VALPARAISO — The coroner told the family they'd have just a few moments to say goodbye to their dead loved one.
They sobbed, screamed and kissed his lifeless body. "Stop touching me," one of them yelled at the other. One of the women wouldn't — didn't want to — let go.
Five minutes later, their time was up. And Porter County Coroner Chuck Harris got to work.
He drew a syringe of blood out of the dead man's neck; he also stuck a needle into the man's eye, to take out vitreous fluid, and into his bladder for urine. The vials would be sent to a lab for toxicology screening.
But Harris already knew what happened.
"This is definitely a heroin overdose," he said.
Just the day before, paramedics had revived the man with the overdose-reversal drug naloxone. On this day, family members found him slumped over on the toilet. First responders revived him, but he died at the hospital.
If Harris looks like a man who has gotten used to this routine — of collecting bodily fluids to be analyzed for drugs — it's because he has.
"This is my most common type of death," he said. "Anytime you see a residential death, one of my gut instincts is it's going to be a heroin overdose. It's that common nowadays."
He said heroin deaths in Porter County were up more than 50 percent in 2017, while deaths from fentanyl doubled.
The man overdosed in Portage, one of the Northwest Indiana communities with the most per-capita overdose deaths, with 15.6 for every 10,000 residents since the start of 2013. The top 10 from 2013 through 2017 were, in order, LaPorte, Valparaiso, Crown Point, Gary, Portage, Lake Station, Michigan City, Dyer, Hobart and Griffith, according to a Times analysis that looked at municipalities with more than 10 overdoses in that span. The numbers, which are cumulative for the five-year period, include both incorporated and unincorporated areas in those communities.
Amid a national opioid overdose epidemic that kills an estimated 115 Americans a day, overdose deaths in Northwest Indiana continue to rise year after year. While many local first responders carry naloxone and police departments have specialized overdose response units, substance abuse treatment isn't always easy to find, particularly for people without health insurance. Of those 10 communities, Crown Point, Portage, Lake Station, Dyer, Hobart and Griffith don't have treatment centers. Analyzing where the deaths occur might inform policy makers and public safety agencies on where best to invest resources.
Communities utilize overdose response teams
Chris Winterhaler's job is to respond to overdoses in rural Porter County. Every time the sheriff's officer gets a call of a person in their 20s or 30s, unconscious, possibly not breathing, he figures it's drug-related. He covers unincorporated Valparaiso, which has had 18.4 overdose deaths for every 10,000 residents between 2013 and 2017.
He carries a nasal version of naloxone, also known by the brand name Narcan. He's so far saved four people with it. After he administers it, the overdose victims usually are so disoriented they try to fight or wrestle him.
He then attempts to determine where they got the drug. Most of the time they're uncooperative. He talks to other people in the house, who often make up excuses, like they were asleep or in the shower when it happened.
Where an overdose occurs doesn't always correlate with where the victim bought their drugs.
"Some of the overdose victims are getting heroin from South Bend, some are going to Michigan City, some are going to Gary. The Southeast Side of Chicago has always been an issue, Chicago Heights, Lansing, areas just on the other side of the border. It's not just one location like it used to be," said Chuck Porucznik, executive director of the Lake County High Intensity Drug Trafficking Area, which has started mapping overdoses to get to the source of the drugs. "Most of the clusters of overdoses are coming from someone who has a contact. They pool money, go to their contact, come back, it's laced with fentanyl."
Fentanyl is an opioid 50 to 100 times stronger than heroin and often is cut with or sold in place of the drug because it's cheaper. Over the course of a few days in mid-February 2017, there were several fentanyl-related overdoses in Lake County. In March 2017, eight people died of drug overdoses in Hammond, some from fentanyl. Several people died from fentanyl in late September in Gary.
Overall, 2017 was a record year for drug overdoses in the Region, in part because of the rise of fentanyl. Lake County had 196 drug overdose deaths, while Porter County had 50 and LaPorte County had 26 (compared to 120, 34 and 32, respectively, the year before). More people died of overdoses in Crown Point in 2017 (26) than did between 2013 and 2016 (24). Same with Munster (15 in 2017 versus 13 in the four years before). Gary had 54 overdose deaths in 2017 alone.
Deaths stand out
"My first fatal was this house over here," Winterhaler said on patrol one night, pointing to a two-story home right next to a dead end in rural Porter County.
The report was of a 27-year-old male found in his bedroom, not conscious or breathing.
"I get to the call. I'm rushing. I'm pretty sure I have my Narcan with me. I saw the guy: He's dead. His knees were on the ground, and he was hunched over his knees, in almost like a praying stance," Winterhaler said. "He was frozen. All his blood rushed forward and he was stiff."
Winterhaler has heard people who overdose get a sharp pain in their stomach; he thinks the man might have leaned forward to clutch his abdomen right before he died.
