Dope Sick

Chapter 1

Helping a friend

TOLEDO, Ohio — DJ Shanks was early into his afternoon shift as a baker at the Tim Hortons doughnut shop when the craving, and the dread, began. He called the one person he knew would help. Fast.

Justin Laycock and DJ had met on their first day of kindergarten in nearby Swanton. Now in their early 20s, they remained best friends. “Do you have anything?” DJ asked Justin. “I’m sick.” Justin didn’t hesitate: “I got you, bud.”

He didn’t need to ask what DJ needed. The childhood pals were consumed by heroin addiction, and Justin knew DJ was dope sick.

Many heroin addicts don’t fear death. Dope sickness is another matter. When the body doesn’t get the heroin it lusts for, it retaliates with brutal force: vomiting, diarrhea, profuse sweating, intense cramping, paralyzing anxiety. Addicts will do whatever they can to avoid it — stealing, lying, or pimping themselves to get heroin. Justin once took his grandmother’s debit card. DJ had pawned his little sister’s video game console.

Two ordinary kids from Middle America, DJ and Justin were caught up in the most pressing public health crisis of the day — a wave of opioid addiction that’s killing nearly 30,000 Americans a year. But their story comes with a terrifying twist.

Their descent began with marijuana use in high school, then escalated to prescription painkiller abuse and heroin. It would end with something even more wicked.

After DJ’s call, Justin phoned his heroin dealer and ordered an “80” — street slang for $80 worth of heroin, about a half-gram. A half-hour later, Justin walked up to the doughnut shop counter and slid a folded dollar bill toward his friend. DJ, wearing white baker’s pants and a Tim Hortons baseball cap, grabbed it and quickly walked to the back of the shop, where he snorted the powdery substance concealed inside the money. Justin, meanwhile, went to the bathroom and injected some of the drug, then returned and handed DJ another bill. DJ went into the bathroom to snort more of the powder.

Feeling good about taking care of his friend, Justin left the doughnut shop around 3:15 p.m. with plans to meet up with DJ later.

DJ went back to work, stopping occasionally to wipe his eyes and face — an apparent side effect addicts call the itchies. After about 20 minutes, video from the shop’s surveillance system shows he became unsteady, bobbing back and forth while pouring glaze over a tray of doughnuts. Slowly, he began to slump forward, as if attached to a winch gently lowering him down. His head came to rest on a sheet of glaze. His body, bent over the counter at the waist, appeared lifeless.

The Tim Hortons manager saw DJ as soon as he came through the shop’s side door. He took off his coat, dragged DJ to a back room, and called 911.

“I just walked in and this guy was passed out,” the manager told the dispatcher. “I have no idea how long he’s been passed out, but he’s got blue lips, no pulse.”

The manager performed CPR, but it was too late. DJ never regained consciousness. At 5:12 p.m. on Feb. 19, 2015, a doctor at the University of Toledo Medical Center pronounced David Andrew Shanks Jr. dead. He was 21.

Toledo Police, in a report filed two weeks later, concluded there was “no indication of foul play in the immediate cause of Shanks death.”

By all appearances, this was just another fatal heroin overdose — something that happens more than once an hour in a country awash in opioids. But it wasn’t heroin that killed DJ. It was fentanyl, an opioid manufactured in hidden laboratories to be up to 100 times more powerful than heroin. It’s what killed the musician Prince.

Fentanyl is a stealth killer, often sold to clueless buyers as heroin, prescription pain pills or the anti-anxiety medication Xanax. DJ and Justin had no idea they were snorting and injecting it.

The drug has flooded the marketplace as street dealers on up to major international cartels have discovered that it delivers heroin’s high at a fraction of the cost. This creates a paradox where the profit margin for drug sellers skyrockets as the street price for opioids drops.

The result: Fentanyl is poised to become the catastrophic exclamation point to 20 years of escalating opioid addiction in the United States.

STAT spent months interviewing friends and relatives of DJ, including hours of conversation with Justin, to piece together this report. DJ’s journals, written in the months before he died, offered insights into the turmoil he felt as he fought to get off drugs while forever chasing the next high. STAT also examined court files, police and medical examiner reports, phone records and text messages, and the surveillance camera recordings from Tim Hortons.

Justin was shattered by DJ’s death. He blamed himself, and dulled the pain with heroin. His family feared he would overdose like his best friend. But when he least expected it, Justin would get one last chance at salvation.

