Staying clean is a battle for opioid-addicted Americans. The fight is the focus of the latest installment of InsideEdition.com's Opioid Addiction Series.
When a very pregnant Keenan Beckhart was told during an ultrasound appointment that she had no amniotic fluid left for childbirth, she panicked.
Not for her baby or for herself as a first-time mother, but because she knew that if she didn’t get a fix soon, she’d start going through withdrawal.
“I said, ‘Fine, I’m going to drive myself [to the hospital],’ and between the doctor’s office and the hospital, I took an hour-long detour so I could go and get dope,” she told InsideEdition.com.
Beckhart knew exactly what she was trying to postpone. The then-24-year-old had come down from drugs more than once in an effort to get clean.
“I couldn’t stop. My parent’s didn’t know, nobody really knew,” she said. “One night, the guy I was dating called my parents and told them I was using drugs. That’s when they got me to a counselor who suggested I try the Vivitrol shot.”
Vivitrol is an injectable, once-monthly medication that blocks opioid receptors in the brain, preventing a person from experiencing the intense high that comes with taking opioids.
It contains naltrexone, one of three FDA-approved meds — the other two being methadone and buprenorphine — used in medication-assisted treatment to help treat opioid use disorder. It's considered by many addiction experts to be the best option, which is backed by evidence, but Beckhart found that medication didn’t work for her.
When she was seven months pregnant, she stopped taking Vivitrol, thinking she was ready to live what she called a truly clean life.
Instead, what followed was a quick, downward spiral.
“I was with somebody who was doing drugs and I decided I could do it one more time and it would be okay,” she said. ”I said it would be one time. It ended up being [for] the last two months I was pregnant.”
Beckhart’s story is not unique. The young mom was once among thousands in the U.S. battling a years-long addiction to opioids and an even longer fight to get and stay clean.
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As America's opioid epidemic shows no signs of slowing, experts say a one-size-fits-all solution isn’t realistic when it comes to such a nuanced problem.
Since 1999, the number of opioid-related drug overdose deaths has quadrupled, and half a million people have died from overdoses in the last 15 years, according to the U.S. Centers for Disease Control and Prevention.
“We have a number of problems when it comes to treating opioid addiction,” said Dr. Kelly Clark, president of the American Society of Addiction Medicine. “People still think of addiction as being a moral problem, or a character flaw, or something that happens briefly and a person needs to get over [it]. We know that addiction is a chronic brain disease and people need ongoing management of their disease. So a lack of understanding is the first issue.”
This affects how some recovery programs operate, she said.
“The traditional detox and in-patient rehab that had been used in the past for alcohol doesn’t have good outcomes for opioid addiction," she said.
Evidence shows that medication-assisted treatment, or MAT, which combines behavioral therapy and medications, works best, she said. But relying on a concrete timeline to get clean, as well as failing to acknowledge that medicine might be needed, only adds to the problem, she said.
"We have an issue of people not knowing what the best treatment is, people using older models based on one-size-fits-all, rather than individualized care," she said.
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The loved ones of Ashley Castro believe outdated treatments contributed, in part, to her death. The young mother's body was found in the median of a New Jersey highway earlier this year.
“She had her demons, and she tried for 10 years — she tried to get off of this stuff,” her aunt, Carol Hayde-Dausch, told InsideEdition.com.
Finally, the birth of her daughter and the chance to start anew with the baby’s father seemed to be incentive enough to remain clean. Then, tragedy struck.
“He passed away this past September of a heart attack brought on by an infection,” Hayde-Dausch said. “She knew she had the baby. She knew she had to hold it together, but she couldn’t.”
Her 10 previous stints in a traditional 28-day rehab program had proved unsuccessful, so she scoured for an affordable, long-term alternative.
“You can get help to detox — that’s it,” Hayde-Dausch said. “Where do you go from there? She had to search high and low… They’re not easy to find.”
Castro finally checked herself into another facility, where she remained for five months. Things began to look up, and Castro spoke of extending her stay, leaving her family hopeful that this time, rehab would work.
But while there, Castro, 29, reportedly met 26-year-old Nicole Barbour. It wasn’t long after that they walked out of rehab and met 32-year-old David DeSantos before making their way to a hotel, Hayde-Dausch said.
