Hooked: Kate O’Neill to Cover the Vermont Opioid Crisis for Seven Days 

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• James Buck
• Kate O'Neill

Burlington native Madelyn "Maddie" Linsenmeir popped her first OxyContin in 2004, a full decade before then-governor Peter Shumlin warned about a "rising tide of drug addiction and drug-related crime spreading across Vermont."

Maddie was 16 and living in Florida. Her 32-year-old half sister, Kate O'Neill, was in Washington, D.C., earning a master's degree in creative writing. Neither of them could have foreseen how drugs would dominate Linsenmeir's adult life. Nor that, 14 years later, O'Neill would memorialize her sister in an obituary that perfectly captured the agony of addiction. Published in Seven Days and the Burlington Free Press, O'Neill's words were shared online around the world.

In the five years since Shumlin formally recognized Vermont's opiate crisis, Seven Days reporters have been covering the story. They've written about long waiting lists for drug treatment and the emergence of the overdose-reversing drug Narcan; profiled Vermont leaders in the field, including doctors and researchers; and chronicled changing attitudes within the local criminal justice system. Their work has won awards and prompted the state to change the way that incarcerated addicts get medication-assisted treatment in prisons.

The coverage has also generated heartfelt comments from readers touched by the opioid crisis — evidence of its persistent grip on Vermont addicts and their families.

But none of that activity prepared us for the public reaction to O'Neill's obituary for Linsenmeir, who died last October. O'Neill's tribute managed to capture the young mother's spirit and also discussed the disease that took her life. The portrayal was both specific and universal.

O'Neill wrote: "To some, Maddie was just a junkie — when they saw her addiction, they stopped seeing her. And what a loss for them. Because Maddie was hilarious, and warm, and fearless and resilient."

Millions of people worldwide read and shared the honest obit, including national reporters and celebrities such as Alyssa Milano and Ivanka Trump. More than 1,000 readers left online comments on the Seven Days website — the largest response to anything we have ever published.

"My 27-year-old daughter died the same day, the same way," read one. "She has been battling her addiction since she was 16 also. I wish I had the strength to speak out the way you did."

The outpouring verified the magnitude, pervasiveness and cruelty of the opioid crisis. But it also pointed out how many stories we, the media, are missing.

So we hired O'Neill to spend the next year finding and reporting on them.

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O'Neill grew up in the Queen City but dropped out of Burlington High School. "I like to say I have a GED and a master's degree," she said. She didn't finish college until she was 30, at the University of Vermont, where she earned a bachelor's degree in English and studio art. From 2008 to 2012, O'Neill worked as the lead proofreader at Seven Days and proved to be an exacting and tireless wordsmith. She's excelled in a variety of writing and editing positions since.

O'Neill tried to help her sister over the years — in Vermont and other states — as Linsenmeir cycled through jails, rehabs, hospitals, police stations and courts. Together they navigated the legal and medical systems that O'Neill will explore in "Hooked: Stories and Solutions From Vermont's Opioid Crisis." The yearlong series starts in February.

O'Neill talked with Seven Days about her decision to honor her sister by turning her attention to others in Vermont who are also touched by addiction.

SEVEN DAYS: Were you surprised by the reaction to the obituary you wrote for your sister?

KATE O'NEILL: Yes, very. An obituary is obviously a public document — my family placed Maddie's in Seven Days and the Burlington Free Press and then posted it on Facebook, because we wanted to make sure friends who don't read the paper would know she had died and when her service was. But we never expected anyone beyond our friends, family and the Vermonters who read those newspapers to see it.

I was nervous when I first realized it was being widely shared. Maddie was ashamed of her addiction, of the things she did and experienced in its name. Telling her story within our community felt safe, but the internet can be unkind. Some people lack empathy for those who suffer from addiction, lack understanding about this disease and, as more and more people started reading about Maddie, I worried she would be judged because she was an addict.

But what happened was the opposite. What happened was a tremendous outpouring of empathy and understanding and connection. What happened was a gift.

