to the ceremony live.

You can also watch the ceremony below.

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HANOVER, Md. – The state of Maryland is failing at providing effective opioid abuse treatment, said Mike Gimbel, former Baltimore County drug czar.

Top politicians, including President Barack Obama, agree.

Maryland and Virginia lawmakers are offering proposals to expand access to treatment programs in their states.

Virginia Gov. Terry McAuliffe announced he is seeking more than $31 million to strengthen the state’s mental health system, including $5.3 million to provide medication-assisted treatment and to buy thousands of doses of naloxone, an overdose-reversal medication.

The legislative reforms he introduced will limit opioid prescriptions written in emergency departments to three days. He also supports during free training classes, and the expansion ofÌędrug court eligibility to include people convicted of violent crimes.

Maryland Lt. Gov. Boyd Rutherford told Âé¶ččÙÍű he expects treatment access to be a priority during the General Assembly session.

“There needs to be an emphasis on care, particularly quality of care,” he said, but he didn’t offer specifics. Gov. Larry HoganÌęhas not released a budget yet.

that other bills expected to be introduced include a measure to keep treatment centers open and mandating treatment for anyone who is revived with naloxone.

But there has been an institutional reluctance for states to dedicate taxpayer money to affordable drug treatment centers.

Following the recommendation from the state’s Heroin and Opioid Emergency Task Force, Hogan announced in August that $3 million in state grants would be used to fight the epidemic. The money was allocated to help police track down violent offenders and heroin coordinators to collect data about overdoses. But none of the money went to in-patient treatment centers.

Though the D.C. Council enacted a law, currently under congressional review, expanding access to naloxone, no current bills address treatment.

As state lawmakers grapple with how to address the epidemic, police departments are filling in the gaps with a new treatment-centered attitude. Where lawmakers fail to agree, officers are pulling together to provide in-person resources on the ground every day.

On the front lines

Over the last couple of years, law enforcement agencies have changed their perception about how to best tackle the opioid epidemic. Officials now say they can’t “arrest their way” out of this crisis and are taking a more holistic approach.

“It’s not like Hollywood,” said Second Lt. James Cox III, a supervisor for the Fairfax County, Virginia, Police Department’s organized crime and narcotics division. “Detectives are putting in 14-, 15-, 16-hour days, killing themselves trying to get this drug off the street.”

Every suspected heroin addict arrested in Anne Arundel County, Maryland, receives a letter from Police Chief Tim Altomare, pleading with them to let the department help them on the road to recovery.

“Drug treatment can work. People recover from addiction every day. WE BELIEVE YOU CAN DO IT BUT WE CAN’T DO IT FOR YOU,” the letter reads.

But letters and outreach can only go so far. And Altomare said the state needs massive increases in treatment funding.

“There aren’t enough treatment beds in the state. That goes hand-in-hand with the treatment beds for mental disorders. About 85 percent of people fighting addiction have a co-occurring emotional health disorder like bipolar disorder or paranoid schizophrenia,” Altomare said.

Montgomery County State’s Attorney John McCarthy puts some of the responsibility for inadequateÌętreatment squarely on the shoulders of insurance companies. He would like the legislature to rewrite insurance regulations to mandate more coverage.

“You need about 18 months of profound treatment to get away from the psychological control of the drug and really beat the addiction. The reality is that we put young people into treatment and it’s just not sufficient,” he said.

In early 2015, Cox and two Fairfax County detectives tried to tackle this crisis in a unique way. They formed a partnership with the Community Services Board to create an informational packet full of addiction recovery resources. The goal was to dispatch a detective to the scene of every heroin overdose and distribute those packets.

But it didn’t work as planned. Out of about 100 overdose cases, Cox said he only knows of one person who sought help. With only two detectives on this task force — and because most overdoses occur between midnight and 4 a.m.Ìę— Cox had to make the difficult decision to cut back.

“If an addict doesn’t want help, they’re not going to get help,” he said.

Instead, Cox’s latest initiative is working to create a Recovery Call List – a resource for people apprehensive about interacting with the police. On-call civilian volunteers who are currently in recovery would immediately respond to the scene of an overdose.

“So at 2 o’clock in the morning, when someone is admitted to Fairfax Hospital for a heroin overdose, a person on this list can reach out and say: ‘Hey. I’ve been there. I’ve done that. This is where you can be right now,’” he said.

Cox’s team recently arrested a pregnant woman on heroin charges. But instead of taking her to jail that night, they coordinated with the Community Services Board to get her into rehab as she waits for trial.

“She needs to beat the drug first, and then we’ll deal with her in the criminal justice system later. First thing we need to do is keep her alive and get her help,” Cox said.

An intellectual solution to a psychological problem

Lawmakers will spend several months hashing out how they want to shape their states’ policies on addiction prevention and treatment. But critics say they’re not focusing on the right ideas.

“They don’t understand what drives the addict,” Mike Gimbel said.

In the past two years, failed proposals in Maryland included measures that would provide drug users with clean needles and allow them to get high in hospitals or similar “safe-injection sites.”

Gimbel called these “intellectual pipe dreams” that aren’t based in reality.

“Nothing gets to the root cause of addiction. When I was doing heroin, I didn’t care if I lived or died. I didn’t care about police. I didn’t care about going to jail. I didn’t care about overdose. I didn’t care about using a clean or dirty needle.”

Gimbel went from shooting heroin every day in high school to becoming the director of Baltimore County’s Bureau of Substance Abuse.

When he hit rock bottom, he enrolled in a long-term drug-free treatment facility in California. A few months ago, heÌęcelebrated his 44thÌęyear of sobriety.

“I’d be dead today if I didn’t have a place to go,” he said. Ìę“We have to get to the inner soul of the person. The work we need to do is on the mental and spiritual side.”

Prison time

As states consider expandingÌętreatment-focused programs for drug users, police are also pushing lawmakers to consider increasingÌęprison sentences for drug dealers.

In October 2015, Anne Arundel County detectives captured the biggest heroin distribution ring in county history after an eight-month, multi-agency investigation. Nearly $1 million in assets were seized, including three kilograms of heroin, 1.5 kilograms of cocaine and 12 firearms.

The drug kingpin was sentenced to 25 years in prison, and the bust made a big dent in the area’s drug trafficking, but officials knew that void would be filled by new dealers who wanted to infiltrate the market.

In Montgomery County, after one particularly deadly week, State’s Attorney John McCarthy and Maryland Del. Kathleen Dumais drafted legislation in 2015 aimed at cracking down on dealers who sold drugs that caused a fatal overdose.

The billÌęwould have allowed judges to sentence such dealers to prison for up to 30 years, and it had widespread support among the law enforcement community. But it wasn’t brought to a vote on the House floor.

“There was a sense that it would unduly affect African-Americans or other minorities in Baltimore City,” DumaisÌęsaid.

A similar bill in Virginia, whichÌęwould have increased the maximum penalty to 40 years, also failed that year.

Law enforcement officials urge politicians to reconsider bringing these measures up for a vote this year.

“If it leads to death, we should be able to charge them with homicide,” Cox said.

“I’d like to see a mandatory 20-year sentence,” Altomare said. “There’s nothing non-violent about a heroin dealer who is selling death in the community.”

While lawmakers slog through committee hearings, arguing about language and scrounging for money, the body count rises.

Altomare recalled one weekend last year when three people fatally overdosed in a 24-hour period.

“It really crushed us,” he said. “On Monday mornings, we dread seeing on paper how many overdoses we’ve had. Some Mondays, we’re reeling.”

