Drugs took their children, but not their hope that others might be saved

Seventh in an occasional series on breaking the grip of addiction.

During the last six years of her short life, Emma Franchek spent at least half her days in one type of treatment or another, seeking care for addiction and mental illness. Psych wards, detoxes, rehabs, sober houses — none gave Emma lasting help.

But she kept trying, until her 4-foot-11 frame, a dancer’s delicate body, was found in a squalid restaurant bathroom in Boston. She had fentanyl, heroin, cocaine, and sedatives in her blood. Emma was 24.

Her father, Jim Franchek, wrote in her 2016 obituary that Emma died “after a long struggle with addiction.” Emma did everything she could, he wrote, “but, in the end, the disease was too powerful.”

Now, as he looks back at her experiences, Jim sometimes wonders whether the disease really was too powerful — or the help provided too weak. Contemplating what might have saved her, he says, the phrase “if only” often comes to mind.

Jim and his ex-wife, Dena Walters, are among three sets of grieving Massachusetts parents who shared their children’s experiences with the Globe, laying bare their journeys through an often chaotic and unwelcoming system of addiction care.

Make no mistake: Many people addicted to opioids survive and recover. But thousands also die, leaving behind loved ones who ponder what went wrong. These parents told their stories in the belief that their cries of “if only” contain wisdom — potential answers, though complex and difficult ones, that might help deescalate the opioid crisis that has claimed some 2,000 lives in Massachusetts in each of the last three years.

Their children had disparate experiences, but their stories share a few striking commonalities: All three had mental health issues that drove their addiction and did not receive effective treatment. None consistently took the medications that control cravings and prevent overdoses — but that, incredibly, many physicians and treatment programs still do not offer. And all died alone in public places where no one could revive them.

If only.

Emma

Emma Franchek had a smile so radiant it embarrassed her. “She would say, ‘Mom, is there a way to make my smile smaller?’ ” her mother, Dena, recalled.

Emma took ballet starting at age 3, and as a little girl enjoyed dressing up and daubing on makeup. She hankered for specific foods, like the pomegranate seeds she excavated from the fruit with delighted precision.

Jim, a lawyer, and Dena, a nurse, met in college and had two daughters; they split up when Emma was 1. In separate interviews, they were a study in contrasts — Jim, at age 62, low-key and somber; Dena, 63, animated, yet quick to tears.

Emma’s drug use started with Percocets obtained from friends at Lincoln-Sudbury Regional High School, where she graduated in 2010. She abandoned college after six weeks, and back at her mother’s house in Sudbury she’d stay in pajamas all day, watching TV. In college, her mother said, Emma had started cutting herself. And then, Dena started finding flattened pieces of foil with burned corners, and her spoons were disappearing — telltale signs of heroin use.

Dena and Jim worked hard to get Emma help. Over the next couple of years, Emma took part in four different treatment programs for addiction and mental illness, but her parents said she never received a consistent diagnosis, never mind effective treatment.

In Jim’s mind, a turning point came in 2012, right before Emma’s 20th birthday. After being abruptly discharged to the street from a psychiatric ward, Emma connected with old classmates and ended up at a heroin dealer’s apartment that was raided by the police. They found drugs and guns. Emma spent eight months at the state prison in Framingham.

Jim said Emma told him the prison provided no treatment for her addiction. And being in prison was especially damaging to her self-image. Now she saw herself as a miscreant, rather than a young person struggling with illness.

Emma emerged from prison into more drug use, more treatment, more relapses. She stayed at some grim places; at one sober home her mother found a dead rat. She suffered four seizures and underwent weeks of hospital treatment for a heart infection caused by injecting drugs.

At one point, Emma disappeared for two weeks. Jim and Dena went door to door in housing projects looking for her. They asked for help from the police, who sent chills down their spines by calling the morgue.

In January 2016, after going through another detox, Emma transferred to Megan’s House, a treatment program in Lowell that her parents speak of with awe and gratitude. Clean and bright, Megan’s House offered a structured program that taught life skills along with sobriety, including ensuring participants started working at a job before they left. And the counselors involved the parents in therapy.

