rules, Taylor had somehow found a way to get high.
Back at her mom’s house, Taylor kept her head down in World War II books. And she kept in touch with Stiltner through letters and text messages on a phone she had managed to keep hidden from her dad.
“Sorry my handwriting sucks, my hands have been really shaky lately,” Taylor wrote to John the week after leaving Highland. “Can you send me [N.A.] meeting times? … I think it would help me.”
Taylor started attending N.A. meetings three times a week and looking for a sober living apartment. But the meetings only did so much as life around her grew more stressful.
Taylor had helped identify the Ohio dealer who allegedly sold her heroin on the day she overdosed. It was that same batch of drugs, apparently spiked with synthetic opioids, that had killed two and sent 25 others to the brink of death on that August day. Taylor was expected to testify against the dealer later in the month; if she failed to show up, she could end up in jail.
If that wasn’t enough, CNN ran a story about the brutal afternoon in Huntington. It described the way she looked after her overdose: drool dribbling from her mouth, a syringe in her lap. Taylor had a hard time reading that. She was upset, too, to read a comment from Lt. David McClure, the senior paramedic who’d revived her. He said no overdose victim had ever thanked him.
She bought McClure a peach-scented Yankee Candle in hopes of being the first.
To help Taylor out, Leigh Ann scheduled appointments with both a physician and psychiatrist. And, still hoping her daughter could get inpatient treatment, she called Karen’s Place, the center where Taylor had stayed briefly after her second overdose.
They had open beds, a staffer said, but there was another problem. Taylor got her insurance through West Virginia’s Medicaid and the facility, despite being less than 50 miles away, was in Kentucky. It couldn’t accept West Virginia Medicaid. Leigh Ann and John no longer had the money to pay the thousands of dollars out of pocket.
By this time, Taylor had come around to her mother’s belief that a bed in a supervised facility was better than outpatient care. She talked to a crisis counselor at Prestera, admitting that a few days earlier she’d relapsed with a small amount of heroin that made her vomit. The counselor advised her to call the following day at 8:01 a.m. to see if any beds had opened.
The sun was on the cusp of rising the next day as they readied for their mission. Before 8 a.m., Leigh Ann pulled out of the driveway, heading toward Prestera, ready to drop Taylor off immediately if beds were available. At 8:01 a.m., Taylor called. No beds were open. A crisis counselor urged her to consider intensive outpatient treatment instead. Her dope sickness, the counselor said, “wasn’t that bad.” Taylor was beside herself: How could they say she wasn’t bad enough?
Despite her distress, Taylor dialed down a list of nearly three dozen treatment centers. Time and again, she got either voicemail or receptionists saying they were full for the day. Try again tomorrow, they said.
“ALL the beds were full,” Taylor wrote to a reporter. “The waiting list for the one rehab in H-town (ironic nickname huh) is extremely wrong. Most of the people on that list will die before they get the chance for treatment.”
A quick exchange at a stop sign
Her friends back at Marshall were well into their fall semester. But Taylor spent her third week in September waiting for her court appearance. After her testimony, she seemed herself, gushing to her mom about a cute detective. In that moment, Leigh Ann thought everything might be fine, so long as treatment arrived in time.
As the week drew to a close, Taylor planned on tailgating with her dad before the big Marshall homecoming game on Sept. 24. That afternoon, she asked her mom for her car keys.
“Where are you going?” Leigh Ann asked.
“An N.A. meeting,” Taylor replied.
“It’s homecoming,” Leigh Ann said skeptically. “There are 25,000 people in town. There’s an N.A. meeting?”
“I’m positive,” Taylor said.
Leigh Ann wasn’t sure she believed her, but she wasn’t feeling well, so she didn’t put up a fight. Taylor headed out around 6 p.m. to pick up her friend John Stiltner. There was indeed an N.A. meeting, and they attended; John even texted Leigh Ann to let her know.
After the meeting, John and Taylor picked up some ice cream and cigarettes. Not ready to call it a night, they cranked the radio and, as old country music blared, cruised Huntington’s back streets. They headed east. Past the nickel plant, Taylor pulled over at a stop sign. They waited.
John had earlier noticed Taylor on the phone. He hadn’t thought much of it, until now a dealer approached Taylor’s car. It was a quick exchange: She pulled out $80, cash she’d gotten from selling pictures of herself to another man, and handed it over. The dealer gave her a half-gram of what looked like heroin.
“What the f— are you doing?” John asked.
“It’s not for me,” she replied.
John demanded to be taken home. Once Taylor dropped him off, he made a point of not texting her all night, hoping to teach her a lesson. “I was trying to get a point across: If you hang out in a barber’s shop, you’re going to get your hair cut,” John said.
A father who could not bear to look
Night had fallen over Barboursville by the time Taylor walked into the house where Leigh Ann planned to stay overnight to care for an elderly retired Marine. Taylor snacked on some Kroger barbecue chicken on the blue couch in the lower level. Leigh Ann walked downstairs before 11 p.m. to find Taylor watching TV.
“You look tired,” Taylor told her mom. “Why don’t you go to bed?”
With her mom gone, Taylor pulled out the drugs she had bought. The early fall evening still felt like summer, so she stood outside in the cul-de-sac just after midnight, firing off texts. A neighbor last saw her outside around 1 a.m.
As Leigh Ann woke up on Sunday, she noticed the TV’s hum. It sounded like Taylor had left it on all night. So she went to check. Taylor was slumped on the blue couch, motionless. Her legs were curled under her body. Her right arm was slung over the back of the couch. Her face leaned against her knees.
Leigh Ann touched Taylor’s skin. It was cold as ice. She fell to her knees, hoping God would take her, too.
Her dad arrived, but he couldn’t bear to look at his little girl, as authorities rolled her body bag down the driveway.
The autopsy would later conclude that Taylor had died of an overdose of opioids — fentanyl, carfentanil, furanyl fentanyl, morphine, and hydrocodone. But no heroin.
The night Taylor overdosed, Leigh Ann sat in the lower level, curtains closed, and downed four beers. It was her worst relapse since her treatment for alcoholism. She hardly ate or slept for three days. On the fourth, she pulled it together to plan Taylor’s funeral and purchase cemetery plots for her daughter and herself.
Before she left home, Leigh Ann’s cellphone rang.
The voice on the other end, full of excitement, had good news. Taylor had cleared the Suboxone waiting list.