A mother, a son, and a fight to survive opioids in Australia
FOUNTAINDALE, Australia (AP) — Deb Ware stared in numb horror at her son, a frail, 22-year-old man in diapers who looked like he'd had a stroke.
This was hardly Sam Ware's first dance with death in the years since his addiction to pharmaceutical opioids began with a simple wisdom tooth extraction; in just the past 12 months, he overdosed more than 60 times.
But on this day in June, inside this hospital in Australia, his mother wondered if it would be his last.
For three years, she had battled to save his life, a lonely war against a system that made pharmaceutical opioids cheap and easy to get, in a country that has quietly endured what was once thought to be a uniquely American crisis of skyrocketing opioid addiction and deaths.
And yet despite all her efforts to rescue her son from an addiction funded largely by her government, here she was: Standing by, helpless, as doctors prepared to place her child in a coma.
"Say goodbye to your son," she heard a doctor say.
Was this goodbye for now, or goodbye for good? How do you say goodbye to your only child?
So she simply kissed him and told him that she loved him. She told him he'd get through this, though she wasn't sure he would.
And then, unable to bear the fear on his face for a moment longer, she turned and walked out of the room.
On the opposite end of the earth from America, where the opioid epidemic has left 400,000 dead, Australia is facing its own crisis of soaring opioid use and fatal overdoses . It has all unfolded despite the glaring warnings from the U.S., and despite more than a decade of warnings from Australian health professionals about a looming disaster.
On the Central Coast, around two hours north of Sydney, the Ware family is one of thousands across Australia locked in a life-or-death fight against opioid addiction. In months of interviews with The Associated Press, years of diary entries, videos, photos and medical records, Deb has shared her own family's fight in the hopes it can alert the world to Australia's plight.
Sam was 19 when it all began, a good kid with a good job as a factory machine operator. He loved photography and walking in the woods and doting on his dog, Holly, and cockatiel, Yazoo. He was close to his mother, who had raised him on her own since he was a toddler, and who shared his fondness for music and the beach. He had little interest in drinking and none in drugs.
In Oct. 2015, his dentist recommended he have his wisdom teeth pulled. He was sent home afterward with a prescription for an opioid painkiller.
Deb had worked for years as a nursing assistant. She'd seen plenty of kids prescribed opioids after wisdom tooth extractions. And so there was nothing that initially worried her about Sam's pills, medication that combined paracetamol (also known as acetaminophen) and codeine.
The instructions stated that Sam should take two for his pain that night. The next morning, he told his mother he'd taken four.
Disturbed, Deb took the remaining pills away. But Sam loved the buzz they'd given him. The codeine had made him feel safe and warm, like being tucked into a cozy bed on a cold winter's night.
He wanted more.
At first, though, he mistakenly believed that he'd need a prescription to get codeine. It took him a few months and a tip from a colleague before he discovered that Australian pharmacies sold it over the counter. Two more years would pass before Australia — facing a surge of pharmaceutical opioid-related deaths — made all codeine products prescription-only.
But in those days, all Sam needed to do was go to a pharmacy, hand over a few dollars, and walk out with an opioid.
Initially, the codeine was an occasional treat. Soon he realized he felt lousy when he wasn't taking it. He took more, moving quickly from a few pills a week to 40 a day. Then 80. Then 110. His abdomen began to ache, which he feared was a result of all the paracetamol in the drugs. So he went online and learned how to extract the codeine from the pills.
Deb watched the kind-hearted, funny boy she loved rapidly disappear, and be replaced by a deceptive, desperate stranger. Looking back, she marvels at how fast it all happened.
"You become the drug," she said.
When the codeine stopped working, Sam knew he needed something stronger — which meant he needed a prescription. He went to a general practitioner and complained of lower back pain and nerve pain in his leg. The doctor scribbled out a prescription for an opioid called tramadol and sent Sam on his way.