Source

FAIRFAX, Va. —ÌęIf Ginny Lovitt had had access to naloxone when her brother overdosed, she might have been able to save his life.

“I was the one who came home and found my brother the day he overdosed and died. At that time, naloxone wasn’t available to the public, so there was nothing I could do about it but call 911 and wait,” the Herndon native said. “I know what it’s like to be in a situation where you need naloxone and [don’t] have it.”

As the heroin and opioid epidemic reaches unprecedented levels in our region, Maryland and Virginia have taken steps to increase public access to naloxone, an opioid reversal drug.

Last November, after declaring a public health emergency, Virginia’s health commissioner issued a standing order for naloxone. Now, any Virginian can walk into a pharmacy and ask for naloxone without a prescription, at a cost of about $120.

The open access to the drug comes at a time when the death toll from fatal overdoses in Virginia has climbed to historic levels. When all of the opioid fatalities are calculated for 2016, officials believe more than 1,000 lives will have been lost —Ìęa record for the state.

Recovery advocates applauded Virginia’s decision, but Lovitt said additional steps are needed to curb this crisis to be on par with Maryland, which allows state-certified trainers, like her, to dispense naloxone during their free training seminars instead of requiring people to take a trip to the pharmacy.

As the Virginia and Maryland legislative sessions begin, several bills aimed at expanding access to naloxone will be on the table. And Lovitt has made it her personal mission to teach anyone who will listen about the drug that can bring someone back from the brink of death.

Regret turns into a calling

Christopher Atwood struggled with heroin abuse as a teenager and a young adult. His family enrolled him in several expensive private treatment programs all over the country. Eventually, he finished each one and was released back home.

“Every day that I came home I wondered if I would find him overdosed. And one day I did,” Lovitt said.

On the morning of Feb. 22, 2013, her worst nightmare became reality.

“I walked in and he was lying on his bed and his arm was a funny color 
 I turned him over and he had been choking 
 I tried to do CPR but it was too late,” Lovitt said. Christopher was 21.

Lovitt still harbors some regret.

“He was my only brother and I loved him more than life itself. How could I not help him? How could I not cure him? How could that not be enough? And so even though I know I couldn’t save him because this was a battle he had to fight on his own, I’m always going to live with regrets.”

In her brother’s memory, Lovitt started the to educate the public and provide resources. The organization partnered with the Fairfax CountyÌęCommunity Services Board and theÌęVirginia Department of Behavioral Health and Developmental Services to create REVIVE!, Virginia’s opioid and naloxone education program. She became a certified instructor and now teaches classes on how to administer naloxone.

Since 2015, she has trained more than 200 people who, in turn, saved at least 10 lives. But that barely scratches the surface of the problem. Only a handful of residents attend these classes every month, despite the fact that Fairfax County is home to more than a million people and heroin deaths there doubled between 2013 and 2014.

“We should be seeing a lot more people, so there’s progress to be made to get the word out,” she said.

Naloxone laws

While Virginia’s standing order makes it easier for people to buy naloxone, Maryland and dozens of other states go one step further.

“One of the main ways that Virginia is a little behind, compared to Maryland, is we don’t currently allow REVIVE! opioid overdose instructors to dispense naloxone to their class participants,” Lovitt said.

Once completing the class, the participants then need to buy naloxone at a pharmacy.

“Unfortunately, there are a lot of reasons — logistical, financial, stigma-related — [why] people can’t get it from the pharmacy, or they choose not to. So a lot of people are getting trained and not getting the medication afterwards,” she said.

Virginia Gov. Terry McAuliffe promised that the opioid crisis will be a focus of this year’s General Assembly. A bill, introduced with bipartisan support, would allow REVIVE! Instructors, like Lovitt, to distribute naloxone directly in their opioid response classes.

Maryland has trained more than 37,000 residents to use naloxone properly.

It’s proven effective in counties all over the state.

“It’s shocking to hear that [in 2015] in Montgomery County, overÌę40 people overdosed and were saved by Narcan.” In 2016,Ìę“that number has tripled,” said Montgomery County Assistant State’s Attorney Steve Chaikin.

Meanwhile, the District has been much slower to adopt laws aimed at increasing access to naloxone. Until recently, friends or family members who may be in a position to help a person experiencing an opioid overdose could not obtain naloxone. Now, under a new law that goes into effect this year, doctors or pharmacists in D.C. will be able to write them prescriptions.

CombatingÌęthe stigma

Now that the drug is available without a prescription in Virginia, officials hope more people will purchase it for themselves or loved ones who are dependent on opioids.

But Lovitt said the stigma is hard to overcome.

“People are afraid to go to the pharmacy counter and ask for this medication in public, because that would constitute admitting that they have a problem with addiction, or that their loved one does,” she said.

And the stigma extends to treatment and recovery facilities such as sober living homes, which don’t always stock naloxone.

“In recovery homes, there are a lot of people who are very early on in their recovery, and unfortunately, that means that they are at a higher risk for relapse. That means these places are the perfect spot to have naloxone and [it’s] really necessary to get it there.”

Lovitt said many private facilities don’t have a naloxone protocol in place, because it might send a message to family members that this is a place where a loved one can come to relapse.

AÌętool, not a cure

Naloxone, also available under the brand name Narcan, is a wonder drug that gives someone a second chance at life. But Second Lt. James Cox III, a supervisor for the Fairfax County Police Department’s organized crime and narcotics division, said it can also be a crutch.

“It can be the godsend and it can also be the biggest nightmare,” said Cox. “Now we have reports that drug dealers are actually giving their customers Narcan with their heroin.”

Lovitt said one of the myths surrounding naloxone is that the drug enables people to continue abusing drugs.

“When somebody is addicted to opioids and they’re given naloxone, it puts them into immediate withdrawal and it is pretty acute withdrawal. They do not want to have naloxone used on them,” Lovitt said.

But most experts agree that although naloxone saves lives, it doesn’t put people on a path to recovery and it is not a cure.

“What we need is a lot more availability to treatment, because otherwise, individuals who are saved from overdosing are going to continue to use the drugs and may overdose again. So we’re just forestalling the problem instead of actually trying to address it,” said Warren Bickel, director of the Addiction Recovery Research Center at the Virginia Tech Carilion Research Institute.

Bickel emphasized that addiction is a chronic disorder and that long-term treatment should be the top priority.

“Imagine the outcomes that you would see if you took other chronic disorders, like Type 2 diabetes or asthma, and just treated it for a short period of time,” Bickel said. “It would be nothing but a medical disaster waiting to happen. Short-term treatment for individuals with opioid dependence, [addiction] to heroin or prescription opioids, is better than nothing. But it’s not really going to address the problem.”

Out of death’s grasp

The Anne Arundel County Police Department was one of the first in the region to train and equip officers with naloxone kits, under former Chief Kevin Davis in 2014.

“If we did not have naloxone, our fatal overdose numbers would be double what they are. And they’re double what they were last year anyway,” said Police Chief Tim Altomare.

He called increasing access to naloxone a “no-brainer,” and said first responders are “using it every day, probably multiple times a day in the county.”

Police often arrive to the scene of an overdose faster than the fire department, Altomare said. And when it’s a heroin overdose, time is the greatest factor determining whether someone lives or dies.

Gina Chen was an Anne Arundel County firefighter and paramedic for nine years before she joined the police department as an officer. She has administered naloxone several times, most recently in May, when a woman overdosed on heroin.

Chen was the first person to respond. “When I got there, a 19-year-old female was lying in the street and her friend was screaming hysterically.”