Megan’s House was such a contrast to other programs that Dena started crying just talking about it. She recalled visiting on a Sunday morning amid the scent of shampoo and the happy hustle-bustle of 20 young women getting ready for the day, wet hair wrapped in towels.

Although Emma appeared to be doing well at Megan’s House, Jim later read in her journal that she was struggling with fierce cravings for drugs.

A medication could have controlled those cravings. But Jim said none of her many treatment programs ever told him she needed it. Dena recalled driving her to a clinic and waiting for hours each time to fill a prescription, and eventually abandoning those trips.

Three drugs have been shown effective in quieting cravings and preventing overdoses among people addicted to opioids — methadone, buprenorphine (often referred to by a trade name, Suboxone), and Vivitrol, a once-a-month injection. Many addiction specialists consider detox and rehab without medication to be extremely dangerous for people addicted to opioids: Relapses are common, and fatal overdoses are more likely when a period of abstinence has lowered tolerance.

Yet just over one-third of treatment centers nationwide offer even one of these medications, and only 6 percent offer all three. The figures are a little better in Massachusetts: 58 percent offer at least one of the medications, though only 4.5 percent offer all three, according to a Globe analysis of federal data.

It’s not clear whether Emma rejected such treatment or was never encouraged to take it. Megan’s House does not prescribe medication, but it maintains relationships with community programs that provide prescriptions, according to its director, who declined to discuss Emma’s treatment for privacy reasons.

Emma “graduated” from Megan’s House after six months. “For the first time in years,” Jim remembered, “I saw that Emma was proud of herself. She had hope. She had light in her eyes.”

But even as Emma settled into life in a new apartment in the summer of 2016, she confided to her mother that she still wanted to use again. Not long afterward, she did. A month after leaving Megan’s House, Emma was back in detox, staying six days.

She returned downcast and weary. Her parents each tried to cheer her up. The day after leaving detox, she joined her mother for a lunch of her favorite foods — chicken nuggets and thin-sliced beef spread with Boursin cheese. Then they hugged good-bye; to her mother, Emma always smelled like a baby.

Jim saw his daughter the next day, a Sunday. They went out for eggs Benedict, and he took her to buy art supplies, hoping the prospect of future creations would inspire her to look forward.

That night, Jim noticed Emma had used his Uber account without asking. The tab came to $65, a long drive. He felt a deep foreboding.

Jacob

Unlike Emma, Jacob Spitz never entered a treatment program. He even refused talk therapy. That’s not unusual. The majority of people who misuse drugs do not get treatment, usually because they can’t find it or don’t want it. Addiction remains, even today, a condition that evokes shame and denial.

Jacob’s parents, David Spitz and Diane DiGennaro, describe their son, adopted at birth, as a young man adrift — a “kind soul” beloved by his friends, but someone who needed a lot of time to find his way in life.

Diane sees the roots of Jake’s troubles in his early life and schooling. As a kid, he was teased for being chubby. A poor student, he felt like a misfit at the achievement-oriented schools he attended in Essex, Vt.

Some of his teachers took a sink-or-swim attitude toward struggling youngsters like Jake, who had trouble sitting still in class.

Diane, a retired elementary school teacher, recalled an assignment to write in a journal every day for three weeks. Knowing this would be difficult for Jake, and that he’d reject his parents’ involvement, Diane urged the teacher to check in with him once a week to nudge him along. The teacher refused. It was up to Jake to succeed or fail — and he failed.

Diane broke down as she thought back on Jake’s school years.

“The opioid issue is the final chapter for most of these kids who are feeling marginalized from the get-go,” she said through tears. “It’s not that hard to pick them out. They’re the ones that cut class and stand outside smoking and have no interest in participating. We need to have dedicated staff for these kids.”

Seeking relief from the stress, Jake started smoking marijuana in ninth grade, and remained a heavy pot smoker throughout his life.

His turn to harder drugs started after his parents moved to Harwich Port in 2009, about a year after Jake graduated from high school. Jake quickly found a landscaping job on the Cape so he could join them.

David and Diane had looked forward to retiring in a seaside community as beautiful, in a different way, as the Vermont mountains they left behind. They didn’t realize that in doing so they would drop Jake into the heart of the Massachusetts opioid crisis. Cape Cod was a hotbed of heroin use, and in time Jake became part of it. The police, his parents say, once found him barely responsive in the back of a car, track marks in his toes — a common injection site.

