RACHEL MARTIN, HOST:
She was in medical school. He was just out of prison. Their romance happened unexpectedly in the shadow of the country's drug overdose crisis. And it grew with an urgent shared conviction that too many lives were being lost. Will Stone brings us their story from Iowa about love, addiction and fear.
WILL STONE, BYLINE: From their first meeting, Sarah Ziegenhorn says she and Andy Beeler were totally in sync.
SARAH ZIEGENHORN: He was just this really sweet, no-nonsense person who was really committed to justice and equity.
STONE: Andy was a blue-collar guy who liked motorcycles and home carpentry.
ZIEGENHORN: He had this very calming presence.
STONE: Sarah had grown up on a farm but had spent years away from Iowa. She was ambitious and driven and could see Andy for who he was, despite his time in prison for drug-related crimes, like stealing and possession. As an aspiring doctor, she knew that addiction was a disease. When she moved back home, she discovered her childhood friends were dying from it. So she started a nonprofit to help drug users - the Iowa Harm Reduction Coalition. When Andy got out of prison in 2018, he started volunteering there.
ZIEGENHORN: He had been a drug user for about half of his life, 15 of his 30 years, primarily a longtime opiate user.
STONE: Andy loved the work. Pretty soon, he was hired. He and Sarah moved in together in Iowa City. She was busy with med school. And Andy loved learning, so he'd study right alongside her.
ZIEGENHORN: Most of the time when he'd been in prison or jails, he had spent his time reading.
STONE: They were in love. But in the background was Andy's struggle with opioids. All that time, he was on parole. He worried that a failed drug test would send him back to prison because he still used heroin, sometimes. While they were dating, Andy overdosed twice on heroin. But Sarah was there to save his life. His parole officer found out about one of those overdoses. After that, Andy was constantly afraid. He believed if he got caught using again, he'd be incarcerated.
ZIEGENHORN: And that was really a period of a lot of tear for him.
STONE: Then a year ago, Andy slipped on the winter ice. He dislocated his shoulder and went to the ER.
ZIEGENHORN: They put his shoulder back into place for him. But the next day, it came out again.
STONE: Andy's shoulder would dislocate daily. The pain was agonizing. But because of his drug history, doctors refused to give him painkillers. Andy needed surgery, but he didn't have health insurance.
ZIEGENHORN: He was living with this daily, really severe, constant pain. He started using heroin very regularly.
STONE: Eventually, they sat down for a talk. They discussed the future. They wanted to have a baby together. And so they agreed. Andy had to stop using heroin.
ZIEGENHORN: Andy didn't want to be in the situation he had gotten into.
STONE: When he was younger, Andy had been prescribed methadone. Sarah says he wanted to try that again or another medicine called buprenorphine. Both are legal opioids and evidence-based treatments for addiction. But parole made that complicated. If Andy was prescribed one of those medications, then his mandatory drug tests would come back positive. And his parole officer would know and figure out he'd also been using illegal drugs. That could land him back in prison. Sarah says he felt trapped, like there were only two options left.
ZIEGENHORN: Go back to prison or continue trying to obtain opiates on the street and slowly detox himself.
STONE: Andy thought it was too risky to ask a doctor for buprenorphine. He decided to keep buying illegal opioids but tried to taper himself off. Sarah had doubts. Just a few days later, Sarah had to leave early for medical school. She kissed Andy goodbye as he slept. Later that day, when she couldn't reach him, she sent a friend over to the house. The friend found Andy at his desk, slumped over in a chair. He died from an overdose.
ZIEGENHORN: He was my partner in thought and in life and in love. And overdose is a really hard thing to deal with.
STONE: She's left with her grief and anger that he couldn't ask for the help he needed. At least he didn't think he could. To this day, it's still unclear if Andy's parole officer would have sent him back to prison for admitting his relapse and seeking out medication-assisted treatment. That officer wouldn't talk to NPR. But Ken Kolthof (ph), who oversees that parole program, did. While he avoided specifics about Andy's case, Kolthof says someone seeking out treatment would not be punished.
KEN KOLTHOF: We would see that that would be an example of somebody actually taking an active role in their treatment and getting the help they needed.
STONE: Kolthof says his team doesn't forbid any medications for opioid addiction if it's prescribed.
KOLTHOF: We have people relapse every single day under our supervision. And are they being sent to prison? No. Are they being put in jail? No.
STONE: But Andy was too scared to even ask. And that distrust of the system is common, according to Dr. Andrea Weber at the University of Iowa.
ANDREA WEBER: Treatment providers, especially in our area, are still very much ingrained in a abstinence-only, 12-step mentality, which traditionally has meant no medications. That perception then invades the entire system.
STONE: And discourages people from taking methadone or buprenorphine. One survey found half of local drug courts in the U.S. simply don't allow methadone or buprenorphine. But advocates are pushing back, filing lawsuits saying rules like these violate the Americans With Disabilities Act, or ADA. Sally Friedman with the Legal Action Center says that's because addiction is a disability.
SALLY FRIEDMAN: Prohibiting people from taking medication that can keep them alive and well violates the ADA.
STONE: Friedman says the rules make ex-offenders like Andy afraid to even ask for treatment.
FRIEDMAN: People who are under supervision of probation, parole often are told that a single relapse can get them violated and incarcerated.
STONE: In January 2019, shortly before falling on the ice, Andy called into a talk show on Iowa Public Radio, joining a discussion on felons and voting rights. The show put him on the air live. And he was blunt about his record.
(SOUNDBITE OF ARCHIVED RECORDING)
ANDY BEELER: Third-degree burglary, delivery of a controlled substance.
STONE: And the reason for it.
(SOUNDBITE OF ARCHIVED RECORDING)
BEELER: All of that pretty much stemming from a substance abuse problem.
STONE: Then Andy shared some deeper feelings about his path.
(SOUNDBITE OF ARCHIVED RECORDING)
BEELER: When you come into the criminal justice system, they have a way of - it feels like you're being beaten down in every way you can be.
STONE: That was Andy Beeler just a few weeks before his death - a man who had committed crimes and committed to love and a man who felt the system had nothing to offer him but punishment. For NPR News, I'm Will Stone.
MARTIN: That story comes from NPR's reporting partnership with Kaiser Health News.[db:翻译]