“Ashley, she kind of followed people if she thought something was a great idea,’” Hayde-Dausch said. “Next thing you know she’s messaging us from somebody’s phone or computer saying she was at a motel on [Route] 22, starting a job in a diner on 22.”
Around this time, Castro is believed to have turned to drugs again, ultimately suffering a fatal overdose, her aunt said. But what happened next is unclear.
“We only know that they were at that motel and something happened,” Hayde-Dausch said. “We know that she hadn’t done drugs in five months. She had a reason to live; she had a plan going forward. All it takes is one mistake.”
Castro’s body was discovered hidden in a highway median by a woman whose car broke down on April 5. Barbour and DeSantos were arrested for allegedly moving Castro’s body.
They both pleaded not guilty to disturbing human remains in the second degree and remain in custody at Somerset County Jail.
“Was Ashley really dead when they put her there? We don’t know that yet,” Hayde-Dausch said. “But who does that? To discard her like she’s an animal... you wouldn’t even treat an animal like that. She was someone’s daughter, someone’s sister, someone’s niece; she was a good mom.”
Hayde-Dausch believes her niece’s death was a direct result of her meeting someone she called a negative influence while in rehab — something she said officials at rehab facilities should be better at spotting.
“She met Nicole in this rehab and they buddied up. They’d pass notes to each other,” Hayde-Dausch said. “You go into these rehab facilities, and you come out knowing how to beat the system a little better. And you just pass [that information] on to the next person.”
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For Beckhart, getting help started with her needing to admit she was an addict, even if she didn’t fit the mold of a stereotypical “junkie.”
“Hearing about drug addicts, you think of people who are covered in scabs and stuff from drugs, you think of people living under a bridge begging for money,” Beckhart said. “That’s what I thought it was until I became an addict.”
For Beckhart, it all started with an OxyContin taken on a lark at a party when she was 21. However, what began as a social recreation quickly devolved into a daily dependency. In the span of two years, she moved on from OxyContin to Opana and eventually landed on heroin.
“I had sold everything I had. I sold two laptops; I even sold my vacuum for drugs,” she said.
No one would assume her group of friends would be the type to take drugs, she said.
“We were all from the same background. We were all using. We were smart kids and went to good schools. It can happen to anybody," she said.
By the time she was preparing to welcome her daughter into the world, Beckhart was readying to detox yet again. And while childbirth was hard, Beckhart says detoxing from opioids while bringing her daughter into the world was far harder.
“I was screaming in the hospital, and everybody thought it was labor pains, but it was [coming off] the drugs,” Beckhart said. “It’s like having a cold, times nine million. Nobody could help me because nobody knew what was going on.”
When she began to come down from the drugs, Beckhart was hit with diarrhea, vomiting, unimaginable back pain and uncontrollable sweating.
“You can’t control your body shaking; you can’t control your bowel movements. You can’t eat anything; you can’t drink anything, because you know you’re going to get sick,” she said.
Beckhart spent more than five days in the hospital before her daughter was born, and most of her time was spent preoccupied by her own feelings and symptoms, she said.
“You’re so selfish because you don’t care about anything else going on,” she said. “I didn’t care about giving birth to my daughter at the time. I was more worried about how sick I was going to be and that someone was going to find out about it.”
And find out they did.
Beckhart’s daughter — whose name InsideEdition.com has agreed not to use — was born addicted to opioids, including heroin. She spent 10 days in a neonatal intensive care unit withdrawing.
“After she was born, the delivery doctor came in and she said, ‘I know you had been using while you were pregnant,’” Beckhart said. “She explained [my daughter] could die from this, and went into everything that could happen to her. She said, ‘She’s going to be developmentally challenged in the first few years of her life.' They explained the process of the NICU, and said they gave her doses of morphine to help her come down before they could let her go… Then CPS got involved.”
Faced with the possibility of having her daughter taken away, Beckhart turned to what she knew.
“I had to do something, so I decided to get back on the Vivitrol shot,” she said.
But her success would be short-lived, as an even more traumatic incident that would put her and her daughter’s lives at risk was not far away.
After the birth of her daughter, Beckhart tried to remain sober and on Vivitrol, but it wasn’t long before she found herself facing the familiar pull toward opioids.
