S1E58 / An Overdose Epidemic – Deaths of Despair Pt I / Sandra Lindie, Will Cooke, Jennifer Fecu
21 Jan 2021 · 19 min
In this first half of a two‑part special of the Epidemic podcast, host Dr. Celine Gounder and research associate Temi Fagbenle explore how COVID‑19 quarantine amplified "deaths of despair" by dismantling the community structures that sustain people in recovery. The episode opens with a personal narrative: Temi recounts the life and tragic overdose of her friend Imani Fiku, describing Imani’s early substance use, bipolar diagnosis, periods of sobriety, and the fatal relapse that occurred after pandemic‑induced isolation forced her back with her grandmother. Through interviews with Imani’s grandmother Sandra Lindy and mother Jennifer Fecu, the show illustrates how loss of in‑person support groups, the shift to Zoom meetings, and strained family dynamics contributed to relapse. The discussion then broadens to the rural opioid crisis in Austin, Indiana, where physician‑author Will Cook describes a historic HIV outbreak driven by needle sharing, the creation of a peer‑recovery‑coach program that cut new HIV cases by 95%, and how the pandemic abruptly halted these gains, leading to an 80% rise in overdose‑related ED visits and a 20% rise in deaths. Cook emphasizes that disasters expose pre‑existing health inequities rather than create them. The episode also highlights the grassroots response of Imani’s mother, who founded Imani Safe House to aid transitions from hospitals and prisons, underscoring the centrality of community for recovery. The episode concludes by noting that Imani’s story is emblematic of many, and previews a follow‑up episode on suicide rates during the pandemic.
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When the pandemic hit, our recovery groups shut down. Many of them went online, but that's really not the same. All that great work that we had been building momentum towards and really seeing amazing results came to a screeching halt.
You're listening to Epidemic, the podcast about the science, public health, and social impacts of the coronavirus pandemic. I'm your host, Dr. Celine Gounder. Since the start of the pandemic, many Americans have had to shelter in place and forego their regular lives. This has disrupted community ties and severed the possibility of in-person, real-world contact. Humans are social creatures. We don't typically do well in isolation. But for some people, the health effects of being alone for so long have been fatal. This is the first in our two-part series discussing the effects of quarantine on deaths of despair, deaths from drug overdose and suicide. Today, my co-host is our research and production associate, Temi Fagbenle.
Hey, I'm Temi.
Tell us what this episode is about and why you wanted to work on it.
So when we first started discussing this topic, I was immediately intrigued. I know a number of people who are in recovery, and for various reasons, the pandemic has been especially hard for them.
So you really had a personal connection to this story. It's a really sensitive topic. How did you go about choosing someone?
Yeah, I actually lost a friend of mine, Imani Fiku, to an overdose this summer. You know, when you're in recovery, it's really important to have community around you, and that was sort of destroyed when the pandemic happened. And that's what happened with Emani. So I wanted to speak to her family and get a sense of what had happened with her. I spoke to Emani's grandma, Sandra Lindy, at her home. If we sound a little muffled, it's because we were wearing masks and keeping our distance during the interview. Hi, it's Temi. Sandra lives in a large pre-war apartment. When I walked in, I recognized a black cat from the last time I saw Sandra, back when Imani and I were still in high school. Sandra had made a shrine to Imani with a collage of photos and a candle. Could you tell me a bit about Imani in your own words?
Like, what was she like?
Amazing. Imani was amazing, really amazing and loving and everything, and just flighty and airy.
But underneath all of that, Imani was really struggling at the time. Her father died, and Imani turned to drugs to cope with the loss.
I don't know what happened, but I remember she told me that somebody said, "Try this." I guess she was really in a lot of pain. After her father died. And so before high school, it already started like with alcohol and I guess, um, maybe some hallucinogenics.
Sandra knew that Imani needed help, so she sent her to a hospital to get help for her alcoholism. While she was there, Imani was also diagnosed with bipolar disorder.
Could you tell me a little bit about that first time?
That she went to the hospital?
Mm-hmm.
She looked like she was dead. And I took a picture of her because I remember telling her, you have to see what you look like. It's not— you know, you can't do this to yourself anymore.
But Imani's struggle with addiction wasn't over. It was only getting worse. She started doing heroin sometime after that first hospitalization.
When we were in high school, there was a time, um, it was Imani, I, um, and some other kids, like, we were all hanging out, um, in a house, and, like, Imani went to the bathroom and she was just in there for really long, so I, like, banged on the door. And when I got there, she was just like on the floor and like her lips were blue.
Really?
And yeah, there was a needle, so I guess she had taken too much. Someone there, they happened to have Narcan.
Yeah.
And so they— it was like a box thing that they put into her thigh. Because I got in there and I was shaking her because I was just like, wake up. I didn't know what was happening. I was like 16 or 17. They woke her up?