The man still had a needle in his hand. There was white powder on a mirror on his dresser. His mother fainted in front of first responders.
Investigators found his drug dealer, who lived in Gary, through Facebook. The man who died had allegedly been trading guns for heroin.
Winterhaler's second fatal overdose happened in rural Valparaiso, near Lakes of the Four Seasons. A father had found his daughter, who was in her late 20s, dead in the family's shed.
She lay sprawled out on a tractor. Police found a syringe stuck to her pant leg, a cooking spoon and tie-off nearby. She likely had been dead nearly a week.
"That was a bad one," Winterhaler said. "You can tell when people come from a good family and when they don't. She came from a good one. They were really upset. To have a parent find a child like that — I wouldn't wish that upon anyone."
Cmdr. Jack Hamady of the Gary Police Department noted that people who overdose in a given community aren't always residents. "They're not waiting like you and I going to Walmart and going home and unpacking our groceries. They're using the heroin wherever they can," he said. "I've seen overdoses right off the interstate in a Walgreens parking lot, in a gas station parking lot. They didn't buy the drugs there. They just see a place where they can shoot or smoke or snort their heroin."
Communities on the Illinois-Indiana border, like Dyer, Hammond and Munster, often have Illinois residents dying of overdoses there, presumably after the people stopped after buying drugs in Indiana.
"You get a bad batch in some place, and we get a rash of them in north Porter County and all of a sudden it filters down to south Porter County," said Valparaiso police Sgt. Mike Grennes. "It's a countywide issue. It's not just one location. And it's not just Porter County."
LaPorte County Coroner Bob Cutler said LaPorte likely had the most per-capita overdose deaths in Northwest Indiana — 22.1 per 10,000 residents — because the city and its unincorporated area cover such a wide part of the county, which itself is the second largest by land mass in the state. He said, as of late, the county has been seeing more overdoses from cocaine than heroin.
"It's easier to get cocaine," he said. "The (LaPorte County) Drug Task Force is going after the heroin dealers with everything. They're shutting down the supply."
Sgt. Andy Hynek, of the LaPorte County Sheriff's Department and commander of the LaPorte County Drug Task Force, said the heroin overdoses that do happen tend to involve fentanyl. And he said the overdose deaths happen all over.
"We've covered overdoses in literally every corner of our county, which for us is a large area," he said. "The demographic makeup of the southern part of the county to the northern part, the east part, the west part, tends to be diverse. It's affected every end of our county."
Treatment, prevention needed
Despite all the overdose deaths, drug treatment can often be difficult to access in Northwest Indiana. Statewide, Indiana ranks 16th worst for the percentage of adults who needed but didn't receive substance abuse treatment, according to the Substance Abuse and Mental Health Services Administration.
"Treatment is needed all around: north (Lake) county, south county," said Amanda Morrison, program director for Supporting Addiction Free Environments, or SAFE, formerly the Lake County Substance Abuse Council.
"It's unfortunate when someone needs help and wants to get help and they can't get in somewhere to get help. Are they going to go back to using again, or are they going to continue looking for a place? If you hit that wall and you're an addict, you're probably going to go back to what you're used to doing."
Northwest Indiana has four inpatient rehabs, four halfway houses and two detox centers, for nearly 800,000 residents, said Christian Gabrano, an addictions counselor at Heartland Recovery Center in Lowell. And the facilities generally have long waiting lists.
Gabrano used to be addicted to opioid painkillers. The first time he tried to get clean, he couldn't find anywhere with an open bed. "I needed inpatient. I needed to be stopped. I needed to be in residential so I couldn't physically get my hands on it," he said.
He entered outpatient treatment but kept using. One Sunday, he got caught stealing and decided to try again to get into inpatient. This time, Regional Mental Health Center in East Chicago had an opening, for its 30-day program. He was admitted that Monday — Nov. 11, 2013. He has been clean ever since.
He knows other people struggling with addiction haven't been so lucky.
"There's a window of opportunity for someone who's willing to get help," he said. "If someone seeks out help today and I can't get them help for two days, sometimes they go back to using. It can be defeating if you reach out for help and you're not able to get any."
Kim Minich, a nurse practitioner at Heartland Recovery Center, said solving the overdose crisis is going to take prevention. She said schools should host people recovering from addiction as guest speakers.
"The schools are our most captive audience," she said. "It's hard for students, as invincible teenagers, to picture their lives once they head down that road. Kids that age are so impressionable, that if you put that image in their head — this could be you after high school — that will stick in their mind."
Porter County Sheriff David Reynolds agrees. He has been showing a video his department made about the heroin epidemic to school kids around the county.