The overdose victim carried naloxone with her, but her friend didn’t know how to administer it. Chen noticed that the woman was barely breathing and that her lips were turning blue.

She acted quickly, and within a minute, the woman began to regain consciousness. If left untreated, the woman would have succumbed to cardiac arrest. But it wasn’t the first time she come so close to death. Her friend said she had overdosed before.

In Friday’s final story of this series: Lawmakers and advocates face off over what should be done to end the heroin epidemic.Ìę

Source

BETHESDA, Md. — A Montgomery County father said he tried everything to help his son, but he may have underestimated theÌępower of his son’s addiction.

“Parents are clueless. Kids know so much more than the parents do. Parents are in denial and they don’t want to think this could happen to them,” Don Wood said. HeÌęadmitted he was clueless, too, when his son Donnie first started struggling with opioid abuse.Ìę“He was so functional. We didn’t know. We didn’t understand addiction. It was a slow spiral downward.”

Looking back, he said he and his wife should have sought professional help earlier, when his son was in middle and high school.Ìę “It is just brutal for parents because you know you are making life-and-death decisions by doing something or by not doing something.”

Don Wood is not alone. More than two dozen other Montgomery County families have lost a son or daughter in the last two years to an opioid overdose.

As Americans stock their medicine cabinets with more and more prescription pills, children are getting caught in the crosshairs. Between 1997 and 2012, the number of children, according to a December study by the Yale School of Medicine. The data showed toddlers and older adolescents were the most vulnerable. Meanwhile, heroin overdoses in teens jumped 161 percent. Teenage methadone use surged 950 percent.

But there is good news. Since that survey, teenage substance abuse has Ìęto its lowest recorded level.

From 2012 to 2016, the National Institute on Drug Abuse found a 4 percent drop in the misuse of Vicodin among 12th-graders. Across all ages, the use of inhalants, heroin, methamphetamine, alcohol, cigarettes and synthetic opioids fell. The dramatic decrease might be in part to the revamped education and outreach programs now available in local schools and communities.

But everything changes after high school.

Young adults, ages 18 to 25, are the biggest abusers of prescription and opioid painkillers.

‘What do you do?’

Wood and his wife helped their son go through two rounds of short-term drug rehab. They let him move in with them. They kicked him out. They supported him financiallyÌęinto his early 30s.ÌęThey gave him ultimatums.

But despite their repeated attempts to get him on the right track, at age 32,ÌęDonnie overdosed on Tramadol, a synthetic opioid painkiller. When Wood found his son’s lifeless body on his bed, for a split second, he felt a wave of relief.

“Just a tremendous sense that he’s at peace. We’re all at peace,” Wood’s voice quivered. “That lasted for a brief second. I just felt it wasn’t him. He’s not there. He’s somewhere else. That was just his shell.”

Of course, that moment was immediately followed by an overwhelming sense of grief that continues to this day.

Wood knows being a parent of a child with substance abuse disorder can be confusing and lonely.

“Everybody’s trying to find that line. What do you do? You want to help because you’re the parent. You want to help fix this. They are your child. You brought them into the world,” Wood said as his eyes filled with tears. “You’re responsible for them. You’ve raised them since they were little babies. So you want to fix this.”

When speaking to parents and teenagers about opioid addiction, he reminds them that it can — and does — happen to families like theirs. He advises parents to search their children’s rooms and cars if they suspect a substance abuse problem. Controlling medications within the home is critical.

“You want them to grow and develop, and be all they can be. But on the other hand, you want them to be alive and not addicted,” he said.

Scaring them straight

As heroin and painkiller deaths rise, local law enforcement agencies are pushing to tackle school drug education in a new way.

Instead of just teaching children to resist peer pressure, like the 1980s-era “Just Say No” campaign or the D.A.R.E. program, officials are showing students the real-life Ìęconsequences of opioid addiction.

Anne Arundel County Police Chief Tim Altomare wants an age-appropriate graphic curriculum.

He believes middle schoolers should see photos of the abscesses in a heroin addict’s arm and high schoolers should see a dead body after a fatal overdose.

“I’d rather have their sensibilities offended for that brief period of time than have them become addicted to heroin and end up on the slab in the morgue,” he said.

The county’s newprogramÌębrings speakers from the police department and treatment coordinators from Pathways Alcohol Drug Treatment Center to families with school-age children. It’s open to anyone — even if you don’t live in the county.

Montgomery County’s Speak Up, Save a Life presentations shows high schoolers a documentary with firsthand accounts of heroin abuse. Survivors share heart-breaking stories of loss. Prosecutors, such as Assistant State’s Attorney Steve Chaikin, educate students about a new law which stipulates that.

“The government has a compelling interest to protect the lives of many rather than prosecute somebody for possession of alcohol or drugs or paraphernalia,” he said. “The new law is a game-changer.”

Kids and sports

One sports injury or surgery could start a downward spiral for vulnerable kids who don’t have the tools or maturityÌęto manage painkillers themselves.

Opioids are becomingÌęmore accessible to everyone, and particularly for teenagers, the physiological aspects of addiction canÌębe life-changing.

Altomare cautions parents to think twice about filling a prescription for painkillers for their child, because once the prescription runs out, heroin becomes a much more attractive and inexpensive temptation for an addict.

“When a kid who had knee surgery takes 30 OxyContins out of a doctor’s office, it’s a problem. It’s absolutely a gateway 
 It becomes much easier for someone fighting this fight to get two gel caps of heroin for $20 than it does to get an 80 mg OxyContin for $80 or $100,” Altomare said.

Second Lt. James Cox III, a supervisor for the Fairfax County Organized Crime and Narcotics Division, has investigated cases where children have stolen their ill grandparents’ fentanyl patches to sell on the street or take themselves.

“The youngest (opioid addict) I’ve seen so far is 14 years old in Fairfax County,” Cox said.

In 2015, the FDA approved the use of OxyContin for children between 11 and 16 years old, primarily for pediatric cancer patients, but the risk of abuse is high.

A recent Yale study found opioid overdose cases in teenagers ages 15 to 19 increased 176 percent, and heroin poisonings jumped 161 percent, between 1997 and 2012. Young adults are also at risk. Prescription painkillers were responsible for a 165 percent increase in overdoses among that age group.

“Listen to your children. If they’re suffering, seek help. Don’t hide from this. If we avoid this problem, it’s resulting in death,” Chaikin said.

The youngest victims

Childhood hospitalizations involving opioids such as Vicodin and OxyContin have spiked nearly 300 percent in recent years, according to a Yale School of Medicine study.

“They’re eating them like candy,” said lead researcher and Yale fellow Julie Gaither.

From 1997 to 2012, the number of poisonings poisonings toddlers jumped more than 200 percent.

Even babies are not immune from the crisis. As the problem grows, local hospitals are changing the way they respond to newborns suffering from opioid withdrawal. New researchÌęshows babies born with an addictionÌę between 2000 and 2012.

The Children’s National Health System, in Virginia, has worked to treat the smallest victims with a new protocol in the three NICU centers: Mary Washington, Sentara Woodbridge and Virginia Hospital Center. Each newborn is assessed for their risk and a score is calculated based on the severity of their condition.

In Maryland, standardizing care and treating infants experiencing withdrawal has been a priority for the state’s 30 birthing hospitals. The Maryland Patient Safety Center has, over the past year, created the Neonatal Abstinence Syndrome Collaborative to tackle this issue. The initiatives aim to standardize the treatment plan for babies and decrease the time they stay in the hospital.

