Brent Patrick Crawford prayed without ceasing. His wife, Tina Crawford, would look outside the wedding venue they ran together to see Brent, all 6 feet of him, kneeling in the grass, straw hat on knees and arms raised to the sky. 

When Brent died last year from a fentanyl overdose at 31, he’d been recovering from his addiction to heroin for years. In the months leading to his death, he kept his cravings quiet. He didn’t share them with his wife, nor the people in his recovery group, she said. “There’s so much shame associated with addiction and especially heroin,” she said. “He was just struggling inside his own head.” 

That stigma keeps evidence-based overdose interventions from taking hold, said Scott Walters, a regents professor with The University of North Texas Health Science Center. “We already know what works in communities to reduce overdoses,” he said. “How do you help communities to implement strategies we already know are going to reduce overdoses?”

As the anniversary of her husband’s death approaches, Tina is working to answer that question. On July 24, she’ll host a community event in Southlake whose purpose is twofold: Provide a glimpse into what overdose interventions can look like, and start a conversation she wished she’d had with Brent.

“I would have done things so much differently had I known really what my husband was going through,” she said. “So that’s my purpose: to educate people so that they know, and to take away the shame and offer help.”

If you go:

What: Overdose awareness community event

When: 4-9 p.m. Sunday, July 24

Where: Paradise Cove on Lake Grapevine

3029 Midway Road, Southlake, Texas 76092

Schedule:

4 p.m.: Outdoor activities (bounce houses, yard games, face painting, etc.) open and substance use professionals will be available for questions, conversation

5-5:30 p.m.: Love Cassidy and Valley hope will offer naloxone training

7:30 p.m.: Featured speakers from the drug enforcement agency, Recovery Resource Council, Love Cassidy and Valley Hope

‘A much more deadly product’

Brent didn’t live in a high-risk community, Tina has heard people say, and they’re somewhat right. When it comes to deaths from drug overdose, Texas is doing relatively well — better than nearly every other state in the U.S., according to 2020 data from the U.S. Centers for Disease Control and Prevention. 

That’s partly because of Texas’ relatively strong economy, Walters said. Walters leads the HEALing Communities Study, a more than $350 million project from the National Institutes of Health that helps put into place best practices in communities hard-hit by the opioid epidemic. As economic stability declines, he said, overdose deaths tend to increase.

But the state’s death rate, along with rates across the country, continues to climb. Early data from 2021 indicate that more than 100,000 people died from drug overdoses in the first year of the pandemic — a nearly 30% increase from the same time period the year before.

“It’s all fentanyl,” Walters said. “It’s not necessarily because there’s more drugs in circulation. It’s because the types of drugs have changed. And it’s just a much more deadly product. The ratio of what’s going to get you high to what’s going to kill you is a lot smaller.”

Fentanyl is an addictive, synthetic opioid originally developed for pain management. For surgery patients, fentanyl causes less vomiting and less drops in blood pressure than morphine, but is 50-100 times stronger. “Fentanyl is just a beautiful anesthetic,” said Dr. Grant Fowler, a physician and the chair of family medicine at the TCU School of Medicine. 

But on the street, people mix it with heroin to increase the latter’s potency, according to the U.S. Drug Enforcement Administration. Sometimes, a person seeking heroin buys fentanyl without knowing it. 

When Brent ordered the drug that would ultimately kill him, he’d asked for heroin, Tina said. She’s seen the text he sent his dealer. “But that heroin had fentanyl in it,” she said. 

‘Addicts relapse. That’s part of it.’

In the five years Tina and Brent were together, Brent mostly stayed clean. After his first relapse, his heart stopped, then started, and Tina promised herself and her girlfriends that she would leave him if he relapsed again. He did, last May, and they separated. Brent died two months later. 

“Now I know what a stupid promise that is,” she said. “Addicts relapse. That’s part of it.”

Relapse rates for people treated for substance use disorders are comparable to relapse rates for people treated for chronic illnesses like asthma and high blood pressure, according to the National Institute on Drug Abuse. 

