By Lauryn Rosengrant & Kiley Shea Steiner
This story is a part of the Cincinnati’s Storytelling of Journalism project, which represents a collaboration between Northern Kentucky University (NKU) journalism students, the NKU Chapter of the Society of Professional Journalists, and the Greater Cincinnati Chapter of the Society of Professional Journalists.
Students interviewed seven professional journalist winners and finalists from the Greater Cincinnati SPJ Chapter’s 2021 Excellence in Journalism Awards to create these Nieman Storyboard Annotations-inspired Q&As and story annotations that analyze and celebrate our region’s award-winning works of journalism.
2021 Excellence in Journalism Award: Camilla Warrick Award
Winning Journalist: Terry DeMio, The Cincinnati Enquirer
Winning Story: “COVID-19 pandemic’s impact on opioid epidemic”
It’s mid to late April 2021 Terry DeMio must soon submit a news story to The Cincinnati Enquirer. The problem: she isn’t sure what to do yet. For years DeMio has devoted her time to writing and reporting on the opioid epidemic: She’s one of the most well respected heroin reporters in the country; she won the Pulitzer Prize for her Seven Days of Heroin article in 2018. However, she isn’t quite sure where to start and the story has a deadline.
Thinking of her personal sources, DeMio reaches out to Jennifer Anderson, who had struggled with addiction for years. She learned that the COVID-19 pandemic had Jennifer struggling to hold onto her sobriety.
DeMio knew that Jennifer couldn’t be the only one struggling with addiction during these challenging times. Support systems and support groups all went online once the pandemic had hit, and not everyone had access to a computer. Libraries were also shut down after the pandemic had initially hit, leaving those with addictions to their own devices.
DeMio reached out to other connections she had in Greater Cincinnati in order to get a more broad scope on the subject. Speaking with doctors and those with addiction, she began to form her story of how COVID-19 was hitting people suffering from addiction hard.
Terry DeMio
In a question and answer session with Terry DeMio, NKU students Lauryn Rosengrant and Kiley Shea Steiner asked the journalist about everything from finding and maintaining sources within her beat to her interviewing style to her favorite part of this particular story. This conversation has been edited for length and clarity and will be followed by the annotated story.
How did you develop sources within this very specific, very new beat?
Before 2016, I did cover the opioid crisis, but I did it on my own as a regular thing I decided to do and I got to know people. And when there were no public health departments doing a thing, and very few medical professionals dealing with it at all, I decided, okay, I really need to know what I’m talking about. First, I found regular people whose families had lost a loved one who were publicly, willingly coming out with their frustrations that no one was helping the community. I just did a personal kind of contact with them, and I kept those people with me. I check in on them, how are you doing, here’s what I’m writing about, what are your thoughts? I may not use them in a story, but keeping up with them is the most important. When I got accepted for a fellowship [the 2016 National Press Foundation fellowship for reporters covering the opioid epidemic], then I knew who to talk to locally. You know what resources and sources are needed. It’s just being able to fight your way through your own lack of knowledge, to learn as much as you can and you go for the people who really know their stuff. There are a lot of people who do things in this case, but it was a little less evident because so many things were being done wrong or just weren’t really helping.
How would you describe your interviewing style?
Conversational. Kind of like what we're doing now. So I have probably no more than a half dozen, maybe a little more or less questions in mind. Or little topics too, that I hope can be addressed. So I throw that out here and there. But I tried to just be conversational, do open ended kind of things. It's one thing to be talking to a public official government person or someone who's out there and just take notes and not repeat the damn thing to them. I want them to be comfortable and I want them to be able to not just be like, oh god deer in headlights. I want them to understand that they can talk to me and tell me anything, but anything they told me could be used in a story. But even with the professionals, while I might start with kind of a preamble, I'm more likely to email first usually to say, Hey, I'm going to be doing the story. When can you talk? You know, just so there's like, oh, they have some idea what it's going to say and it's a conversation more than anything else.
What was the most difficult part of writing this story?