As a boy, DJ lived in a subdivision in Swanton called Westpointe Estates, near the end of a cul de sac where neighborhood kids gathered to skateboard, ride bikes, or play games like Ghost in the Graveyard. Justin, who lived with his father and grandmother in a remote part of town, was a frequent visitor.

About a dozen miles west of the Toledo city limits, Swanton is home to just under 4,000 people. On Main Street downtown, there is an Elks Lodge and a few insurance agents operating out of storefronts. Other buildings appear empty. The biggest event of the year is the Swanton Corn Festival, which was first held in 1908.

Justin said he was attracted to DJ’s thirst for adventure, and they both considered themselves daredevils. When skateboarding or snowboarding, they would try to one-up each other with tricks. In school, it was a contest to see who could come up with the funniest joke or pull off the best prank.

At Swanton High School, DJ, a catcher on the baseball team, was the rare athlete who also performed in the show choir and school drama productions. He played Bob Cratchit in “A Christmas Carol” and was part of the cast of “The Wizard of Oz.”

Justin was a talented illustrator who could sketch intricate comic book covers that looked professional. He aspired to work in the video production industry and did on-air reports for his high school television station. He also ran on the cross country and track teams.

Toward the end of sophomore year, the venturesome spirit that bonded DJ and Justin resulted in a fateful decision. The boys had tried cigarettes before, mostly out of adolescent curiosity. On this day, they were at a friend’s house and noticed smoke with a different odor. It was marijuana. The boys tried it and were quickly buzzed.

“I felt more laid-back, carefree,” said Justin of that first experience with drugs, “just like everything was kind of pushed off to the side.”

DJ, in a journal he kept in a drawer next to his bed, wrote that he started smoking pot at 15 because “it was the cool thing to do, all the cool kids were doing it. So I felt like I needed to. … Big mistake.”

The two smoked more marijuana the next day, and within a few months they were smoking daily. It became a ritual before they went outside and tried stunts on their skateboards. The drug emboldened them to try riskier moves.

DJ’s grades, which had been average, plummeted to D’s and F’s. He stopped playing sports and performing.

“I would skip school with my buddies to get high,” DJ wrote. “It was the life I was having soo much fun, not knowing I was going down a terrible path.”

When he did go to school, DJ was getting in trouble. He had always been an extrovert, the class clown. He delighted in the attention and in making people laugh. But his behavior was more reckless now. He was given long suspensions, once for starting a massive food fight, and another time for writing insults about an administrator on a school wall. In his senior year, having fallen hopelessly behind, he left school.

He worked to get his GED and found a job at a pizzeria, but not being in school or playing sports left him ample time to experiment with drugs. He became a heavy user of Percocet, one of the most commonly prescribed opioid pain pills. It was an escalation that worried his family. He seemed to need the drug.

Justin’s behavior also changed after he started regularly smoking pot. He would become loud when high. He woke up one morning with mustard all over his face, having no memory of making a sandwich the day before.

Justin transferred to a vocational high school a half-hour away for his junior year, to enroll in a digital video production program. He transferred to another high school the next year, when his family moved to a new town about 20 minutes west of Swanton.

By then, he wasn’t seeing much of DJ, who had moved to Toledo with his mother. But he made new friends. And they introduced him to Percocet.

Soon, Justin was taking the pain pills between classes. He remembers being high during a broadcasting class and going on air to anchor the school news report.

“I’m on screen and I’m feeling good,” he said.

Despite his drug use, Justin managed to graduate high school on time and moved into an apartment in Toledo in early 2013.

He and DJ found each other a short time later. A mutual friend visiting Justin’s apartment told him DJ was living just around the corner. Justin left immediately to find DJ’s house and knocked on the door. DJ was surprised and delighted to see Justin on his front step.

“It was a connection right away,” Justin said. “I mean, it was good. He started coming over every day, hanging out.”

The friends picked up where they had left off — doing drugs every chance they could.

Chapter 2

‘Kissed by Jesus’

DJ’s mother kept a silver serving platter in their house for special occasions. In July 2013, DJ and Justin decided to use it for a memorable moment of their own — the first time they would use heroin together.

The gleaming platter was the perfect surface for chopping the drug into fine lines. As they leaned over and snorted the powder, Justin recalled, their faces reflected back at them.

Justin was leery of heroin — he’d refused several requests from DJ that they do it together. He had heard that it grabs hold of you and doesn’t let go. He had seen homeless addicts in Toledo, strung out on the drug, and didn’t want to end up like them.

