The cautionary tale of one Johnson County man's personal battle with addiction
The sores on their faces are blistered and scabbed over. Their cheeks are sunken, and their eyes are vacant, any light behind them long since extinguished. They appear years older than their age and don't look at the camera, perhaps too high to focus or too ashamed. The mugshots are familiar, not because we know the people, but because we've seen so many like them, cautionary tales told by mugshots of people lost. We tell ourselves these people aren't like us; they're addicts. Their place is in the dark corners of the city, a safe distance from our lives of responsibility and filtered Instagram images. We can tell ourselves that, but it's not true. Drug addiction doesn't always look like a cautionary tale; sometimes, it looks like an ordinary, Instagram-filtered life.
When Nick Callegari walked into a room, everyone noticed. He was Hollywood handsome, dark hair and a killer smile with a personality to match. The women at Halls on Grand knew him by name, his style one of class and impeccable taste. Callegari loved a good joke, whether it was telling a manicurist he was a hand and foot model or planting a fake house tree in the backyard. And he adored his dog, taking him for a windows-down joyride before the appointment to put his old friend down. Callegari seemed to have it all: He was highly educated, came from a loving family and had a wide circle of friends. Of course he had struggles in life, dabbling in alcohol and marijuana as a teen, prescriptions for Ambien given when the Adderall he took for his ADHD deprived him of sleep. His mid-20s brought additional challenges. Like most his age, building a career and professional reputation was always on his mind, but a few curveballs were thrown his way. That's the thing with curveballs: You never see them coming.
There was suspicious behavior. His parents, Chris and Lori, noticed his dilated pupils and odd behavior at family gatherings, telltale signs of a path gone wrong. They're not the type to hold back. There were conversations and attempts at confrontation, but Callegari wouldn't talk. There were trips to the hospital and rehabilitation when he took too many pills, but he claimed he was fine. Life was stressful: Work was on his mind, a long-term relationship had ended, and his beloved grandmother had passed away. Life is hard sometimes, and he was determined to make his way through.
Lori didn't know. She didn't know the small orange plastic pieces occasionally found in the laundry were syringe caps. The Q-tips found around the house didn't raise any red flags. How would his parents know that cotton swabs are commonly used to filter heroin? If you’re not an addict, your mind simply doesn't go there. Callegari had seemed upbeat, happy in his new apartment and doing great at work. His parents continued to worry, however. His personality altered sometimes, a seesaw between the Callegari they knew and the one they didn't recognize. Then one day, he stopped responding to their texts, and their worst fears were realized. His parents shouldn't have been the ones to find him. He was only 30 years old.
There is a drug-induced death in the United States every 13 minutes. Because drug trends shift as new products emerge and distribution channels develop, it's impossible to stay one step ahead of it all. David Barton knows that all too well. As the former executive director of the Midwest High Intensity Drug Trafficking Area (HIDTA), his career started during the height of crack cocaine's infiltration. Created by Congress in the 1988, HIDTA provides coordination and assistance to law enforcement in high drug-trafficking areas — areas like Kansas City.
The drug business, like any other, is fueled by supply and demand. Kansas City has long been considered a drug hub because — quite simply — there is a market for it here and the city is a prime distribution point geographically. And those in control of drug distribution aren't as far away as you think. Barton says many successful drug distributors also share concerns about living in a safe neighborhood and sending their kids to good schools. Like other families, smart drug dealers move to the suburbs seeking peace of mind, their day-to-day business inconceivable based on the minivan that might be parked next to yours at school.
Back in the 1990s, crack cocaine, alcohol and marijuana were widely used. Hydrocodone and oxycodone followed years later, initially available in extended-release forms that could be easily crushed, dissolved and injected. New formulations were then developed that made that more difficult to do, which fueled the transition to heroin and opened the pipeline to “pure” (up to 30 percent) heroin coming in from Mexican and Colombia.
Phencyclidine (PCP) use is back on the rise among young people in the city, and the misuse of prescription ADHD drugs among youth has been prevalent for quite some time. Teens attend “pill parties” or “pharming” parties,” where everyone contributes random prescription drugs to a community party bowl and unidentified pills are ingested to obtain a high. Drug addiction in Kansas City crosses every cultural, socioeconomic and educational boundary. No one is immune.
Last year, more than 1,000 people came through ReDiscover, a drug treatment center in Kansas City. According to Marsha Page-White, clinical director of substance use disorder services at ReDiscover, this is just a fraction of the population that needs help. “There may not be as many meth busts in Kansas City, but alcohol, PCP and prescription pill use runs across gender, race and cultural status.”
Prescription pill use in particular can be deceptive, the little pills in a plastic bottle appearing somehow safer because a physician determined there was a need for them. According to the Hospital Industry Data Institute, however, inpatient hospitalizations and emergency visits for analgesic opioid overuse in Missouri increased 137 percent between 2005 and 2014, with the highest rate of growth in patients who were white, male and under 30 years old.