SD: How did you get from there to the decision to devote the next 12 months of your life to writing about Vermont's opioid crisis?

KO: I think it's a cliché because it's true: The death of someone you love can change everything. And that's what happened when my sister died.

Until then, I didn't think much about the opioid crisis. Which might seem strange, given that for the past decade one of the people I love the most in this world was addicted to opioids. But, while my family was living the opioid epidemic, and ultimately lost my sister to it, until she died I didn't read books about it, I didn't look up statistics, I didn't investigate solutions beyond those that would help Maddie directly, from the big picture (What is the most effective treatment? How could we help her raise her son while protecting him from her disease? What would convince her to love herself and fight for her life?) to the quotidian (Who can take Friday off to drive her to rehab? How do we put money in her commissary account in jail? How do we figure out who her court-appointed lawyer is?).

The response to her obituary reminded me of the larger context in which her addiction occurred and woke me to the heartbreaking reality that my sister was one of many. That the struggles she and my family went through are shared by millions. My family heard from people in the throes of their addiction and people who have been sober for 20 years, people who are ashamed and scared and people who are strong now but know that relapse is one wrong step away.

People who are incarcerated and people who visit their spouses in jail each week. People who have lost custody of their kids because of their drug use and people who are raising their grandkids because their own children have disappeared into the black hole of addiction. People whose siblings and partners and parents and children and aunts and cousins and best friends and coworkers have died of this disease. And people who are working every day in intractable systems trying to make a dent in this overwhelming problem; people who are advocating for prisoners and training public defenders and saving the lives of addicts who have OD'd.

When I returned to my job the day after Maddie's service, in communications at a technology company, I knew immediately that it wasn't the place for me anymore, that I needed to find work doing something meaningful. So, when Seven Days reached out and offered me a job writing about the opioid epidemic in Vermont, I took it.

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• Courtesy Of Kate O'neill
• From left: Maura O'Neill, Kate O'Neill, Madelyn Linsenmeir and Maureen Linsenmeir

SD: You were part of a panel discussion here in Burlington. Why not just continue those conversations across the country?

KO: I'm grateful to have had the opportunity to talk about Maddie and share some of her story, grateful that her death, which was absolutely unnecessary, has helped develop an understanding both of people living with opioid use disorder and those who know, love and work with them. But Maddie's story is one of many, and through this project I hope to tell other people's stories, to paint a broader picture of what's happening in Vermont, to go more in-depth than I could participating in panel discussions.

SD: Was there any debate within your family about how revealing the obituary should be?

KO: No, not at all. I was a little worried that my mom and stepdad might feel that it exposed Maddie, but they were unequivocal that it was the right thing to do. It would have been dishonest not to talk about her addiction — it shaped so much of her adult life. We hoped that, in being open, we might help reduce some of the stigma we saw Maddie experience, and we wanted to speak directly to people who suffer from this disease and to people who work every day with addicts.

SD: Did you hold anything back?

KO: There was nothing I wanted to include but chose not to, or that my family asked me to withhold. But it was an obituary, and obituaries are traditionally meant to celebrate a person's life and accomplishments, not serve as a rap sheet. So I didn't write about many things that happened to Maddie as a result of her disease, many things she did to herself and to others, because it would not have been appropriate to include them in an obituary.

But my family is committed to being open about Maddie's life and our own experiences so that people have an understanding of what this epidemic looks like, what addiction actually does to people. Secrecy and shame do not serve those who are suffering, and I want anyone who is going through what Maddie and my family did to know they are not alone. To know that, no matter what they've gone through, no matter what they've experienced or done, no matter what they've lost, even if they have lost every single thing, it is not too late. It is never too late.

SD: Do you expect that addicts and their families will be more inclined to talk to you because of your honest portrayal of Maddie in her obituary?

KO: I hope so. I hope people know they can trust me with their stories. I hope I can be a bridge between those who are living this epidemic and those who have the power to end it.

SD: I know Maddie had interactions with cops, courts, hospitals, treatment facilities. Through her, you've seen the system from the inside. How do you think that will benefit you as a journalist?

