Call them Generation O, the children growing up in families trapped in a relentless grip of addiction, rehab and prison. Dan Levin of The New York Times reports.
Layla Kegg's mother, back home after three weeks who knows where, says she's done with heroin, ready for rehab and wants to be part of her daughter's life. But Layla has heard all of this before and doesn't believe a single word.
Layla's trust was broken long ago, after years of watching her mother cycle in and out of addiction and rehab. And now this latest discovery: "I found a needle in your purse the other day," says Layla, seated at her grandmother's kitchen table, her arms crossed. "And Mamaw found two more in the dryer."
A pause, and then a fitful tumble of excuses from her mum: She doesn't know why the needles were there; they were only syringes, actually, and not needles; she was keeping them for a friend.
Layla, 17, rolls her eyes and sighs.
"It's almost like you want me to be using," her mother pleads tearfully, in a voice children more often use with their parents. "Everything I do is never going to be good enough, so what's the point."
Five days later, Layla's mother, Nikki Horr, is gone again.
More than 20 years after the introduction of OxyContin — and nearly 400,000 opioid overdose deaths later — a generation is growing up amid the throes of a historic epidemic. Call them Generation O: the children whose families are trapped in a relentless grip of addiction, rehab and prison. Here in Scioto County, a mix of verdant farmland and old mill towns on the southern edge of Ohio where everyone appears to know someone who has struggled with dependency, 51 people died of an overdose in 2017. At one school, administrators said, four kindergartners lost parents to drugs, and a fifth to a drug-related homicide.
Nearly two dozen young people across the county described chaotic home lives rife with neglect and abuse. They recounted begging their parents — who more often spent money on the next fix than on food — to stop using drugs. And they described finding relatives unconscious or frothing at the mouth after overdosing. The interviews were coordinated by social workers, educators and community activists, and for those younger than 18, church staff, their guardians or their parents gave them permission to speak, and were present in some cases.
Schools in Scioto County, educators said, have seen a surge in the number of children born addicted to opioids or suffering from neglect, many with severe learning disabilities, some barely able to speak. Teachers told of tantrums, at times violent, and of chairs thrown in classrooms.
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In a nation where more than 130 people die every day from an opioid overdose — and in a region where the impact of addiction has taken a severe emotional toll on children — school is for many students a refuge; a place where they attend classes, but also have access to hot meals, hot showers and donated clean clothes. On Fridays, educators said, students can take home backpacks full of food so they won't go hungry over the weekend.
Still, school is only a temporary respite.
Educators said that students growing up in families affected by addiction tended to linger on campus until the doors were locked at night, reluctant to go home. Some had returned the next morning and casually mentioned that a parent had died or overdosed the prior evening. And law enforcement officials described instances of children who were sexually assaulted, tied up or found sleeping on cardboard in houses littered with needles and dog faeces.
Last academic year, 28 middle and high school students in the Portsmouth City School District told counsellors that they had contemplated suicide, said Beth Burke, a guidance counsellor at Portsmouth High School in Portsmouth, the county seat.
"I spend a lot of time putting kids in ambulances," she said. "They don't want to live this life and they have no way out."
In many ways, Portsmouth High is like home for many of these students. They eat breakfast and lunch there, and modern classrooms and computer labs are starkly juxtaposed with laundry facilities. Many students frequently come to school wearing the same, unwashed clothes days in a row, so shelves are stocked with clean garments, along with fresh shampoo, bars of soap and deodorant.
Yet some of the teenagers change back into their own clothes after the final bell rings and the last class ends, "because parents will take new clothes and sell them for drug money," said Drew Applegate, an assistant principal.
"We don't live in a Third World country, but some of these kids are living in Third World conditions," continued Applegate, who added that the neglect he has seen reminded him of the deprivation he witnessed two decades ago during a peacekeeping mission in the Balkans.
"Kids out there are raising themselves to the best of their abilities," he said. "The parents are gone just like they were in Bosnia."
