When Rachel Tinney realized her brother Josiah had moved beyond prescription pain pills to heroin, she tried begging him, using her other brother's death to reach him.
"I actually said to him, 'Josiah, people are getting bad stuff and not realizing it and they are dying, and I am so afraid that I am going to bury another brother, and I just can't do that.' And I cried," Tinney said. "And he said, 'Ray, no, you won't. I promise that won't happen.' And within days he was dead."
Next month marks the second anniversary of Josiah's overdose. One of Rachel's other brothers, David, died when he was 17 and she was 24.
"He was very depressed and he took his own life," she said. "And that was the day after 9-11."
A sudden, unexpected death offers no time for goodbyes or professions of love. It's like a punch to the stomach, leaving people breathless and sometimes desperate for answers. Families of heroin addicts often talk about their fear they will one day get a phone call with the worst of news, or a knock on the door.
"And they came to the door," Tinney said, "and told me that he had been found dead from a heroin overdose. And of course I sobbed and sobbed. And I then told them I need to go see my brother."
Rachel didn't want to be left with questions. She had to know if it was an accident. So she told the officers she was a registered nurse and pleaded with them to take her to her brother. And they did.
"They provided that courtesy. It definitely was an accident," she said.
With growing frequency, families are experiencing the pain that comes with a sudden death from a drug overdose. They also are experiencing the stigma that comes with it.
"I've heard from many, many families," said Patricia Mitrokostas, the director of prevention at Gosnold, Cape Cod. "People offer their sympathy, but they often are offered, 'Well, they're at peace now. You don't have to worry about them anymore.' As though that's supposed to be a consolation for a parent who just lost a child. That to me speaks to a lack of knowledge about the disease and how it's not a choice."
Mitrokostas said people should treat an overdose death the same as they would any other death. A loss is a loss, she said. And it's worth remembering that the families may have already been going through a grieving process, as they've watched a person trapped in the disease and seemingly losing their core values.
"And their families see them disintegrate, oftentimes quickly, other times slowly," she said. "I think the family sees something happening, and they see that person that they love slipping away—a grieving process goes with that."
Other times, rather than offering the comforting words they typically would, people act like the person chose to die.
"'Oh, how did they die?' 'Well, they died of addiction?' 'Oh! That's not like someone dying of cancer,' can be the perception of some," Mitrokostas said. "I think that is changing. But we still have a lot to do to know that this was somebody's child, mother, brother, sister, friend, coworker—the same as it is when we lose someone to an accident or cancer. It is still the same person, and it is the same loss."
As overdose deaths increase, Mitrokostas said some families are using their loved one's obituary to talk about their addiction problems. They're pushing back against any stigma, hoping that the information may help another family.
"I think it takes tremendous courage," she said, "for anyone to risk the judgment in addition to the incredible grief that goes with losing any loved one. To take that chance that you will be judged, or your loved one will be judged, takes tremendous courage."
Sometimes it's children who feel the stigma of shame or scorn. Mitrokostas said in one Cape Cod elementary school last year, seven children lost parents to addiction. In reaction, Gosnold has placed clinicians in 15 Cape Cod schools to help the children—and their peers—cope.
"What does the child say to their friends? 'How did your mother or father die?'" she said. "We grew up hearing someone's dad died of a heart attack, or somebody's mom died of cancer, or an accident."
Outside Falmouth's recreation center, Samantha Mueller watches her 2-year-old daughter play on the jungle gym. In 2011, Mueller lost her 16-year-old brother Jack to a drunk driver. Then, last year, she lost her other brother, Alvah Pearsall, who went by the name Squig, to a heroin overdose. Now, she's desperate to keep her daughter safe.
"It's scary," she said. "My kid, she just turned two—and it gets pretty emotional, actually, just thinking about it…"
Out of her grief, Mueller started a youth advisory group called 'Jack's Pact.' The idea is to highlight the positive things kids do in the community, and bring awareness to the issues of drunk driving and addiction. The goal is to save as many young people as she can.
"That's what we're all trying to figure out—how do we prevent substance abuse, or dependence. I just hope my kid can learn from husband and I, and my family. We talk about Uncle Squig, we talk about Uncle Jack."
This is how some people react to an overdose death—they talk about it. Like Mueller with Jack's Pact, Rachel Tinney started a group of her own called "The Open Doorway of Cape Cod." Both women are pushing through their grief and past any stigma in order to reach out, start new organizations, and do what they can to make things better.