WOONSOCKET, R.I. — The sun barely rises when John Hayes gets behind the wheel of a 27-foot-long RV and starts to rev up the engine.

Hayes sits on the edge of a mostly empty parking lot in Providence, Rhode Island, right outside of a methadone treatment clinic where, even at 5 a.m., patients start lining up.

But Hayes is not there to help people inside the brick-and-mortar clinic. Instead, he's taking the converted RV about 30 minutes north— to Woonsocket, Rhode Island. It's a community with some of the highest opioid use rates in the state.

"They’re just nice people that hit a bump," Hayes said.

It does not take long for patients to arrive.

One of the first people to arrive is Raul Rodriquez. Addicted to drugs for more than 20 years, Rodriquez use to have to travel 30 minutes to Providence to receive the methadone treatment he needs to get better.

But now, this first-in-the-nation mobile methadone clinic is bringing the medicine to him.

"It's wonderful. I live around the corner, you don't have to drive. It's right here," he said.

Methadone is a medication used to help people reduce or quit their use of heroin or other drugs. By increasing ease and access, the mobile medical unit hopes to keep patients on the right path.

"Substance use disorder is just a disease of the brain," said Linda Hurley, president of CODAC Behavioral Health, which owns and operates the mobile unit.

Last month, CODAC received approval from the Drug Enforcement Administration (DEA) to dispense methadone at mobile treatment sites. Aside from the convenience, it's a more cost-effective way for treatment centers to operate. Instead of $4 million for a new building, CODAC can spend closer to $400,000 to renovate an RV.

"This is a highly effective, efficient and kind way to provide care to individuals that are dying," Hurley said.

This type of innovative methadone treatment couldn't come at a more critical American juncture. According to the Centers for Disease Control and Prevention, an estimated 107,000 people died of drug overdoses in the U.S. in 2021. An estimated 75 percent of those deaths involved an opioid but only 18 percent of people with an opioid use disorder received medication as treatment.

"With a mobile unit, we go to individuals and see them when they can be seen, and that’s really important," Hurley noted.

There's another layer to all of this. It's keeping patients from having to go to a traditional doctor's office setting, which comes with its own set of stigmas.

As a physician specializing in addiction medicine, the mobile medical unit is a new frontier for Dr. Cara Zimmerman.

"This is definitely meeting someone where they're at," Dr. Zimmerman said.

Not only can she offer patients methadone treatment, but she can also help with wound care or write a prescription.

"This is more we're here; we're coming to you on your schedule and whatever, as much or as little as you need," she added.

Communities across the country are visiting the mobile clinic to see what's working as more treatment centers apply for DEA approval to get other mobile methadone clinics rolling nationwide.

"Most of them are just regular people who are coming in early to go to work. They're coming in before their day starts, so they can get their methadone and live a life," Hayes said.

BOULDER, Colo. — It's a question that's started a debate in communities across the country: should schools keep overdose-reversing spray Narcan in classrooms or on campus?

As opioid overdoses continue to rise, especially among teens, more and more schools are saying yes.

After multiple students overdosed in the Boulder Valley School District in Boulder, Colorado, the community and the district worked together to get Narcan stocked in schools to help save the next student who overdoses from dying.

“The opioid crisis that's happening across the United States is scary, and people are dying, and families are affected. It's a really big deal,” said Jennifer Kerker, a registered nurse and school nurse consultant at Monarch High School in Boulder.

A study from UCLA found that the rate of overdose deaths among U.S. teenagers nearly doubled in 2020, then went up again in the first half of 2021.

That's why Kerker says schools need to be ready to help.

“The only problem with Narcan is not having it when you need it,” said Kerker. “Students want to protect themselves. They want to protect their friends, and parents want to help keep their students safe. Narcan is one way we can do that.”

In the short time since her school had Narcan, Kerker had to use it on a student that was unresponsive.

“Having this medication and knowing we had it in the bag was actually really reassuring. We didn't hesitate. I gave it, and I was glad I had it on hand.”

More than half of states now allow school systems to stock Narcan in schools, and seven states require it for either high schools or colleges. Those states include Oregon, Arizona, Tennessee, Maryland, Rhode Island, Washington, and Connecticut.

