S1E58: An Overdose Epidemic – Deaths of Despair Pt I / Sandra Lindie, Will Cooke, Jennifer Fecu

Overdoses have spiked during the pandemic. One of the reasons is a breakdown in the community support so critical to keeping people off drugs. Social distancing measures and quarantine have created deadly complications for people recovering from addiction. In this episode we’ll hear two stories, one from New York City and another from Austin, Indiana, about how the coronavirus pandemic is exacerbating the overdose epidemic. This is the first in a two part series on Deaths of Despair and the pandemic.

For more information about Imani’s Safe House, go to https://www.imanissafehouse.com

This podcast was created by Just Human Productions. We’re powered and distributed by Simplecast. We’re supported, in part, by listeners like you.

Will Cooke: When the pandemic hit, our recovery groups shut down. Many of them went online. But that’s really not the same. All that great work that we had been building momentum towards and really seeing amazing results came to a screeching halt.

Céline Gounder: You’re listening to EPIDEMIC, the podcast about the science, public health, and social impacts of the coronavirus pandemic. I’m your host, Dr. Celine Gounder.

Since the start of the pandemic many Americans have had to shelter in place and forgo their regular lives. This has disrupted community ties and severed the possibility of in-person, real-world contact. Humans are social creatures. We don’t typically do well in isolation – but for some people – the health effects of being alone for so long have been fatal.

Céline Gounder: This is the first in our two part series discussing the effects of quarantine on Deaths of Despair: deaths from drug overdose and suicide. Today my co-host is our Research and Production Associate, Temi Fagbenle.

Temi Fagbenle: Hey, I’m Temi.

Céline Gounder: Tell us what this episode is about… and why you wanted to work on it.

Temi Fagbenle: So when we started discussing this topic, I was immediately intrigued. I know a number of people who are in recovery, and for various reasons, the pandemic has been especially hard for them.

Céline Gounder: So you really had a personal connection to the story. It’s a really sensitive topic, how did you go about choosing someone?

Temi Fagbenle: Yeah, I actually lost a friend of mine, Imani Fecu, to an overdose this summer.  You know when you’re in recovery, it’s really important to have community around you … and that was sort of destroyed when the pandemic happened. And thats what happened with Imani. So I wanted to speak to her family and get a sense of what had happened with her.

I spoke to Imani’s grandma, Sandra Lindie at her home. If we sound a little muffled, it’s because we were wearing masks and keeping our distance during the interview.

Temi Fagbenle: Hi, uh, it’s Temi.

Temi Fagbenle: Sandra lives in a large pre-war apartment. When I walked in, I recognized a black cat from the last time I saw Sandra… back when Imani and I were still in high school. Sandra had made a shrine to Imani, with a collage of photos and a candle.

Temi Fagbenle:  Could you tell me a bit about Imani in your own words? What was she like?

Sandra Lindie: Amazing. Imani was amazing. Really amazing and loving and everything and just flighty and airy.

Temi Fagbenle: But underneath all of that, Imani was really struggling at the time. Her father died, and Imani turned to drugs to cope with the loss.

Sandra Lindie: I don’t know what happened, but I remember she told me that somebody said, try this. I guess she was really in a lot of pain after her father died. And so before high school, it already started like with alcohol and I guess, um, maybe some, uh, hallucinogenics.

Temi Fagbenle: Sandra knew that Imani needed help. So she sent her to a hospital to get help for her alcoholism. While she was there, Imani was also diagnosed with bipolar disorder.

Temi Fagbenle: Could you tell me a little bit about that first time?

Sandra Lindie: That she went to the hospital? She looked like she was dead and I took a picture of her because I remember telling her, you have to see what you look like. It’s not, you know, you can’t do this to yourself anymore.

Temi Fagbenle: But Imani’s struggle with addiction wasn’t over, it was only getting worse. She started doing heroin some time after that first hospitalization.

Temi Fagbenle: When we were in high school, there, there was a time, it was Imani and I, and some other kids, like we were, we were all hanging out, um, in a house and, uh, like Imani went to the bathroom and she was just in there for really long. So I like banged on the door and. You know when I got – when I got there, she was just like on the floor and like her lips were blue.

Sandra Lindie: Oh really?

Temi Fagbenle: And, um, yeah, there was a needle, so I guess she had taken too much.

Someone, someone there, they happened to have a, um, Narcan. Yeah. And so they, they, it was like a box thing that they put into her thigh. Cause I got in there and I was shaking her. Cause I was just like, it was like wake up. I didn’t know what was happening. I was like 16 or 17. I didn’t know…

Sandra Lindie: They woke her up?

Temi Fagbenle: Yeah, they woke her up. And um, I stayed with her, stayed with her, I stayed with her for awhile….

Sandra Lindie: Imani dealt with this demon for a long time, huh?

Temi Fagbenle: Yeah.

Temi Fagbenle: But things turned around for Imani after that. I guess, around 2015. She got clean.

Sandra Lindie: Yeah. She got clean.

Temi Fagbenle: Well, what, what, what part do you think her social support system at the time played in? Um, keeping her sober.

