Stephanie Gilmore is preparing to throw herself on the mercy of a federal court, hoping the judge will send her daughter to drug treatment rather than back to prison.
Gilmore said her daughter, Stephanie Harris, has struggled with opioid use disorder for a third of her life, tracking all the way back to a legal prescription she got as a teenager.
She said Harris has raided medicine cabinets in strangers’ homes, fallen in with heroin dealers, survived two overdoses, entered into a sham marriage for drug money and served a year in federal prison. After violating her probation by using drugs, Harris had a hearing Wednesday, June 27, to decide what will happen to her next. The judge ruled that she should remain in jail until a final ruling on her probation. The date for that hearing has yet to be set.
In eight years, she's received just two weeks of treatment for her addiction, although her mother says treatment is really what she needs.
“How do we fight this epidemic and how does this lead to the penitentiary?” Gilmore said. “Prison is not the answer. It has to be some type of treatment and rehab, and it is not happening.”
Harris declined, through her mom, to be interviewed for this story.
She has fallen into a gap that Kansas City must close if it is to resolve an opioid crisis that, while not as bad as in some parts of the country, has hit the metro hard.
State and local governments have halted the rise in opioid deaths by improving access to naloxone, the drug that stops overdoses. But experts say that's just a Band-Aid that doesn't solve the underlying drug problem.
“Even if you are able to save that life, you really haven’t changed any of the conditions that put them into that level of despair or risk,” Kansas City Health Department director Rex Archer said. “So, we’re real good at mopping. We’re not very good at turning down the flow.”
After topping out at 115 in 2015, the number of opioid-related deaths in a four-county area around Kansas City, Mo., dropped to 93 in 2017, its lowest level since 2012.
At the same time, the number of times the Kansas City Fire Department has administered naloxone has risen each year, from 381 in 2012 to 544 in 2017.
Naloxone saves lives, but then comes the hard part: getting people off opioids so they don’t end up right back in the emergency room. That's a problem across the country, according to a study published Tuesday in the Annals of Internal Medicine journal.
In Kansas City, the problem can be seen in things like the rising rate of babies born dependent on drugs and the rising demand for addiction treatment — demand that substance-abuse specialists like First Call president and CEO Susan Whitmore say simply can’t be met right now.
“There’s no place to send people,” Whitmore said during a recent panel discussion on the opioid crisis. “What are we supposed to do? They show up at the hospital, they show up at the ER, they may go to the triage center for 23 hours, but then they have to go somewhere else. So there are a whole bunch of people on waiting lists who are not getting adequate services.”
Whitmore's group estimates that more than 150,000 people in the metro area need substance abuse treatment and only about 8 percent are getting it. While methamphetamine remains a bigger problem overall, opioids' share of that 150,000 is growing.
More money is starting to flow in to help. Whitmore's nonprofit is teaming with the University of Kansas School of Social Welfare to identify the gaps in the area's recovery system and just got the biggest grant in its history: $425,000 a year for five years to help people in the municipal drug court or those leaving the Jackson County jail get treatment.
But it will take time to implement, and Whitmore and others say there is also a host of social supports that people need to kick opioid addiction long-term.
Housing. Good jobs. Mental health care. Peer support.
Advocates and government agencies are quietly working to build a system that includes all those elements.
Gilmore hopes her daughter isn't in a prison cell when it's ready. She hopes her daughter is able to raise her kids, ages 6 and 2.
It's a long way from what she hoped for when Harris was growing up, having princess parties with the neighborhood kids and dreaming of being a pediatrician.
"I didn't choose this and I never would have thought I'd be here talking about it," Gilmore said. "But here we are."
Pills handed out ‘like Skittles’
Gilmore said her daughter's opioid problem started with a painkiller prescription she got while being treated for a kidney infection at age 15.
Gilmore tried to monitor what her daughter was taking, but Harris still managed to get a prescription refill that Gilmore didn't know about until the pharmacy called to tell her it was ready.
“I said, 'What prescription?' ” Gilmore said. “Lo and behold, it was for painkillers. We were three or four days in and there was no reason (for a refill).”
Refills were not hard to come by at the time.
Opioid manufacturers had said for decades that their products were rarely addictive when used to treat legitimate pain, and the medical community was only beginning to recognize that wasn't true.
Multiple studies showed that more than 20 percent of people prescribed opioids for chronic pain ended up misusing them, leading the Centers for Disease Control and Prevention to issue new guidelines in 2016.
Drew Roberts, a pharmacology researcher at the University of Kansas Medical Center, said other studies showed that 6 to 10 percent of people prescribed opioids after surgery were still taking them more than three months later — well after the pain should have subsided.
“There was no difference between minor surgery and major surgery," Roberts said during a panel discussion. "So it’s a major problem here. Opioid dependence, and potentially developing opioid addiction, is a complication of surgery.”
Leftover pills from people who didn't develop addiction created a floating societal supply that proved enticing for people who did.
Gilmore said her daughter, young and attractive, was able to charm her way into the houses of people she had barely met and check for medications when she didn't have a prescription of her own.
She often didn't have to do that, though. Missouri is the only state without a prescription drug monitoring system, and Gilmore said her daughter was usually able to find a doctor who would write her something for pills.
"She said, 'Momma, these doctors would just throw it to me like they were Skittles,' ” Gilmore said.