On October 24, 2015, while visiting with a friend about a half hour away, Beckhart decided to take Opana, an opioid typically prescribed to manage long-term and severe pain.
And then, with her 3-month-old daughter in tow, Beckhart got in the car to drive home.
“I was high. I didn’t think I was that high,” she said. “I didn’t think that it would affect my driving, but you think crazy things when you’re on drugs.
“I put my daughter in the car. I buckled her up, and that day, on the way home from Taylorsville, I had a seizure."
Beckhart hit another car (no one was injured) and totaled her own car in the collision.
“It took the Jaws of Life to get both of us out of the car,” Beckhart said. “The only area of the car that wasn’t touched was where my daughter was sitting. She didn’t have a scratch on her.”
Beckhart wasn’t so lucky.
“They told my father to call a priest,” she said. “I was bleeding internally and they couldn’t find where the bleeding was coming from. Finally, they figured out that my bowels had exploded.”
Beckhart underwent reconstructive surgery to repair her bowels, a torn rotator cuff, a broken leg and a broken ankle. She remained hospitalized for 10 days.
By then, her family was fed up, she said.
“My parents were like, ‘We’re done with you. You almost killed yourself and our granddaughter,” she said. “They said, ‘We’ll take your daughter while you get help. But that’s it. We’re not supporting you anymore. We’re not giving you any money.’ They were done. Everyone was done.”
Beckhart finally realized the gravity of her addiction. With nowhere else to turn and equipped with the knowledge that medicine didn’t seem to work for her, Beckhart considered The Healing Place, a local and free long-term program lasting up to 15 months that focuses on a social and medicine-free model of recovery.
“I didn’t think I needed that long of a recovery,” she said. “I didn’t think I had an addiction [at all], but I did. But I had nowhere else to go, and it was either die on the street or get help.”
The Healing Place’s peer-driven program and focus on the 12 steps of Alcoholics Anonymous and Narcotics Anonymous proved effective for Beckhart, who has been sober since the car crash.
“I went to The Healing Place for my daughter,” she said. “I wanted to be her mother. I didn’t even care about myself—I wanted to die at that point. It wasn’t until a month into it that I realized I needed to be there for myself.
"So I started to take recovery seriously. I started to trust the process… I had to try many different paths to find the one for me. People are all different. They’re all different in their processes.”
Echoing Beckhart’s sentiments, Clark noted that care must be individualized, but maintains that in most cases, medication is the best treatment. And medical professionals need to push back against stereotypes of Medication-Assisted Treatment, or MAT, she said.
“Not all people with opioid addiction need medication... but to deal with an epidemic, we have to deal with a population-based approach,” Clark said. “Right now, patients and their loved ones, communities, don’t understand what the science shows.”
The science shows that the medication on the market — methadone, buprenorphine, and extended release naltrexone — have been proven to help people get their lives back on track, she said. The length a person remains on the medicine depends on them, she said.
Addiction, a chronic brain disease, needs to be treated like other chronic diseases, she said.
“The purpose of treating opioid addiction using medication is like treating diabetes using insulin," she said. "We use insulin so that people stay alive despite their diabetes. We do the same thing for medication for opioid addiction. We start by saying, 'how can we decrease the risk that you die? How can we get you back functioning, back to work, to taking care of kids, back to taking care of parents?'”
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The pushback against MAT is steeped in a misunderstanding of how it works, according to another doctor who oversees addiction treatment plans.
“There’s a difference between using a substance, or taking a substance, and having a problem with a substance,” said Dr. Benjamin Nordstrom, chief clinical officer and senior vice president of Phoenix House.
“When the medication is taken as prescribed, they won’t cause people to get high... It won’t cause the same problems in their lives that other recreational drugs will cause.”
At the Phoenix House, a nationwide addiction treatment provider with locations in 13 states, officials are focused on an individualized, holistic approach to treat the underlying causes of substance abuse.
“It isn’t just a simple matter of only making a few minor adjustments for someone to get into stable recovery,” said Nordstrom. ”People come with different needs depending on circumstances, so we believe in individualizing care.”
As evidence continued to show a growing need for more individual-oriented programs, officials at Phoenix House decided to open the Phoenix Life Center in Brooklyn, N.Y.
