By Noelle Crombie | The Oregonian/OregonLive
Jennifer Epstein was headed on a walk one morning last December when she noticed her son’s car still in the driveway.
She worried Cal would be late for an appointment to get a COVID-19 test. She went to check on him and found him in bed, unresponsive. His breathing was shallow.
As a 911 dispatcher coached her husband how to administer CPR to their son, Epstein noticed a plastic baggie of small blue pills in the room.
Later, the Washington County couple would learn that the black market OxyContin their 18-year-old son thought he’d bought through Snapchat contained fentanyl, a painkiller up to 200 times more potent than morphine.
Cal, whose big personality and generous spirit had filled the family home, never regained consciousness.
He died five days later at Providence St. Vincent Medical Center.
He was one of at least 92 people who died from a fentanyl overdose in Oregon last year.
Another 115 people died from overdoses linked to multiple drugs, including fentanyl, state officials said.
FLOODED WITH FENTANYL
Oregon is awash in cheap black market fentanyl.
Local, state and federal law enforcement officials reported record-high seizures of counterfeit pills containing fentanyl last year and a corresponding grim human toll: The state reported the most deaths ever from fentanyl in 2020.
For the first time, the drug eclipsed heroin as the second leading cause of overdose deaths in Oregon, according to an analysis by Dr. Sean Hurst, the state’s chief medical examiner.
Hurst’s office reported a total of 857 drug overdose deaths in 2020, a 36% increase over the previous year. Methamphetamine remains the leading cause of fatal overdoses in Oregon.
Fentanyl is typically sold on the illicit market as OxyContin pills marked “M” on one side and “30” on the other, commonly referred to as M30s. Fentanyl has also been found in illicit pills purporting to be Xanax and even Adderall.
Police say the drug is moved into the market by the same drug trafficking organizations that distribute cocaine, methamphetamine and heroin.
Authorities say it often comes through Mexico and China or made here using fentanyl powder purchased off the darknet.
Amounts of the painkiller vary from pill to pill and it doesn’t take more than a grain of it to be lethal. In pharmaceutical form, fentanyl is used as a short-acting drug to treat severe pain.
In general, police and public health officials say fentanyl is finding its way into the hands of two kinds of consumers: People addicted to opioids and novice recreational users like Cal Epstein who seek out black market OxyContin only to discover, sometimes too late, that the pills contain fentanyl instead.
People who die from fentanyl overdoses don’t typically have long histories of opiate addiction or treatment, said John McIlveen, who oversees the state’s opioid treatment programs.
“It doesn’t seem to be predominantly people who have these 10-, 20-, 30-year histories of drug use and 10-, 20-, 30-year histories of incarceration or treatment,” he said.
The pandemic has accelerated the fentanyl crisis, he and other public health officials said, likely due to the toll of social isolation and the low-cost and portability of fentanyl.
McIlveen speculated that fentanyl filled in for other drugs that may have been harder to traffic during the pandemic due to border closures and other disruptions to the illicit market.
“The vacuum has been filled by fentanyl,” he said.
Last year, police seized more than 713,000 counterfeit pills in Oregon, up from more than 79,000 in 2019, according to data collected by the Oregon High Intensity Drug Trafficking Area, a federally funded program that manages drug enforcement resources.
Most of last year’s seizures were reported in the Portland metro area and Marion County.
All likely contained fentanyl, the agency said.
DEVELOPING INTO A ‘SLOW BOIL’
Police and public health officials are left struggling to contain the crisis.
Dr. Jennifer Vines, Multnomah County’s health officer and the lead health officer for the tri-county region, said fentanyl-related overdose deaths have been steadily rising, a trend she referred to as “a slow boil.”
Multnomah County saw 25 fentanyl overdoses in 2019, followed by 52 last year, she said.
Fentanyl-related deaths increasingly make up a larger share of all fatal opioid-related overdoses, including those linked to heroin, Vines said.
Vines said public health officials have redoubled their efforts this spring to alert the public, young people in particular, about the dangers of fentanyl.