Lawsuits against the opioid manufacturers, including one brought by Missouri Attorney General Josh Hawley, are piling up and drawing scrutiny to the industry's marketing practices. With new federal and state guidelines on opioid use taking hold, prescriptions are down about 20 percent in Kansas and Missouri since 2013.
Missouri still doesn't have a comprehensive statewide monitoring system, but Gilmore said her daughter is now "red-flagged" in a system Jackson County set up in 2016.
Still, as the supply of prescription opioids tightens, new problems crop up.
Roberts said there's a danger of "parallel epidemics," of opioid misuse and chronic pain. Patients who have been put on higher and higher doses of painkillers may suddenly no longer be able to find doctors who will prescribe them or help them get off them.
“There’s going to be collateral damage if we’re not thoughtful about this,” Roberts said.
Gilmore said her daughter's experience shows that plenty of dealers are ready to step in with illegal alternatives, like heroin and synthetic fentanyl, for those who are desperate to avoid withdrawal.
A marriage for drug money
In the fall of 2015, a man named Delmar Dixon approached Harris, offering to set her up with an African immigrant who would pay her $250 a month if she married him so he could get a green card.
They were married that November, and Harris took the payments for months. But it turned out the immigrant was working undercover for the federal government.
According to court records, federal agents were running a sting operation on Dixon, who would eventually be sentenced to three years in prison for arranging dozens of fraudulent marriages for cash.
Harris was among several women who pleaded guilty to participating in the scheme. She got 10 months in prison and three years of supervised probation.
Gilmore said she didn't know whether her daughter understood that the sham marriage was a federal crime. But in retrospect, Gilmore said, it's obvious why she did it.
“She did this for the money, the money went toward drugs, and she just fed her habit,” Gilmore said. "She was addicted at this point and an adult, so I couldn’t really monitor her.”
Gilmore said she got Harris' phone when Harris went to prison. For days it buzzed almost nonstop with texts from people either looking for drugs or looking to sell them.
She realized her daughter had developed an entire network of people who were feeding her addiction and no longer needed the medical pipeline to get opioids because of what was available on the streets.
U.S. Sen. Claire McCaskill, a Missouri Democrat, released two reports in May that showed that the amount of illegal fentanyl, a powerful concentrated opioid, being seized by border patrol and customs agents has increased dramatically in the last few years. McCaskill sent a letter to the U.S. Department of Homeland Security seeking information about how much of that fentanyl might have been bound for Missouri.
Fentanyl's potency increases the risk of overdose, though Gilmore's not sure that's what twice landed her daughter "in the back of an ambulance" needing naloxone.
Under the terms of Harris' probation, she had to stay off drugs and submit to periodic drug tests. The first time she tested positive, she did get sent to treatment, at a facility in rural Missouri. But only for two weeks.
“They let her out early,” Gilmore said.
Gilmore said she warned her daughter's probation officer that she was hanging out with drug users and was likely to relapse, but it didn't do any good. Now Harris has tested positive again.
“Hopefully the judge will see that she needs treatment," Gilmore said. "I’m in prayer that he’ll see that ‘Hey, this is a drug issue.’ ”
But she's losing faith in the justice system, and she said she can't help but wonder whether her daughter would have gotten more help for her drug problem if she were a white woman from the suburbs instead of a black woman from the inner city.
The answer is complicated. Archer, the Kansas City Health Department director, and others say there's no doubt that socioeconomic factors contribute mightily to substance abuse.
But the opioid epidemic has crossed all boundaries, and even in the suburbs, there's not sufficient treatment or support.
Jodi Jackson, the director of the Shawnee Mission Medical Center nursery, said her team regularly shepherds women with drug problems through a healthy pregnancy and delivery only to see them relapse under the stress of caring for a newborn after they're discharged.
Which isn't surprising, she said.
“To send women home who aren’t equipped with these supports, who have a history of using substances and that’s their crutch, and then they have these connections that aren’t supportive and then expect anything different than what we’re seeing is absurd," Jackson said. "To expect any good thing to happen, it just doesn’t make sense. Why should they not overdose?"
A treatment plan
People recovering from opioid addiction often need inpatient detox, followed by weeks of residential treatment, followed by months or even years of outpatient treatment with medications such as methadone or Suboxone combined with counseling.
The Kansas City area has seven detox centers, but only two take people who aren't insured, according to First Call. The area has four residential treatment centers, but the wait time to get in is three to six weeks, so if the client has commercial insurance, First Call will usually refer them to private facilities in places like Atchison or Osawatomie, Kan., where they're more likely to get in right away.
Doctors need a special certification to prescribe Suboxone or methadone, and, according to a study published earlier this year, Missouri had the nation's worst ratio of providers who have that certification compared to opioid overdose deaths.
There's a host of challenges, but a plan is forming to fix them.
A group of experts, government agencies and nonprofits called the KC Regional Opioid Task Force developed an 11-point plan to create a "Model Recovery Community."
"It's a comprehensive, multifaceted, holistic approach to recovery," said Lou Steele, a business executive and task force member. "There may be others out there, but we have not found them."
Steele said the group isn't ready to give a lot of details yet, but the plan will be rolled out in phases over the next year or two and will include more treatment capacity, more sober-housing, a jobs component and places where people in recovery can meet and support each other.
It's the kind of treatment and support that Gilmore said her daughter needs. Whether she gets it or not, Gilmore said, she wants her story told to help others understand the downward spiral of addiction.
"I hope this has shed some type of light on where it started, the middle of it and," Gilmore said, "where it ends up."