Editor's note: Since this story was first posted, we have received word that Destini Johnson is regaining consciousness and is out of intensive care.
Last August, Destini Johnson practically danced out of jail, after landing there for two months on drug charges. She bubbled with excitement about her new freedom and returning home to her parents in Muncie, Ind. She even talked about plans to find a job.
Eight months later, Johnson, 27, lay in a coma, silent except for the beeping of machines. She looked small and pale, buried in a tangle of hospital bedsheets and tubes, after suffering a dozen or so strokes as a result of her latest opioid overdose.
Her mother, Katiena Johnson, kept vigil at the intensive care unit at Ball Memorial Hospital in Muncie every day, fretting not only about whether her daughter would live, or how much brain damage she'd suffered, but also how to pay for the myriad costs resulting from the latest harrowing chapter of Destini's opioid addiction. Katiena Johnson says her daughter is regaining consciousness and is out of the ICU.
"Her troubles just kept piling on top of one and the other and the other and the other," she says. "They just bury [themselves] deeper and deeper in cost after cost after cost, of court costs and everything else."
There are many different types of costs associated with the opioid epidemic: including emergency response, health care, criminal justice, rehabilitation and lost productivity. It's no wonder the total estimated burden from the epidemic is enormous. Health care research firm Altarum put the figure at $1 trillion since 2001. The White House Council of Economic Advisers estimates that, including lost productivity because of opioid deaths, the total economic cost from the opioid crisis reached $504 billion in 2015 alone.
The biggest share of that burden is borne by families — who measure the damage not only in financial terms, but in terms of anxiety and heartache.
When I met Destini Johnson's parents last summer, they talked about missing days of work to drive their daughter to rehab or treatment, delaying retirement to pay for the additional costs, and caring for Destini's two young children. By that point, their daughter's addiction had already spun off a string of dramas, including prostitution, homelessness and an arrest on drug charges. Katiena Johnson expressed deep frustration that rehab programs were too few and too short-term, and — after several failed attempts — had become far too expensive for the Johnsons to afford at about $50,000 a month.
Now, if Destini lives, she will require intensive, expensive long-term nursing. Her mother hopes state insurance will foot the bill for the weeks-long ICU stay. Still, the bills could outlive Destini.
"I got a call from ... a collection agency, and I hate getting stuff like that while she's in this condition," Katiena Johnson says. "The second day she was in here, I got a court paper rolled up on my door for damage at some kind of apartment complex." In all the discussion about the cost of opioid addiction, Johnson says, there are few words about the toll it takes on families.
Multiply the Johnsons' story by about 143,000 opioid-related overdoses and 42,000 deaths across the country per year, according to the Centers for Disease Control and Prevention's latest data, and you get a sense of the damage ravaging families and their finances.
Michael Hicks, an economist at Ball State University in Muncie, compares the epidemic to a war — those who survive can remain scarred for life. The economic loss can be measured in paychecks not earned, absent parents not coaching soccer, and careers cut short by a criminal drug charge.
Hicks says it will likely require more money — government funds and family resources — to address. Congress has approved $6 billion in funding to respond to the opioid epidemic over the next two years.
"I think we're looking at a fairly grim period of investment to try to solve a problem that we're going to still have around for some time," Hicks says.
When a person dies, they don't just leave empty space for the family, he says. That loss can be measured in economic terms — lifetimes of lost earnings and the loss of what victims would have contributed to their families and society.
The White House's estimate of a half-trillion dollars in economic impact represents a best guess as to what a person's life might have been worth, multiplied by the tens of thousands of lives diminished or abruptly ended by opioids.
For Melissa Sexton, it misses the most important loss — of joy and hope.
"And now we are left with this huge, gaping void in our life, in our family, trying to figure out: How are we supposed to move on from this?" she says. Her daughter, Kathryn, or Katy, died on Halloween. She was 23.
Katy Sexton was tall, poised and beloved by the regulars at Road to Redemption, a weekly recovery meeting at the Tabernacle of Praise church in Muncie. In an interview last August, she talked unflinchingly about death, and of losing most of her high school friends and her college scholarship to addiction.