“If you are getting and using pills from anywhere other than a pharmacy,” she said, “you are at risk of ingesting fentanyl and that fentanyl is enough or could be enough to be lethal.”
So far this year, Washington County, where the Epsteins live, recorded at least 10 overdose deaths from counterfeit pills that authorities suspect contained fentanyl. Toxicology tests on another three fatal overdoses are pending.
Last summer, the Washington County Sheriff’s Office saw a spike in fatal overdoses from pills they suspected contained fentanyl. By year’s end, the agency saw 13 overdoses linked to fentanyl. One of them was Cal Epstein.
Police say they’ve seized nearly 28,000 counterfeit pills so far this year in Washington County, most of them fake OxyContin. That’s up from about 500 in the first five months of 2019.
“A lot of these pills are handed off from a trusted friend or someone they know or someone off social media,” said Washington County Sheriff’s Sgt. Danny DiPietro. “They think what they’re getting is a quick high.”
The Clackamas County Sheriff’s Office has seen similar numbers, said Capt. Marc Wold.
Between 2018 and 2020, the agency seized about 2,500 pills. So far this year, that figure has skyrocketed to 12,671.
Wold said fentanyl investigations pose a challenge: The bogus pills are made to look like pharmaceuticals and drug deals made on platforms like Snapchat vanish quickly, making them hard to track.
Plus, handling the drug is a risk for investigators because it can enter the system through skin contact, he said.
“It’s quite frankly too powerful of a drug to be considered a recreational drug,” said Wold, who oversees criminal investigations for the agency. “Your first time could literally be your last time.”
The same trend has played out across the country, triggering a health warning from the Centers for Disease Control and Prevention last December about the spike in opioid overdose deaths linked to illicit fentanyl.
The warning followed data that showed a deepening of the drug overdose epidemic. A record-high 81,230 overdose deaths were reported in the 12-month period that ended in May 2020.
Federal public health officials said the COVID-19 pandemic -- and the availability of fentanyl -- have accelerated the alarming upswing.
REMEMBERED AS ‘BIG SOUL’
The Epsteins recently spoke about their son’s life and the circumstances of his death in an interview with The Oregonian/OregonLive.
They said they want to honor their son’s memory and warn the public -- young people and parents in particular -- about the dangers of fentanyl in counterfeit pills.
“He would have done everything in his power to protect his friends,” said Jon Epstein, 51, who works at Nike. “He’s not here to do that so we are.”
Sitting at the dining room table of the Bonny Slope home where they raised Cal and his older brother, Miles, 20, the couple described the close friendships their son nurtured and the thrill he felt at the prospect of going off to college.
He was, as his dad put it, “an energetic, vibrant, gregarious, outgoing, lived-big soul from the day he showed up.”
They want Cal to be remembered for the life he led, how he was a loyal friend who would bake cupcakes or brownies to bring to school or throw a sushi dinner party for friends.
“He was always adding stuff to my grocery list,” said Jennifer Epstein, 52.
Cal was drawn to a range of personalities and took a generous view of others. He was unafraid to challenge his parents if he sensed they had judged someone unfairly.
“He was ready to be friends with anybody,” said Jon Epstein. “He was just really special that way.”
A social kid who thrived on connection, he often had friends over or was over at their houses. His parents recall finding him doing homework at the table, his cell phone propped up nearby so he could talk with friends.
In the months before he left for college, he worked at a local grocery store, where his boss’s only complaint was a good-natured one: Cal spent too much time chatting with families he knew as they checked out.
As a child, he disappeared for hours in the Harry Potter series and other epic tales. At Sunset High School in Beaverton, he worked backstage on productions of “Mary Poppins” and “It’s a Wonderful Life.”
He was a good student and looked forward to leaving home for the University of Hawaii, a school he picked for its academics as much as its laid-back vibe.
His plans for his future included someday having a family of his own, a dream he touched on in a fourth-grade photo collage. “I hope to be a house dad that gets to spend time with my future kids,” he wrote.