Like many US towns ravaged by opioids, Portsmouth was once an economic powerhouse. Nearly a century ago, it was home to thriving shoe and steel industries and a professional football team. Parts of the town, which hugs the Ohio River and borders Kentucky, are tidy and maintained, flecked with 19th-century homes and more recently built McMansions.
But much of Portsmouth is forlorn and frayed. Vacant brick buildings, their windows boarded up, dot downtown. The old Mitchellace shoestring factory is scrawled with graffiti that warns, "Beware of HIV/Hep C! We have it!" Nearby, women and men wander along the train tracks at all hours, offering sex for drug money. Billboards along the main highway advertise rehab services and the opioid treatment Suboxone.
Ground zero for opioids
In Scioto County, long considered ground zero in Ohio's opioid epidemic, nearly 9.7 million pills were prescribed in 2010 — enough to give 123 to each resident, according to official statistics. Over the years, as opioid prescriptions have fallen, many drug users have moved on to heroin and fentanyl.
Today, Scioto County, where the per capita income in 2017 was US$22,586, has the state's highest rates of Medicaid recipients diagnosed with opioid addiction and newborns suffering from the opioid-withdrawal condition known as neonatal abstinence syndrome.
With Ohio's state spending on child welfare the lowest in the nation, social workers in the county say they have felt the strain. In April, more than 220 children in Scioto County were in foster care, the majority of whom were removed from their homes because of parental drug use, child welfare officials said.
Across Ohio, more than 16,000 children were in similar circumstances last year, a 28% increase since 2013 that has cost the state roughly US$95 million in additional funding for the foster case system. Governor Mike DeWine has proposed doubling state funding for child welfare, to US$148 million over the next two years.
Harrowing stories of living amid addiction spill out during play therapy sessions at school or in halting conversations with a sympathetic basketball coach. One recent afternoon, Christian Robinson, a lanky 18-year-old who plans to join the Marines after he graduates from high school, said his mum went to rehab when he was 11, but she relapsed last year on meth and heroin. She now lives in another city several hours away.
"Mum has said that even us kids are not a good enough reason to stay clean," Christian said. One of his sisters was born addicted to crack, he said, and a brother was born addicted to Oxycodone.
"I've seen what drugs can do to a family and it's not worth it to me," he said.
Amid the tumult, many children said they faulted themselves for not saving their parents from addiction. Others said they were made to feel guilty.
"Mum told me all the time that it's my fault she's using," said Cadence Nance, 12, a sixth grader whose mother gave her permission to be interviewed.
A cheerleader and member of her school choir, Cadence has endured her share of emotional hardships. Three years ago, her father killed himself in a West Virginia hotel room as the police closed in to arrest him for murder. Then there was Halloween last year, when her mother overdosed at home while she was out trick-or-treating. Cadence said it took four doses of Narcan to revive her, an account confirmed by her mother.
"My biggest fear," Cadence said, "is I'm going to get home and she'll be dead."
Dabbling in Pills
Not too long ago, Layla lived in a middle-class neighbourhood with her half sister, Lilly, her stepfather and her mum. They sat down most evening for dinners cooked by her mother, who worked then as a hospice nurse.
"We always had everything we wanted and they made sure of that," said Layla, an avid athlete who loves country music and dreams of becoming a nurse practitioner.
But her mother was secretly stealing bags of morphine and other painkillers from hospice patients who had died. Horr, 38, said she stockpiled the pills at home. Her plan, she said, was to sell them around town. That changed one day when, feeling overwhelmed at work, she began "dabbling in pills."
Drug use wasn't new to her. As a teenager, Horr said she had snorted cocaine with her parents. In 2013, after hospice officials discovered she was over prescribing narcotics, she was given a drug test, which she failed, and was promptly fired. She entered outpatient rehab and stayed clean for a while.