They woke her up?
Yeah, they woke her up. And I stayed with her. I stayed with her. I stayed with her for a while.
Imani dealt with this demon for a long time, huh?
Yeah.
But things turned around for Imani after that.
I guess around 2015, she got clean.
She got clean.
Yeah.
What part do you think her social support system at the time played in keeping her sober?
She decided to reach out and get some help. And she got clean. She put herself away and got clean. Finished high school and graduated and started NYU. And she was already involved with college and working. She was coding and teaching kids coding. She was like amazing, doing so many different things. Everything just changed.
But Imani was a temperamental person. She and her grandmother would often butt heads, and sometimes Imani would not have a place to stay. But despite going through these periods of homelessness, She stayed clean. But when everything shut down at the start of the pandemic, Imani needed a place to stay.
Imani was tough, you know that. And she didn't want to come home. But she didn't want to be out there either. And Corona hit, and I'm like, okay, I guess you're gonna have to come home. Because you're gonna get killed out there.
So Imani moved back in with her grandmother. But the isolation of quarantine was really hard on her. They disagreed about visitors in the apartment. The argument started again, and Sandra was worried about Imani's mental health.
I asked her, can you please go to the doctor? I want you to go back to the doctor and get back on your medication so you could stabilize again.
Imani did go to the hospital. She was prescribed medications that were meant to stabilize her. Imani's treatment plan included group sessions. Imani had done these before, but things were different in the pandemic. This time, everything was remote.
Do you think there was adequate enough outpatient care?
No.
No, I do, uh, you know, like Al-Anon and AA. It's not the same thing. It's not the same kind of interaction among people. People that are in recovery, you have to have contact. A TV screen is not— doesn't do it.
Imani kept up with the meetings for months, but it was really hard for her to maintain the same momentum she'd had in the past.
And then after March, when everything locked down and it was all on the computer, it's impossible just to be sitting there for 7 hours straight. Meeting after meeting after— how do you sit there? She couldn't do it.
Sandra remembers a week when Imani found it really difficult to attend the Zoom meetings.
Thursday, she wouldn't go on her program, and she laid in the bed with me all day on Thursday. She just said her stomach hurt. And I didn't have the fucking brains to think that she might have relapsed. And I went out for a couple of hours to get—
oh.
And when I came home, she was in her room on the floor. And my son came and tried to get her up and did compressions until the cops came.
By the time the cops came, Imani was gone. Later, they said they found a needle containing heroin behind the air conditioner.
You think things would have been different if the pandemic hadn't happened?
Of course. Absolutely. Not having her friends around, not being able to see her people. A lot of people she was connected to with the yoga and, you know, saw in her own business. Money was doing a lot of stuff. Like, she was doing so much, even like with everything that was going on, she was involved with so much. But you made me realize that 7 years, only 7 years. She's trying to fight that demon, and she succeeded. She really did. She kept her word about not getting high out there. She stayed clean even without the medicine. She said, "I'm not gonna take the—" She was celibate. She was like really holy, but lonely. Really lonely.
We'll be back after the break.
Imani's story is not unique. Quarantine has taken away a lot of the community resources that are crucial for people in recovery to have in order to remain sober. We spoke to Will Cook about this, author of the upcoming book Canary in the Coal Mine, which focuses on the national response to the opioid epidemic. He's also the only medical doctor in the town of Austin, Indiana.
I've been practicing in the, the rural community of Austin, Indiana since 2004. A lot of generational poverty, a lot of generational trauma, a lot of social isolation and disconnectedness from the community.
At the height of its opioid epidemic, Austin, Indiana was the site of the largest HIV outbreak in U.S. history. It's a story we covered in Season 2 of our sister podcast, American Diagnosis. The outbreak was fueled by needle sharing.
You know, people would gather around a single soda can, melt down a pill, everybody would stick their needle in, draw it up, inject. There's still some in there, so they're not going to waste it. They'd put their needles back in again. Sometimes not everybody would have a needle. They would draw it up and pass the needle around so other people could inject in that circle. And in 2015, what we all knew was going to happen did happen, where, you know, somebody with HIV entered into that community of people who were injecting together, and HIV started spreading.
Will Cook worked to develop one of the most successful programs in the state to help people who are struggling with addiction.
We realized that what we needed was to really abolish the old system that harmed people by isolating them and relegating them to the shadows and building barriers between them and care.
And things started to really change.
Our recovery community exploded over 3,000% in just 5 years. We developed peer recovery coaches, and so partnering with a peer recovery coach that could walk alongside them, who's walked that trail, that knows the pitfalls, and when they fall down, you know, is right there to help reach down and pick them back up. The result has been that since the 2015 outbreak, we've had a 95% reduction in new HIV cases.
Then in March 2020, the COVID pandemic hit Austin.