It was so easy. He started going from doctor to doctor, collecting prescriptions for a smorgasbord of opioids: OxyContin, Endone, Targin.
After he got a CT scan that showed a bulging disc in his spine, his quest for opioids became even easier. The CT scan was his golden ticket, proof that he had legitimate pain. He began carrying the scan's results with him everywhere in a plastic shopping bag, along with his pill crusher. Around 70 percent of the time, he could convince a doctor to write him a prescription for whatever he wanted. He also sought out benzodiazepines, used to treat anxiety, and — after a doctor handed him a sample pack — Lyrica, a brand of pregabalin that is typically used for nerve pain.
The drugs were cheap. Most medications in Australia are government subsidized. For people like Sam who have concession cards — those who are older, or on low incomes, or have a disability — the out-of-pocket cost is just 6.50 Australian dollars (US$4.50) per prescription.
Deb called and wrote letters to the doctors whose names she found on Sam's prescriptions, warning them that he was addicted to the medications.
But Sam just went to other doctors, riding the train up and down the coast and stopping in clinic after clinic. Deb found his pills in the bathroom ceiling, under the mattress, under the computer keyboard. Whenever he came home, she patted him down. It was futile.
She chronicled his swift downfall in a diary that catalogued all the drugs, the hospitalizations, the broken promises:
Sept. 8, 2016: "Said he wants to get off codeine. Withdrawal symptoms: nausea headache stomach cramps. Called paramedics."
Sept. 13: "Sam — tested positive to valium. Suspended from work until Tuesday next week."
Sept. 29: "Sam sacked."
Dec. 25: "Sam evicted from Adam's due to continuing drug abuse."
Dec. 27: "Sam slept in his car — unable to contact him by phone. I contacted police."
His first overdose came around four months into his addiction. "I don't feel well," he told Deb, heart hammering, face pale.
Deb fetched him a bag, into which he ejected a stream of bright pink vomit. He had mixed codeine pills with a codeine-based, pink cough syrup. Deb called the paramedics.
At the hospital, Deb was furious. Why would he do this to himself?
"I know it's really bad for me," he told her. "I won't do this again."
But he did.
The first time Deb truly began to fear that Sam might die was on Feb. 16, 2017.
He had taken a cocktail of opioids and Lyrica, then walked to a restaurant to pick up a falafel wrap for dinner. His limbs began to jerk. He blacked out.
He woke up in an ambulance, in a panic. The paramedics told him he'd had a massive seizure. They called Deb, and she rushed to meet them at the emergency department.
She found Sam there, lying on a bed, twitching.
She begged him to go to rehab. He refused. One day, he told her he just wanted to take pills until he didn't wake up. She called the police and they took him to the mental hospital. He stayed there for a week. The day he got out, he overdosed again, and ended up back in the emergency department.
His life became an endless pursuit of pills. He lost friends and family and most of his belongings. His phones, laptop and clothes were left behind or stolen while overdosing on trains, in shopping centers, in a library. Eventually, all he owned would fit into his plastic shopping bag.
Inside, always, was his precious CT scan, his fast pass to opioids.
Deb tried to get him committed to the state's involuntary drug and alcohol treatment program, but there are only 12 beds available for New South Wales' population of 8 million. It took her two years to get him a spot. While he was there, she brought him a Bible, in which she had inscribed this verse: "For I know the plans I have for you, says the Lord. Plans to give you hope and a future."
Soon after, he jumped the fence and fled.
Each time the police called, she braced for the worst. She started asking Sam what music he wanted at his funeral.
On the nights he slept at home, she checked to make sure he was still breathing. On the nights he was gone, she would awaken to the sound of the train going by and wonder whether Sam was on board, dead in his seat.
She kept fighting. She contacted politicians, working her way up to federal Health Minister Greg Hunt. In an email, she begged him to implement a national prescription monitoring system. "This is an URGENT situation which must be addressed as soon as possible," she wrote.