It all starts innocently enough: A patient is prescribed a synthetic opiate (opioid) for pain. Perhaps they were prescribed too many, took them for too long, or had a genetic predisposition to becoming addicted. The result is the same. “We have now increased opioid use and exposed a huge population to opioids when we don't know genetic predictability,” explains Dr. Jan Campbell, professor of psychiatry at KU Medical Center. “There are ways to reduce the amount of opioid that will minimize risk of addiction,” she says, “But that's time-consuming.” Not all providers, or insurance companies, are on board with alternative treatment, which is why opioids remain the go-to for pain management. We're seeing the results: Prescription drugs are the second most abused category of drugs, following marijuana.
The transition from user to abuser is effortless, almost fluid in its escalation. Patients start shopping online, justifying an illegal purchase because of ongoing pain or the friend of a friend who does the same thing and is fine. This transition, Campbell says, is very subtle. As tolerance to the drugs' effects builds, and the habit becomes more expensive, they then look for other options — options they never imagined they'd entertain.
Enter heroin. Also an opiate, heroin provides a much cheaper alternative to prescription drugs that can run upwards of $40 per pill on the street and are harder to come by. “St. Louis and Kansas City have always had a heroin problem,” Barton says. “But it wasn't always an opioid-abuse-based problem.” Reportedly more than 80 percent of heroin users start their habit with the abuse of prescription drug opioids. And because withdrawal can be worse than the pain itself, some users make the jump to heroin to continue their habit. “By that time, a lot of people aren't just taking pills,” Page-White explains. “They're injecting it, so sometimes that's not so big of a jump.” With much talk of the national heroin epidemic, we'd be naive to think it somehow spared Kansas City. “Oh, it's here,” Campbell says. Referring to heroin as a “seduction drug,” she likens it to cocaine and prescription opioids by its abrupt high onset and dramatic fall. The Kansas City Metro Methadone Program at KU Medical Center provides monitored detoxification from opiate addiction and is at full capacity with 250 patients. Like other clinics in the area, the need for help exceeds the capacity. “All the methadone clinics are overflowing,” Campbell says. “And there are waiting lists at all of them.”
“Most people don't get casually exposed to heroin,” Campbell says. “By the time you get to the place where you know how to use it, you're already part of the culture.” The National Institute on Drug Abuse estimates that 23 percent of those exposed to heroin will become dependent — an alarming statistic when you think of young people who believe they can dabble in it recreationally and emerge unscathed. Campbell still recalls a heroin patient from Blue Valley High School years ago, a bright student with every socioeconomic advantage available to her. Those things didn't matter, however; she had a genetic liability toward addiction and surrounded herself with a culture that supported her use. “Teenage brains' maturation is still in process,” Campbell says. “When you see drug use at that age, typical drug treatment strategies don't apply to this group.” Because teens struggle with identity and peer acceptance, residential treatment for extended periods of time is often the best option. When asked how the former patient is doing now, Campbell smiles sadly and says she doesn’t know. After multiple rehab stays, the teen eventually moved out of state.
Addiction lives in our brains' “drive state,” the part that drives us to feed an inner need such as hunger and thirst, in contrast to our brains' intellectual side that analyzes without emotional attachment. “Drive state overrides intellectual concerns,” Campbell says. Willpower, an intellectual process, isn't going to factor in. “I wish that people understood that drugs alter the brain,” she says. “Recovery isn't an intellectual exercise; it's an emotional process.” Page-White seconds that, saying the greatest misconception about addiction is believing that it's within the users’ control. “There's a belief that it is a choice.”
Methadone and suboxone, which activate the brain's receptors to facilitate detoxification and reduce withdrawal symptoms, offer hope for many. According to Campbell, 80 percent of people who go straight to rehab will relapse, so she emphasizes the need to get the brain to a functional level with medical treatment first. And because addiction always remains a part of someone, it requires ongoing treatment. “When you get a diabetic stabilized on insulin, you don't take them off of it,” Page-White explains, stressing the importance of stabilizing and support systems throughout the long-term recovery process. “We provide education, skill building and counseling. If they can stay clean and sober, their brains function differently, but they have to get motivated to live life differently.” Most importantly, Campbell wants people to know that relapse doesn't equate with failure. “This is a chronic disorder,” she says. “If you relapse, pick yourself back up and do it again.”
For Callegari’s parents, the fight against addiction wasn't buried with their son. It's a battle that leaves wounds and scars they'll carry with them forever. “Addiction is bigger than anyone can imagine,” Lori says. “It's all encompassing, and it takes on a life of its own.” They urge parents to do whatever they can — whether it’s arranging for rehabilitation or contacting authorities — if they see signs of drug use in their children. On a table in their home stands a picture of Callegari and his beloved dog, a broken rosary delicately laid in front of the frame and touched lovingly by his mom. “A broken rosary for a broken guy.”