All that great work that we had been building momentum towards and really seeing amazing results came to a screeching halt. In the state of Indiana, overdoses that present to the emergency department are up 80% over last year. And deaths are up 20%. So it's been a dramatic impact.
Will says that the aggravating factor was the sudden loss of community.
It's when people start isolating that they are at the most risk for relapsing. And we all basically had to isolate because of what was going on with the spread of COVID-19. It basically just severed those lines. And people that found hope, opportunity, community, and recovery lost it.
Despite the constraints of the pandemic, Will has still been trying to work with what he has to provide support for those who need it. But things have not been so straightforward.
You know, just for example, when the national lockdown occurred, we went to 100% virtual care because that's really what we were asked to do. And so, you know, having someone do a drug screen became very challenging. To some degree, we were just kind of holding on, you know, and trying not to lose people and have them fall out of care and relapse.
But Will stresses that COVID didn't create these problems.
One of the messages that I try to bring out in the book is that diseases and disasters, they don't create disparities and inequalities, they expose them. So we're seeing that now with We're seeing it with COVID-19 where there's certain demographic groups, you know, Black people, for example, dying at a higher rate. And it's not that the diseases and disasters create those disparities. They were already there before. What diseases and disasters do is they expose those disparities that were already in existence.
Listening to what Will is dealing with in Austin, It really reminds me a lot of the same struggles that Emani was dealing with, especially the loss of community. That got me thinking about the things that were going on in Emani's life that all came to a head at the start of the pandemic. Emani's mother Jennifer was incarcerated for much of Emani's life, and I know that caused her a lot of pain. But Jennifer was released in February, just before New York City shut down. I spoke with Jennifer in her Brooklyn apartment. The first thing I noticed when I walked in was how much Jennifer looked like Imani.
Sorry, she just looks a lot like you. I know.
I was like, okay.
Oh, you want to see this?
I'm like adjusting. She showed me this beautiful memorial she had set up for Imani in her home.
Look, that's for Imani.
Oh. Oh my God. Sorry.
I know, it's fine. I cry every day. It took me a month before I could look at her pictures.
Even though Jennifer was incarcerated for much of Imani's life, they were close.
Yes, Imani, she was the most amazing daughter. She came to visit me regularly. She wrote me regularly. She always kept in contact with me. So she gave me my motivation to get through every day that I lived in prison for 17 and a half years.
Jennifer and Imani got even closer. When Jennifer's birthday came in June, it was the first time in almost 18 years that she was able to celebrate her birthday with her daughter on her own terms.
We went to the beach. First I was like, oh, I don't know if the beach is a good idea because they say it's no good with quarantine and the COVID and this and that. She said, "Mom, I told everybody in that Zoom thing that, um, in my treatment plan that you was taking me to the beach." I said, "All right, we going to the beach." Jennifer started a nonprofit called Imani Safe House in honor of her daughter.
The organization provides support for people to successfully transition out of hospitals and prisons. Jennifer wants to remind people about the importance of community.
Community is what gives us our identity. Western individualism kind of teaches us to like every man for himself, but as we see, that's not really working. So like people like me, Manny, really embrace it, and a lot of people are learning that community is very important. We kind of inspire each other, we build each each other up. Imani really brings a lot of people together, and that's something that she's still doing.
Imani's Safe House is accepting donations. You can learn more about their mission and donate by visiting imanisafehouse.com. Alongside Imani's struggle with substance use, she also struggled with suicidal thoughts. In next week's episode, we'll focus on how suicide rates have been impacted by the pandemic. If you or anyone you know is experiencing thoughts of suicide, please call the National Suicide Prevention Hotline at 800-273-8255. The call is free, confidential, and 24/7. Epidemic is brought to you by Just Human Productions. We're funded in part by listeners like you. We're powered and distributed by Simplecast. Today's episode was produced by Zach Dyer, Temitayo Fagbenle, and me. Our music is by the Blue Dot Sessions. Our interns are Annabel Chen, Brian Chen, and Julie Levy. If you enjoy the show, please tell a friend about it today. And if you haven't already done so, leave us a review on Apple Podcasts. It helps more people find out about the show. Follow Epidemic on Twitter and Just Human Productions on Instagram to learn more about the characters and big ideas you hear on the podcast. We love providing this and our other podcasts to the public for free. For free, but producing a podcast costs money, and we've got to pay our staff. So please make a donation to help us keep this going. Just Human Productions is a 501(c)(3) nonprofit organization, so your donations to support our podcasts are tax deductible. Go to epidemic.fm to make a donation. That's epidemic.fm. And if you like the storytelling you hear on Epidemic, check out our sister podcast, American Diagnosis. On American Diagnosis, we cover some of the biggest public health challenges affecting the nation today. Past seasons covered topics like youth and mental health, the opioid overdose crisis, and gun violence in America. I'm Dr. Celine Gounder. Thanks for listening to Epidemic.