Larry Schwartz sits at a table in a noisy coffeeshop and pulls out his cellphone. He thumbs through text messages until he finds the one he’s looking for: 8:43 p.m. on July 22, 2018. It’s a terse request from his son Daniel’s roommate: Call me ASAP. It’s about Dan.
When Larry saw the text at 9:30, he called the roommate immediately. He heard two devastating words: Dan’s dead. Larry’s 29-year-old son had returned to his apartment for a movie night, gone to his room to take a nap and hadn’t returned. His roommate went in to check on him, found him unresponsive and called for emergency help.
It was too late. “By the time I got there, the paramedics were already gone and his body had been moved,” Larry said.
The terrible scene was one that Larry had dreaded. Daniel had long battled depression, anxiety and addiction. His drug use included opioids, meth, hallucinogens, and marijuana. But none of those substances killed him.
A “natural” death
The autopsy report issued by the Office of the Coroner of Arapahoe County stated that Daniel died from acute mitragynine toxicity. Mitragynine is an opioid-receptor and the primary active compound in kratom, a substance found in the leaves of a tree native to Southeast Asia of the same name. It is legal in all but a handful of states and local communities. Kratom can be purchased legally in Colorado, save for Denver County, which banned its sale in November 2017. The Colorado Department of Public Health and Environment nonetheless strongly cautions against using kratom.
Unregulated risk
Meanwhile, kratom is unregulated and its status is murky. That’s one of the things that troubles Dr. Patrick Fehling, attending psychiatrist with the UCHealth Center for Dependency, Addiction and Rehabilitation (CeDAR) on the Anschutz Medical Campus. Fehling said kratom falls into a “gray area” in which some consider it a relatively benign herb while others view it as a potentially dangerous drug.
“That’s confusing to consumers,” he said. “It is highly concerning to me that people are ingesting a psycho-active compound that is unregulated. All bets are off in terms of what is going into your body.”
Fehling added that many of the short-term, seemingly positive effects of kratom mimic those of opioids, including pain relief, mood elevation, energy uplifts. However, he maintained that the data gathered thus far also point to kratom carrying risks similar to opioids: dependency, altered moods and respiratory depression. He said he has treated a small number of patients who have developed a dependence on kratom and experienced withdrawal symptoms like restlessness, sweating, insomnia and mood disturbances. Others, he said, have found that using it contributes to a “constellation” of alcohol and substance use problems, including depression and anxiety.
Daniel Schwartz’s death came two years after treatment at CeDAR that his father deems a strong success. In a letter to CeDAR Executive Director Gary Kushner and Supervisor of Men’s Residential Program Mike Lyons, Larry wrote that “the period beginning with his entry into the CeDAR program was the best time of Dan’s adult life. He attained levels of sobriety, happiness and satisfaction that he had never reached before.”
Fehling can’t comment on Dan’s or any other patient’s case. But he stressed that people considering using kratom should exercise caution.
“I want people to have good knowledge of what they put in their bodies,” he said. “My word of advice is to wait. [Kratom] should absolutely go through the rigors of being well analyzed and studied before jumping for it to ease whatever ails you.”
Those words ring painfully for Larry Schwartz, who says he knew Daniel was taking kratom and a host of other herbal products. In his letter to Kushner and Lyons, he also says that Daniel had “researched kratom extensively, and he believed that it didn’t pose a significant risk.”
For his part, Larry says he wasn’t sure, especially because Daniel was taking other “natural” supplements. “I questioned him about whether they did any good and that we don’t how it interacts with or impacts other medications,” Larry said.
But he admits he may have been lulled by the positive changes Daniel had made after his treatment at CeDAR, which included a 30-day inpatient stay as well as 60 days of residential extended care and intensive outpatient therapy. He was also active at CeDAR alumni meetings and a regular at open-mike nights, where he resumed developing his guitar-playing and songwriting skills. He still smoked pot regularly, Larry says, but he saw “Daniel emerging again. He was the person he used to be before the drugs. He was happy, had a job, a girlfriend and his music.”
Path to pain pills
Indeed, the irony and the tragedy of Daniel’s death emerge because he so easily might have lost his life in the years before kratom unexpectedly claimed it. The youngest of three – he has two sisters – Daniel was “always the most vulnerable,” said Larry, who practices law in Highlands Ranch. He acknowledges that his divorce from his ex-wife when Daniel was six and the co-parenting arrangement that followed was “difficult.”
Daniel began smoking pot in his early teens and generally performed poorly in high school, although music was an early and constant interest. There were also troubling behavioral issues that went largely unaddressed, Larry admits.
Shortly after graduating from Columbine High School, Daniel had a tonsillectomy and was given a prescription for painkillers that he was able to refill twice. Sometime later, he called Larry, admitting he was addicted to pain pills. There was additional fall-out. Daniel had written bad checks and racked up debt, but Larry was relieved to confront the problem and got him into medication-assisted treatment with Suboxone, a drug used to relieve withdrawal symptoms from opioid addiction.