"I don't want to go to any more funerals," she said. She had been sober 30 days and said she intended to remain that way, in part to free her parents from constant worry. "It stresses them out every single day," she said of her opioid addiction.
I had kept in touch with Katy, texting about her treatment, and plans to meet up again. But in September, she stopped responding. I kept texting until, in early November, her mother texted back to say Katy had died.
The five months since have done nothing to diminish Dale and Melissa Sexton's grief.
Between sobs, her mother recounts how a mundane day of grocery shopping and making coffee suddenly turned tragic. She discovered Katy slumped in her bed.
In a tiny town outside Muncie, the fire station is around the block. The medical personnel are friends. For more than an hour, they tried to revive Katy.
The coroner said he found traces of fentanyl, the powerful synthetic opioid, in her system.
Her parents say Katy had been trying to fill a prescription for medication to blunt the drug cravings. But insurance required a waiting period.
Melissa Sexton says she cannot bring herself to enter Katy's room, but occupies herself collecting mementos in a box, including photos and items that played parts in cherished histories, or inside jokes.
Talking and thumbing through 23 years of Katy's life, the Sextons tabulate, in a sense, all they have lost: innocence, laughter, a future with grandchildren, a cellist, and a daughter who wanted to become a nurse, so she could help care for her severely autistic brother, Jacob.
The financial loss, on top of everything, they say, is another source of despair. They drained their accounts to try to save Katy. Now they're left with feelings of failure and self-recrimination.
"I don't know what would or could have made a difference. I just know it was my responsibility, and I didn't meet it," Dale Sexton says, sobbing.
His wife turns to him, trying to reassure him that he had, in fact, put everything on the line. "Honey, you cashed in your last pension [check] so that we could send her to rehab," she says. "At every turn, we did everything we could to the expense of our family's well-being to try to save her."
The Sextons are still trying to tie up the loose ends of Katy's financial life: student loans, bills from Katy's stay in rehab last year, her cellphone service.
"Last time I got a collection call from rehab saying, 'We still need this much money,' I didn't send them a check; I sent them a death certificate," Dale Sexton says. These are the cruel practicalities he tries to spare his wife, going to the mortuary to make cash payments, for example, so that she never sees the paper trail.
With so many young people all around the Sextons dying from opioids, Dale Sexton says it's no wonder treatment can be so hard to come by.
"The problem has outspent the resources. You know, the problem has far outraced the resources," he says.
DAVID GREENE, HOST:
For a family dealing with opioid addiction, there are countless costs. Emergency response, health care, lost jobs, rehab, criminal defense. These are costs that can easily run in the hundreds of thousands of dollars.
NOEL KING, HOST:
Yeah. And you multiply those costs by 42,000 deaths and hundreds of thousands of overdoses across the country every year, and you begin to get a sense of the damage that addiction can do to families.
GREENE: NPR's Yuki Noguchi has been following several families in Muncie, Ind., who are grappling with the toll of opioid addiction measured in money, anxiety and heartache.
YUKI NOGUCHI, BYLINE: Last summer I had come to Muncie to report on the opioid epidemic's effect on the workforce. There, I met Katiena and Roger Johnson, who talked about missing work, delaying retirement and taking care of their grandchildren because of their daughter, Destini's, addiction. As we talked on their porch, Destini surprised us, returning to her parents' home unexpectedly after being jailed on drug charges.
DESTINI JOHNSON: Hey.
KATIENA JOHNSON: This is my daughter.
ROGER JOHNSON: This is Destini.
K. JOHNSON: This is - did you get out of jail?
D. JOHNSON: Yes.
R. JOHNSON: She's right here.
K. JOHNSON: This is so great that you're here to see this.
(SOUNDBITE OF HOSPITAL ROOM MACHINE BEEPING)
NOGUCHI: Now nearly eight months later, Destini lies silent in a coma. Small and pale, she looks buried in a tangle of hospital linens, machines and tubes. Her mother, Katiena Johnson, keeps vigil nearby. She's strung up lights, photo collages and handwritten prayers.