But all their efforts to help over the years — telling him he couldn’t come home if he was high, finding him therapists and treatment programs, hiring an “interventionist” to try to coax him into treatment, even finding him an affordable apartment — failed to get any traction.

They warned Jake he would have to move out of their house when he turned 24. When the time came, he crashed with friends for a while and then moved in with a new girlfriend, a woman a decade older than him. He and Brooke Murphy had a child in 2015 and married the next year, after they learned their daughter had cystic fibrosis, a serious genetic illness that requires consistent medical care.

When the little girl was 15 months old, Jake called his parents with distressing news: The family had been evicted from their apartment for failure to pay rent. Jake was working two jobs at the time, and his parents were pretty sure they knew where the money had gone.

David and Diane obtained temporary custody of the baby and took charge of her complicated medical care — trips to Boston doctors, the medications, and tests. They hoped Jake and Brooke would get resettled, but instead the couple couch-surfed with friends.

Still, Jake took a parenting course for fathers who had lost custody of their children. “His biggest joy was his daughter,” David said. “He wanted to be able to raise her.”

He didn’t get the chance. On Feb. 4, 2018, a woman walking her dog in Coy’s Brook Woodlands saw a body slumped over a fence, and called the police. The cause of death, the medical examiner later determined: acute fentanyl poisoning.

Jake was found alone, about a mile from his parents’ home, where they kept a supply of Narcan. David and Diane are tormented by the thought that he may have been with friends who fled after he overdosed. Diane wept, “The thought that he was that close and I could have helped.”

The couple know that no glorious recovery lay in Jake’s immediate future. But he was young — only 27 — and had he survived, he might have pulled himself together.

David believes that people like Jake, people not ready for treatment or unable to achieve sobriety, still deserve a chance to live. He supports providing a safe supply of drugs and a safe place to use them — ideas that are gaining acceptance in some other countries but still considered radical in the United States. (The Massachusetts Legislature is expected to consider allowing the creation of safe injection sites to help prevent people from overdosing.)

Diane is uncomfortable with such notions, but open to anything that might have helped Jake. “If Jake was here today and he was still using, we would still have that opportunity to help him make better choices,” she said.

After Jake died, David and Diane obtained permanent guardianship of their granddaughter, now 3. Brooke visits every other week, and other relatives in the region help out.

Raising a medically fragile child hadn’t been part of their retirement plans. David is 69, and Diane, 62; they will be elderly when their granddaughter graduates from high school. Still, the little girl adds a new element of fun to their lives.

“She’s a delightful, charismatic little kid,” Diane said. “When we’re not tired, she does bring so much joy to us.”

Diane keeps a box of memorabilia that she takes out from time to time for her granddaughter to play with. A photo of Jake holding her. His baseball card collection. A shirt and tie he wore. A bowl with his name glazed into the bottom. It’s one way they keep Jake alive, for his daughter.

Brian

When he was little, Brian Simpson loved playing a game with his mother. She would wrap him in a blanket and drag him around the house, and then he would try to guess what room he had landed in.

Brian mentioned the “blanket game” among the memories in a Christmas poem he wrote to his parents when he was 30. It reminded Kate Donaghue how happy her son had been as a young child, growing up in a “storybook neighborhood” in Westborough — with lots of children his age and the school bus stop within view of their front door.

But around sixth grade, something changed inside Brian. He lost interest in school, stopped doing his homework. Once Brian refused to get out of bed, defeated by a homework assignment to write about himself. He was supposed to describe what was special about him.

“He just didn’t feel special,” Kate said. “He didn’t feel he had anything to write about.”

Kate, 64, a software developer well-known in her community as a Democratic Party activist, and her husband, Kim Simpson, 75, a retired environmental engineer, talk about Brian in slow, measured tones, as if grief and resignation weigh down each word.

Brian was diagnosed with depression and attention deficit disorder as a child. He underwent counseling and took medications over the years, but never found anything that made him feel better.

Until, that is, he found heroin.

