The Washington Post spoke with families and friends of more than 70 victims that span the epidemic. Here are some of their stories, remembered through the lens of their families.
The first wave: Prescription pills
Overdose deaths from prescription drug abuse began to surge in the 1990s as usage expanded, with the advent of new philosophies about pain management and more-aggressive marketing techniques by drug companies. By 2011, more than 115,000 Americans had died.
Dominic Rosa was 6 years old when he first tried out for hockey in 1989.
He didn’t have the proper equipment and padding, so he looked smaller than the other players, remembered his father, Charles Rosa, 60. Dominic grasped onto the sides of the rink with his mittens, trying not to fall over. Charles thought about hauling him out of the arena. But another father told him to wait it out.
Dominic wasn’t a quitter, though. He went on to play as a forward for more than 10 years, becoming a co-captain of the Peabody High School team and getting picked for the regional all-star team. But he couldn’t beat opioids.
“He thought he could be the guy who used heroin and gets away with it, but no one can,” Charles said.
Even after his younger brother Vincent overdosed and died after chewing on a fentanyl patch, Dominic still thought he could overcome his addiction. However, on Nov. 24, 2004, one day after leaving a treatment center in California, Dominic returned home and overdosed on a “cocktail of pills,” including opioids, his father said. He was 21.
Dominic and Vincent “were the first kids on the block” to die, said Charles, who now runs a nonprofit group that provides educational programming to schools about substance abuse.
“Now, a lot of the people that my sons grew up with are struggling,” Charles said. “It’s unbelievable how many of those kids are dead or struggling.”
The second wave: Heroin
From 2011 to 2014, as deaths from prescription pills plateaued, heroin — a cheaper alternative to pills — began to flood communities across the country, killing over 29,500 people.
Eric Pavona was an honors student. He got a 32 on his ACT. He worked two jobs in high school, saving enough money to buy a used, silver 2005 Mustang. He was studying to be a pharmacist.
Then, around 2008, he became addicted to heroin. “He turned into a totally different human being, like a Martian,” said his father, Phil Pavona, 62, who is a retired hospital administrative director.
Eric accrued debt, he dropped out of college, he lied.
At first, Phil was clueless. Spoons would go missing from their kitchen and Phil would wonder whether someone was throwing them out.
It wasn’t until Phil went to the courthouse after Eric told him he had a ticket that he found out Eric actually had a drug charge. That began a 2½-year battle within the family.
“We lived through the court system, we lived through inpatient, outpatient or rehab, 12-step meetings,” Phil said. “You name anything an addict can do, he experienced that.”
Phil felt adrift. They were a middle-class family in Lansing, Mich. He didn’t feel like there was anyone else in their community who could relate.
“I watched the news,” Phil said. “It wasn’t in the news.”
After being released from jail, Eric overdosed but survived. Three people released with Eric had overdosed and died shortly afterward. A clerk at the jail told Phil he was lucky.
“I didn’t feel lucky,” Phil said. “It was disheartening. I remember saying to her, ‘But why didn’t you warn us?’ ”
Phil said he didn’t realize addicts tend to quickly relapse after being released. He thought his son would want to go home, relax and watch TV.
On Aug. 12, 2011, Eric was released from jail again. Two weeks later, he died.
He was 25.
The third wave: Fentanyl
Since 2013, fentanyl, which is 50 times the strength of heroin, has overtaken prescription pills and heroin as the leading cause of overdose deaths among Americans, killing more than 100,000.
Starting in 2015, people on the Cherokee reservation in western North Carolina were dying, and Kallup McCoy worried for his sister.
Kallup had entered recovery after getting out of jail for a drug-related charge in 2017. His sister, Leighann Rose McCoy, was in the throes of her opioid addiction. Kallup called her repeatedly, telling her to get help before she made her four children motherless.
“She finally stopped answering my calls,” he said.
Kallup said he and Leighann grew up surrounded by a drug culture. Several family members were marijuana and cocaine dealers.
“It was so normalized,” he said.
Although Kallup and Leighann had used marijuana, he said, they became addicted to harder drugs only after they were given pain medication. He first tried opioids in 1998 when he was given Stadol, a brand of the morphine-like opioid butorphanol, for migraines.
She was treated with Percocet, which contains oxycodone, for scoliosis after leaving the Navy in 2007.
Her opioid addiction lasted 12 years. In March, Leighann, 39, overdosed on fentanyl. She had used her per capita disbursements from the tribe’s casino to buy the drugs. Kallup said many people use that money to buy drugs on the reservation.
“Our tribe is very blessed and fortunate, but also it seems to give a sense of entitlement to our people,” Kallup said.
As part of a nonprofit he created called RezHope, Kallup visits other reservations to talk about recovery — and now includes his sister’s story.
“I’ve been doing this for a while, and it doesn’t necessarily get easier,” he said.