Sandra Lindie: She decided to reach out and get some help, and she got clean, and she put herself away and got clean and, um, finished high school, and graduated and started NYU.

And everything just changed. And she was already involved in college and she was coding and. Um, teaching kids coding. She was like amazing in so many different things. Everything just changed.

Temi Fagbenle: But Imani was a temperamental person. She and her grandmother would often butt heads. Sometimes Imani would not have a place to stay. But despite going through these periods of homelessness, she stayed clean.

But when everything shut down at the start of the pandemic, Imani needed a place to stay.

Sandra Lindie: Imani was tough, you know that, and she didn’t want to come home, but she didn’t want to be out there either. And Corona hit and I’m like, okay, I guess you’re going to have to come home because you’re going to get killed out there.

Temi Fagbenle: So Imani moved back in with her grandmother. But… the isolation of quarantine was really hard on her. They disagreed about visitors in the apartment, the arguments started again. And Sandra was worried about Imani’s mental health.

Sandra Lindie: I asked her, can you please go to the doctor? I want you to go back to the doctor and. And get back on your medication so you could stabilize.

Temi Fagbenle: Imani did go to the hospital. Imanis treatment plan included group sessions. Imani had done these before… but things were different in the pandemic. This time, everything was remote.

Temi Fagbenle: Do you think there was adequate enough outpatient care?

Sandra Lindie: No, I do, uh, you know, like Al-Anon and AA, it’s not the same thing. It’s not the same kind of interaction among people. People that are in recovery, you have to have contact. A TV screen is not, doesn’t do it.

Temi Fagbenle: Imani kept up with the meetings for months … but it was really hard for her to maintain the same momentum she’d had in the past.

Sandra Lindie: And then after March, when everything locked down and it was all on the computer, it’s impossible just to be sitting there for hours straight. Meeting after meeting after – how do you sit there? She couldn’t do it.

Temi Fagbenle: Sandra remembers a week when Imani found it really difficult to attend Zoom meetings. 

Sandra Lindie: Thursday, she wouldn’t go on her program and she laid her in the bed with me all day on Thursday. She just said her stomach hurt. And I don’t have the fucking brains to think that she had might’ve relapsed. And I went out for a couple of hours… to get… Oh. And when I came home, she was in her room on the floor and my son came and tried to get her up and did compression until the cops came.

Temi Fagbenle: By the time the cops came, Imani was gone. Later they said they found a needle containing heroin behind the air conditioner.

Temi Fagbenle: You think things would’ve been different if the pandemic hadn’t happened?

Sandra Lindie: Of course. Absolutely. Not having her friends around, not being able to see her people, a lot of people, she was connected to with the yoga and, you know, um, starting her own business. Imani was doing a lot of stuff. Like she was doing so much even like with, everything that was going on, she was involved with so much.

Sandra Lindie: But you made me realize it seven years, at least seven years. She’s trying to fight that demon. And she succeeded. She really did. She kept her word about not getting high out there, stayed clean, even without the medicine. She said, I’m not going to take the, she was celibate. She was like, really Holy. But lonely. Really lonely.

Temi Fagbenle: We’ll be back after the break.

* * *

Céline Gounder: Imani’s story is not unique. Quarantine has taken away a lot of the community resources that are crucial for people in recovery to have in order to remain sober. We spoke to Will Cooke about this, author of the upcoming book, Canary In The Coal Mine, which focuses on the national response to the opioid epidemic. He’s also the only medical doctor in the town of Austin, Indiana.

Will Cooke: I’ve been practicing in the rural community of Austin, Indiana since 2004. A lot of generational poverty, a lot of generational trauma, a lot of social isolation and disconnectedness from the community.

Céline Gounder: At the height of its opioid epidemic, Austin, Indiana was the site of the largest HIV outbreak in U.S. history. It’s a story we covered in Season 2 of our sister podcast AMERICAN DIAGNOSIS. The outbreak was fueled by needle sharing.

Will Cooke: You know, people would gather around a single soda can, meltdown a pill. Everybody would stick their needle in, draw it up, inject. There’s still some in there, so they’re not going to waste it. They’d put their needles back in again. Sometimes not everybody would have a needle, they would draw it up and pass the needle around so other people could inject in that circle.

And in 2015, what we all knew was going on going to happen did happen where, you know, somebody with HIV entered into that community of, of people who were injecting together and HIV started spreading.

Céline Gounder: Will Cooke worked to develop one of the most successful programs in the state to help people who were struggling with addiction…

Will Cooke: We realized that what we needed was to really abolish the old system that harmed people by isolating them and relegating them to the shadows and building barriers between them and care.

Céline Gounder: And things started to really change.

Will Cooke: Our recovery community exploded over 3000% in, in just five years. We developed peer recovery coaches. And so partnering with a peer recovery coach that could walk alongside them, who’s walked that trail that knows the pitfalls. And when they fall down, is right there to help reach down and pick them back up. The result has been that since the 2015 outbreak, we’ve had a 95% reduction in new HIV cases.