But this time, he gave in. They had been smoking synthetic marijuana, called K2, which gave them a more intense buzz than regular pot, but they were out. He needed to get high.

The next day, the friends woke up with the same thought: We need more heroin.

“I absolutely fell in love with it,” Justin said. When he was high on heroin, all of the problems with his family and the shame he felt from his drug use washed away.

“People say you literally have been kissed by Jesus,” he said. “It’s like escaping reality.”

DJ had first used heroin more than a year earlier, and he was despondent as he fell under its spell again.

“I couldn’t believe that I went back to this stupid drug,” DJ later wrote in his journal. “I hated myself soo much. But I kept getting high, and so did my best friend Justin.”

The two were off on a months-long binge.

Everything else became subservient to the need for a daily fix. Family, girlfriends, jobs — none of them mattered.

Both were unemployed, and any money they had was going toward the drugs and alcohol. They weren’t paying rent for the apartment they now shared. They weren’t even buying food.

When DJ’s mom, Angela, showed up at their apartment one day, she discovered the kitchen cabinets and refrigerator were empty. She drove to a supermarket and returned with cans of beef stew and other groceries.

“They were so thankful,” Angela said. “Made me feel like a million dollars.”

Angela had a soft spot for Justin. He was introverted and shy, and didn’t make friends as easily as DJ. Tall and slightly built, Justin appeared younger than he was. Whenever Angela was around, he was polite and courteous.

“I would have never in a million years pegged him for a kid that would get in trouble,” she said.

So when the two were evicted from their apartment, Angela let them move into her place and helped them get jobs at a landscaping company. It was good money — some weeks they earned as much as $800 each. Eventually, every cent went to purchase heroin and marijuana. They soon lost their jobs.

“My mom knew that we were on drugs and she was very worried,” DJ wrote in his journal. But her concern had no impact, DJ wrote, as he was “sucked in deep.”

Angela had been down this road before with DJ.

He told his mother he started on heroin around the beginning of 2012, when he was having difficulty getting Percocet. At one point, desperate for the painkillers, DJ intensely questioned his ill grandmother about her pain medications. She worried DJ might try to steal her pills.

Then he discovered heroin could fill the void.

DJ’s path is a well-traveled one: Four out of five new heroin addicts in the United States started by using prescription painkillers, according to the Centers for Disease Control and Prevention. The shift to heroin has occurred as prescription pain medications like Percocet and OxyContin have become harder to find and more expensive on the street because of tighter controls on prescribing, as well as the development of abuse-deterrent versions of the drugs.

DJ tried many times to break his addiction.

His first attempt failed. A Toledo treatment center was reluctant to accept him because no drugs were detected in his urine, Angela said. DJ was baffled. He was smoking marijuana and using heroin. The detox center finally agreed to take him, but just for three or four days. It did nothing to curb his desire to get high.

Soon he had moved from snorting heroin to injecting it for a quicker and more powerful high.

“I started shooting it up, and this was terrible,” he wrote. “About 2 weeks after I started shooting, I died for the first time. My heart stopped. My friend had to rush me to the hospital, and they had to stab me in my heart with adrenaline to bring me back to life. To most people that would have taught them a lesson and make them want to quit. But I loved it. I was playing on the edge of life and death. I was in a whirlpool of emotions.”

To support their habits, Justin and DJ pawned the Wii game consoles and an iPod of DJ’s younger siblings. They stole Angela’s camera.

Angela kicked them out of her basement. Justin moved in with his grandmother, and DJ went to live with his father. They were back in Swanton — and little changed. One day, DJ’s father called Justin to confront him about the pair stealing items from his house. Justin was playing the card game Rummy with his grandmother, and she overheard the conversation. She knew Justin was doing drugs and wasn’t going to put up with it. If he wanted to stay at her house, he was to have no more contact with DJ. She took Justin’s phone and broke it. If he was going anywhere, he had to clear it with her.

“She put me on house arrest,” Justin said.

By then, DJ’s father had thrown him out of his home. It was December and temperatures were falling below zero at night. Angela and DJ’s father, who were divorced, had no idea where their son was living. They worried he would die.

They devised a plan to save him.

They told the Swanton Police that DJ had stolen several items from their home, including a snowboard, two pairs of snow boots, a music mixer, and a microphone, Angela said. They let the police know DJ would be coming by his father’s house later to pick up clothes — and that he was driving with a suspended license.