K. JOHNSON: We're just hoping she wakes up. They're not giving us much hope, though. That's just the way it is. But she suffered 10 to 12 strokes, mainly on the right side of her brain.
NOGUCHI: Doctors told her mother the strokes resulted from an overdose two weeks earlier. A person who was with Destini called Katiena to say her daughter was unresponsive. He gave her an address then left before emergency workers arrived.
K. JOHNSON: Yeah. He couldn't even stay with her, but I was glad he called. Some people don't even do that when it comes to an addict.
NOGUCHI: The Johnson's harrowing experience with opioid addiction began about seven years ago when Destini was 20. Before that, Destini liked being class clown and playing board games. Her mother says she would have made a great cruise director. Instead, Destini's addiction spun up a string of dramas including prostitution, homelessness, jail time, a previous overdose and now severe brain damage, if she survives. Katiena Johnson and her husband now have custody of Destini's 2-year-old son, Schad (ph), and pay for his diapers and food. Katiena says she read a recent newspaper article about the cost of opioid addiction.
K. JOHNSON: I didn't hear it one time mention the toll it was taking on the families, the addicts' kids. Her troubles just kept piling on top of one and the other and the other and the other. They just buried herself deeper and deeper in the, you know, cost after cost after cost of court costs and everything else.
NOGUCHI: If Destini lives, she will need intensive, expensive long-term nursing. Her mother hopes state insurance will foot the bill for the weeks-long ICU stay. Still, the bills could outlast her.
K. JOHNSON: I got a call from Atlas from her today, and that's a collection agency. And you just - I hate getting stuff like that while she's in this condition, you know? On the second day she was in here, I got a court paper rolled up on my door, you know, for damage at some kind of apartment complex.
NOGUCHI: One local economist compares the opioid epidemic to a war. Those that survive can remain scarred for life. The economic loss can be measured in paychecks not earned, absent parents not coaching soccer, careers that end because of criminal drug charges. The heavy finality of a death or brain damage is heartbreaking. But the chaos of life with an active addict can be every bit as devastating. Karen Rench (ph) grapples with that daily, sometimes coming to work after another sleepless night.
KAREN RENCH: Shipping, you have a call on park one.
NOGUCHI: Rench works at the reception desk at Mursix, a metal parts manufacturer in Muncie. Her home has become the stop of last resort for her 31-year-old grandson. He's been an addict for more than a decade.
RENCH: The destruction they leave in their path is horrendous.
NOGUCHI: There are emotional body blows, she says, which cannot be measured, and the financial devastation, which can.
RENCH: You put out money by handing them money. You put out the money by it being stolen. You put out the money by the cost of wrecking a car, rehab, prescriptions and supporting him. I buy food. I replaced a door that he busted. It's endless. The dollars, those are real. Those are real.
NOGUCHI: Rench, who is 71, came out of retirement. Her grandson hasn't held a job for years so she helps support his 5-year-old daughter.
RENCH: How much have we spent on him? It's been in the hundreds of thousands, and we're working-class people.
NOGUCHI: Is the reason you're working because of that?
RENCH: Probably, yeah. I'm paying on two loans now that I took out for him. You know, I feel bad for myself. This isn't what I wanted to do at 71 years old. This is not the life I envisioned for him. When I rocked his baby when she was first born and I just cried because I can remember rocking him, and I thought, I don't even know what's going to happen to this baby because I had no idea what would happen to him.
NOGUCHI: She worries he will die. But there is also terror in watching the once athletic, handsome grandson turn bedraggled and mow down everything in his path.
RENCH: We kind of don't have a feeling that it's going to be a good end, wondering if it's going to be a suicide, an overdose, a prison sentence.
NOGUCHI: If it comes to that, Rench says, it won't matter what her family has already sacrificed. She'll still wonder what more she might have done. Yuki Noguchi, NPR News, Muncie, Ind.
(SOUNDBITE OF MUSIC)
GREENE: Now, since Yuki visited Muncie, there have been some developments. Destini Johnson's mother reports that her daughter is regaining consciousness and is now out of the ICU. Transcript provided by NPR, Copyright NPR.