Today and Monday mark the beginning of a monthly series probing the financial and emotional costs of overdose deaths. The articles will look at the toll paid by those who have lost loved ones to addiction, as well as those who help treat or respond to it. We welcome reader feedback as we continue to probe this difficult subject.

When Shona Trettel learned her cousin died of an overdose last year, she and her mother cried hysterically over the phone to each other.

Her husband shepherded their three children, ages 5 through 11, upstairs in their Monongahela home until he could talk to her and find out what had happened.

She would eventually break the news to him: three days shy of his 27th birthday, on Jan. 31, 2016, her cousin, Christopher Ferris, died of an overdose of heroin laced with fentanyl.

Trettel had known that Christopher’s brother was an addict, but said Christopher himself had shown the family no outward signs of addiction.

The phenomenal baseball player, the little boy who would climb trees when playing with Trettel, was suddenly gone. And Trettel had some explaining to do to 11-year-old Ava and 7-year-old Lily, who were old enough to process what had happened.

Ava asked whether her cousin was bad.

“‘No, your cousin’s not bad,’” Trettel recalled replying. “Oh shoot, I’ve got to rethink how I’m teaching you.”

Then came another hysterical phone call from her mother just six days later: Trettel’s aunt Tammy had died.

Tammy Radovich died of a suspected prescription drug overdose at 47, ending what Trettel said was Tammy’s long-term dependence on prescription medication following the death of her daughter. Tammy’s death came the morning after Christopher’s memorial service in Tennessee, where both Christopher and Tammy lived.

This time, Trettel hit the kitchen floor.

“It was just a really tough time having to talk to them,” she says of her kids 15 months later, holding back tears.

Trettel, 36, said she likes to take Ava, Lily and 7-year-old Bobby to the Monongahela Aquatorium to feed the ducks.

But Trettel is alone during the weekdays now, her kids at school. Reflecting on what happened, her black sunglasses can only do so much to hide the pain she feels when she remembers how her cousin and aunt left this world.

“The confusion of why,” Trettel says. “Why did it have to happen? Why did it have to happen like that? You know, we’re all reeling from Christopher’s passing, which was completely unexpected, and then you turn around and it happens again. I mean, how much can one family take?”

The confusion is multigenerational.

“One of the worst questions they asked me was, ‘Why?’” Trettel says about her kids, choking up as she continues.

“It’s the only one I couldn’t give them an answer for. As a mother, that’s horrible when they ask you, ‘Why did this happen?’ And your answer is, ‘I don’t know.’”

A record number of overdoses in Washington and Westmoreland counties are sowing more of that kind of confusion than ever.

Washington County was the site of 109 deaths by drug overdose in 2016 according to the county coroner’s office, comprising nearly 18 percent of all drug overdoses in the county in the past 25 years in just a 12-month span and numbering as many as the previous two years combined. Westmoreland County had 174 fatal accidental drug and alcohol overdoses in 2016 and 300 in the past two years, and fatal accidental overdoses have increased 691 percent there since 2002.

“These aren’t just a statistic that you read in the paper, another young person gone,” Trettel says. “These are people. This was my family.”

The stigma lives on

As president and CEO of Gateway Rehab, which opened a 16-bed inpatient detox and rehab facility at Excela Health Frick Hospital in Mount Pleasant in October, Paul Bacharach knows a lot about drug statistics. He knows that fentanyl is 50 times more potent than heroin, bad news for Westmoreland County, whose fentanyl-related overdoses jumped 364 percent last year from 2015. He recalls that patients tell Gateway’s medical director, Dr. Neil Capretto, that drug withdrawal is like “having the flu times 100.”

And he guesses that roughly half of Gateway’s patients have a similar story to his son Nathan, who died at 26 in 2009 of complications caused by an opioid addiction.

An avid snowboarder and soccer player, Nathan broke his leg in a pickup soccer game while attending West Virginia University.

“It started there,” Bacharach says.

Nathan received pain medication for his injury and became addicted, using pain meds for eight years before his death.

“What at the time we didn’t realize was a drug issue just looked like a bad decision that people make, and Nate could always kind of charm his way through it,” Bacharach remembers.

So Nathan worked for a while in a salon and as an X-ray technician before excelling as a bartender.

“He was a very personable kid,” Bacharach says. “So he did very well there. Always able to take care of himself.”

Still, Nathan made several bad choices which ultimately led to him either losing a job or not being able to continue on as an X-ray technician. He underwent treatment for his addiction and went back to school, this time for cosmetology. But then he relapsed, fatally.