KO: Do you know the expression "cradle to grave"? Well, I have seen firsthand what the system is like from cradle to grave. From a preterm baby born to an opioid-addicted mom to an addict dying while incarcerated for crimes related to her disease. I know that Vermont has made some incredible progress in the decade that my sister was a drug addict, and I know that progress is not nearly enough. Not even close. I know there are real-life heroes working both within and outside the system to change it. I know there are many stories that need to be heard, and I hope to help tell them.

SD: What do you want to write about?

KO: I want to write about the experiences common to addicts and their families, including my sister and our family: what effective treatment looks like and what the barriers to it are; the arrest and incarceration of people with opioid use disorder; the sexual exploitation of addicts, from survival sex to human trafficking; the children who are in foster care because their parents are addicts, the people who've lost their kids because of their addiction, and the families who are fostering and adopting those kids.

I also want to explore the impact of this epidemic on people who depend on opioid medications to manage chronic pain. And I want to look at solutions, including what's working (and not) in Vermont right now, and ideas that range from the realistic to the radical. Because if there's any place willing to implement a radical solution, it's Vermont.

SD: How do you think your stories will be different from others we've read about opiate addiction?

KO: There has been such great reporting on this issue, and I hope what I write will be a meaningful contribution. I want it to reflect the lived experience of people who are touched by opioid use disorder. Addicts themselves, but also their parents and partners and kids, their doctors and social workers and jailers.

SD: Based on what you've seen so far, what do you think Vermont is doing well in regard to this crisis?

KO: Vermont should get enormous credit for making medication-assisted treatment available to all prisoners who are addicted to opioids. There's a problem with our system when an estimated 80 percent of people in state prisons in the U.S. suffer from substance-use disorder; we are clearly criminalizing a public health problem. But as it stands now, our prisons are our largest potential rehabs, so it's great that we're taking steps toward getting people the help they need while they're incarcerated.

It's also great that naloxone is widely available in Vermont. The hub-and-spoke system has made medications such as buprenorphine and methadone much more accessible. In some municipalities within the state, people are no longer being arrested or prosecuted for illegal possession of buprenorphine.

We have eight needle exchanges in Vermont, including Safe Recovery in Burlington, where people can get an immediate prescription for buprenorphine (or that's the intention). Needle exchanges are important not only because clean works prevent disease but also because these are places people can go to learn about treatment options and housing and health care, to remain connected to society.

SD: What is the state doing poorly?

KO: The system is still ultimately failing a lot of people. While there has been progress toward helping Vermonters access treatment, according to Commissioner of Health Mark Levine, approximately eight out of 10 people with opioid use disorder are not actively seeking it. The hub-and-spoke system has received a lot of well-deserved attention and praise, but who is it not reaching? And why?

Safe Recovery is a great example of what the state is doing right, but the doctor there reached her prescribing limit of buprenorphine in eight days, and people are OD'ing in the bathrooms and parking lot. Why not have many Safe Recoveries, not just in Burlington but across the state, with enough staff to provide low-barrier access to medication and counseling to anyone in need and monitor people for overdose?

While prescribing buprenorphine to people who are incarcerated is an important step forward, the rollout of medication-assisted treatment in prison continues to be bumpy, and there are many issues to be addressed, including underdosing, patient privacy and protection, prisoners being pulled from their jobs, and the treatment of those who are on medication-assisted treatment. And research suggests that MAT is most successful when it includes behavioral therapy, a component that is absent in prison.

Also, many collateral issues are not yet being adequately addressed, including children in foster care, the lack of long-term treatment options and the sexual exploitation of addicts.

SD: Are there lessons here for the rest of the country?

KO: Vermont is a truly exceptional place that has been ahead of the rest of the country on many issues, from civil unions to universal health care to the legalization of marijuana. There is no doubt in my mind the state will continue to lead the way, this time in finding solutions to the opioid epidemic. How great would that be? To be the state that solved the opioid crisis.

The original print version of this article was headlined "Sister's Keeper"