The police were waiting on Dec. 13, 2013, when DJ rolled into town in his white Hyundai Sonata. They confirmed the suspended license and opened the trunk, where they found the snowboard and boots. They also discovered three clear plastic baggies in the car, one of which tested positive for traces of heroin. DJ was charged with possession of drugs, receiving stolen property, and driving with a suspended license.

“We set our son up basically to be arrested,” Angela said.

At least DJ was not freezing to death. At least he wasn’t overdosing. It was a relief. “And how sad is that?”

Chapter 3

Feeling the devil

The arrest was a jolt for DJ.

He spent his first few days out on bail sleeping on the floor of a house with other addicts he barely knew. He told his mother he was worried he would have to prostitute himself to stay there. He begged her to allow him to come home. She refused.

Out of options, DJ checked himself into the Arrowhead Behavioral Health center near Toledo, in his second stab at rehab. He was admitted for only a week. Angela fought with her insurance company and the center to keep her son there longer.

The best they could do, Angela said, was allow DJ to participate in a day program for an additional two weeks. During that time, she dropped DJ off in the morning and picked him up on her way home from her job at a local bank. She didn’t want him alone in her house.

“I’ve never been so happy in my life now that I am finally clean,” DJ wrote on a yellow legal pad while at Arrowhead. “I can now think straight, I have good goals set ahead for me. I want to get a good factory job and start making some real money.”

“I really want to be done with this drug,” he continued. “I really hate this and what I was doing. I can’t believe that I stole from my own mother and father. I really wish I could go back in time and never start this thing. It has ruined my whole life right now.”

DJ pleaded with himself, and offered himself encouragement. On one sheet of paper he wrote “I can do this” 49 times.

“I cannot give up on this,” he wrote on another page. “I got this. I know that I can do this. I really can. I will use all the tools I can to stay on top of this nasty disease. DJ you can do this.”

After Arrowhead, DJ was convicted of the drug charge and sent to jail on March 14, 2014. He was released eight months later, after successfully completing another drug treatment program.

With DJ out of his life for nearly a year, Justin had also stopped using drugs. The tight restrictions placed on him by his grandmother kept him away from old temptations. His father was able to get him a job at the auto parts plant where several family members were employed. Justin worked the second shift as a laser technician, making parts for the Acura RDX. It was more money than he had ever made. He found a new girlfriend and was thinking about getting married.

“I just came back up,” Justin said. “I made a name for myself. I just got a truck. I got my family back.”

DJ was released the week before Thanksgiving in 2014. He landed a job as a baker at the Tim Hortons and was making enough money to put some in savings. He, too, had a new girlfriend.

“I thought he was good. I really did,” said Angela. “I thought … he was moving forward with his life. He was so happy.”

A short while later, Angela walked into her house — and saw Justin. “Oh my God, what are you doing here?” Angela recalled saying. “Why are you here?”

Justin tried to put Angela at ease. He said he was just checking in on DJ after not talking to him for months. “DJ is like my brother,” Justin told her. “I just wanted to come and see him.”

DJ’s sister Julia knew better. She was a year younger than DJ and the two were close. She had helped get him the job at Tim Hortons, where she worked part-time. She had also introduced him to his new girlfriend. The reappearance of Justin rattled her.

“I could feel the devil,” Julia said. “You could feel that this was not supposed to happen … that these two needed to stop being friends.”

Justin’s family shared those fears.

“He knew not to go back to him, and he did,” said Justin’s grandmother, Marilyn Laycock. “You know they were inseparable. One looked out for the other no matter what you say or did.”

Justin was using heroin again when he showed up at DJ’s house. Grief-stricken by another friend’s fatal overdose, he had relapsed about a month before DJ finished his jail term.

“It went downhill from there,” he recalled. “This was the worst I’ve ever been in my entire life. Using, using, using, using.”

He was found passed out in his truck during his shift at the auto parts plant and failed a drug test. Justin knew he needed help and agreed to go to Arrowhead, the treatment center where DJ had gone earlier that year. The facility initially refused to take him because a urine test didn’t turn up any drugs, Justin said. So he left, did heroin, and came back.

He was discharged in less than a week. Justin’s father, Ron, was stunned.

“He’s calling, ‘Come and get me, they said I’m not bad enough,’” Ron said. “They should know better.” He said the message to addicts such as Justin is that “nobody cares, why should I?”

Arrowhead’s chief executive declined to comment. The center did give Justin a prescription for Suboxone, a drug used to treat opioid addiction by suppressing symptoms of craving and withdrawal.

Justin knew just what to do with it.