However, many say having the option to have Narcan isn't enough because even in states where Narcan is allowed, many schools still don't stock it.

In 2022, students have overdosed and died in schools in Colorado, Connecticut, Nevada and New Jersey.

Despite the grim reality, there is hope, too. A school in Kansas City that carried Narcan was able to save a student's life.

In Boulder, Colorado, Dad Ryan Christoff saw Narcan bring his own teenage daughter back to life.

“Her lips were blue. Her face was kind of a pale green,” recalled Christoff. “I was, you know, shaking her, trying to wake her up, you know, just yelling her name.”

Christoff didn't know Sofia was using drugs, but police used Narcan just in case. It worked.

“I don't look at it like that was the day she overdosed,” said Christoff. “I look at it like that was the day that my daughter was brought back to life."

Christoff is so grateful for his daughter’s second chance and for the fact that Sofia's school is one that now carries Narcan. Christoff is now a community advocate dedicated to getting rid of the stigma around using Narcan and is educating parents and nearby schools.

“We need to face that head-on, with our eyes open and realize, 'OK, people are using drugs and they're dying. Let's start with harm reduction. How can we keep them from dying?'"

The good news, Christoff said, is that help is free. The company that makes Narcan will send any school two boxes of doses at no cost.

Christoff just hopes schools see the value in a simple tool that can have a deep impact on our students.

“I'm positive that by the schools having it, they are going to save a lot of lives,” said Christoff.

Christoff said he is proud of his community for embracing the mission to help save student lives. The school district worked with Boulder County Public Health on this project and involved the entire community.

“Boulder County Public Health works closely with our school districts to reduce overdoses, including training on accessing and administering Naloxone,” said Lexi Nolen, interim executive director. “Taking even one pill can be a fatal mistake if it contains even a small amount of fentanyl, and there is no way to be sure of the pill’s content.”

BCPH recommends following these steps to help prevent overdoses:

• Assume that any pills purchased from a non-pharmacy source may contain a lethal dose of fentanyl and follow all precautions to prevent and respond to an overdose.
• Ensure that you, and those you are with, carry Naloxone and know how to administer it. Naloxone can reverse the effects of opioid overdoses. Fentanyl is stronger and may require additional doses of Naloxone.
• Always call 911 if you suspect someone has overdosed. Colorado has the Good Samaritan Law, and you will not be charged with drug possession in amounts for personal consumption if you call 911 and remain present until help arrives.
• Don’t use alone. If you can’t be with someone else, plan to have someone check in on you so that they can come help you if needed. If you are with someone else who is also going to use, have someone else check in with both of you.
• Start with a small dose every time you have something new. You can always add more, but you cannot subtract.
• Test your drugs using fentanyl strips. However, if it does not alert to fentanyl, it does not mean it is not there. The fentanyl may still be in another untested part of the pill or another unknown synthetic.

Resources:

• Overdose prevention: boco.org/overdose-prevention [boco.org]

• How to dispose of drugs: boco.org/TheWorksProgram [boco.org]

• Talk to a harm reduction specialist: Georgia Babatsikos, 303-441-1100

At age 14, Alexander Neville was still very much a curious kid. He was a Boy Scout who enjoyed getting outdoors and camping. He played with Legos and liked to skateboard. He slept with a stuffed Iron Man figure and still snuggled with a teddy bear he'd had since he was much younger.

But about a year and a half ago, the middle schooler confessed to his parents about a very adult problem: He was experimenting with oxycodone, a prescription painkiller.

He had no idea that the pills he was taking were actually prescription knockoffs laced with fentanyl, a synthetic opioid. Just a few milligrams of fentanyl can be a fatal dose.

One morning in June 2020, his mother, Amy, found him dead in his bedroom.

"I went to his room, and he was blue, just laying on his beanbag chair. Just like he had gone to bed, you know, just like he had fallen asleep there," she said.

Drug deaths more than double

Though still rare, drug deaths among children ages 10 to 14 more than tripled from 2019 to 2020, according to an analysis done for CNN by the U.S. Centers for Disease Control and Prevention.

Unintentional drug overdoses led to 200,000 years of lost life for U.S. preteens and teens who died between 2015 and 2019, a January study found. And experts suspect that the problem has gotten worse during the pandemic, research shows.

