This report is part of News4 and Telemundo 44’s Fighting Fentanyl series. Go here for full coverage.
In her son Stafford’s empty bedroom, Liz Nibley dropped to her knees and prayed, “God, please keep Stafford alive.”
The Bethesda resident didn’t pray for a cure for her youngest son, only that he was still alive.
“We love you. Give him another chance. We never, ever want to lose you,” her prayer continued.
That night came years into Nibley’s fight to get her son off drugs. Stafford ran away from a drug treatment program. Liz said it wasn’t the first time he had done so. It would be days before her mother saw him again.
Stafford was in high school when he first started using drugs. He started with marijuana and escalated to heroin and eventually fentanyl.
Nibley showed News4 video clips of her son playing a lead role in Our Lady of Good Counsel High School’s production of Les Misérables in his junior year.
“Listen to that voice,” she said as she watched how happy he was on stage. “Look how beautiful his eyes look.”
It wasn’t long after that performance when Nibley, her husband and their other sons knew Stafford needed help to get off drugs.
“It’s very, very hard. There is no guidebook and at times you really feel like you’re navigating this journey alone,” Nibley said.
What families face as they seek care for their kids
Families can face a long path to finding treatment when a young person is using fentanyl, said Dr. Marc Fishman, a Maryland psychiatrist specializing in addiction treatment. He didn’t treat Stafford but he treats teens in what he knows is tough environment to find care.
“It shouldn’t be this hard,” he said.
“When I see parents, they are up to their ears in alligators. They are exhausted … They don't know which way to turn. They don't know what to do,” he said.
Fishman just opened Maryland’s first inpatient drug treatment center specifically for teens – the very first one. There aren't many more in Northern Virginia, and there are none in D.C.
A young person struggling with drug use may repeatedly need treatment, he said.
“Sometimes, people are lucky and get it the first or second time, but a lot of people flounder and don't know and only get [to treatment] after a near-fatal overdose, which is way too late,” he said.
Stafford’s family found 42 drug treatment programs for him
Stafford didn’t participate in just one or two drug treatment programs. His family found 42 programs for him.
The number 42 rolled off his mother’s tongue as if finding her son those programs was not a remarkable feat of persistence.
Even now, she has the list of all 42 programs on her phone. Scrolling through the list, she said the programs took place all over the country. Some were better than others, some were awful, and a few worked for Stafford for a while. Few of the programs had coordinated care at home.
Together, the 42 drug treatment programs cost hundreds of thousands of dollars, even with insurance.
As Stafford began every one of the programs, his mother said so many goodbyes to him, she recalled.
“I just hoped always for the future. I always had hope for the future,” she said.
But after 42 programs and almost 10 years of fighting, addiction beat Stafford just days before his 25th birthday.
Police found him dead in a motel in Baltimore.
“The police said there was so much fentanyl. There was so much fentanyl,” Nibley said.
The role pediatricians can play in addiction treatment
Stafford isn’t alone in starting to use drugs as a teen. Fishman, the psychiatrist, pointed to research suggesting 90 to 95% of adults with substance use disorders started using drugs before they turned 18.
He said primary care doctors should know how to treat young people.
“We need to do a better job about pushing these treatments out into primary care, because that's where kids already are,” Fishman insisted.
For teens, that is most likely a pediatrician. But in most cases, a child’s pediatrician does not have experience treating drug use. The American Academy of Pediatrics has a telephone hotline offering advice for pediatricians but no formal clinical guidelines to treat opioid use.
Research published in the Journal of the American Medical Association in late February shows nearly a quarter of American pediatricians surveyed had diagnosed an adolescent with opioid use disorder, but only 5.5% of them had prescribed medicine that can save their lives by negating the effect of opioids.
Buprenorphine is the medication used to treat many patients fighting opioid use. It is often prescribed under the brand names Suboxone, Subutex, or Zubsolv, among others. According to the Centre for Addiction and Mental Health, it is a “long-acting opioid drug used to replace the shorter-acting opioids that someone may be addicted to, such as heroin, oxycodone, or fentanyl. When taken at the correct dose, buprenorphine prevents withdrawal symptoms and reduces drug cravings without causing the person to feel high or sleepy. This lowers the harms associated with opioid misuse and gives people who are addicted to opioids a chance to stabilize their lives.”
The FDA has only approved buprenorphine for patients 16 and older, but addiction specialists told the I-Team it can safely be used “off-label” for younger patients.
How Virginia law affects teens seeking life-saving drug treatment
In Virginia, however, it’s against the law to prescribe buprenorphine to anyone under 16.
Dr. Zeina Saliba, the chief of addiction and recovery services for Inova, said she believes Virginia’s law hurts kids who need treatment the most.
“If there is a young person who's below that age, for whom the standard of care or the recommendation would be ‘Let’s get you on a life-saving medication,’ that's not easy to do in this state,” she said.
Saliba said she hears from frustrated and overwhelmed parents and the medical colleagues who are trying to convince them to make sure kids aren’t going without treatment for fentanyl use.
“A dream state would be that no matter where you enter the health care sector, we will help you get to the right place,” she said. “[…] That's not where we are right now.”
Saliba said not every kid needs in-patient detox or treatment. Sometimes outpatient therapy and medication can be enough. Finding someone who can help direct care is crucial.
"One of the most important things is going to be meeting with a professional who is skilled in identifying the different domains, evaluating to be able to give you a strong recommendation,” she said.
An average of 22 people age 14 to 18 died in the U.S. each week in 2022 from drug overdoses driven by fentanyl in counterfeit pills, according to new research from UCLA Health. That’s the equivalent to losing one classroom of teens every week.
If you need help for a young person struggling with fentanyl use in the D.C. area, many resources are available. Go here for information on how to find help.
Reported by Ted Oberg, produced by Rick Yarborough, shot and edited by Steve Jones