There’s a black market for Suboxone. Some addicts who have developed high tolerances for heroin switch to Suboxone for a few weeks as a way to reduce their tolerance without getting dope sick. When they resume using heroin, the euphoric effect is heightened in what addicts describe as a “virgin high.”

So as soon as he was out, Justin went to his drug dealer — and traded the Suboxone for heroin.

His relapse was not unusual. Typically, 40 percent to 60 percent of drug addicts relapse in the first year after treatment. One study found the rate was even higher for opioid detoxification programs, with 91 percent of patients relapsing — more than half within a week of release. Some studies of newer medications used to treat opioid addiction have reported more promising results.

Justin said DJ had already started using heroin again before they reunited around Thanksgiving. DJ was trying to use less than before. His job at Tim Hortons was going well, and he didn’t want his family or his girlfriend to know what he was up to.

Macey Fruth was a high school senior from Ottawa Hills, a wealthy Toledo suburb that is home to the area’s professional and business elite. While Ottawa Hills is only 17 miles from Swanton, it was a foreign land to DJ.

Despite their different backgrounds, the couple hit it off. Macey loved how DJ easily connected with and looked out for people. When they went sledding one day, DJ pulled his car over to help a stranger stuck in the snow.

The couple went to a Christmas Eve church service with her family and took a ski trip to Michigan. Six days before he died, DJ updated his Facebook profile picture with a snapshot from that trip: Macey was kissing his cheek, and he was smiling.

Behind the smiles, though, DJ was spinning out of control.

Before dawn one February morning, Julia woke up her mother with alarming news: DJ had relapsed.

A few days earlier, he had been admitted to a hospital with pneumonia-like symptoms, after Justin had put him in a tub of ice at a drug dealer’s house when DJ began to overdose.

“He was embarrassed about it,” Macey said. “He didn’t want to talk to anyone about it. He got upset and was crying. He needed to show everyone he was doing better.”

DJ’s family mobilized in an urgent attempt to save him. The first priority: making sure he was never alone with Justin.

Macey would do her homework at a table at Tim Hortons during DJ’s shift, watching to be sure Justin didn’t come in. Angela would drop by DJ’s place unannounced. Julia reached out to DJ’s other friends, asking everyone to keep an eye on him.

Angela called DJ’s probation officer in early February, pleading with him to come out and give her son a drug test. She desperately wanted DJ back in jail. It had been the only place that could keep him safe from heroin.

Angela said the probation officer told her that if she was worried, she should take DJ to the hospital. “It was not the answer I was really looking for,” she said.

The Fulton County Probation Department said it couldn’t comment on DJ’s case because parole records are not public.

On Feb. 18, Angela found out that Justin was planning to stop by and visit her son. She sent DJ an anguished text.

DJ was enraged, and texted his mother back.

Angela persisted.

DJ didn’t respond.

He wasn’t scheduled to work at Tim Hortons on Feb. 19, but was called in for a short afternoon shift. Normally, Macey would have been there, doing her homework and watching for Justin. But on this day, she was attending an event at her father’s real estate company.

She wanted to be at the restaurant instead. She knew DJ was in a bad way. He had just found out a friend’s little brother had died from an overdose. He also had told her he wanted to hang out with Justin that night, a signal to her that he was thinking of heroin.

Macey wrote DJ a text message at 3:31 p.m.

Two minutes later, DJ texted back.

He was close to passing out, having already snorted the fatal doses of fentanyl delivered by Justin.

Macey could sense something was wrong.

After getting no response, she texted again 15 minutes later.

DJ couldn’t reply. He was sprawled across the doughnut shop counter.

DJ lay there for more than a half-hour after falling unconscious. A coworker noticed him after about four minutes. Twice, she came over to try to wake him before placing her hand on her headset and walking away toward the drive-thru window. She returned at one point, but only to walk around DJ’s limp body, open an oven door just above him, and put a tray inside. Two customers came through the side entrance, with a clear view of DJ behind a glass partition, and either failed to recognize something was wrong or decided not to do anything. Only then did the manager arrive and call 911.

A detective investigating DJ’s death, Sgt. Brian Bortel, said later that the coworker’s delay in summoning help for DJ was likely costly. “He has a better chance of survival if she calls our fire department,” he said in an interview. The coworker told another investigator that she panicked.

As word spread of DJ passing out at work, his family scrambled to the hospital.

“It was just disbelief,” said Macey. “I’m looking at his gray dead body with blood all over his teeth, thinking, I just talked to you two hours ago. We were fine two hours ago.”