Read more on Thursday as the series continues: How states are getting lifesaving overdose-reversal drugs into more hands.

Source

WASHINGTON — A year ago, if you had your wisdom teeth removed, you might have been prescribed more than 20 hydrocodone pills. Or an emergency doctor might have given you a month’s worth of Percocet after a minor car accident.

But the practice of aggressively treating pain is changing. Experts say the over-prescribing of opioids in the last 15 years has contributed to the nation’s current heroin epidemic — a slippery slope from recovering patient to recovering addict. Four out of five heroin addicts first became addicted to painkillers, the Substance Abuse and Mental Health Services Administration says.

New CDC guidelines adviseÌędoctors to prescribe fewer painkillers for acute pain. And some physicians have even been arrested for selling massive quantities of opioids to drug users.

So is it the doctors’ fault?

Under the microscope

“There has been a marked increase in the prescribing of opioids,” said Dr. Nancy Nielsen, former president of the American Medical Association and currently senior associate dean for Health Policy at the Jacobs School of Medicine at the University of Buffalo.

Opioids have been used to treat acute or chronic pain for decades, but officials are starting to realize that patients, who have legitimate pain, are getting hooked.

In 2012, health care providers wrote 259 million prescriptions for opioid medications — enough for every adult in America to have a bottle, and a 7 percent increase over 2007.

Since 1999, sales of prescription opioids in the United States have quadrupled, according to the CDC, and nearly 2 million Americans were dependent on opioid medications in 2014.

The reason prescriptions have skyrocketed, Nielsen said, is twofold.

First, “We were told by the pharmaceutical companies that these newer drugs were not addictive and that they were safe. None of that was exactly true,” Nielsen said.

Second, patient satisfaction surveys would essentially grade doctors on whether they “totally” treated patients’ pain.

The questionnaires were used by the Centers for Medicare & Medicaid Services to determine how much money the hospital would be reimbursed. The system incentivized employers to make decisions about patient care that might not have been in patients’ best interest.

“It wasn’t direct financial incentive or disincentive to the doctor, but it was to the hospital.”

So doctors were caught in the middle.

“Doctors have always tried to deal with their patients’ pain,” Nielsen said. But if a doctor refused a drug-seeking patient, there would be serious consequences if the patient handled the survey in a retaliatory way. The hospitals, in turn, came down on the doctors who appeared to not be adequately treating patients’ pain.

“All of that contributed to having doctors become … probably way too cavalier and too ready to use these drugs,” Nielsen said.

After nationwide backlash from medical professions, the Centers for Medicare & Medicaid Services changed the way the questions would be analyzed and used in November. While the pain management questions remain, the new rule de-links patient responses from any financial incentives to a hospital or practice.

But under a new federal law that went into effect this month, doctors who treat Medicare patients will eventually receive incentives or penalties tied to satisfaction surveys.

The Medicare Access and CHIP Reauthorization Act replaces the traditional fee-for-service system with a value-based structure. Advocates hope the system will help improve bedside manner and overall care, but critics say it will bring complications and potential conflicts of interest because treating pain with opioids could cause more harm than good, in some cases.

It’s a particular concern for oral surgeons who regularly prescribe painkillers for tooth extractions. A 2016 study by the University of Pennsylvania’s Perelman School of Medicine and School of Dental Medicine

Patients were prescribed an average of 28 pills; after three weeks, 54 percent were left over.

“When translated to the broad U.S. population, our findings suggest that more than 100 million opioid pills prescribed to patients following surgical removal of impacted wisdom teeth are not used, leaving the door open for possible abuse or misuse by patients, or their friends or family,” said lead authorÌęBrandon Maughan, an emergency physician.

“Results of our study show within five days of surgery, most patients are experiencing relatively little pain, and yet, most still had well over half of their opioid prescription left,” said co-author Elliot Hersh, aÌęprofessor at Penn Dental Medicine.

Instead, Hersh said, over-the-counter drugs, such as ibuprofen and Tylenol, should be used to ease oral surgery pain.

In fact, Nielsen said, most dentists will advise that opioids are not necessary for tooth extractions, and if a prescription is needed, patients should ask why it’s being given and for how long.

And it’s not just dentists under the microscope. In March 2016, the to primary care physicians to avoid prescribing opioids as a first line of defense against pain. Drugs such as OxyContin and Vicodin should be limited and only given at the lowest doses because of the risk of abuse. The CDC is urging doctors to only write three-day prescriptions, as opposed to 30- or 60-day prescriptions, for short-term pain. In cases of chronic pain, follow-ups should be scheduled more frequently.

In a landmark report, the U.S. Surgeon General in November . Dr. Vivek Murthy said 78 people die each day from an opioid overdose, and he said he hopes the findings shift public opinion like the Surgeon General’s report on smoking 50 years ago.

But the public’s opinion about the painkiller problem is split. A poll by Stat-Harvard T.H. Chan School of Public Health found that 37 percent of Americans blame drug users while 34 percent say doctors are responsible for writing too many prescriptions.

“We are all part of the problem, and doctors have a role to play here, because we’re the ones who prescribe it,” Nielsen said.

Pain management and the octopus from hell

Americans, Nielsen said, don’t like to be in pain. “We don’t like discomfort of any sort. We don’t tolerate it well.”

As new scientific research and technology were developed, new drugs were marketed to the public for all kinds of pain applications. The popularity of these drugs grew, and to meet the demand, pharmaceutical companies developed long-lasting doses to more effectively eradicate pain, such as OxyContin, an extended-release version of Oxycodone.

“You get an injury. You go see a doctor. He prescribes you pain medication and gives you a three-month supply. You take Dilaudid, Percodan, Percocet, Demerol, the list goes on, OxyContin,” saidÌęSecond Lt. James Cox III, a supervisor for the Fairfax County Organized Crime and Narcotics Division.

But in recent years, pharmaceutical companies have been sued for misleading the public about how safe their drugs really are. In 2008, CephalonÌęover the marketing of potent opioids for unapproved off-label uses, such as migraines.

Despite some pharmaceutical companies’ claims, research showed the drugs were incredibly addictive.

“The brain becomes very dependent on them,” said Nielsen.

Opioids, like heroin, are central nervous depressants that dull the senses and make the brain feel good, even happy. But they also have unwanted side effects — drowsiness, concentration issues, shallow breathing and apathy. A person who overdoses may slip into unconsciousness and never wake up.

Once someone is hooked, it’s nearly impossible to stop.

Anne Arundel County Police Chief Tim Altomare calls it “an octopus from hell” that infiltrates every aspect of someone’s life. “It’s poison. Everyone knows it’s poison,” he said.

Even if the narcotic is used as prescribed and for legitimate pain, the body builds up a tolerance and the brain starts to crave it. When the opioid-dependent patient returns to the doctor but is denied another prescription, they may seek another, cheaper option.

“Why pay $40 for an OxyContin pill when I can buy a $10 bag of heroin?”ÌęCox asked.

Once hooked, repeat users need a baseline opioid fix to live day by day.

“They’re waking up in the morning and if they don’t have that drug, they’re going to be vomiting, sweating profusely. As soon as they’re up, they’re going to buy their heroin just so they can make it through the day,” saidÌęCox. “Nobody wakes up and says they’re going to be a heroin addict today.”

Pill mills

But law enforcement officials say some doctors are actively contributing to the rising opioid addiction rate.

Police departments have cracked down on “pill mills” — practices or clinics that knowingly prescribe narcotics to patients who are addicted to them.Ìę In August 2016, Prince William County psychiatrist Craig Charles Krause was arrested for selling thousands of Xanax pills, a popular sedative, to drug dealers.