An assistant secretary in the health department replied, assuring Deb that the minister took Australia's opioid problem seriously, that a prescription monitoring system was in the works, but that the rollout's timing was left to each state.
"I wish you and your son all the best for the challenges you are both facing," the bureaucrat wrote, infuriatingly, in closing.
One day, she was tending to a patient Sam's age who had just had his wisdom teeth removed. She handed him his discharge papers, along with the prescription a doctor had written for the same opioid Sam was prescribed after his own teeth were pulled.
Deb stared at the young man holding ice to his swollen cheek. She saw Sam.
"Only take it if you really need to," she said of the prescription. "Get your mum to hang onto it."
She paused. "Actually, probably try not to take it."
The patient stared at her strangely.
"No, really," she urged, tearing up. "It's really addictive. Just be really careful."
"Please. Don't take it."
The day that Sam refused to go to detox was the day Deb hit her limit.
"Get out of the car," she told him.
It had been another horrible morning at the emergency department. A bed in detox was available. Sam agreed to take it. And then, at the last minute, he changed his mind.
She refused to bring him home and tried to drop him off at a shopping center. He refused to get out of her car.
As he sat in the passenger's seat and sobbed, her rage and desperation grew. She had tried almost everything to save him.
"You got your seatbelt on?" she asked, a plan hatching in her head, as she threw the car into gear.
"Why?" he replied.
Her response was matter-of-fact: "I'm going to go as fast as this car can go. And I'm going to swerve off the road into a tree or a barrier. Because you're going to die if you keep doing what you're doing. And if you die, I might as well die, too. Let's just get it over with now."
She steered toward the freeway and jammed her foot on the accelerator. Sam clutched his seatbelt. "Let me out of the car!" he screamed.
Deb jerked the wheel left and right. Sam wailed, pressing his flip-flop clad feet against the dashboard so hard they left scuff marks.
"I'M GOING TO KILL US BOTH!" she roared.
"NO, NO, NO!" he shrieked.
"THIS IS IT!"
Then she heard the beep-beep-beep of the seat belt alarm. Saw Sam unbuckling himself. Watched him yank the emergency brake and open the door.
She pulled over just as Sam commando-rolled out of the car, shredding his knees on the pavement.
She went from manic to calm in two seconds. Sam stumbled along the street, blood pouring down his legs, frantically trying to wave down passing cars. She went after him.
"Don't come near me!" he shouted.
"I'm not going to hurt you, Sam," she said. "But this is my desperation."
She never really intended to hurt either of them that day. But there had been that little voice inside her urging her to do it, just do it, just end the misery now.
The end felt near that day in June, when the doctors told Deb to say goodbye and placed Sam into a coma.
Her son was on life support. Even if he survived, he could spend the rest of his life in a vegetative state.
Family and friends gathered. Her sister flew down from Queensland.
The doctors tried repeatedly to bring him out of the sedation, but his body went rigid every time.
Day after day, she sat by his bed and prayed. She held up her phone to his pale face and played a song they both loved, "When the Rain Comes" by Third Day.
"I can't stop the rain
From falling down on you again
I can't stop the rain
But I will hold you 'til it goes away"
She saw tears leaking from his eyes. She cried, too. Maybe Sam was still in there, somewhere.
After 10 days, the doctors successfully awakened him. He looked terrible. Deb went home that night with low expectations.
She returned in the morning to find him sitting in a chair, eating breakfast.
"You're alive!" she cried.
She began recording the moment on her phone. In the video, dated June 20, a bleary but smiling Sam flashes a triumphant thumbs-up. "Praise the lord," he says.
"Sam the super man!" she declares.
Deb warned him he couldn't do this again, and that if he did, their relationship was over.
Sam agreed. No more drugs, he told her. He'd seen the light.
The day he was discharged, Deb welcomed him back into her home. The next morning, he went to a shopping center to buy a box of chocolates and a thank you card for the hospital staff who had saved his life.