Julia hugged her big brother goodbye and felt sticky doughnut glaze in his hair.

“That’s just not how he wanted to go out,” she said.

The family was overcome with despair. They had desperately tried to keep DJ alive. Nothing had worked.

“I want to sit here and give people a good message about my brother,” said Julia. “But, at the same time, I don’t know what to say to help them. I don’t. What can you do besides praying to God that you won’t have that itch tomorrow?”

Justin, meanwhile, had no idea what had happened to his friend.

He was waiting for DJ down the street from Tim Hortons, at the Knights Inn. The hotel is hard by Interstate 475 and offers rooms by the week. Weeds spring from cracks in the parking lot asphalt. The rooms are bare, with hooks where pictures once hung. As he waited, he continued to inject what he believed was heroin with a young woman he grew up with, a former standout athlete in high school.

Justin thought DJ would finish work at around 4 p.m. At seven seconds past 4, he started calling his friend. No response. He texted him.

Shortly before 5, he messaged DJ again.

An hour and a half later, he called DJ. The manager at Tim Hortons answered DJ’s phone. He wanted to know who was calling.

“I said, ‘This is Justin,’ and he says, ‘Justin who?’”

“Laycock, his best friend,” Justin replied. “Is DJ there?”

“Hold on,” the manager said. “I think the police want to talk to you.”

Justin hung up.

Assuming DJ had been caught with the drugs, Justin continued getting high.

Julia, meanwhile, was quickly putting together the last moments of her brother’s life. She found out Justin had been at Tim Hortons that afternoon and correctly assumed it was to bring her brother drugs. Later in the evening, she started sending Justin messages.

“My phone blows up,” Justin said. “I mean notification, notification, notification … and I am thinking to myself, what is going on.”

Julia had sent him a series of Snapchat videos. He hit play: “You killed my brother. You’re a killer. You’re a murderer.”

Justin was stunned. “I didn’t believe it,” he said.

Chapter 4

An offer of redemption

DJ was buried beneath a temporary stone marker engraved with a baseball bat and a ball and inscribed with the words “Fun Loving Free Spirit.” Justin didn’t attend the funeral — his best friend’s family made clear he wasn’t welcome.

Justin retreated to his grandmother’s house in Swanton, where he numbed himself with heroin to escape the pain of DJ’s death, and his role in it.

He began stealing again from his family, pawning his father’s laptop and making off with his grandmother’s debit card to withdraw $150 for a day’s worth of heroin.

It was “the lowest I’ve ever been in my entire life,” Justin said. His grandmother, after all, had helped him get off drugs for a while and taken him in when no one else would.

Now, as DJ’s parents had done two years before, Justin’s grandmother turned to the law as a last resort. She called the police, who came and arrested Justin.

After he was hauled away to jail, she found a note Justin left behind. “I’ll be watching over you all … til we meet again,” he wrote. “I love you all and I’ll miss you all.” Was Justin contemplating death? His family was unsure.

“Any day I expected to lift up the phone and (hear) Justin overdosed or he got killed or whatever,” his grandmother said.

The withdrawal from heroin while locked up was punishing. Justin defecated on himself. He sweated profusely. He couldn’t eat or sleep. He would sit in the shower for hours, hardly able to move. Still, all he could think about was doing heroin again.

Justin was released on bail after two weeks and went to stay with a friend. He never unpacked his bag. Only hours after leaving jail, he removed an ankle monitor with tree limb cutters and stole a truck parked in his friend’s driveway. He drove straight to his dealer. After a four-day binge, he was out of money and the police were looking for him.

He sent his family a group message apologizing for the pain he had caused and telling them he didn’t expect to live through the night. They begged him to turn himself in and let him know they loved him. His dad told him he was still young and had a chance to turn his life around. The outpouring surprised Justin.

“I mean, how do you love someone like me when I don’t even love myself?” he said.

Just after midnight on April 19, in the middle of a residential street on the south side of Toledo, Justin walked toward a police cruiser with his arms in the air and surrendered.

While Justin unraveled in the weeks after DJ’s death, Lucas County chief toxicologist Robert Forney and his staff meticulously screened DJ’s blood for drugs. Forney’s team didn’t find any heroin.

What they did discover was a lethal dose of fentanyl.

Forney has been on the job for 40 years. His lab does testing for 21 counties in Ohio and Michigan and has chronicled the rise of drug overdose deaths, which have now surpassed auto accident fatalities nationally. He started testing for fentanyl in 2014, when there were 13 fentanyl-related deaths. By the next year, the number was 66. It’s still growing.

