By Karen Wang

Lilly Puri went back home at 11:30 p.m., laughing, hugging and kissing her mother. Lilly was small, about 80 pounds. “She was all over me,” her mother Preeti Puri recalls. 

That morning, Lilly said she would sleep out during the night. “You’re not going to sleep out. You’ll come home. You love your bed too much,” Puri knew her daughter all too well. But what Puri didn’t know was that Lilly came back with a bag of powder that took her life that night.

“Acute overdose from fentanyl,” Puri read from her daughter’s death certificate weeks later. “We were told she died within minutes and wouldn’t have felt anything.”

“Get yourself a damn testing kit”

A year into the pandemic, as Americans grappled with the fact that COVID-19 had hit the country hard, another health crisis took hold amid chaos and anxiety – drug overdoses. Last summer, we witnessed the highest number of drug overdose deaths ever. About half of U.S. jurisdictions reported an over 50% increase in opioid-involved deaths, and in many western states, the fatality nearly doubled

Over 81,000 people died from drug overdoses – Lilly, as well as many other teens and college students – were among them. But to her family, Lilly is so much more than just a part of the statistics – Puri had been seeking for answers after Lilly’s death. One of those lingering questions was, “Why didn’t she test the drugs?”

This image has an empty alt attribute; its file name is Screen-Shot-2021-04-28-at-4.32.16-PM-1024x856.png
A visual representation of how numbers of fentanyl-related deaths have increased since 2016. Source: Injuryfacts.

During the pandemic, the drug supply becomes more fragmented and harder to predict – with the supply of fentanyl, a drug much more potent than heroin, further accelerating during the pandemic. As a drug prone to be laced with other opioids, many new fentanyl contaminants also emerged during the pandemic, said Claire Zagorski, the program coordinator and harm reduction instructor at the University of Texas at Austin. 

Fentanyl has spread so much that it has become ubiquitous in cities like Boston. The public health department found that 93% to 95% of all opiates on the street contain fentanyl, said Miriam Harris, an assistant professor at Boston University and addiction doctor. “There are parts of the country where heroin isn’t even really sold anymore. It’s all fentanyl. That is true in Boston right now,” Zagorski added. 

In San Francisco, there were 713 fatal overdoses in 2020; the majority of deaths were attributed to fentanyl, a report from Medical Examiner shows. Butler County, Ohio saw 177 fatal overdoses last year in 2020, marking the fourth worst year since 2012. 88% of deaths involved opioids and were “overwhelmingly fentanyl,” expert told Journal-News, a local media in the county. Santa Clara, California reported seeing a tripling of fatal fentanyl overdoses in May 2020, with most of the cases being between the ages of 16 and 25. 

A lot of the users know about the potency of fentanyl, they just didn’t know there was fentanyl in their pockets. A five-minute drug test could have saved many from fatal overdoses. 

But the implementation of test strips falls short in light of the rapid spread of fentanyl. Lilly, who struggled with bipolar disorder and addiction, was always against fentanyl. “Lilly had a very scientific mind … She would be like ‘holy shit, this has fentanyl in it,'” Puri said. “And she would talk about it and brag about it, I’m sure.” But Puri couldn’t understand why Lilly wouldn’t buy the test strips, which are readily available online and in stores. 

While grieving for her daughter, Puri believes that test strips should become even more accessible to students. “They need to get it very early in high school because high schoolers are experimenting. And definitely when they (schools) give up the condoms and the welcome pack, they should have the testing strips,” she said. For young drug users, Puri believes test strips can educate them and act like a deterrent. 

“I think it should be everywhere. I think if you’re in that college lifestyle, you should carry it with you. It’s like carrying a condom in your purse. If the urge comes, then at least you’re safe and you’re not sorry,” Puri added. “And you know what? You are safe for the group.”

Puri, now a mother of three, promised that this tragedy must not happen to Lilly’s sisters. All of her sisters are anti-drugs. They would leave parties if they saw cocaine or refuse to be friends with people who use drugs. One of her daughters, who goes to school in Toronto, is raising awareness and advocating for test strips on her campus.

“I have told both daughters that if they do decide to use something… no one’s judging at home. Obviously, I would want them to stay in as a mother. But get yourself a damn testing kit,” Puri told her daughters. “Keep those strips with you, and make sure what you’re having is pure and clean. Because that one time that you’re curious may turn into your last time.”

What else can schools do?

Drugs can be dangerous, especially mixed with other illicit drugs. One alarming concern associated with unregulated drug use is that buyers might unknowingly purchase contaminated or counterfeit substances. 

Rachel Barry, a CSU Monterey Bay student, wanted to advocate for more fentanyl test strips provided on campus to reduce the chance of misusing contaminated drugs. She handed out the test strips to students last May and surveyed their attitude toward harm reduction with testing kits. The study indicated that most students were in favor of utilizing testing kits if they are available on campus.

“Our campus and surrounding community has been impacted by overdoses caused by fentanyl-contaminated drugs, so I’m hoping that having access to these strips will be positive,” Barry said. 

Trojan Awareness Combatting Overdose, or USC T.A.C.O, is a newly-formed student-led initiative at the University of Southern California aiming to empower the students to make informed decisions about personal drug use by providing non-judgmental facts on drugs. Madeline Hilliard, a computational neuroscience senior at USC, founded the organization after drug overdoses, especially mixed drugs, took lives of four fellow students in 2019 and many others in 2020 at the university. Hilliard’s friend was one of them.