The trend among adolescents follows a wider one.

Annual drug overdose deaths have reached another record high in the United States, with an estimated 104,288 in the 12-month period ending September 2021, according to provisional data published Wednesday by the CDC's National Center for Health Statistics.

That's double the number from six years prior; there were an estimated 52,000 drug overdose deaths annually in September 2015.

The fentanyl factor

Alexander Neville had gone to his parents to ask them for help just two days before he died. He told them he had started on the pills, in large part, because he was curious.

"He said, 'I got to tell you something. I wanted to experiment with oxy -- oxycodone. I looked up how much to take for my size, so I wouldn't get addicted. But it really has got a hold on me. And I don't know why,' " his mother said.

His parents immediately made calls to get him into treatment.

"He really wanted to stop completely," Alexander's father, Aaron, recalled.

Amy remembered, "He wanted to be done. He's like, 'I'm done. I thought this stuff was going to be fun, but it's not.' "

But Alexander took that one last pill, unaware it was actually a deadly fake.

Tests later showed that the pill had enough fentanyl in it to kill at least four people, according to a toxicology report that his parents obtained.

Fentanyl is a drug intended to help people like cancer patients manage severe pain. It's 50 to 100 times more potent than morphine. But most overdose deaths aren't from using it legitimately; rather, they are linked to fentanyl made illegally. Four out of every 10 fake pills with fentanyl contain a potentially deadly dose, according to the Drug Enforcement Administration.

Since 2013, a rise in opioid deaths involved illicitly made fentanyl, according to the CDC. The agency says dealers combine it with counterfeit prescription pills, cocaine and heroin.

During the pandemic, the spike in deaths has increased significantly. From May 2020 through April 2021, more than 100,000 people of all ages died from drug overdoses in the US, according to the CDC. That's a record -- a near-30% rise from a year earlier and a near doubling over the past five years. Synthetic opioids like fentanyl accounted for the bulk of those deaths -- around 64,000.

"We're dealing with a different drug threat. Fentanyl has changed the game," DEA Special Agent Robert Murphy said. "I've been in law enforcement my entire adult life -- so it's 31 years now. And I've never seen a threat of the drug threat like the one we're dealing with now. It's frightening."

Social media makes drug deals easy

Social media may also contribute to the problem. Drug dealers no longer have to stand on streetcorners. They can now connect with kids online through platforms like Facebook, Instagram, Snapchat and YouTube, Murphy said.

Alexander's parents believe that he got his fake pills through Snapchat. Another parent in the area got in touch to tell them that her son died two weeks after Alexander did, and she had screengrabs of a conversation believed to be with a drug dealer through Snapchat. There's still an investigation underway.

"The fentanyl epidemic has had a devastating effect on the lives of too many Americans, and our hearts go out to the families who have suffered unimaginable losses," a Snap spokesperson said in a statement to CNN.

"We share their outrage over how drug dealers have abused online platforms, including Snapchat, and are working tirelessly to eradicate them from our platform. We use tools to proactively detect drug-dealing activity and shut down dealers. To help inform our ongoing strategy and efforts, we work closely with a wide range of experts in counternarcotics, the law enforcement community, and government agencies, including the Drug Enforcement Agency, as well as with families. We are committed to bringing every resource to bear to fight this national crisis both on Snapchat and across the tech industry, particularly by raising awareness about the dangers of counterfeit pills laced with fentanyl."

Buying drugs is as easy as planting a string of emojis on a social media platform to signal the interest in a sale, Murphy said. The DEA says drug traffickers and the criminal networks are there waiting for you.

Dealers may reassure people that their pills are fentanyl-free, but there's no easy way to tell by looking at them, nor is it easy to know how much fentanyl is in them.

"That's why it could be a 'one pill kill,' because we don't know the dose," said Dr. Robert Bassett, assistant associate director of the Poison Control Center at Children's Hospital of Philadelphia. "It's like driving at night with your headlights off."

The opioid overdose antidote

Fentanyl has become such a big problem among young people that some schools have started keeping naloxone, an antidote to opioid overdoses that's available under the brand name Narcan, on hand.