But after losing an appeal to regain her nursing license during Layla's freshman year of high school, Horr said she lost her resolve. Distraught, she tracked down one of her sisters, who introduced her to heroin.
"I went straight to the needle," Horr said.
At first, Horr left no trace of her drug use. But soon stray pills were tucked into sofa cushions and syringes were rattling at the back of drawers. Then one day, Layla, who had grown suspicious, peeked through a porch window and watched with horror as her mother wrapped her arm with a rubber strap and pierced her skin with a needle.
As her mother surrendered to the drugs, Layla said their home filled up with filthy dishes, dog faeces and strangers who came over to shoot up. She said she pleaded with her mum to go to rehab.
"I'd be crying, begging her to stop," Layla said, "but she was too out of it to care." The addiction got so bad, both she and her mother said, and her mother's nodding in and out of consciousness so frequent, that Layla became too embarrassed to invite friends over.
For a while, they survived on money sent by Layla's stepfather, who worked out of state for months at a time. In his absence, her mother began a relationship with another drug user, and more and more of the money went to buy drugs, they said.
In the summer of 2017, the family moved to a shabbier house. The girls spent many nights at home alone, sustaining themselves on cans of ravioli and frozen dinners. "Sometimes I'd have to go without eating," Layla said, "so my sister could eat."
Last summer, Layla's mother overdosed on painkillers in a Walmart parking lot. She spent 45 days in rehab before abruptly leaving and resuming her drug use. Layla's stepfather left for good, and her stepsister went to live with her paternal grandparents in another town.
With her own father long out of the picture, Layla moved in with her great-grandfather and grandmother, Karen Alley, a 56-year-old stroke survivor with little sympathy, or patience, for her daughter's addiction. Horr mostly stays with her boyfriend.
At first glance, her grandmother's house is the portrait of suburban calm. Wind chimes tinkle outside the front door, and the bedroom Layla shares with her grandmother is adorned with a photo of her smiling relatives and a poster of a tropical beach.
But Layla said her life there has not been tranquil. Crammed in with cantankerous relatives, a cat and a white Shih Tzu mix named WALL-E, tension chokes the house like a noxious gas. One recent night, Layla fled in tears to a friend's house, where she remains, after yet another fight with her grandmother.
"She's at a breaking point"
More than half the members of Portsmouth High's softball team have a close family member who uses drugs, and many live with their grandparents or a neighbour, said Kristen Bradshaw, the softball coach, who often provides breakfast before weekend games.
For years, Layla's love for her mother, plus her stepfather's support, helped contain the anxiety wrought by the disorder of her home life, and Bradshaw marvelled at the girl's inner strength and her ability to focus on the field.
But these days, with her family absent and no one to drive her to games, Bradshaw said the stress has taken a toll.
"She's at a breaking point," Bradshaw said. "Her emotions are just out of whack."
Through it all, Layla has managed to maintain A's and B's — and a 3.8 grade-point average — while playing centre on her school's basketball team. In softball, she ranks as one of her team's top hitters.
"School's my happy place," Layla said.
Still, it's hard to hide the constant dread and disappointment. Her mother has only seen two of her 24 softball games this year. In a recent conversation, Horr didn't know that her daughter played right field for the Portsmouth Trojans.
"There are times I still see the mum I used to know," Layla said. "Other times I'm like, where did she go and when will she come back? It's heartbreaking. She was my best friend."
In some ways, Layla said she has given up on a happy ending. She talks about going to college in South Carolina, where she can escape the maelstrom of love and fury she feels toward her mother.
Nearly a week after she disappeared, Horr texted Layla during math class. Layla implored her to come home, and to enter inpatient rehab.
Her mother refused, saying that she was sober, but was going away for a while.
"I want to be nonexistent," she texted.
"You're ill, you can't admit it," Layla replied. "Get help and become my mum again."
Written by: Dan Levin
Photographs by: Alyssa Shukar
© 2019 THE NEW YORK TIMES