We are brought up into our profession, as people who look at things, observe things, research things, report things and do so. And yet, we are human. And you know, I felt for my primary source as she started to exhibit signs of abuse, even as she was taken off in that car to go down to the treatment center. I think as journalists we can better convey the truth when we can really see it and feel it, but I also know that we need to be sure that our lens is on their story. The worst part about it is the most impactful part.
Some sources simply don’t work out due to schedules or other conflicts. What’s your advice on dealing with this?
If you get a core group of people that work with you and then see your work and share your work and see the impact, you get to know the people enough that they will jump when you are ready for them. I try to have a few things in my head, such as an alternative and it’s important that you keep a broad network of sources. I am lucky to have national and even some international sources, regional and local alike, y’know, real people and sometimes I’ll say, I’m not going to talk to you about the same things, but chances are that she knows someone else who knows someone else.
What is your favorite thing about this story in particular?
Jennifer. I loved that she came full circle again. You can and should envision your story and as you gather things, be open to changing it. It might not end. Tell your editor for heaven's sake because a few that you filed a story that they never expected. You know, that's where the coaching comes into the back and forth with them. But you should be flexible enough to realize that oh, what I thought was a story isn't but with her I did have that moment of fleeting panic that it's important. It's not something I want, but it's important for me to know that she's not doing well. But how will I deal with this story? And I didn't know the end, right? How will I deal with this story if she vanishes? And I honestly don't know where she, I mean, these are people who have cell phone burners or, or lose a charge and that they don't have anywhere to charge it. You know, these are people who are, in their own way, victims of a hellish health catastrophe. And so, you know, but I just love that she did well, and you know, it's interesting.My favorite part was just that whole process and then of course I have talked to her since and she's still doing very well. It's just incredible.
A version of the award-winning or finalist story is included below with annotations throughout. NKU student questions are in red; journalist responses are in blue.
What happens when an ongoing epidemic collides with a pandemic? Some who want to get well falter
By Terry DeMio, The Cincinnati Enquirer
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| Liz Dufour / The Enquirer |
Isolation is the enemy.
Question: What inspired you to write this story: Need for a story, knowing the source, or both?
DeMio: I think a little bit of both because you know, I knew I needed to do something. I knew that in a couple of months, this deadline would be there. And because I was so immersed with pandemic coverage, and you know, everybody was just kind of looking at the pandemic itself. What is this doing to everyone's life? How is this changing us? How is this impacting people? We were very focused on the direct impacts, the direct, you know, results. If you have a moment to breathe and think that people who are already struggling with anything from, getting some kind of service to having a mental health issue, even a physical health, they've got to be observing a whole different kind of impact. I made those check ins and like I said, I could have contacted other people. Jennifer just happened to be the first one I called and she was very receptive, and she seemed at the beginning to have that whole. I mean, she seemed to fit the story. Here's this person who was struggling and had these insights right away. It just seemed like 'oh my goodness look at this person and what she's gone through it must be what a lot of people are going through.' So it just stuck.
Jennifer Anderson watched helplessly as her boyfriend spent two days early in April isolating himself in their bedroom in Covington watching endless TV news about how COVID-19 was threatening the globe.
Question: How much time did you spend with Jennifer?
DeMio: Well, we were face to face once or twice. I don't remember...but most of it was just by phone. That was her easiest way. She is someone who's like, 'Okay, I'll be in Kentucky. I'm going to be driving or someone's gonna give me a ride to Cincinnati. Then I can get my stuff done and then I'll call you.' This has happened to me before but in this case, she was everywhere. I was very lucky that in the past I had had contact with her face to face and we know each other. We did a lot of zooming.
"People who are drug addicts, you're seeing it on the screen, it's gonna get to you," she said. Her boyfriend took off to the streets after that, besieged by that familiar compulsion to use drugs to cope, and although he eventually sought treatment, she lost track of him for days.
Which made her own recovery more precarious.
Anderson tried to hang on by offering help to others. On April 7 she posted to Facebook:
"Today is a beautiful day. I'm so grateful I woke up. Sober and not dope sick. I have healthy relationships in my life. Sober people that love me just the way I am. We all deserve that. We are NEVER alone. I'm here if you need to talk or just need someone to listen. Call me. ... Anytime."
