The visit was supposed to last only a few days.
Louis P. Canuso was returning to Haddonfield just long enough to pick up his car and some belongings. Then he was leaving New Jersey — and his long battle with opioid addiction — behind.
He had moved to North Carolina and then Mississippi in the spring to undergo treatment. This time rehab seemed to take, and Canuso planned to rebuild his life back in Mississippi where he made friends and reconnected with a woman who lived there.
But familiar temptations awaited him in New Jersey, his mother feared. Mary Canuso worried they might seduce him once again.
“I had a conversation with her,” said Leslie Nardozzi, Louis’ twin sister. “ʻMom, it’s just one week.’”
Canuso did not live to see the end of it.
He died at his parents’ home July 7 from a fentanyl overdose, his family said. They lost a man with a magnetic personality, who loved golf and the Philadelphia Eagles. He was just 37.
In a year dominated by the coronavirus, the opioid epidemic continues to rage behind the scenes, a deep-rooted, public health crisis claiming 3,000 lives each year in the state. They are adored sons like Canuso. Cherished daughters like Newton’s Dana Keim. And beloved aunts like Somerset’s Michelle Kehr.
That epidemic may be escalating, with New Jersey witnessing an 8% jump in overdose deaths this year.
In the first eight months of 2020, 2,093 people are suspected to have died of drug overdoses, outpacing 2018 and 2019. The statistics in May were especially alarming: 309 deaths — an average of 10 a day — were recorded, the highest monthly total the New Jersey State Police has ever seen and 61 more than in May 2019.
The COVID-19 pandemic has only made the despair of addiction worse, a broad consensus of experts in the recovery community told NJ Advance Media. Social isolation, financial pressures and disruptions in the state’s treatment network have hampered recovery efforts — and enabled those struggling with substance abuse to continue using undetected.
From Bergen County to Burlington County, from Newton to Haddonfield, New Jersey residents in the throes of addiction face even steeper paths to find help or continue treatment.
Advocates worry it could reverse the small gains the state has made in its fight against opioids. New Jersey continues to confront one of the highest death tolls in the nation, especially since the rise of fentanyl, a powerful synthetic often responsible for overdoses.
The state’s crisis mirrors the rest of the country, which is also seeing a rise in drug fatalities. The mounting deaths have raised alarms with the Centers for Disease Control and Prevention and the American Medical Association — which said it was “greatly concerned” about increases in opioid overdoses in more than 40 states.
But it remains unclear just how much the pandemic is driving the surge in drug fatalities. Even before the outbreak, the number of overdoses rose in January and February compared to the past two years.
But the figured dipped in July and August.
Still, state Human Services Commissioner Carole Johnson said she looks at the monthly statistics and fears what could happen if there’s a second wave of the virus. Though the state has scrambled to plug newly formed gaps in the treatment system, Johnson remains concerned that a deluge of COVID-19 cases could make it harder for those in crisis to obtain treatment, as it did last spring.
“I’m still going to be staying up at night looking at those February to May numbers,” Johnson said. “What will that look like if we have a second surge?”
That second wave looms, as coronavirus cases have spiked in New Jersey since late September.
ʻA wrench in the works’
Life for Joseph, a recovering addict staying in a sober living house in Secaucus, was looking up.
He was well into his first year of recovery and piecing his life back together. For the 40- year-old from Miami, that meant getting his driver’s license, his GED and hopefully a job.
This is his second shot at sobriety.
He developed an addiction to prescription painkillers at 27 after a car crash left him with severe injuries. When his doctors stopped prescribing the pills, Joseph turned to heroin — an alternative that’s cheaper and easier to obtain.
Seeking a fresh start, he traveled to Virginia in early 2019 to live with his cousin, but relapsed after six months. A job with a traveling carnival eventually landed him in Paramus, but he was fired for using drugs. Police officers in Teterboro helped him get into a rehab facility.
Joseph has been with the Integrity House recovery program since July 1, 2019.
Then the coronavirus upended everything. The Motor Vehicle Commission closed. GED classes were canceled. The prospects of a new job dwindled in the worst economic environment since the Great Depression.
And for an addict like Joseph, who asked that NJ Advance Media use only his first name, that added several hurdles to an existence already beset by the daily struggle of staying sober.