“You’re certainly always looking back and trying to second guess what could have been,” Bacharach said. “Could you see this in advance maybe in some way or another?”

Yet Bacharach doesn’t dwell on the loss of his son.

“You can’t turn back time,” he says.

Instead, he rerouted his career toward more directly helping those in addiction recovery, stepping down as president and CEO of Uniontown Hospital in 2013 after 21 years in that position to take the helm at Gateway Rehab.

“That’s the reason I’m at Gateway now,” Bacharach says. “I can’t help Nathan, but hopefully I can help some other people, young people in particular, that are going through the same thing.”

So the numbers Bacharach cares most about now are ones like those written in marker on a whiteboard in a meeting room at Gateway Rehab’s Excela Health Frick Hospital location. They denote the numbers of days clean 14 patients have put behind them so far, ranging from 26 to four. The goal from the patient 26 days clean was to “finish this M.F,” while a patient five days clean just wants to “get thru day.” Two patients with 19 and 11 days clean, meanwhile, aim to “stay here.”

Bacharach has what he calls “a personal disagreement” regarding health information. He’d like to see it less restricted when appropriate, and he notes that Nathan’s family didn’t know a lot about the treatment he received until after he was gone, because he did not want others to know and access was restricted.

“There is an excessive amount of confidentiality as far as treatment services,” Bacharach says. “So it’s hard for providers to talk to other providers, even to talk to other insurance companies.”

Bacharach calls it “kind of like HIPAA (the Health Insurance Portability and Accountability Act of 1996 protecting the privacy and security of certain health information) on steroids” and thinks that excessive confidentiality has added to the stigma of addiction.

“Instead of saying the person has a problem, they’re being treated for the disease, we kind of keep it hidden away,” Bacharach says. “In many ways, it in my mind mirrors what we saw with HIV and AIDS, when it was first starting to come to light in society. It was all hidden away.”

Sometimes the hiding happens in plain sight.

Shelby Ferguson, funeral director at Ferguson Funeral Home in Belle Vernon, has noticed that people often don’t admit up front they know that a decedent died of an overdose. Seven out of 10 times, Ferguson estimates, family members don’t believe the death was drug-related, even when it’s the apparent cause.

“Most times, the family doesn’t realize it or is in denial,” Ferguson said.

Ferguson has noticed a dramatic rise in services for those lost to an overdose in recent years at his establishment, including five last year and three already in 2017. He observed that those decedents are generally middle-aged or younger, and that means a more crowded funeral home.

“You get a 40-year-old — he has lots of friends, and if he has children, the children have lots of friends,” Ferguson said. “Generally the parents are living too so the parents have friends. So there’s three generations coming in.”

“I think you’d be hard-pressed to find anyone that hasn’t been touched by this problem at some point,” Bacharach says.

“The best I could do”

When families are past denial and do know about a loved one’s addiction, the fatal overdose becomes a different kind of devastating, abruptly ending a roller coaster of hope and desperation.

“You get clean, you give your parents hope,” said Joey Pagano, recovering addict four years sober and president of Club Serenity, a Charleroi-based addiction recovery center.

Mother and father get to finally sleep at night.

“You go back out and relapse, parents get crushed again,” Pagano said. “This could just repeat forever, until you either die or get clean and stay clean.”

Trettel’s cousin and aunt never achieved the latter scenario, even though Christopher’s brother did, now celebrating eight months clean.

When Trettel got over the shock of losing Christopher and Tammy, she realized she had to do something.

“That’s when I started thinking, I’ve got to look into this,” Trettel said. “I gotta learn what’s going on.”

Trettel hadn’t lost anyone to an overdose before Christopher and as a Monongahela stay-at-home mom had only heard secondhand of people finding used needles in alleys. Now she’s more aware of the challenges addicts face, from a shortage of treatment centers to difficulty finding employment after recovery. And she successfully encouraged her daughter Ava, who was embarrassed by Christopher’s death at first, to talk about it.

“It was the best I could do,” Trettel says.

Now that Trettel’s talking publicly about it for the first time herself, she hopes that people will stop referring to those with addiction as junkies.

“I can’t understand where the compassion has gone,” Trettel says. “There’s no compassion for them anymore.”

Holding memorial cards for her cousin and aunt, her voice about to break, she has one more thing to add about Christopher and aunt Tammy.

“They had families,” Trettel says. “They were good people. And they didn’t want to die.”

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