Question: How did you decide to include the detail of a quote from her Facebook post?
DeMio: I've always asked permission, like 'Hey, can I look at your Facebook?' type of thing. The idea came to me as an idea a few years before this when I was writing another story. Some of the things that the girl from the other story was going through were not anything that I would have guessed and wasn't anything she could really tell me or would think to tell me. By the time we got to this situation, Jennifer was still healthy at the time I first talked to her and she told me, "Terry, just go ahead and use whatever you think is important." So I just checked in and I loved how she was encouraging them. This is when I knew kind of where the story was going. Here she is encouraging others and telling them she's there for them. Yet I see I hear her slipping. She had no idea at that point that she broke the poignancy of that because pretty soon she was gonna be one of those needing help. So I cleared it through her. I peeked in every now and then. And I grabbed that to illustrate that part of what she was going through and I let the story kind of fall where she felt you know.
She included her phone number.
It didn't dawn on her then that she needed as much help as her peers did.
Five days after that post, she was struggling to hold onto her sobriety.
"I'm tired," she said by phone.
What was once hard about staying free from addiction is now harder.
An epidemic that was difficult for most people to appreciate is now an epidemic that's in hiding. It's the epidemic of overdose deaths that killed almost 1,296 people a week in 2018. Seventy percent of those deaths involved an opioid.
It's an epidemic that continues to kill people every day.
The novel coronavirus has taken the stage. But those still in need of help for addiction now must jump new hurdles.
These are hurdles that make getting counseling harder, make getting human contact harder and make getting food, clothing and shelter harder.
For the diligent, telehealth counseling has replaced face-to-face therapy sessions. Discreet sober meetings and intimate faith services have been swapped out for Zoom and Facebook Live encounters.
For those in active addiction who depend on libraries for internet access and an ability to join digital counseling sessions, the closure of public libraries has shut the door on even that lifeline.
Anderson is 40. She has wrestled with addiction for years with a fierce determination to stay well, but this COVID-19 threat and all that it has brought with it has hurled a new level of anxiety her way.
"It's been hard," she said.
"I was used to three groups a week, three hours a day, so that filled up my time," Anderson said. "Then it was gone."
The structure of those in-person meetings with peers, maybe getting a peer sponsor and eventually, helping others, often helps those in recovery maintain their sobriety.
"You become a link in the peer chain of recovery," said Dr. Mina "Mike" Kalfas, an addiction specialist with St. Elizabeth Physicians Journey Recovery Center in Northern Kentucky.
Addiction is a chronic, often relapsing health condition that, when treated with medication, counseling and other support can be effectively managed.
Question: How do you work the medical context into the narrative?
DeMio: It’s not hard. Because you’re telling the story of someone struggling with addiction, and it’s fairly natural to explain what that means, why people with addiction react a certain way. And you just use the medical knowledge you’ve gained through sources to help readers understand what’s going on with these individuals.
Experts felt like they were making progress now that medication-assisted treatment has become more commonplace.
Now, as the pandemic continues, treatment providers are trying to prevent setbacks – to, in effect, bend the links among those in recovery into a new shape, so that people with addiction can get help without risking their lives to COVID-19. And without succumbing to a recurrence of addiction.
To their credit, experts were not taken by surprise.
"We saw this coming," said Dr. Roberto Soria, chief medical officer at Crossroads Clinic in Corryville, and addiction specialists planned for it.
As stay-at-home orders bubbled up across the United States, the federal Substance Abuse and Mental Health Administration announced guidelines in March that allowed states to take the lead in how methadone providers would give medication to patients. Instead of coming to a clinic every day, people deemed stable can take home up to 28 days of medication, depending on state rules. Ohio's rule restricts take-homes to 14 days.
Question: How did you select the action verbs like “bubbled” that you used?