He turned to the group meetings at the sober home, but they were limited to 10 people due to social distancing mandates. Joseph used to have 30 people to seek guidance from.
“That was very helpful to me, hearing everybody’s point of view,” he said. “Now it’s very limited.”
As New Jersey locked down in March and April to slow the spread of COVID-19, some rehab and sober living centers closed. Others began to closely screen prospective patients, turning away some out of fear they might bring the coronavirus into their facilities. Meanwhile, 12-step support groups suddenly could no longer meet in person, forcing sessions onto online platforms like Zoom. And as unemployment skyrocketed, many people lost their insurance, a lifeline to cover the expense of recovery.
“You grab someone who wants to go to treatment. You want to strike while the iron is hot,” said Tom Finnerty, an outreach services coordinator with the nonprofit Ocean Mental Health Services in Bayville. “That has become difficult.”
The demand for help has exploded. Calls to ReachNJ, the state’s 24-hour addiction helpline, have soared. The hotline logged 3,180 calls through August, exceeding the 2,850 calls received over the entirety of 2019 — though state officials attribute some of the increase to promotional campaigns to raise awareness of the service.
State regulators rushed to open new pathways for treatment. They loosened restrictions to allow addiction doctors to meet with patients virtually. They made it easier for doctors to prescribe opiate maintenance medications such as buprenorphine or methadone, which reduce cravings.
And New Jersey expanded access to naloxone, an overdose reversal drug, sponsoring three days in September in which residents could anonymously obtain it for free at pharmacies.
Suzanne Harrison sees the desperation firsthand in Burlington County.
She runs King’s Crusade, a nonprofit that helps people struggling with addiction navigate the treatment system. It is named after her brother, King Shaffer, who died in 2016 from an overdose.
Harrison has been flooded with calls the past six months, she says. She attributes the surge to the effects of COVID-19 and its stresses: the loss of a job, the rent coming due and the lack of face-to-face interaction.
“We’ve had a lot of people that were strong in their recovery that relapsed,” Harrison said.
Glynis Burke lost her 26-year-old son Patrick Dolan to an overdose in 2019. Burke, a Closter resident active in the North Jersey recovery community, said she worries that as hard times continue, there will be more mothers like her.
“There’s a lot of isolation out there. If you are a single person and are in recovery, you lost a lot of your AA groups,” Burke said. “They’re gone. They’re cold turkey.”
Paradoxically, some treatment providers say they’ve been surprised by the successes therapeutic communities have seen with virtual medicine.
Telemedicine has made it easier for those with addictions to reach their counselors and doctors, said Frank Ghinassi, the chief executive of Rutgers University Behavioral Healthcare and a senior vice president at RWJBarnabas Health, two large recovery providers in the state. It alleviates concerns about transportation, child care and other hurdles those on the edge face.
At some clinics, no-show rates for appointments run as high as 30% to 45%, Ghinassi said. But with telehealth, those rates have fallen to as low of 5% to 10%, he said.
“We’re actually seeing them use the services more than before,” Ghinassi said.
As life returned to some semblance of normalcy this summer, the communal aspect of recovery also began to reemerge.
Robert Budsock, the president and CEO of Integrity House, a nonprofit that runs several rehab centers and sober living homes, said people seeking recovery are once again entering treatment facilities.
The uptick in admissions, Budsock said, could be why the state is seeing the number of fatal overdoses level off.
“Right now, things have settled down a little bit and more people feel safe and comfortable entering treatment programs,” he said.
Even so, a staggering number continue to die.
ʻSo many different emotions’
The last time Danielle Oswald saw her aunt alive, the woman would come no closer than her front doorway.
The final days of Michelle Kehr’s life were spent in her Somerset house, hiding in the shadows of the coronavirus pandemic.
Oswald visited Kehr on Aug. 6 for her aunt’s 55th birthday, bringing along her two children and standing in the front yard. Oswald hadn’t seen her “Aunt Sugar” since Kehr told the family she had contracted COVID-19.
“I believe she said she tested positive to keep us away from her, to have us not drop in and visit,” Oswald said. Her addiction “was really bad towards the end.”