In no state is the fentanyl crisis more dire than in Ohio, where officials last year requested emergency assistance from the federal Centers for Disease Control and Prevention. In 2014, there were 502 fatal fentanyl-related overdoses in the state, a 500 percent increase from 2013. The victims tended to be younger, single white males, according to the CDC’s review. But the drug’s reach is long. A third of the victims were women, and the ages of those who died ranged from 17 to 71.

The most terrifying aspect of the rise in fentanyl is that many victims, like DJ, have no idea they are using it. In the Sacramento, Calif., area earlier this year, 12 people died after taking counterfeit Norco pills, a common prescription painkiller, that contained fentanyl. In Florida, nine people died from counterfeit Xanax pills containing fentanyl.

And in Akron, Ohio, police have identified an even more potent version of fentanyl that is being cut into heroin. Called carfentanil, it is the main suspect in 296 overdoses and 23 deaths since July 5, said Lt. Rick Edwards, a police spokesman. Carfentanil is used to sedate elephants and other large animals — to confirm what it was, detectives obtained a sample of the drug from the Cleveland Zoo.

Calling it an “unprecedented threat,” the US Drug Enforcement Administration warned last month of an “expansion of the fentanyl market” that “will likely result in more opioid-dependent individuals, overdoses, and deaths.”

Although it is legally prescribed for pain sufferers, such as those with cancer, almost all of the street-level fentanyl is illicitly produced in places such as China. A kilogram of fentanyl purchased from a lab in China for $3,000 to $5,000 can generate $1.5 million in revenue on the street, according to the DEA. That is about 20 times the return for a similar amount of heroin. The reason is the potency of fentanyl: It can be mixed with cutting agents in low doses to stretch the supply.

Forney doesn’t know why DJ died and Justin survived, or whether DJ would have lived if he used heroin instead of fentanyl. There was alcohol in DJ’s blood, the equivalent of two and a half beers, which could have exacerbated his distress. And everyone’s tolerance level for opioids is different.

On Nov. 19, 2015, exactly nine months after DJ’s death, Justin was indicted and charged with one felony count of corrupting another with drugs. Toledo Police activated the dormant case after obtaining the Tim Hortons surveillance tape and the toxicology results. The charge against Justin came amid a nationwide push by prosecutors to punish those supplying fatal doses of fentanyl.

Those charged have mostly been street-level dealers rather than major players in drug rings. In the case of DJ’s death, the dealer who drove to Tim Hortons to deliver the fatal dose was never charged. Toledo Police said they were unable to positively identify the dealer — a man in his 20s Justin knew as BG.

Justin decided early on not to fight the charge. He admitted to detectives that he bought the drugs that DJ used just before he died.

He was brought in to Lucas County Common Pleas Court Judge Ian English’s courtroom on March 17 to plead no contest — admitting that the allegations in the complaint against him were true. A prosecutor for 13 years, English had been a judge for a year and was known as a critic of harsh sentences for substance abusers. Justin hoped for leniency.

Instead, he learned the charge carried a mandatory sentence of at least two years in prison and a maximum of eight. “I was devastated,” Justin said. Moreover, under the charge, the judge could not require that he get drug treatment while locked up.

The judge was surprised by the harshness of the mandatory sentence as well. He saw in Justin someone more in need of help than punishment. He wasn’t a drug dealer, the judge explained later in an interview: “This wasn’t a crime of profit.”

In the courtroom, he called Justin’s public defender and the prosecutor to the bench and proposed a novel alternative: He could craft a sentence that included less jail time and the treatment Justin was seeking for his addiction — but Justin would have to admit to a more serious charge of involuntary manslaughter. In the rigid world of mandatory drug sentences, the only way the judge would have discretion was if Justin admitted to killing his best friend.

“I read the charge over and over and over in my head,” Justin said. “I am thinking to myself that if there’s anybody that looks at my record and sees that, they are going to know that somebody died.” His attorney advised against it, warning Justin that it would be difficult to find a job and start a new life with a manslaughter conviction. Only murder and child molestation are considered more serious felonies in Ohio.

Justin’s family was mystified by the need to plead to the higher charge. “He didn’t murder him intentionally,” Justin’s grandmother said. “But in order to get help he had to take that charge, and I don’t think that was right at all.”