Hartford, Connecticut, is one example. In January, a 13-year-old boy died after collapsing in gym class at a Hartford school. Two other seventh-graders were taken to Connecticut Children's for treatment and evaluation. Police found 40 bags of fentanyl at the school and 100 bags in boy's bedroom.

On Tuesday, the American Medical Association encouraged the Biden administration to remove the prescription status of naloxone to make it more easily available over the counter.

All 50 states and the District of Columbia have some form of naloxone access laws that allow for the prescribing and dispensing of the treatment to substance users vulnerable to overdose and to nonmedical first responders like family and friends, according to the Legislative Analysis and Public Policy Association. As of 2020, at least 20 states allow schools to possess naloxone and administer it, but they are not required to do so.

How to get help

Though the experts say there are not enough counselors and treatment programs for preteens and teens, there are treatment programs that work for adolescents.

The first step in successful treatment is recognition. Parents need to stay vigilant for changes in a child's behavior, which may be an early sign that they're using drugs.

The changes can be subtle at first, Bassett said. They may not hang out with the same friends or may stop showing interest in favorite activities. They may be angry or sleep more. But parents need to talk to their kids about it -- even middle schoolers -- and do it more than once.

"This is not a 'one conversation and forget it.' This is something you're going to have to just pound in terms of every night at the kitchen table," Murphy said.

Children's brains aren't fully formed, and their risk-reward centers may not help them make the right choices all the time. "They're the perfect, most vulnerable population," Bassett said.

Bassett recommends that parents check with the National Institute on Drug Abuse for resources. They can also call Poison Control at (800) 222-1222 for free inforrmation.

Medication-assisted treatment is considered more effective than abstinence, Bassett said. Wraparound services, individualized treatment to help the child and family, can include peer counseling and drug rehabilitation. And, Bassett said, it may be important to address underlying issues that lead the child to experiment with the drugs in the first place.

"There may be unmet psychological conditions that force people into self-medicating," Bassett said. "They're just looking not to suffer."

NEW YORK —

Four men have been charged in the overdose death of actor Michael K. Williams, a federal prosecutor said Wednesday.

Video above: Michael K. Williams laid to rest in Pennsylvania

U.S. Attorney Damian Williams and New York City Police Commissioner Keechant Sewell said the four were charged in a criminal complaint unsealed Tuesday in Manhattan federal court in a narcotics conspiracy alleging the distribution of fentanyl-laced heroin that resulted in the death of Williams, who gained fame playing Omar Little on “The Wire.”

New York City's medical examiner earlier ruled that Williams, 54, died of acute drug intoxication Sept. 6. He was found dead by family members in his penthouse apartment. At that time, the medical examiner’s office ruled Williams’ death an accident.

America's drug epidemic is the deadliest it has ever been, new federal data suggests.

More than 100,000 people died of drug overdoses in the United States during the 12-month period ending April 2021, according to provisional data published Wednesday by the U.S. Centers for Disease Control and Prevention.

That's a new record high, with overdose deaths jumping 28.5% from the same period a year earlier.

Opioids continue to be the driving cause of drug overdose deaths. Synthetic opioids, primarily fentanyl, caused nearly two-thirds (64%) of all drug overdose deaths in the 12-month period ending April 2021, up 49% from the year before, the CDC's 's National Center for Health Statistics found.

The COVID-19 pandemic and the rise in use of fentanyl have both been key contributors to the rising overdose death toll, experts say.

The latest provisional data on drug overdose deaths captures those occurring in May 2020 through April 2021. COVID-19 killed about 509,000 people in that same timeframe, according to data from Johns Hopkins University.

"What we're seeing are the effects of these patterns of crisis and the appearance of more dangerous drugs at much lower prices," Dr. Nora Volkow, director of the National Institute on Drug Abuse, told CNN. "In a crisis of this magnitude, those already taking drugs may take higher amounts and those in recovery may relapse. It's a phenomenon we've seen and perhaps could have predicted."

But the rise of fentanyl, a stronger and faster-acting drug than natural opiates, has made those effects even more deadly, she said.

Increasing use of the synthetic drug caught the attention of experts before COVID-19 hit, but the pandemic may have exacerbated the problem.

With international travel limited, synthetics that are easier to manufacture and more concentrated were likely more efficient to smuggle across borders, Volkow said.