Kehr was found dead Aug. 30 from a suspected heroin and fentanyl overdose.
Oswald later learned that Kehr was living in a foreclosed home with no running water.
“I don’t know how she lived,” Oswald said, pausing for a moment to collect her thoughts. “I’m finding out all these pieces. I’m mad at her. I’m sad. I miss her. So many different emotions.”
Kehr used drugs most of her adult life, enduring an endless cycle of fragile sobriety and relapses. Addiction thrives in isolation. And Kehr, like many others, found there is no better opportunity to isolate than during a pandemic.
New Jersey has long been battered by the opioid crisis. It took root in the 1990s and exploded in the past decade. Still, last year ended on a hopeful note, when deaths in the state decreased for the first time in five years. It recorded 3,021 suspected overdoses, a drop of nearly 100 from 2018.
But then came 2020.
Even before it arrived, the year began with a foreboding rise. More than 530 people died of suspected overdoses in January and February, a 20% increase over the same months in 2018 and 2019.
“The increase started before the COVID pandemic, but then what may have been a small spike early in the year turned into a sustained increase,” said Budsock, the Integrity House president. “We could attribute part of that sustained increase to the COVID pandemic.”
For years, law enforcement officials have cited fentanyl as the driver behind many fatal overdoses in New Jersey. Fentanyl — a potent, highly addictive synthetic made in labs in Mexico and then smuggled across the U.S. border — is more powerful than heroin and cheaper to produce.
Susan A. Gibson, the special agent in charge of the Drug Enforcement Administration’s New Jersey division, said agents have conducted more than 430 drug seizures since the start of the outbreak. And a bulk of those seizures included fentanyl, she said.
“Their shipments are less frequent. However, the quantity is higher,” Gibson said. “One kilo of fentanyl goes a lot further than a kilo of heroin. Most of the drugs that we are getting back — that we’re seizing — definitely have a lot of fentanyl in it, and the purity levels are very high.”
Fentanyl continues to kill, even if it has been pushed out of the national discourse by COVID-19.
“We know the issue has not gone away,” said Angela Conover, the director of opioid response and prevention for the Partnership for a Drug-Free New Jersey. “Yes, it has been overshadowed by the pandemic, but it still remains an issue.”
ʻHer funeral was beautiful, just like her’
Deborah Dinnocenzo lost her 25-year-old daughter just weeks before the first confirmed coronavirus case in New Jersey.
Dana Keim walked away from a drug rehab facility in Newark on Feb. 19, her mother said. Two days later, she died in Irvington from a fentanyl overdose.
Dinnocenzo, of Garfield, remembered Keim as her “best friend” and a generous person. After Dinnocenzo survived a bout with cancer last year, Keim got a tattoo of the breast cancer ribbon on her wrist and drove around in a car bearing the message, “My mom won!” painted in pink on the back of a windshield.
Keim, a Newton resident, leaves behind two daughters, ages 6 and 4. They are being raised by their grandparents.
At least Dinnocenzo got to have a funeral, unlike other parents whose children died during the COVID-19 lockdown.
“Her funeral was beautiful, just like her,” her mother said.
Canuso died in the pandemic’s fifth month, but his family does not blame the outbreak for his overdose. But the coronavirus did make it harder for him to find a rehab program this spring, it said.
Canuso had grappled with addiction for more than 15 years and underwent treatment many times, said Nardozzi and their older sister, Nicole Canuso. He was a functioning addict, working in sales for a family-owned business and coming to work every day, they said.
“He definitely wanted to be better. I know that 100%,” Nicole Canuso said. “He didn’t want to disappoint everyone. He did try.”
Nicole Canuso, who lives in Dallas and is herself in recovery, said her brother just struggled and struggled.
“Do I think the outcome would have been different because of COVID?” she asked.
Those losses should be remembered, said Nancy Labov, who runs a Bergen County drug prevention nonprofit, Alumni in Recovery.
Labov points to Gov. Phil Murphy’s regular coronavirus briefings, in which he celebrates the lives of three New Jersey residents who died from COVID-19, describing their accomplishments and the families they left behind. Watching the broadcast recently, Labov said she was struck by something.
“All I could think about,” Labov said, “was why don’t we do this for the opiate epidemic?”