But first there would be alcohol and marijuana during high school and a failed semester in college, and opioid painkillers obtained from doctors in Florida to treat back pain. Brian returned to Massachusetts addicted to the pills. He entered an outpatient treatment program, and that’s where he met a fellow patient who introduced him to heroin.

Years later, Brian would tell his mother that before his head touched the pillow after his first hit of heroin, he knew it was the only drug he needed or wanted. He wished he could take it as medication to treat his depression.

Brian spent a few stable years with a job and girlfriend in Texas, but after the relationship ended, he came home, resuming drug use and pingponging from one treatment program to another. He completed some, walked away from several, and got kicked out of three. He attempted suicide twice, both leading to days in intensive care.

“He was just profoundly unhappy,” Kate said. “He never saw happiness as something that was in his future. I always hoped that he’d turn the corner, that something could click and that he’d find happiness.”

When Brian abandoned treatment, Kate recalled, it was often because he was having panic attacks. But none of the programs seemed equipped to address his anxiety.

On one occasion he begged a treatment program to keep on hand the benzodiazepines prescribed to treat his anxiety, so that he could request a pill if he panicked. But benzos weren’t allowed and rules are rules. Two days later, Brian was gone.

Rules are rules in addiction treatment, and patients who break them get kicked out.

One hospital-based treatment program ejected Brian and five other patients in the middle of the night because they had gotten drunk. He and a friend spent the night behind a dumpster.

Brian was thrown out of another program for smoking. With no place to go, he and a fellow patient found their way into the empty waiting room of a hospital outpatient clinic, where they were arrested. A few days later, Brian made his second suicide attempt, which led to three days in the ICU and a week and a half on a psych ward.

Kate estimates the ICU stay alone cost at least $100,000. “Could there have been a more cost-effective and compassionate way of dealing with a young man who smoked a cigarette?” she asked.

This practice of kicking patients out of treatment, euphemistically called “administrative discharge,” is not uncommon. Programs routinely eject patients for exhibiting the symptoms of their illness — taking drugs — or breaking rules that have little to do with recovery, such as wearing a hat or talking to a member of the opposite sex.

In October 2017, Brian was back at his favorite sober house, Goddard House in Quincy. He stayed there for several months and then moved to a rooming house in February. But without the drug testing, structure, and support the sober house provided, he soon overdosed and had to be revived with Narcan.

Kate asked him whether he’d thought about taking medication, like Suboxone or methadone. Brian rejected the idea with a common, and inaccurate, view: “I don’t want to trade one addiction for another.”

But he agreed to other tactics to prevent another relapse. He’d have his paychecks deposited into a debit card so he wouldn’t have access to cash, and he’d install a tracking app on his phone so his parents would know where he was.

Four weeks after his overdose, Brian, then 32, faced another setback. He was fired from his job at a Walgreens after what he described as a misunderstanding. His boss gave him his last paycheck. He was angry — and he had money.

Kate later read his text messages from that day in March 2018 — his last. Brian contacted a friend asking for help getting drugs. “Just this once,” he told her. “Heroin for you. Heroin for me.”

Always a shock

Death never comes as a surprise when your child is addicted to opioids. But it is always a shock.

The phone call that Emma’s mom had long feared came two days after their good-bye hug, one day after Emma’s brunch with her father. At first, Dena Walters refused to believe it. No, they will Narcan her, she’ll be fine. By the time she called Emma’s father, Jim Franchek, she was screaming.

Jake’s parents, Diane DiGennaro and David Spitz, were at home in Harwich Port watching the 2018 Super Bowl when their daughter-in-law called. She asked to come over. She had something to tell them about Jake.

For Kate Donaghue and Kim Simpson, the news about Brian made its way toward them over the course of a long excruciating evening, as hope flashed against dread until the very last.

Brian, expected for a visit, failed to text that he was on the train, as he normally would. Checking the tracking app, Kate and Kim saw with trepidation that he’d wandered into a Quincy neighborhood where they knew drugs were sold.

But then he seemed to head toward the train station. He’s on his way. The signal stopped. Perhaps his phone died.

Hours later the doorbell rang. He made it! As Kate headed to the door, through the glass she saw two policemen.

That’s when Kate knew her only child was gone.

Correction: An earlier version of this story misstated where Brian Simpson worked.