DeMio: I have two editors. One of the editors for this kind of story is much more a story writer herself and the other editor is more of a news, AP style himself. I do have some more leeway also to try to capture Jennifer. I heard her voice and the way she spoke to me. I could hear panic and you can if you talk with people enough who have this condition you can tell if they're in crisis, aka I'm in withdrawal or I'm using I'm shaking, my voice is shaky, you know, whatever. But yeah, this is the kind of story since it's in part narrative that I just tried to write. I don't try to just report. There's a report, there's a story and there's storytelling, and I always try to make it a story telling story. I also trust Amy, (one of the editors) to tell me if I've gone off the deep end. I have always been more stark in the way I write and she's been more flowers. She's the one who had said, "Wow, what a great turn of phrase encouraging me the next time" or "Oh, I like this word you used to feel more comfortable writing."
Still, some are left out: "The only people that we cannot give it to are the people who are actively using fentanyl," Soria said.
His clinic has put in place safeguards to protect clients. Temperatures are taken outside. Inside, floors are marked at 6-foot intervals for those waiting in line for methadone. The number of clients allowed in at one time is limited to 12. The clinic has extended hours so that fewer people will be there at any given time, Soria said.
Pew Research Center also put out strategies for care of those with opioid use disorder during the pandemic. Among recommendations: Have a lead point of contact who ensures patients are following a comprehensive care program.
Elsewhere, doctors who prescribe buprenorphine products such as Suboxone, which diminishes opioid cravings, are reevaluating patients to learn who can have prescriptions for a longer duration.
Question: Were you prepared to simplify these medications for readers when you were writing this story?
DeMio: I had to talk to actual scientists and researchers early on, while I’m trying to learn about what the best treatments are that will save lives. Everybody has a different way of going through recovery, but at the beginning of all of this, I would have someone explain it to me. Every time I was going to write, I was like, “okay, I want to make sure I understand this, this kind of drug goes into the opiate receptors—what the heck is that, in my brain? What do they look like?” I literally had one of the doctors draw it out for me and it only partially blocks out this receptor, and then it fully blocks it, and blah blah blah. I made them explain it to me multiple times, more than one person. And I have had times, you know, we don’t let anybody see what we’re writing prior to publication, but I will very specifically say if I decide to write this a certain way and I’m not talking about a paragraph or something that this does, and this is how it works, is this wrong? I let them look at it and tell me how what’s wrong or what’s not right or whatever, so that I become so familiar with the concept, that I can explain it in my own way.
Anderson said her prescription, originally a week's worth of Suboxone, was extended to two weeks through the University of Cincinnati College of Medicine's Addiction Sciences clinic, also in Corryville.
That helped, she said, because she didn't have to find a way across the river every week. Her counseling was restricted to phone conversations. That proved harder.
Locating peer support she felt she could trust was not easy, but she managed to do it for a while.
"There’s a lot of underground AA meetings that people are doing in their yards and at farms, and you have to reach out," she said on April 6. "They’ll help you."
In the Cincinnati area, treatment providers want people to know there is help.
The Center for Addiction Treatment in the West End is trying to get word out that services are available. First Step Home in Walnut Hills, which provides housing and treatment for pregnant women, is reaching out for clients.
The Northern Kentucky Office of Drug Control Policy continues to link those with addiction to treatment. "We have had an increase of inquiries around reentry or recovery resources, where folks are asking for sober living or food services as well as online recovery resources," said Director Amanda Peters. Outreach looks different: Less face-to-face contact, more door hangers outlining treatment options.
Dr. Shawn Ryan, founding partner of BrightView Health, which has nearly 5,000 medication-assisted treatment patients in Ohio, said patients have adjusted rapidly to the call-in appointments.
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Not everything is going smoothly.
In Greater Cincinnati, Quick Response Teams, which go to the homes of overdose survivors to link them with treatment, have suspended operations. "The biggest part of QRT is that rapport ... when you knock on the door. We've lost that relationship," said Tom Fallon, investigative commander of the Hamilton County Heroin Task Force.
Hamilton County Public Health temporarily changed its syringe exchange operation, an effort to prevent the spread of HIV and other blood-borne infections, to appointment-only. The tentative plan is to reopen the week of May 18 with outdoor services.