Under Maryland’s Prescription Drug Monitoring Program, created in 2014, doctors and pharmacies are required to report each prescription to the state, allowing the government to identify and investigate physicians who are taking advantage of the system. Virginia and D.C. have similar databases.

“These drugs are life-saving drugs; they are also life-altering and life-ending drugs if used inappropriately,” Nielsen said.

Read more on Wednesday as the series continues: A parent who said he was in denial about his child’s addiction and why kids are the most at risk.

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“(Heroin) is the most powerful drug there is on Earth. It’s a wonder I’m still alive,” Lancaster told Âé¶ččÙÍű in 2014, just weeks before his release.

Lancaster was one of thousands of D.C.-area residents who have died of a heroin or opioid overdose in recent years. Opioids are the No. 1 cause of injury-related deaths in the nation, the U.S. Centers for Disease Control and Prevention says.

The crisis has reached a boiling point in the region, as a new breed of designer opioids has infiltrated the region’s drug market.

As the deaths continue to be tallied, at least 1,600 people in D.C., Maryland and Virginia died from heroin or opioid overdoses in 2016, and that’s just a preliminary figure. Several months of data from last year have yet to be published.

An epidemic

In November 2016, Virginia’s Health Commissioner declared a public health emergency. Officials projected that by the end of last year, a record of more than 1,000 Virginians would have died, an increase of 77 percent compared to five years ago.

Fairfax County has the second-highest rate of fatal opioid overdoses in the state after Richmond.

Meanwhile, in Maryland, heroin-related deaths jumped a whopping 70 percent in the first nine months of 2016 compared with the same period in 2015, according to the most recent data available from the Department of Health and Mental Hygiene.

Heroin outpaces all other intoxication deaths, including those attributed to alcohol, prescription opioids and cocaine.

The Baltimore area is still the heroin capital of Maryland,Ìęwith nearly 500 heroin-related deaths from January to September 2016 in the city of Baltimore and Baltimore County.

Nearby Anne Arundel County, where officials have declared a public health emergency, has the next-greatest rate of fatal overdoses; Prince George’s and Montgomery counties round out the top five. Every single Maryland county, except for Garrett, Somerset and Washington, has seen an increase in heroin-related deaths since 2015.

The District also is experiencing the same trend: The number of fatal heroin overdoses has increased every year the past three years. The Office of the Chief Medical Examiner reports that in the first half of 2016, 233 people died of an opioid-related overdose. Such deaths are most prevalent in Ward 8.

As potency skyrockets, so do deaths

Lancaster, a longtime heroin user, was in recovery during his incarceration, but just hours after he was released, his body was found lifeless in a car. The Virginia Medical Examiner’s report says he fatally overdosed from a combination of heroin, cocaine and alcohol.

“He said he was so glad he was free and clean. He just wanted to start all over,” Lancaster’s mother, Lois Coffman, said.

“I knew that Danny had been addicted for so many years. But when he was clean, I just couldn’t believe that he would just go right back to it … I just cried. It just broke my heart.”

Lancaster had been in and out of prison for seven of the past 14 years, chasing the high. But even as a regular user, he was no match for the drugs. The year he died,Ìę— a record. That’s more than vehicle crashes and gun homicides.

“I don’t think we’ve ever seen anything like this. Certainly not in modern times,” Robert Anderson, who oversees death statistics at the U.S. Centers for Disease Control and Prevention, told The Associated Press.

Heroin deaths jumped 23 percent and synthetic opioids, such as fentanyl, surged by 73 percent.

Though it’s unknown whether Lancaster’s heroin was laced with any synthetic additives, designer drugs manufactured overseas turn ordinary heroin into a lethal weapon so dangerous that even just touching them could stop a heart.

In the past two years, heroin’s potency has skyrocketed as drug dealers began regularly mixing heroin with synthetics, increasing the potency of the drug to 90 percent or more — levels law enforcement officials have never seen before.

“We’ve got a major problem. The first time a person uses one of those products with such a high potency level, it can stop their heart,” said Anne Arundel County Police Chief Tim Altomare, a 24-year veteran police officer.

In comparison, street-level heroin during the 1970s was about 3 to 7 percent pure, enough to make someone high but typically not strong enough to cause a regular user to fatally overdose.

“That wasn’t killing people then,” said Altomare.

Fentanyl: Fatal on contact

Fentanyl is a prescription drug legally produced to treat chronic pain for terminal cancer patients in the United States. It’s about 50 to 100 times more potent than morphine.

More people are dying from a heroin-fentanyl mix than any other lethal combination.

Fentanyl is so dangerous that police officers must wear protective gloves when responding to the scene of an overdose.

“We put safety equipment on because contact with the skin can stop the heart. We wear respirators so we don’t breathe dust in and we cover our skin with protective gear,” Altomare said.

Second Lt. James Cox III, a supervisor for the Fairfax County Organized Crime and Narcotics Division, said fentanyl-laced heroin is on the rise in the D.C. area.

“We’re seeing this mass increase in overdoses,” Cox said.

The number of fentanyl-related deaths in Maryland rose more than 280 percent in 2016, compared withÌęthe same period one year earlier. Officials cite the mix as the cause of more than 700 deaths from January to September.

In Virginia, where the 2016 data is still being gathered by the Department of Health, the number of fatal fentanyl overdoses was expected to double from 2015 — from 224 deaths to nearly 500.

But fentanyl is not even the most deadly heroin additive. Recently, heroin laced with carfentanil — an elephant tranquilizer — was found in Fairfax County, Virginia Health Commissioner Marissa Levine said. Carfentanil is 100 times more potent than fentanyl, 10,000 times more potent than morphine.

Cooking up death

Criminals working in overseas labs use advanced technology to copy deadly compounds and add them to heroin. And these chemical concoctions are flooding into the local heroin market.

“It’s taking morphine and changing the chemical structure to make a synthetic look-alike to that drug,” Cox said. “If you have a really good chemist, they’re going to be able to synthesize heroin or fentanyl themselves.”

Law enforcement officials also have discovered heroin laced with designer drugs that hasn’t been seen in the United States before —Ìęa problem because, without an official name, these compounds can’t be classified as an illegal substance.

In November, the Drug Enforcement Administration added an illicitly manufactured opioid known as “pink” heroin — under the chemical name U-47700 — to the list of narcotics that have no medical use and are therefore illegal in the United States.

This synthetic drug is blamed for deaths across the country, but it hadn’t been regulated until now. Rogue scientists are developing new chemical compounds faster than the federal government can keep up.

The DEA’s action was too late to help a Loudoun County resident. An Ashburn man died after ingesting U-47700 back in July.

“When heroin comes into the United States, there is no such thing as a pure drug,” Cox said. “Dealers need to make money.”

So the dealers cut the product with additives to increase their profits and supply.

At your fingertips

Synthetic opioids can be ordered online from China, and the packages are shipped all over the United States. Meanwhile, the DEA said, poppy cultivation in Mexico remains the greatest source of high-purity, low-cost heroin in the United States, especially in the Northeast.Ìę Dealers combine synthetics with heroin to create a super drug.

Cox said police investigated two cases in Fairfax where several residents ordered synthetic fentanyl mailed directly to their home. In one instance, a Reston resident injected fentanyl-laced heroin and immediately overdosed. His body appeared lifeless but because of a quick-thinking roommate, first responders arrived on the scene to revive the man with an antidote called naloxone.