"People don't smoke as much as they did in the '50s. The demand for smoking has been drastically reduced," he said. "Hopefully we can look back maybe in 30 years and say, 'There used to be a lot of heroin around here but not now.'"
Bob Krumwied, president and CEO of Regional Mental Health Center, said some of the measures the state has been implementing lately — tracking opioid prescriptions through the INSPECT program, allowing Medicaid to pay for residential drug treatment — are starting to pay dividends.
"This didn't happen overnight," he said. "It's not going to end overnight."
Insight into addiction
While the Lake and Porter county coroner's offices provided The Times with the overdose data digitally, in LaPorte County The Times had to go through boxes of paper death records to obtain the information. Those records provided a rare, intimate glimpse into a crisis ravaging the Region and nation.
The coroner's records include a narrative on the deaths and, often, the days and years leading up to them. The victims tend to be in their 20s and 30s, overwhelmingly white, mostly male, generally overdosing on a combination of drugs, with opioids being the most common. They usually were struggling with addictions for years; some had just gotten out of jail or treatment. The older victims often had other chronic health problems and were on a cocktail of medications, of which they took more than the prescribed amount. Family members interviewed by investigators generally were not surprised by the deaths.
There was the heroin addict who just had her kids taken away by the courts; the young couple — the girl's ID for Lake Central High School was in the coroner's file — both found dead of overdoses on the couch together; the 29-year-old man who overdosed in bed with his kids.
The reports note the position the body was found in, whether it was in rigor mortis, the types of drugs and paraphernalia at the scene. Families often try to revive the victims — with CPR, by putting them in a cold shower — without success.
Some of the details are banal, like how one woman died with blue cake icing on her face. One account noted that "The weather was sunny with temps around 45 degrees." "Sections of the esophagus, stomach, duodenum, jejunum and colon, show an intact mucosal surface with no abnormality of the underlying muscular or connective tissue layers," one report read, in medical jargon typical of the reports.
One record included a letter an overdose victim wrote to her partner shortly before her death, as she decided to leave home: "I know you all will be better off without me. You deserve to be happy and I know that I cannot do that for you. I guess that I have known most of my life that I am a liar and probably always will be. I don't know how to change that. Because I love you I need to leave you to free you from any further destruction I could cause. ... It's because I love you, I am doing this. It's better in the long run for us all."
According to the coroner's report, on Dec. 9, she left her home in Missouri to stay at a friend's apartment in Michigan City, which had 14.4 overdose deaths for every 10,000 residents between 2013 and 2017. She arrived early in the morning of Dec. 10, meeting her friend at Walmart. She didn't sleep that night.
That afternoon, she told her friend she was going to take a shower. A few hours later, he found her sleeping on the bathroom floor in a "seated kneeling position." She said she was "exhausted" and wanted to go to sleep. He helped her to his bed.
That evening, he went to see if she wanted to get dinner. He found her in bed, laying on her back, unresponsive, with "no signs of life."
He called 911. LaPorte County Emergency Medical Services arrived and confirmed that she was dead. Toxicology reports revealed she died of an overdose of opioids and benzodiazepines. She was 47 years old.
Families are impacted
Late last year in a Valparaiso trailer, Michelle Newsome, 51, reminisced about her son, Josh, who died from a heroin overdose in South Haven. His pictures adorned the walls; a photo of him with angel wings at the bottom hung from a Christmas tree.
In 2016, he left rehab in central Indiana to spend Valentine's Day with his girlfriend. After they got into a fight, he went out with a friend to buy heroin. He was dead by the morning. He was 24.
It was his fourth stint in treatment. Just beforehand, he had finally admitted to his mom he'd been using heroin.
"The last time, he came up to me, I came home one from the store and he was behind my shed, it was raining, and he came up to me by the stairs here and asked me if I would help him," she said, tears forming in her eyes. "That's when he finally came around and wanted to get help."
She wore a shirt that said, "One day at a time" on the front and "RIP Josh Newsome" on the back. She tattooed his favorite saying, "Don't worry about it," on her right arm, "One day at a time" on her left.
"I don't have to worry about things," she said. "I just look at at my arm now. Everything's all right. Or will be."
Josh's father died while drunken driving when Josh was 9. Three years later, he was struck by a drunken driver, leaving him with lasting injuries. He got a big settlement at the age of 18. That's where the problems began.
He bought two cars, a stereo system, a trailer for his mom. And he had endless cash for drugs.
"That was too much money for him too soon," his mother said.
Before he died, Josh was about to get his GED. His mom believes he would have become an addictions counselor.
She wishes there were more long-term rehabs in the area, and more people talking about this epidemic. She wants to add her voice to the mix and reach children before they start using.
"My thing is mostly getting to the elementary kids and getting to the little kids," she said. "They're the ones who are going to stop this. I don't think the generation now is. They're already too deep in it. All I see is death."