The exchange has drawn some clients. In a three-week span, from March 30-April 20, 231 appointments were made, and 139, or 60%, were kept, records show. Participants received Narcan and a month's worth of syringes to help keep public contact down.
But for some, the restrictions were too much to manage in their already chaotic lives.
One woman who routinely used syringe exchanges before the COVID-19 outbreak stopped going. "I haven't even tried," she said early in May.
So far in Hamilton County, overdose counts have remained stable when compared to 2019. But on April 23, the county's addiction response team issued an alert, saying 13 people died from suspected overdose in just five days, and 911 calls about overdose were up.
Other Ohio coroners have reported spikes in overdose deaths. The Franklin County coroner saw six deaths in 24 hours early in April. And in mid-April, the coroner's office reported via Twitter that five people died from overdose in 12 hours.
Compounding the issue, doctors who treat addiction are beginning to see the erosion of previous progress in some patients.
"We're seeing pretty good attendance to our physicians' video visits," said Kalfas, "but some of the patients seem to be skirting the therapist."
Peer support specialists and case managers are calling patients more in response, and doctors are increasing drug screens for some patients to counter setbacks, he said.
The results of the screens aren't always good.
"I'm starting to see substances creeping in," Kalfas said. "I'm starting to see meth and even some of the older stuff: A little more heroin. A little more cocaine."
Newtown Police Chief Tom Synan, a coordinator with the Hamilton County Addiction Response Coalition, suspects the fentanyl supply, largely from China, has decreased with the coronavirus pandemic. He believes other drugs – heroin, cocaine – are being used in its place, exacerbating the addiction crisis.
No one knows yet how much the new crisis will affect the one that's been here for years.
Question: Was it hard to summarize such a broad issue at the end of this article?
DeMio: It didn’t feel difficult. This is a story that has its own end, like any, but it’s very clear that this situation is ongoing, and so you say it is. You let your readers know, through an expert or data or something like that, that this is the first answer, and things can change.
"It'll be tough to tell exactly what impact the crisis has had on patients with opioid use disorder until we see at least a few months of trends," Ryan said.
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Inside those trends will be the individuals who make them, including Anderson.
For her, the day-in-day-out pressures that piled on with COVID-19 were too much to manage.
"You can't see your psychiatrist. You can’t see your counselor," she said.
In mid-April, she felt so alone and anxious that she broke her no-drug-use rule and started taking Xanax, a benzodiazepine sedative sometimes prescribed for anxiety, but known to cause dependence. It triggered her active addiction, again.
"You do it because you want the pain to stop," she said.
It was a medication she'd long ago been prescribed, along with the opioid painkiller Percocet, after a fall in her mother's home. That's what started her addiction disorder 20 years ago.
Some uncertain number of days after she relapsed, Anderson went to Sun Behavioral Health in Northern Kentucky to detox. She doesn't remember much of the stay.
By April 20, she decided she'd have to get farther from the Cincinnati area to recover. The drug scene is too ingrained here, she said.
She arranged for a Karen's Place treatment advocate to pick her up in a Covington park on April 22 and drive her to the center, in Louisa, Kentucky.
"I am a nervous wreck," Anderson told The Enquirer by text on her way.
She texted once more: "I'm doing intake now. It's a really nice place."
It has been a hard road, with the pandemic capsizing so much of what she'd learned about staying sober. But Anderson has remained unwavering in her persistence.
"I'm OK," she said early on. "I’m gonna be OK."
"No matter what, this is just part of my story.”
Question: How did you decide to end the story this way?
DeMio: I wanted to capture her again. I take notes right from the start. There was something about this plain speaking. "I'm okay, I’m going to be okay. No matter what, this is just part of my story." I didn't know at the time that that was going to end my story, but I sort of hoped that there would be something that led to her rounding up the story. When I really looked at my notes, I was like... it hurts. Her words are so small, but they're so big and it sounds like to me, just from learning what I learned that this is the way a lot of people are. Well, these are the more optimistic people with addiction. But this shows anything can happen, but whatever it is is part of my story, it just felt that it went beyond even her. So it's both personal and I thought enlightening to someone who has a substance use disorder.