“When placing an order on the internet, especially if it’s from some underground lab, you have no idea what you’re getting,” said Cox. “Somebody could make it in their basement as long as they have the chemicals to do it and the know-how.”

Altomare said synthetics allow dealers to stretch the product out and it gives them “more bang for the buck.” Unlike traditional cutting agents, which dilute the heroin, these additives increase its potency.

“People who are in the cycle of addiction are looking for the strong products,” Altomare said.

Danny LancasterÌęstarted snorting heroin in his early 30s with his fiancee until she overdosed and died in 2000. HisÌęlife spiraled out of control and he fell into a deep depression. He stole to fund his addiction, shooting $150 to $300 worth of heroin a day.

AfterÌęthree years in recovery behind bars, it only took a few hours of freedom for Danny Lancaster to slip back into old habits.

The morning of his release, Lancaster took the bus to the Krispy Kreme along U.S. 1 to meet his brother, Tim. The two brothers had coffee and doughnuts and talked about Lancaster’s new life. TheyÌęplanned to meet up again around 4 p.m. to have dinner.

But that never happened.

Tim’s calls went unanswered. His brother never answered the phone. Early the next morning, police found Lancaster’s lifeless body in a car nearby.

“That disease made me do something I didn’t want to do every day,” he told Âé¶ččÙÍű while he was still behind bars, just weeks before his fatal overdose. His dream was to mentor young adults who were struggling with drugs too.

“I want to talk to young people about addiction. It’s going to be hard with my record. But I can share stories. I just want to change.”

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The victim told Prince William County Police that around 10 a.m. Sunday, a man walked into ZY Massage on Dynasty Loop in Woodbridge, Virginia, and asked to use the restroom.

As he left the building, he asked the 44-year-old woman for a hug but she said no. Later, he returned to the business and locked himself and the employee inside. The two got into a struggle but she was able to break free and run away. She received minor injuries from the attack.

Police identified Olowu, 32, after releasing photos from the massage parlor, but they have not been able to find the Manassas man, who is wanted for abduction and assault and battery.

They say he was last seen walking toward Telegraph Road. He is described as black, around 6 feet tall and weighs about 190 pounds. He has dark hair with a dark-colored, unshaven beard and mustache. He was last seen wearing blue jeans with a skull on the back right pocket, a black shirt with “Blackwatch” written on the front, a gray New York Yankees hat and dark shoes.

Anyone with information about where Olowu is should call police at 703-792-6500 or Crime Solvers atÌę703-670-3700 or 1-866-411-TIPS.

Âé¶ččÙÍű’s Colleen Kelleher contributed to this report.

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The state health commissioner, Dr. Marissa Levine, announced Monday that she has issued a standing order for naloxone, a drug that counteracts the effects of an opioid overdose. Now, any Virginian can walk into a pharmacy and ask for naloxone without a prescription.

Advocates applaud the state’s decision, but some say it needs to take additional steps to curb this crisis, which is expected to take the lives of more than 1,000 Virginians this year alone.

Naloxone, which has the brand name of Narcan, can reverse an opioid overdose, and it has been used to save countless lives. Now that the drug is available without a prescription, officials hope more people will purchase the drug for themselves or loved ones who have substance dependency.

But Ginny Lovitt, whose brother died of a heroin overdose, said the stigma is hard to overcome.

“People are afraid to go to the pharmacy counter and ask for this medication in public because that would constitute admitting that they have a problem with addiction or that their loved one does,” she said.

After Lovitt’s brother, Chris Atwood, died in 2013, she started a foundation in his name to educate the public and provide resources. She also became a certified instructor for REVIVE!, Virginia’s opioid and naloxone education program, and teaches how to administer naloxone. Since the training began in 2015, her class has trained more than 200 people and saved at least 10 lives.

While Virginia’s standing order makes it easier for people to buy naloxone, Maryland and dozens of other states go one step further.

“One of the main ways that Virginia is a little behind, compared to Maryland, is we don’t currently allow REVIVE! opioid overdose instructors to dispense naloxone to their class participants,” Lovitt said. “After the class, someone needs to go out and get it from the pharmacy. Unfortunately, there are a lot of reasons — logistical, financial, stigma-related — where people can’t get it from the pharmacy, or they choose not to. So a lot of people are getting trained and not getting the medication afterwards.”

Naloxone’s average cost is about $120, Virginia officials said.

Treatment

There’s also the issue of treatment itself. There’s not enough affordable treatment centers or beds to meet the skyrocketing demand, experts said. And though naloxone saves lives, it doesn’t put people on a path to recovery.

“What we need is a lot more availability to treatment because otherwise, individuals who are saved from overdosing are going to continue to use the drugs and may overdose again. So we’re just forestalling the problem instead of actually trying to address it,” said Warren Bickel, director of the Addiction Recovery Research Center at the Virginia Tech Carilion Research Institute.

Bickel emphasized that addiction is a chronic disorder and that long-term treatment should be the top priority.

“Imagine the outcomes that you would see if you took other chronic disorders, like type 2 diabetes or asthma, and just treated it for a short period of time,” Bickel said. “It would be nothing but a medical disaster waiting to happen. Short-term treatment for individuals with opioid dependence, addicted to heroin or prescription opioids, is better than nothing. Bbut it’s not really going to address the problem.”

Bickel also supports increasing medication-assisted treatment with drugs like methadone and Suboxone, which help to ease withdraw symptoms and opioid cravings.

“There is unmet need for individuals to get that treatment,” he said. “Suboxone is very expensive, but methadone is not. So it requires some sort of support because many people would not be able to afford some of these treatments and, therefore, will just continue doing what they got to do to stay on the street.”

Scope of the epidemic

More people are dying from opioid overdoses than vehicle crashes inÌęVirginia.

And officials project that by the end of 2016, a record of more than 1,000 Virginians will die from an opioid overdose, an increase of 77 percent compared with five years ago. Fatal overdoses in the first six months of this year are up 35 percent compared with the same period last year.

The potency of these drugs is unlike anything law enforcement officials have seen before, and it’s not just pure heroin that they are concerned about.

New powerful synthetic opioids that are manufactured in labs and often mixed with heroin increase the risk of death tremendously.

One of the most deadly synthetic drugs is fentanyl, which is about 50 times more potent than heroin. It’s so dangerous that a person could die from just touching fentanyl with their fingers.

Officials are also seeing variations of fentanyl flood the market like carfentanil, an elephant tranquilizer that’s 100 times more potent than fentanyl and 10,000 times more powerful than morphine. Dr. Levine said it has shown up in Fairfax County in the past year.

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Here’s how they finished:

Ìę— 3:51:05. ÌęThis was the 100th marathon for the Alexandria, Virginia, native, who is raising money to renovate local playgroundsÌęthrough her nonprofit RunningBrooke.

— 4:34:03. Raised in Reston, Virginia, Anderson ran to honor a high school friend who was killed in the 9/11 terrorist attack at the Pentagon.

— 5:06:21.ÌęShe ran in memory of her son, Army 1st Lt. Jeff Kaylor, who was killed during Operation Iraqi Freedom.

— 4:58:11. The first-time marathoner from Springfield, Ohio, decided to take control of his health and lost 160 pounds, nearly half his body weight.

— 6:52:17. Three days before the marathon, she completed her last round of radiation to treat a life-threatening brain tumor.

— 6:04:41. Anna ran her first marathon in memory of her brother, Army Spc. Thomas Doerflinger, who was killed in Iraq on Veterans Day in 2004. She is part of the wear blue: run to remember Gold Star Race Program.