Céline Gounder:  Then in March 2020, the COVID pandemic hit Austin.

Will Cooke: All that great work that we had been building momentum towards and really seeing amazing results came to a screeching halt. In the state of Indiana, overdoses that present to the emergency department are up 80% over last year, and deaths are up 20%. So it’s been a dramatic impact.

Céline Gounder: Will says that the aggravating factor was the sudden loss of community.

Will Cooke: It’s when people start isolating that they are at the most risk for relapsing. And we all basically, had to isolate because of what was going on with the spread of COVID-19. It basically just severed those lines and people that had been disconnected and found hope, opportunity, community and recovery, lost it.

Céline Gounder: Despite the constraints of the pandemic, Will has still been trying to work with what he has… to provide support for those that need it. But things have not been so straightforward.

Will Cooke: You know, just for example, when the national lockdown occurred, we went to a hundred percent virtual care because that’s really what we were asked to do. And so having someone do a drug screen became very challenging. To some to some degree, we were just kind of holding on, you know, and, and trying not to lose people, and, and have them fall out of care and relapse.

Céline Gounder: But Will stresses that COVID didn’t create these problems.

Will Cooke: One of the messages that I try to bring out in the book is that diseases and disasters, they don’t, they don’t create disparities and inequalities, they expose them. So we’re seeing that now, with, with COVID-19 where there’s a certain demographic groups, you know, Black people, for example, dying at a higher rate. And it’s not that the diseases and disasters create those disparities, they were already there before. What diseases and disasters do is they expose those disparities that were already in existence.

Temi Fagbenle: Listening to what Will is dealing with in Austin, it really reminds me a lot of the same struggles that Imani was dealing with. Especially the loss of community… that got me thinking about the things that were going on in Imani’s life that all came to a head at the start of the pandemic.

Imani’s mother, Jennifer was incarcerated for much of Imani’s life and I know that caused her a lot of pain… but Jennifer was released in February — just before New York City shut down. I spoke with Jennifer in her Brooklyn apartment.

The first thing I noticed when I walked in was how much Jennfier looked like Imani.

Temi Fagbenle: I’m, sorry….She just looks a lot like you. I’m like… like adjusting?

Temi Fagbenle: She showed me this beautiful memorial she had set up for Imani in her home.

Jennifer Fecu: Look, that’s for Imani.

Temi Fagbenle: Oh, oh my god… (crying)

Jennifer Fecu: I know it’s fine. I cry every day. It took me a month before I could look at her pictures. Especially to have her pictures up. It was like a lot to get to that point.

Temi Fagbenle: Even though Jennifer was incarcerated for much of Imanis life, they were close.

Jennifer Fecu: Yes- Imani. She was the most amazing daughter. She came to visit me regularly. She wrote me regularly. So she gave me my motivation to get through every day that I lived in prison for 17 and a half years. She always kept in contact with me.

Temi Fagbenle: Jennifer and Imani got even closer. When Jennifer’s birthday came in June, it was the first time in almost 18 years that she was able to celebrate her birthday with her daughter on her own terms.

Jennifer Fecu: We went to the beach. At first I was like, I don’t know if the beach is a good idea, because they say it’s no good with quarantine and the covid and this and that. She said, mom, I told everybody in that Zoom thing that um in my treatment plan that you was taking me to the beach. I said, all right, we’re going to the beach.

Temi Fagbenle: Jennifer started a non-profit called Imani’s Safehouse in honor of her daughter. The organization provides support for people to successfully transition out of hospitals and prisons. Jennifer wants to remind people about the importance of community.

Jennifer Fecu: Community is like what gives us our identity… Western individualism kind of teaches us like every man for himself. But as we see, that’s not really working. So, people like me, Imani, really embraced it. We kind of inspire each other, we bring each other up. Imani really brings a lot of people together and that’s something that she’s still doing.

Céline Gounder: Imani’s Safehouse is accepting donations. You can learn more about their mission and donate by visiting ImanisSafehouse.com. Alongside Imani’s struggle with substance use, she also struggled with suicidal thoughts. In next week’s episode, we’ll focus on how suicide rates have been impacted by the pandemic.

CREDITS

If you or anyone you know is experiencing thoughts of suicide, please call the National Suicide Prevention Hotline at 800-273-8255. The call is free, confidential, and 24/7.

EPIDEMIC is brought to you by Just Human Productions. We’re funded in part by listeners like you. We’re powered and distributed by Simplecast.

Today’s episode was produced by Zach Dyer, Temitayo Fagbenle, and me. Our music is by the Blue Dot Sessions. Our interns are Annabel Chen, Bryan Chen, and Julie Levey.

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And if you like the storytelling you hear on EPIDEMIC, check out our sister podcast, AMERICAN DIAGNOSIS. On AMERICAN DIAGNOSIS, we cover some of the biggest public health challenges affecting the nation today. Past seasons covered topics like youth and mental health; the opioid overdose crisis; and gun violence in America.

I’m Dr. Celine Gounder. Thanks for listening to EPIDEMIC.