Harm reduction specialists say people who use opiates should try not to consume them alone or should let someone know if they are using them and what kind of drug they are using. Narcan, also known as Naloxone, can reverse an opioid overdose. In Oregon, pharmacists may dispense Narcan without a prescription. Narcan is covered by most insurance, including the Oregon Health Plan with no limit on the number of doses.
In his senior year at Sunset, Cal struggled with anxiety, which developed into an eating disorder.
Looking back, his parents wonder if the pandemic and the isolation it demanded compounded his mental health struggles. It was harder to find a therapist as the pandemic temporarily shuttered practitioners’ offices.
School, too, came to a halt and with it the structure it provided.
“Cal’s super social so that entire angle of his life, that whole get up every morning, go to school at 7 a.m. so I can see all my friends and then theater after -- that was completely turned off for him suddenly,” Jon Epstein said.
The Epsteins knew their son had used marijuana and had disciplined him over it. But if he had been using harder drugs in the weeks or months before his death, they didn’t know about it.
They said he was receiving mental health care for his anxiety while at college, where he encountered similar strict pandemic-related rules that limited his social life.
In December, the Epsteins welcomed Cal home for winter break. It was the first time they’d seen him since he’d left for college.
Sometime in the days that followed, Cal arranged to purchase OxyContin pills via Snapchat, his parents said.
The circumstances of that transaction remain under investigation by the Washington County Sheriff’s Office. The agency declined to comment on the case, citing the open investigation.
Four days after he had arrived home, Cal’s parents found him unconscious in bed, a bag of blue pills marked M30 nearby.
Jennifer Epstein showed them to a sheriff’s deputy who was in the room.
“These look like fake oxy,” he said.
SILENT TRIBUTE HONORS TEEN
That morning, Cal’s father moved him from his bed to the floor and followed the directions of the 911 dispatcher who guided him on CPR.
Soon, Tualatin Valley Fire & Rescue firefighters flooded the room. They worked to revive the teen.
The Epsteins waited outside with Miles.
Deputy Chris Schroeder stood with the family. He was gentle but somber: Don’t lose hope, he told them, but things didn’t look good for Cal.
He hugged Jon Epstein.
Cal was rushed to Providence St. Vincent Medical Center and admitted to the intensive care unit.
Two days later, on Dec. 16, tests confirmed the Epsteins’ worst fear: Cal was brain dead.
The Epsteins and Miles agreed they would donate Cal’s organs in keeping with his generous spirit. They knew it was something he would have wanted.
“He had a really great heart,” a doctor told Cal’s dad at the hospital.
The family held a memorial at his bedside.
Jennifer Epstein placed her son’s well-loved baby blanket on his body. She put the beanie she knitted for him when he was in high school on his head. His cousins added a poster filled with notes they and their parents, Cal’s aunts and uncles, had written to him.
A cousin laid a Nerf foam sword, the one Cal loved to play with as a boy, on his body -- a symbol, Jennifer Epstein said, meant to “protect him as he continued his journey.”
Nurses and doctors lined the hall outside Cal’s room.
Among those who had come to the hospital to honor the teen: the investigator on the case, Washington County Sheriff’s Detective Jim Weed, and Kenzie Rivera, the 911 dispatcher who had tried to help Jon Epstein revive his son.
Cal’s gurney made its way through the silent tribute, trailed by Cal’s brother, then his parents and his cousins.
At the end of the corridor, the doors to the surgical suite opened. Cal’s bed continued on, leaving his family behind.
Since their son’s death, the Epsteins have channeled their grief into advocacy.
They’re speaking out about the risks of fentanyl for young people who might experiment with pills. They’re working with Beaverton school leaders on a curriculum about the drug’s risks.
The couple said they focused on warning their son of other dangers, like drunken driving.
Said Jennifer Epstein: “We never knew to tell him one pill could kill you.”
-- Noelle Crombie; firstname.lastname@example.org; 503-276-7184; @noellecrombie