Even members of DJ’s family acknowledged Justin acted without ill intent. “In no way shape or form do I think that Justin intentionally meant to hurt DJ,” Angela said. “I think Justin was simply DJ’s friend, DJ’s connection for what he wanted to get.”

Justin ultimately decided the trade-off was worth it. He wanted treatment that would give him a legitimate chance to stay off drugs, even if it meant being labeled a killer. On April 21, he stood before the judge in an orange jumpsuit with a chain around his waist, attached to manacles for his hands and feet. His head was shaved. No family members came to support him.

“I never knew it was fentanyl,” Justin told the judge. “It wasn’t my intention to kill my best friend at all. It was to help him out.”

He begged for a chance to get treatment. “I am just asking if I can please just get help, your honor,” he said.

The prosecutor said a young man was dead and that justice required Justin be punished with a prison term.

The judge said that he struggled with the decision but that the punishment had to include jail time because a life was lost. He sentenced Justin to a year in jail — half the mandatory minimum sentence he faced under the original drug charge. More importantly, he ordered that the jail term be followed by six months of treatment in a locked facility. When Justin finishes treatment, he will be required to wear an electronic monitor for six months, undergo drug tests, and attend 12-step meetings.

The judge told Justin that he was giving him “a chance for treatment so that you can make the life you took worth something.” He warned that if Justin used drugs again, he would impose an eight-year prison sentence. He then wished Justin good luck.

DJ’s family, and even some of Justin’s, were hoping he would get a longer jail term. The more time he is forced to go without heroin and other drugs, the more likely he is to break his addiction, they said.

“It would have been nice to see it be longer,” said Angela, who saw her own son struggle to get off drugs. She figured if Justin received a sentence of seven years or so, that “maybe that will be long enough for him where he’ll have a chance. And it will get him where he needs to be. And he’s going to be alive.”

Justin said he is focused on redemption, starting with repairing his relationships with his grandmother, father, and sisters. During an interview at the Corrections Center of Northwest Ohio a month after his sentencing, he said he thinks often of DJ. “He’s on my mind all the time,” Justin said. “He’s in my dreams.”

He acknowledged he also thinks of heroin.

“If you’re asking if it’s on my mind, it comes and goes,” he said. “Whenever I imagine myself doing it again, I imagine this place. I imagine my friends dying. I imagine myself overdosing, dying myself. I imagine going back to prison. You know, I mean none of this is worth it.” He talked about losing the girlfriend he wanted to marry, as well as the respect of his family, and the hurt he caused DJ’s family.

“I am not willing to do it again,” he said.

This is the tragedy of America’s opioid crisis: A young man goes to help his best friend and ends up helping to kill him. Their families, seeing what’s coming, can’t stop it. They turn to an overwhelmed health care system for treatment and instead mostly find indifference. In the end, they see jail, of all things, as their only hope.

What will become of Justin? Despite an eight-year sentence hanging over his head, will he go back to drugs when he is released?

The man who gave Justin one last chance didn’t hesitate to answer.

“Yes,” Judge English said. “He will get out, maybe find a job. He will have money, and the people who do heroin that he hung around with will find him.”

Epilogue

DJ Shanks would have turned 23 on May 18 this year. His father, David Sr., declined to participate in this story.

Justin Laycock turned 24 this past Saturday. He is scheduled to finish his jail term next April. He will then begin a six-month treatment program in another locked facility, with his release set for October 2017. His prison caseworker reported to Judge English in May that Justin has been cooperative with staff, attends AA meetings, and participates in other programs designed to teach life skills.

Angela Shanks, DJ’s mother, is active in a local support group for families of victims of the opioid crisis. She is open to the idea of speaking with Justin one day.

Macey Fruth, DJ’s girlfriend at the time of his death, will be a sophomore at Ohio University this fall. She spent this summer as a marketing intern in Florida. She goes home to Toledo infrequently.

Ron Laycock, Justin’s father, has not communicated with his son in jail. Justin has written several letters to his father apologizing for his actions and expressing hope they can have a relationship in the future.

Marilyn Laycock, Justin’s grandmother, remains in contact with her grandson. She said he is welcome to stay with her when he is released.

Julia Shanks, DJ’s younger sister, suffered from depression and anxiety in the months after her brother’s death. She said she is doing much better today and recently started a job as a bank teller.

DJ was one of 215 people to die from heroin- or fentanyl-related overdoses in the greater Toledo area in 2015. This year, based on cases in the first few months of 2016, the local medical examiner projects there will be even more deaths — at least 236.