The new federal data shows that overdose deaths from methamphetamine and other psychostimulants also increased significantly, up 48% in the year ending April 2021 compared to the year before. They accounted for more than a quarter of all overdose deaths in the latest 12-month period.

While fentanyl was once more popular on the East Coast and methamphetamine on the West Coast, Volkow says both have now proliferated nationwide.

Deaths from cocaine and prescription pain medication also increased compared with a year earlier, but not as drastically.

As the country reopens and society returns to some pre-pandemic normalcy, experts say people will continue to die from drug overdoses at very high rates if action isn't taken to significantly improve access to treatment.

"Even if COVID went away tomorrow, we'd still have a problem. What will have an impact is dramatic improvement to access to treatment," said Dr. Andrew Kolodny, medical director of opioid policy research at the Brandeis University Heller School for Social Policy and Management.

"These are deaths in people with a preventable, treatable condition. The United States continues to fail on both fronts, both on preventing opioid addiction and treating addiction," he said, emphasizing the need for President Joe Biden to deliver on his campaign promises to address the crisis.

Last month, the U.S. Department of Health and Human Services released an overview of the Biden administration's plan to combat drug overdoses. It includes measures aimed at addressing opioid prescription practices and removing barriers to treatments, as well as recovery support and federal support for harm reduction strategies.

On Wednesday, the White House Office of National Drug Control Policy released a model law, providing states with a template to pass their own legislation to improve access to naloxone, a drug that reverses opioid overdoses.

"If we really want to turn the corner, we have to get to a point where treatment for opioid addiction is easier to access than fentanyl, heroin or prescription opioids are," Kolodny said, referring to medications including buprenorphine.

"The evidence is really clear that using medications to treat opioid addiction disorders saves lives," said Beth Connolly, director of the Pew Charitable Trusts substance use prevention and treatment initiative. "As we see more and more evidence that (medication) does save lives, that will hopefully reduce stigmatizing and categorizing in favor of supporting individuals."

Provisional overdose death data is updated monthly by the NCHS and is subject to change, as drug overdose deaths often require "lengthy investigation, including toxicology testing" to confirm cause of death.

In 2019, heart disease was the leading cause of death in the U.S., according to data from the CDC, killing nearly 660,000 people. Cancer killed nearly 600,000 people in 2019, while accidents, chronic lower respiratory diseases, stroke and Alzheimer's disease also caused more than 100,000 deaths each. These figures reflect final, annual updates and are not directly comparable to provisional data.

RICHMOND, Va. — Jennifer Campbell has faced loss, addiction, and domestic abuse.

“It just took being in the wrong place at the wrong time, at a weak moment, and I used again, and from the next six months was the deepest, darkest hell I've ever known,” Campbell said.

Campbell has even been on the brink of death.

“He beat me so badly, he put me in a body bag in a river and I was unconscious, but I kept waking up," Campbell said. "I don't know if the cold water, but I kept waking up and I try to fight my way out of a body bag. And someone pulled up into these woods, by the grace of God, and he saw them. So he came and got me out of the river and took me back to the house. So God saved me once again.”

It wasn’t until she was arrested for drug distribution that she finally got away from that man. She says she believes God used the time she served behind bars as an opportunity to press the reset button.

After jail, Campbell went to a long-term residential facility called the Mercy House. She’s now been sober for four years. Rosalinda Rivera is the executive director of Mercy House.

“Our home represents probably about 90% of women that have been through sexual abuse, through some kind of physical abuse," Rivera said. "They are victims of violence, domestic violence, who have many of them have turned to addiction to find a way of an escape.”

Rivera says the women go through a series of family classes, job-related training, and relapse prevention. She says a recent study done by the University of Maryland shows 65% of the women who finish the program never go back to their addiction.

“For the 50 years that we've been doing this program, we have seen that the core issue is a lack of hope.”

As the U.S. opioid crisis continues to get worse, Rivera says it was heartbreaking to turn ladies away at the beginning of the pandemic.

“Once we realized that we could do testing and let people in the door, the phones, well, the phones never stop ringing,” Campbell said.

Campbell says there are many reasons people facing addiction have been struggling more throughout the pandemic.