In the midst of this challenge, however, Daniel was diagnosed with Stevens-Johnson syndrome, a rare, serious condition that causes the skin to blister and peel off. He received care from the Burn Center at UCHealth University of Colorado Hospital, one of a small number of facilities that specialize in treating the disease. Daniel recovered after a more than two-week stay in the intensive care unit. He also received painkillers, but Larry got him into a methadone clinic to continue treatment for his addiction.
Downward spiral
What followed was a bewildering period that illustrates the insidiousness of addiction and the difficulty of the health care system to respond to it in a coherent way. For example, Daniel saw a therapist for depression and anxiety and received a prescription for Xanax from the psychiatrist that was managing his Suboxone treatment despite its link to opioid overdose risk. The prescription led to a car accident that landed Daniel at Denver Health and then in jail for driving under the influence – Xanax was identified as the incriminating substance. The police also found cocaine in his possession.
Larry was at a loss, unsure if his son’s depression exacerbated his drug use or vice versa. “We never got on top of it,” he said. “I felt like a lot of people feel in this situation: really helpless. You don’t know who to turn to, what to do.”
The Schwartzes bailed Daniel out and got him a lawyer who swung a two-year probation that avoided jail time but required him to take random urinalyses. Larry put a tracking device in his car so he could monitor Daniel’s movements. Nothing led to sobriety, however. Daniel admitted to abusing cough syrup and buying online products designed to mask THC so he could continue to smoke pot. He showed up to his job selling high-end sunglasses at a store in the Cherry Creek Mall so badly impaired one day that an ambulance had to be called. On a skiing trip with one of his sisters, Daniel couldn’t get downhill.
After an emergency department admission to UCH and signs that he was injecting drugs, Larry and his family planned an intervention in April of 2015. They engaged a person recommended by a rehabilitation center in Battle Creek, Michigan, who flew to Denver and confronted a highly resistant Daniel, who nonetheless agreed to return with the interventionist to Indiana and then drive on to the Michigan facility.
It was, in retrospect, “not the right place for Daniel,” Larry said. The facility took a firm no-drugs approach, which included taking away Daniel’s antidepressant and anti-anxiety medications and the Suboxone he’d begun retaking after the hospitalization for Stevens-Johnson syndrome. Returning to Denver after two months in Battle Creek, Daniel drifted back to drug use and eventually relapsed completely.
That led to a nightmarish periodic series of drug-induced paranoid fantasies that culminated in Daniel embarking on a wild trip that included stops in Utah, Las Vegas and Los Angeles. The Schwartzes followed, eventually catching up to him in a rundown motel in LA. He agreed to move into an apartment in Dallas near his sister Stephanie, who was attending Southern Methodist University. He stabilized for a time, finding a place in the Dallas music community, but eventually “veered off course,” Larry said. He experienced the drug-induced fantasies again and wound up spending a week in a psychiatric hospital.
Steps toward recovery
From this low point, the Schwartzes finally seemed to find an upward trajectory. After doing some extensive on-line research, Larry found CeDAR. Daniel agreed to go there in August 2016 and flourished after a brief period of resistance, Larry said.
“It was the perfect place for him because they gave him a dual diagnosis to treat his psychiatric and drug issues,” he said. “It was a workable way to deal with it: treating the whole panoply of issues he had. I felt they were treating him like a human being, not like an inmate.”
Larry said he also personally benefited from CeDAR’s Family Program, which educated him about the disease of addiction. Daniel followed his treatment regimen with an extended stay at a sober living home in the Englewood area.
By the summer of 2017, Daniel was “as good as I had seen him in years,” Larry said. But his story also underscores the point that there are few straight lines in the path to recovery. Daniel was not comfortable with the 12 Steps approach to recovery and continued to use marijuana regularly, in addition to experimenting with kratom and other “natural” substances. “I’m in control of my own recovery,” he told Larry.
Finding meaning in misery
Larry talks about the terrible night that he lost his son with a mixture of sadness, resignation and determination.
“You always have that fear any time you get a call,” he said. “He’s been arrested. He’s taken this or that. I never thought kratom would be the one.” Yet he sees kratom as a part of Daniel’s long struggle.
“I view kratom as part of his solution,” Larry said. “He was never going to be 100 percent substance-free. I couldn’t convince him that he didn’t need to alter his state to be a person that other people liked to be with.”
But Larry says he’s committed to doing what he can to prevent another parent from getting the call he got on July 22.
“It is absolutely critical that kratom be regulated somehow or, barring that, that information about it is disseminated, that people know the risks and that there be some guidelines on how much you can take and with what – rather than this totally unregulated, undirected environment where people quite innocently can kill themselves,” he said.
He can speak with authority. “Daniel left at a time when he was happy. He just didn’t get to play it out.”
This story also appeared on Denver’s 9News: https://www.9news.com/article/news/health/colorado-coroners-link-kratom-to-at-least-23-deaths-since-2016/73-614063305