“He passed away from mixing Xanax and alcohol, which when I woke up to the news that morning, I was equal parts just heartbroken but also infuriated because he was extremely bright, was going to graduate magna cum laude, and like had so so much in front of him,” Hilliard said. “And just because no one had ever told him better, and no one had ever told him about the risks he was taking, that he ended up dying from it.”

“We’ve lost like almost 20 kids in my senior class alone in my time at USC to drug overdose. So no, USC is not doing anywhere near enough,” she added. “And that gap is what necessitated the founding of our organization.”

Starting distributing fentanyl test strips six weeks ago, the organization has handed out about 500 strips to USC students. Partnering with greek life at the university, T.A.C.O. has informed every single new member about the risk of using drugs and how to deal with overdose, Hilliard said.

Hilliard noticed that the general college students do not always have access to even the most basic facts – mixed drugs can be lethal, for example. “Your parents don’t teach it to you, because they don’t really know how, and a lot of times, your school teachers don’t tell you about it, because it’s taboo. And if you go on the internet, you’re probably going to find either sources that are shaming all drug use… or scientific research papers,” she said.

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“Our core value is we are neither pro- nor anti-drug use… Because we’re not here to shame anybody,” she added.

Moving forward, Hilliard and other co-founders of T.A.C.O hope to expand the organization’s branch to the surrounding communities, including other colleges like UCLA, Loyola Marymount University and Chapman University.

With universities and schools shutting its door under social distancing policies, students were left without any in-person resource to help them combat addiction. Working at two universities in Buffalo, former addiction doctor Richard Blondell said the drug issue has been intractable for academic institutions even before the pandemic. He recognized that the on-campus treatment programs are expensive, and the schools usually do not have a clear plan about what to do with the situation. Meanwhile, promoting drug treatment policy can turn off potential parents of potential students, he said.

“You have a budget problem because people aren’t coming to school. And because of the pandemic, your tuition revenue is falling down. You know there’s a drug problem that you have no idea what to do about it,” he explained. “So from the administrative point of view … it’s gonna cost you money, it’s gonna put negative PR, and you’re going to commit to doing something that may or may not work.”

“How do you prevent people from starting things that are going to lead to bad outcomes?” Blondell said. “That’s the dilemma we have. We don’t really know what to do.”

Last year, 13 people were arrested for drug trafficking on campus at Zagorski’s university. At a university level, Zagorski thinks confronting the stigma of drug use is at the center of fighting against the drug epidemic. “Trying to normalize conversations around drug use is different than, I think, for normalizing drug use, people get very antsy about that,” she said. “There’s a lot of assumption that if we talk openly about drug use, like it’s a real thing that normalizes it, in general, and then people get kind of upset about it.”

“Step one is just having that honest conversation. We see lots of, you know, talking about drugs, that’s really just limited to abstinence-only kind of conversations,” she added. “Because there is a spectrum, there is a spectrum in between abstinence and drugs really taking control of your life, there’s a lot of different ways to kind of approach it.”

Blondell welcomes students who come to his office for addiction-related help, and he tries to give them “factual, non-judgemental matter of fact” and encourages them to make the right decision on their own. “The only thing we have is education,” he said. 

“Other than that, what else can you do? I wish I knew.”

Puri thinks “schools are turning a blind eye” although “they know drug use is going on.” 

University and high school teachers know when the students come in high, but they’re literally turning their head the other way, because they don’t want the legal implications, Puri said. “And this is why I think it’s going to be really hard. And you know, we have to take it all the way up to the government and to Congress in the Senate, or whatever the higher ups are to make this a mandate that schools should be responsible,” she added.

“We’re paying for freaking mental health with our tuition fees,” Puri said. “Why is the school not providing that and … not putting the kid out of classes and helping out with that?”

Students think they are invincible

Puri believes that students, like the doctors, lawyers and millionaires who use drugs, feel they are invincible. “And I don’t think they’ve adopted the psychology of drug testing.”

“They don’t believe in testing and they feel they are paying for the pure product because they’re rich and white-collar. They’re not getting the shit that’s on the street,” Puri said. “But what they don’t realize is, the shit on the street doesn’t see white collar, blue collar, student or homeless. It can get into your batch at any time.” Even for students, Puri said, “they feel like ‘not them.’”

Puri believes having posters like “carry the strip” would help raise awareness and ingrain the idea of testing drugs. “I think it’s because we haven’t had these open conversations. They haven’t made it. You don’t see the posters everywhere.”

Lilly passed away at a time when she was graduating her drug support and entering a new live. “In my heart, I felt that Lilly was transforming.  She was scared about graduating the group, scared and anxious about getting additional mental health support, scared of what life was going to look like outside the rehab ‘bubble.’” Puri wrote in her blog a week before Lilly’s death. “We were going to support her every step of the way.  We were going to hold her hand.  I had already made an appointment for July 20th with the mental health facility” – an appointment Lilly never made to.

As an IT project manager, Puri became a self-taught expert on drugs ever since Lilly became an addict. “We’ve gone through so many psychiatrists and psychologists since she was 13 that I feel I could write a book on it,” she said. But one thing she thinks that is missing from the whole equation is the post-rehabilitation care and service for drug users. “These people need constant love attention. And there’s no facility out there that can teach them how to live normally.”