And then he popped into a doctor's office and got himself a prescription for an opioid and a benzodiazepine.
"Open your eyes, Sam."
He is staring vacantly at the camera, eyes flickering, then closing.
"Open your eyes, Sam," Deb orders again, voice tight with rage. "OPEN."
The video was shot on June 29, five days after Sam was released from the hospital. He is slumped on Deb's couch, overdosing on opioids, benzodiazepines and Lyrica.
Deb has called the paramedics. She just has to keep Sam alive until they turn up.
"Why are you doing this?" he asks. "Why are you filming me?"
"So you can see what you're like," she replies. "I thought seeing yourself on life support would help you not do this anymore, but clearly not."
"Do you have any Lyrica left?" he mumbles.
The ambulance arrives. Deb is too fed up to follow. She calls the hospital later and learns that Sam was briefly put back on life support, but that it's not as bad as last time.
When she gets to the hospital the next day, a nurse delivers another blow: Sam has withdrawn his consent for Deb to be updated on his medical care.
Deb goes home, gathers Sam's few belongings, and dumps them at the hospital.
She is done.
And yet, she's not. She is his mother. He is her son.
On July 19, three weeks later, he steps off the bus, carrying his shopping bag. His sweatshirt and sweatpants hang loosely on his skeletal frame. It is clear from the smell that he hasn't showered.
Deb is waiting for him. She wraps him in a hug and rustles his messy hair.
Back at her house, he sits on the porch and stares out at the surrounding gum trees. He ignores the sandwich his mother places in front of him, and begins to talk.
He tries to explain why he withdrew his consent. He was worried she'd say something to the doctors that would get him committed to the mental health ward. He regrets it now.
"For me to say that after everything mum's done for me... especially bringing me up by herself, providing for me. And then with the OD in ICU when I was in the coma, coming to visit me every day, the toll that would have taken — I can't begin to imagine," he says, eyes darting toward his mother, who stares back in silence. "I felt terrible."
A couple weeks ago, he says, he was trying to sleep on the train but couldn't stop crying, thinking about how badly he had hurt his mother. In his bed at the men's shelter in Sydney, he lay awake all night, thinking of her pain.
And then he went to another doctor and got another prescription and had another overdose. He ended up back in the emergency department.
That was the moment he decided, "Enough's enough," he says. That's why he agreed to go into detox for a few days. He says he hasn't touched a drug since. He says he's been staying in a hostel, but has no money left, no place to go. He says he can stay clean, if only he had a roof over his head.
"It doesn't have to be like that, Sam," Deb interjects. "You've been advised what the best thing to do is to get your life back on track, and that's to go to rehab."
But he doesn't like rehab, he says. He doesn't like the people who go there. He doesn't like the rules.
And there's something else.
"What if it doesn't work?" he asks.
"You haven't tried!" she snaps.
The argument goes on in a relentless loop. And in the end, there's the desperate request she knew was coming.
"Can I please stay here tonight?"
She tells herself that coddling him is enabling him. That if she lets him get one foot in the door, he will force his way back into her life until the inevitable, awful end of his own.
"I don't want you staying here, Sam."
"Can I at least have dinner here?"
"And then what?"
"I don't know. Sleep on the footpath or walk to the train station or something."
It is dark now, and they are freezing. Deb lets Sam into the warmth of the living room. He sits on the couch where he overdosed three weeks earlier and wolfs down a sandwich, and toast, and cereal, and cookies. Deb sinks into her armchair, looking broken.
She tells herself to stay strong, not to give in.
But she cannot send him into the darkness. And so she keeps him home for one last night, for one last chance.
This story, part of the AP's reporting on the global opioid crisis, was produced in partnership with the Pulitzer Center on Crisis Reporting. The Global Opioids project can be seen here. https://www.apnews.com/GlobalOpioids