Those relapse rates mean white-knuckling it often doesn’t work, said Walters, with the Health Science Center. Instead, one evidence-based practice to curb overdoses is prescription medication like Suboxone, a drug made from both an opioid that manages cravings and naloxone, a medicine that reverses an overdose. Drugs like Suboxone can lower a person’s risk of a fatal overdose by about 50%, according to a 2021 article from Harvard Medical School. 

The practice of prescribing an opioid to combat addiction can create conflict even among physicians, Fowler, with the school of medicine, said. Some people think “the only good narcotic is zero narcotic,” he said. Still, he’s noticed, the medical students he teaches tend to favor practices like prescribing Suboxone. 

For the national HEALing Communities Study, Walters and his colleagues oversee efforts to reduce stigma in high-risk communities so people more readily embrace overdose interventions. 

For example, in the fishing community of Gloucester, Massachusetts, the HEALing Communities team helped create Provider on the Pier, a medical clinic that offers substance use treatment and harm reduction from the harbormaster’s office. In Portsmouth, Ohio, a symbol of the opioid epidemic in Dreamland, the team helped broadcast messages like “Naloxone saves” and “People who use drugs are worthy” to connect with religious communities in the area.

The goal, in part, is to help people think about addiction “as more of a medical condition rather than a character issue,” Walters said.

The study is far from over, but the first three years have yielded lessons: Foremost, he said, the community itself needs to be invested. “It can’t be some university that comes in and tries to do this,” he said. “It has to be a core group of people and champions that are going to really sink their teeth into (the issue).” 

Since Brent’s death, Tina has researched his addiction every day. She’s already started to share her findings with others.

“My purpose in life is to make sure that nobody has to live with regret,” she said. She’s careful to differentiate between regret and blame. “I don’t blame myself in any way, shape or form,” she said. “But I totally regret the decision that I made May 1 through July 24 (last year).”

The ‘yin and the yang’

When Brent asked Tina for a part-time job in December 2015, she needed the help. Earlier that year, Lake Grapevine had flooded, submerging sections of her wedding venue — like the patio — in water. 

Brent was tall, dark and handsome. Tina’s office is connected to the venue’s bridal suite, so before ceremonies she could hear the bridesmaids talking about her employee: “‘Man, did you see that good-looking guy?’ and somebody would say, ‘Yeah, he’s got a girlfriend,’ or ‘Yeah, he’s in love.’”

“That was not his best feature,” Tina said of her husband’s appearance. “As good looking as he was, his heart was better looking.”

After the couple took their first look, Brent read Tina a letter on their “big” wedding day: July 7, 2018. The pair had already eloped in May 2017. (Courtesy | Scott Livermore)

Brent’s gentleness drew Tina to him. He helped drop each bride’s train before she walked down the aisle. He loved yorkies and never gave half a hug. When his grandma slipped from consciousness in the hospital, he rubbed her head night after night. Her vital signs improved when he did so, the nurses said. 

Tina, 52, was 20 years older than Brent, but their closeness as friends, then partners, then spouses nullified any gaps. They lived in a 299-square-foot tiny home on the wedding venue property. They were, she said, the “yin and the yang.”

After the flood, Brent helped Tina grow the business. He became landscaper and chef, bartender and manager. He built a yurt for overnight rentals. He prayed over the flowers he planted. 

Tina, too, hopes the July 24 event will be about planting seeds. Representatives from the drug enforcement agency will be there, and Recovery Resource Council, Love Cassidy and Valley Hope. The latter two will provide naloxone training, so people feel equipped to reverse an overdose in progress. For children, Tina’s promised balloon art, face painting, yard games and bounce houses. 

She hopes families come; she wants parents to talk to their kids about drugs.

“The only way we can get the shame out of it is by openly talking about it, and openly realizing that everybody in our world is addicted to something, whether it’s caffeine, whether it’s sugar,” she said. “The only difference is, drugs can kill you very easily. And they can destroy your life.”

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email at alexis.allison@fortworthreport.org or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis Allison

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....