“Probably they lost their jobs and they were struggling financially," Campbell said. "Maybe someone in their family was suffering from COVID-19 and maybe someone in their family passed away due to it. And I mean, that just brings on so many different aspects of grief. And some people don't know any way to deal with that other than to run to drugs.”

According to the CDC, a record 93,000 people died from a drug overdose in 2020.

Dr. Nora Volkow is the director of the National Institute on Drug Abuse at the National Institutes of Health. She says the opioid crisis has basically been put on the backburner during the pandemic.

“The number of people that have died from opioids significantly rose during the pandemic year of 2020," Dr. Volkow said. "The estimate is that there was at least a 30% increase from 2019. And so this is the largest increase in overdose deaths that we have ever recorded.”

She says the health care system was saturated because of COVID-19 and there’s been a rise in more dangerous drugs like fentanyl.

“The people that are mostly affected are between 24 and 54 years of age, so they are at the prime of their lives,” Dr. Volkow said.

In order to make these numbers go down, Dr. Volkow says we need to end the stigmas surrounding addiction so people aren’t ashamed to seek medical help. She also would like to see an expansion of access to naloxone – a medication that rapidly reverses an opioid overdose.

Places like the Mercy House help these women to view themselves in a more positive light giving them the chance to start a new chapter.

“It's a battle that they're going to deal with the rest of their life, and so if they plug in a community that's thriving, if you get plugged and if they have purpose, so many people are just looking for a purpose," Rivera said. "And when they find purpose, that is what kind of separates them and helps them stay on the path to recovery.”

A group of states' Attorneys General announced a proposed $26 billion opioid crisis settlement Wednesday that, if approved, will resolve claims against the "big three" drug distributors — McKesson, Cardinal Health and AmerisourceBergen Drug — as well as manufacturer Johnson & Johnson.

The proposed agreement, if approved by enough state and local governments, would resolve the claims of nearly 4,000 entities that have filed lawsuits in federal and state courts against the four companies, according to a press release from New York Attorney General Letitia James.

The three distributors collectively will pay up to $21 billion over the next 18 years.

Johnson & Johnson will pay up to $5 billion over nine years, with up to $3.7 billion paid during the first three years, according to the release.

The proposed agreement would result in court orders requiring Johnson & Johnson to stop selling opioids, not fund or provide grants to third parties for promoting opioids, and not lobby for any activities related to opioids. It would also prohibit sales staff from influencing decisions related to identifying suspicious opioid orders.

McKesson, Cardinal Health and AmerisourceBergen will be required to share their data with an independent clearinghouse. The distributors would need to account for their own shipments and the shipments of the other distributors to detect, stop and report suspicious orders.

The three companies released a joint statement Wednesday: "While the companies strongly dispute the allegations at issue in the trial, they believe this resolution will allow the companies to focus their attention and resources on the safe and secure delivery of medications and therapies while delivering meaningful relief to affected communities, and will also support efforts to achieve a broad resolution," they said, in part.

Johnson & Johnson released a statement saying it would contribute $5 billion to the settlement, depending on the number of state and local governments that decide to opt into the agreement.

"We recognize the opioid crisis is a tremendously complex public health issue, and we have deep sympathy for everyone affected," said Michael Ullmann, Johnson & Johnson's executive vice president and general counsel. "This settlement will directly support state and local efforts to make meaningful progress in addressing the opioid crisis in the United States."

New York will specifically receive up to $1.25 billion to fund prevention, treatment and recovery programs.

"The numerous companies that manufactured and distributed opioids across the nation did so without regard to life or even the national crisis they were helping to fuel," said James, the New York attorney general.

A total of fourteen states — New York, California, Colorado, Connecticut, Delaware, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Ohio, Pennsylvania, Tennessee and Texas — were involved in reaching the proposed settlement agreement, according to the release.

Pennsylvania Attorney General Josh Shapiro said during a press conference, "We collectively took on some of the most powerful companies in the world to fight for you," speaking to the families who have lost loved ones to the opioid crisis.

Cases against Mallinckrodt and Rochester Drug Cooperative will move forward separately through US bankruptcy court.

The trial against the three remaining defendants — Endo Health Solutions, Teva Pharmaceuticals USA and Allergan Finance — is currently underway and will continue in state court.