— 5:20:33. This was aÌęfirst marathon for Falcone, who wasÌęcritically injured when a car crashed through a restaurant. She ran to raise money for the Semper Fi Foundation.

— 6:24:27. She completed the marathon while pushing Jeffrey Bergeman, a 10-year-old boy with special needs.

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WASHINGTON — When Kareen Lawson’s feet hit the pavement at this year’s Marine Corps Marathon, she won’t just be powering herself through the 26.2 mile race. She will also be pushing her favorite 10-year-old buddy in his running chair.

Kareen, 48, started running 15 years ago to lose some weight, but became more serious about racing when she became an empty-nester about three years ago. She joined the Potomac River Running group in Burke, Virginia, where she lives, and eventually became a coach. Since then, she has completed about 90 races, including four marathons, three of which were Marine Corps Marathons.

A couple of years ago, she reached out to the group , which matches special needs children with athletes, to motivate herself and to connect with the families.

“I was matched up with Jeffrey randomly. It has been a match made in heaven. He’s become like a member of my family,” she said.

When Jeffrey Bergeman was almost 2 years old, he went into cardiac arrest; his brain was deprived of oxygen for a period of time. Today, he is wheelchair-bound and has difficulty communicating.

“He obviously cannot run for himself, so I have the honor of being his legs,” she said. “He is a very, very smart young man. Even though he cannot communicate, he has a lot to say and he is very bright.”

Their first race together was a 5K for autism in Wisconsin, where Jeffrey lives.

“The entire time, he was looking up at me and just smiling and cheering and laughing. He was having so much fun. Every single time I looked down at him, he was looking right in my eyes. It was an amazing experience,” she said. “I cannot wait to do this again.”

Last year, Kareen and the Bergeman family teamed up with Ìęand raised enough money to get Jeffrey a new running chair.

“It’s called a Blade II. It’s an awesome running chair and it can hook to a bike so he could participate in a triathlon now if he wanted to,” Kareen said.

On Sunday, Kareen and Jeffrey’s mother will take turns pushing him in his new chair for the entire marathon.

“I just believe that Jeffrey will carry us across the finish line. I know that when we cross the finish line, I will probably be a puddle of tears and joy, because it’s going to be amazing.”

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WASHINGTON – Lori Falcone, 43, could have died instantly in a freak accident on Aug. 8, 2011.

One minute, she was sitting outside a café in Stamford, Conn., where she lives, having lunch with friend. The next minute, she was being hurled through the glass window and a car landed on top of her.

“It was a beautiful Monday morning,” Lori recalled. “What started as a great day ended as a life-changing experience.”

Around 12:30 p.m., a 92-year-old driver attempted to park in a handicapped space just in front of where Lori and her friend were sitting at Cafe Oo La La when the driver accidentally pressed the gas instead of the brake.

A split-second later, the car jumped the curb and smashed into the crowded restaurant.

“(He) hit me head-on, barreled me 25 feet through the restaurant until my body stopped the car,” Lori said.

That’s whenÌęher memory ends. She can’t remember the aftermath but says that according to Ìęnews reports and police, her body slammed through the tempered glass and came to a rest underneath a countertop inside the cafĂ©, pinned under the still-running car. She was bleeding profusely and her injuries were obviously very serious, but bystanders didn’t know, at the time, whether her spinal cord was damaged.

The shopping center manager witnessed the crash and Lori’s trapped body. He had to make the difficult decision: do nothing or pull her out and risk paralyzing her.

“He saved my life that day. He had the courage and fortitude to pull me out and say, ‘I can’t watch this girl die. I’m going to pull her out and stop the bleeding.’ You wonder how many people would have made that difficult decision,” she said.

An ambulance rushed her to the hospital, and Lori remembers wanting to contact her husband. Ìę“I knew it was bad. I didn’t have pain at that point. I was in and out of consciousness,” she said. “But I was determined to get in touch with my husband and tell him it was okay for him to move on.”

Once at the hospital, doctors confirmed her pelvis was fracturedÌęmultiple times and her organs began failing. But, incredibly, her spine was not damaged.

“My break was about a tenth of an inch from my spinal cord. I wasn’t paralyzed. My injuries could have been so much worse. To this day, I really don’t know how I survived,” she said. “The fact that I lived is incredible. The fact that I wasn’t paralyzed is a miracle.”

Meanwhile, nine other people, including her friend, who was six months pregnant, were also injured in the crash, but no one died – another miracle.

During Lori’s recovery, a nurse encouraged her to make short-term and long-term goals. Lori decided that if she could walk again, she wanted to complete a marathon. “I started in a wheelchair, went to crutches and a cane. Finally I was able to walk again. It was a very long road to recovery. I had to re-learn how to do everything.”

Doctors warned Lori that she may have to remain in the hospital for six months, but Lori was released within a month and continued getting stronger. She started with a 5K and built up her confidence. In February of this year, a colleague suggested running the Marine Corps Marathon.

“I said, ‘Okay! Let’s do it!’”

She decided to run the marathon to raise money for the , which provides financial support for wounded Marines and their families.

“I try and look at the bright side, the silver lining, because so many times you can give up. But I wanted to fight.”

She says the experience changed her life, and made her realize some very important lessons: Spend more time with loved ones; don’t sweat the small stuff, and ask for help when you need it.

And finally, she suggests, don’t sit outdoors in front of a parking spot.

The driver, 92-year-old Samuel Leighton, was charged with second-degree reckless endangerment and reckless operation of a motor vehicle. He passed away in March 2013.

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The reports the boards of the two companies are meeting SaturdayÌęto approve the transaction.

The deal brings together AT&T’s wireless and pay-television subscribers with Time Warner’s media networks such as CNN, TNT, HBO. and Warner Bros. film and TV studio.

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ELLICOTT CITY, Md.Ìę— Anna Bevill and her brother Thomas Doerflinger had a love-hate sibling relationship growing up in Mount Rainier, Maryland.

“I’m the oldest of four. My brother was the first sibling that I got. He was three years younger than me,” Anna said. “We fought a lot, but we were really close.”

But by the time Thomas turned 18 in 2002, they were developing their friendship as adults. He joined the Army that year and while his family respected his decision, they were apprehensive.

“I said, ‘Thomas, why would you want to do this when you know we are at war? 9/11 just happened. It’s inevitable. You will be in conflict.’ He was like, ‘Well, I’d rather join now and be useful than sit around wasting taxpayer money during a time of peace.’”

Two years later, he was preparing to deploy to Iraq. The family flew to Fort Lewis in Washington state — now known as Joint Base Lewis-McChord — to see him off in October 2004.

“The last thing I said to him was, ‘I love you.’ And I gave him a big hug,” she recalled. “He knew I was getting emotional. He was like, ‘Pff. Come on. I’m coming back.’”

Less than one month later, Army Spc. Doerflinger was killed by a sniper in Mosul, Iraq.

“He was shot in the head. He died instantly. There was no pain. Because this sniper had this armor-penetrating ammunition, it went through his helmet,” Anna said.

It was Nov. 11, 2004 — Veterans Day. He was 20 years old.

“A loss like that changes your family forever. It changes your life forever. It changes your perspective on things forever,” she said.

With Thomas in mind, Anna made a life-altering decision on her 30th birthday. At the time, she had a 1-year-old child and was recently separated from her husband.

“One day, I realized I needed to do something better for myself. So I quit smoking and started running the same day,” she said.

In his memory, she completed the D.C. Veterans Day 10K that year and thought about signing up for a marathon — something Thomas would have found amusing.