“It’s going to be a place where we can do detox, residential care, outpatient care, a day program; it can be intensive out-patient or as infrequently as a couple times a year,” he said. “That’s what we’re trying to build, a network of places people can come in and receive an individualized care plan.”
The facility is an in-network provider for many major insurance carriers, and officials work with patients to secure coverage, he said.
Combating that stigma of being labeled a drug addict is another integral part in educating the public at large as to what’s really at stake in the opioid epidemic, experts said.
“If people are honest and take a look at their family trees, they can probably name a few people that have struggled with this kind of thing [addiction],” Nordstrom said. “In reality, the vast majority of people struggling with these problems are very regular people.”
The stereotype extends into addiction medicine itself.
Only about 4,200 doctors in the United States are board-certified to specifically practice addiction medicine or addiction psychiatry, which Clark said is due in part to a slow realization that addiction comes with its own unique set of problems to treat.
“People for a long time didn’t understand addiction... but it’s a medical condition, not a moral failing,” she said.
She believes that lack of workforce is bound to change, as a new generation of doctors shows interest in addressing the epidemic at hand.
“They’re really looking at things and saying, ‘Why do we keep people in the ER if we’re not sending them to treatment that works? Why are we having this high death rate?’” she said.
Clark said the field has its own unique set of rewards.
“A lot of what we do as doctors is postpone death — by a week, month, or year — but in addiction medicine, I’ve had people come in and reach into their pockets and pull out a set of keys and say, ‘Look I have a vehicle, I have an apartment,’” Clark said. “We save the potential for people’s lives to take care of their kids and their parents and there’s not a more rewarding part of medicine.”
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Recognizing the epidemic as one similar to any other will be instrumental to successfully contain it, according to Dr. Kim Johnson, director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration.
“Physicians are learning more about managing pain without medication," she said. "There are pain medication guidelines that people are starting to adopt. We need to go a lot further. We’re starting to go in the right direction… We need to do a better job getting people into treatment and keeping them in treatment… being in a residential setting can help people stabilize… but what rehabs can’t do is manage the cravings and manage the physical symptoms. The evidence is that the medication is a necessary component.
“People need to have better information about what treatments work the best and how they work and why they work, and also that whole sort of issue of disease management,” she continued. “The medications or any of the treatments are not a cure, because we don’t have a cure.”
Johnson is also exploring the work that can be done to communicate directly with those grappling with addiction.
Read: Opioid Epidemic Series: What is Fentanyl? Drug Is So Powerful a Cop Overdosed From Touching It
“I think we need to do more outreach,” she said, noting that she and others with the agency are working with elected officials to develop a more impactful and personal approach to fighting the epidemic.
“We’re talking about actually doing more on-the-ground outreach, seeking people… like we did in the early days, like we did in the AIDS epidemic,” she said.
Johnson said the hardest-hit states would see the biggest outreach attempts, but she declined to name specific areas that would benefit from the push.
“For the most part, we know what we need to do,” she said. “We need to prevent misuse, we need to get the people who are already sick into treatment, and when people are unwilling to [enter into] treatment, we need to do what we can… making sure that we have a coordinated effort doing all of those things: Prevention, treatment and intervention.”
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Beckhart, now 27, works at The Healing Center, and in December, was granted full custody of her daughter, a healthy girl who recently celebrated her third birthday.
She’s already preparing for the day that she talks with her daughter about her past, including that fateful day in October 2015.
“She sees the scars on my leg and my stomach from the car wreck and she’ll ask about it, but she doesn’t remember that,” Beckhart said. “I just hope when she gets older she will understand that I did everything I could for her. That’s all I want her to know. I did mess up with her... I can never forgive myself for that but I’m gonna be the best parent I can be and the best daughter I can be. I can’t apologize, but I can do everything I can to make it right.”
Beckhart has also rebuilt a relationship with her family, whom she now sees on a daily basis.
“I can talk to my parents about everything,” she said. “It feels good not to lie about everything, like I was before. It’s great. Everything is really great.”
This is the latest in InsideEdition.com's series looking at the U.S.'s growing opioid crisis. Click here to read about one addict's struggle to get clean, click here for more on Fentanyl, the drug so powerful a cop overdosed by touching it, and a little boy died after coming into contact with it.
Watch: 10-Year-Old Boy Among Youngest Victims of Country's Opioid Crisis