“One of the things we bonded over as adult friends was smoking,” she said, laughing. “I know that running wasn’t something that he loved to do. He enjoyed a good cigarette and having a drink with his friends. So I know that if he saw that I signed up for a marathon, he would be like, ‘Why? Why would you want to do this to yourself?’”

She joined the “” organization two years ago, a running community of aboutÌę6,000 members worldwide. She began running with them at Centennial Park in Ellicott City, close to her home in Columbia.

Anna, now 35, was invited to run this year’s Marine Corps Marathon — her first marathon — as part of their Gold Star Race Program.

“As you can imagine, losing somebody like that — a spouse, a child, a sibling — that ache just continues day after day. To have that type of support network, even in a small way, helps them,” said program director Chris Bryant. “On the weekend of the race, we just try to make sure that they understand how much we appreciate what they’ve sacrificed. We try to make sure it’s an experience for them that they will never forget and one that helps launch them into the adventure that their lives still hold for them.”

Before each race, the group huddles up in a circle and reads the names of fallen service members who died on that day since the beginning of the war on terror. Bryant says it reminds them they are about to take purposeful steps.

“The people who cross the finish line are different from the people who toe it up at the beginning. It’s a transformation that occurs on any marathon. You are changed by the experience,” he said. “The Marine Corps Marathon is special because the officers drape that medal across your neck and they salute you. It’s such a powerful way to end the race.”

Anna says the group has given her a way to move forward with her life and honor the little brother she lost.

“I would want people to remember he had an amazing sense of humor. He was such a funny guy. He did great impressions. He loved to write. I’m very confident he would have written some amazing books if he was still with us today,” she said.

She added, “We were all very proud of him. He was out there, ultimately, to protect his brothers. We will always miss him. We would never let him be forgotten.”

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WASHINGTON — Any marathoner can tell you that training to run 26.2 miles can be mentally and physically exhausting. Runners plan months beforehand and stick to a strict exercise regimen, gradually increasing strength and stamina until the big day.

But Samaria Hunter’s plans were suddenly interrupted two years ago, when doctors revealed she had been suffering from a life-threatening condition for more than a decade.

It was October 2014 — the 39th Marine Corps Marathon. Thousands of runners, bounding with nervous energy, burst through the starting line. Among them was 45-year-old Hunter, a retired lieutenant commander in the U.S. Navy.

The Suffolk, Virginia, resident had prepared for that MCM just like she had the year before. But trouble came at mile nine.

“My knee buckled,” she said. “My husband and everybody else were telling me to get off the course. But I stayed on the course the entire time. I ran-walked the last 17 miles.”

After finishing, she drove back to the Hampton Roads area and checked into an emergency room. Something wasn’t right.

“[The doctors] thought I had some type of leg issue,” she said.

Since 2000, HunterÌęhad struggled with weakness and pain on the left side of her body. At the time, doctors ruled out a neurological problem. No one thought her brain was the cause.

“What I know now, that I did not know then, is when they did the brain study in 2000, they did not use contrast on the MRI.”

Even after the episode during the marathon, her doctors believed she had just injured herself.

But the pain, leg spasms and migraines intensified until July 2015. An MRI with contrast confirmed a mass on her brain, which had likely been growing undiagnosed for 15 years.

“The spasms, we now know, were seizures. It made perfect sense. I was actually a textbook case for the type of brain tumor I had, which was a meningioma on my right frontal lobe,” she said. “By the time it was discovered, it was already the size of a plum.”

The mass was benign, not cancerous, but still life-threatening. She decided to undergo awake brain surgery at the Duke University Medical Center’s Brain Tumor Center in August 2015.

“I was really at peace going into surgery,” she said. She could feel and hear everything around her as the surgeon opened up her skull and removed as much of the tumor as he could. But doctors warned her family that there was a chance Samaria would be paralyzed.

“While the doctor thought he needed me to guide his hands, I really believe he didn’t need me. God was already with us,” she said.

Sure enough, she walked out of the hospital a day later. She returned to running a month after surgery and began training for this year’sÌęmarathon. She built up her strength, one step at a time. But in May of this year, an MRI revealed the tumor had grown.

“I had already done all this practice and preparation for the Marine Corps Marathon and found out that I had to enter radiation,” she said.

It’s aÌęmajor setback, but she is determined. Radiation treatment began last month,Ìęand she plans to complete the last round of radiation just three days before the marathon. As she juggles treatments and a grueling training program, she is monitoring her body and aware of the risks of brain swelling.

“I have continued to run at least four or five days a week, with at least one being a long run.”

She says her faith keeps her going. “The night we were in the hospital and they came to me and said, ‘You have a mass on your brain,’ I immediately thought my life was going to be very short. As I was crying, my husband looked at me and said, ‘We believe in God.’ In an instant, that changed for me. Everything changed for me. It wasn’t ‘Why me’ but ‘Why not me?’”

She says this is a chance to let her test become her testimony. Despite the challenges, she feels abundantly blessed.

“Yes, some days are harder than others. For me, it is just keeping one foot in front of the other.”

She plans to launch a nonprofit next year for brain tumor awareness and research.

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Editor’s note: All this month leading up to the Marine Corps Marathon, Âé¶ččÙÍű’s Jamie Forzato is bringing you stories of runners who have endured loss, persevered through personal struggles and found hope.

WASHINGTON — Ron Allison was overweight and confident. He didn’t see his expanding waistline as a problem because he had great self-esteem and thought he was active. But when his overweight father died after complications from surgery, he knew he had to make a transformation.

“I come from a family that’s pretty obese,” Allison said. “After high school, I got really heavy — somewhere in the high 200 mark — and from there, continued to gain weight.”

The Springfield, Ohio, resident suffered from depression and ate food to cope with his emotions.

In February 2011, his father passed away after abdominal hernia surgery. Ron’s emotional eating spiraled out of control, and by the end of 2013 he tipped the scale at 321 pounds.

“It kind of hit me,” he said. “For somebody that was so self-confident and so emotionally stable to be going through the amount of depression I was after losing my dad … I said, ‘this is silly.’ If I [could] keep from putting my family, my wife, my kids through that, then I was going to. It was at that point that I decided I was going to do something.”

His first goal was to lose 100 pounds over the following year.

“I started by eating halfway decent and exercising. The exercising started with just walking,” he said.

But it didn’t come easy.

“That progression of walking to walking up hills to start to jog … it was horrible. The only time I used to run before was to run after a food truck, probably,” he said. “At some point, it clicked and I fell in love with it.”

Nine months into his journey, he’d lost 90 pounds and completed his first 5K.

By the end of 2014, he was down 121 pounds. He was training for a local marathon in October 2015, and he was hooked.

“The person that handed me my medal said, ‘Congratulations, you’re a marathon runner.’ That’s when I broke down. If that was never said, I still probably wouldn’t have thought of myself as a marathon runner. It took me a while to even consider myself a runner at that point.”

Allison wants to run one marathon per year, perhaps qualify for the Boston Marathon one day or even finish a 32-miler.

He chose the Marine Corps Marathon this year since his younger brother is in the Marine Corps Reserve. “I thought, how fitting. I love Washington D.C. Obviously [I] have a heart for the Marines and our country,” he said.

He’s down to 159 pounds — a drop of about half his highest body weight. He stays fit by being active, but doesn’t work out every day.

“I’m extremely happier and healthier,” he said. “The good news is as you start losing weight, you will feel better.”

His message to others who are struggling with weight loss: “Just start. I tell people that all the time. If you’re eating bad right now, just start eating better. If you’re not active, just start walking. I think your body will naturally take you there.”

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