A fatal overdose, a stunning coincidence, and a mother’s long quest to heal.
The phone rang, piercing the lonely quiet of Joy Fishman’s Manhattan apartment. It was October 2003, and Joy was watching TV and waiting for her husband to come home. She glanced at the caller ID. 305. Miami-Dade County. Her heart raced. At this hour, after 9 p.m. on a Tuesday, it had to be about her son, Jonathan.
Jonathan was 32 and had struggled to quit using heroin for nearly a decade. He had been arrested some two dozen times and gone to rehab more often than Joy could count. She had tried everything she could think of to help her son. She had issued stern warnings, staged interventions, accompanied him to detox, paid for inpatient care, and searched for experimental therapies. She had received so many calls about Jonathan that they’d become a way of marking time, like tracking a child’s height with pencil marks on the frame of the kitchen door.
Still, in the months leading up to this particular call, Joy had allowed herself to feel hope. Jonathan had moved in with his girlfriend, Ashley, and even introduced her to Joy. He had a job at a treatment facility helping other people stay sober. In the past, Jonathan’s drug-free stretches lasted only days or weeks, but now he hadn’t used in roughly two years—his longest stint without heroin since his early twenties. Joy had let a sliver of optimism into her life, a faint belief that this time Jonathan’s sobriety would last.
But when the phone echoed through the apartment, Joy knew it meant bad news. She always knew. She picked up the receiver. Her daughter, Julie, was on the line. A suburban Miami hospital had called her. The doctor had spoken tersely, with an urgency reserved for news of the dead and dying: Jonathan’s family should hurry.
The next morning, Joy and her husband, Jack, arrived in Miami on an early flight and raced to the Hialeah Hospital intensive care unit. Joy greeted Julie with a hug, a long one, like those Jonathan often gave the people he loved. She glanced at her son on the bed. His hefty frame—six foot two and 250 pounds—was a commanding presence even in stillness. She kissed his forehead, leaning around the breathing tube that obscured most of his face, and placed a hand on his tattooed arm. It seemed cool to the touch. “I knew this was going to happen one day,” Joy said. “I knew.”
The day before, Jonathan had been dumped outside the hospital, unconscious and weakly gasping for air. A nurse rushed outside and observed the pinpoint size of his pupils—a telltale sign of an overdose. Hospital personnel hoisted him onto a stretcher and raced him inside. A doctor ordered a drip of naloxone, a clear, odorless drug that can reverse the effects of an overdose. But the drug didn’t work—its efficacy depended on being administered as soon as possible after an overdose, and that narrow window had closed as Jonathan lay sprawled alone outside Hialeah’s doors.
Moments after receiving the naloxone drip, Jonathan stopped breathing, and his heart went into overdrive. A doctor ripped open his shirt, slapped two pads onto his chest, and powered up a defibrillator. “Clear!” they shouted. And again. “Clear!” The electrical shocks jolted through Jonathan’s body, resetting his heart to a steady rhythm. Hialeah’s doctors called his next of kin to tell them that Jonathan was in critical condition.
After Joy’s arrival, at the family’s request, the doctors agreed to send Jonathan to Jackson Memorial Hospital, one of America’s best-resourced medical facilities, located in the heart of Miami. Joy had been there before with Jonathan and knew it had more specialists, more advanced treatment options, and more hope to offer. Paramedics loaded Jonathan into an ambulance for the seven-mile trip. As the ambulance neared Jackson, seizures violently shook Jonathan’s body, and he had to be sedated. Jonathan went into a coma. For the next two days, doctors ran a battery of tests looking for any sign that he would recover. They found none.
Joy had always thought that the worst day of her life would be the one when she attended Jonathan’s funeral. She had never considered that she might have to make the decision for him to die. One night as Joy was leaving the hospital, she passed a young man in a motorized wheelchair; he was hooked up to tubes that assisted his breathing. She thought, I can’t let Jonathan live like that.
Before she could tell the doctors that she wanted to take her son off life support, however, the hospital staff informed Joy that Jonathan had died. It was as if he had spared his mother one final agony. A decade later, Joy would find a way to do the same for other parents in her position, thanks to a remarkable coincidence and some unlikely allies.
Jonathan was born in 1970, two weeks before the new year. When New Year’s Eve arrived, Joy held a flute of champagne and thought about how sweet the rest of her life would be. She had left suburban Long Island, where she was raised, and traveled the country selling Italian-made clothes. She’d married Dan Stampler, the tall, dapper owner of the Steak Joint, a Greenwich Village fixture that served portions so big Stampler was credited with inventing the doggie bag. As midnight approached, Joy checked on baby Jonathan and gazed out the window to watch fireworks explode over a snow-covered Central Park. This is as good as it gets, she thought.
The family soon moved to Miami Beach, where Joy would have a house, a yard, and a slower pace of life. There, Stampler’s heavy drinking worsened. At home, when his tumbler ran dry, Stampler sometimes screamed at her and hurled the empty glass at the wall. He ignored her pleas to seek treatment. So Joy left him, abandoning her dreams of an easy life, to protect her children.
Divorced by age 30, Joy worked odd jobs and attended psychology classes in the evening to become a therapist. A professor advised Joy not to get a job that involved seeing patients—he felt that she was too direct and dismissive. She began working for a 30-bed drug-treatment program run by Catholic Charities, a faith-based organization that oversaw a network of social services. Her take-charge attitude and talent for tackling laundry lists of tasks led her up the ranks. Before long, she was running the program.
When it came to recovery, Joy clung to a philosophy of abstinence, which fit with national opinion. In the 1970s and ’80s, the war on drugs was in full swing. Politicians spoke about illegal drugs and those who used them as threats to America’s moral fabric. The country had moved from an era of hippies and hallucinogens to one of Just Say No and D.A.R.E. A fundamental misunderstanding of dependency flourished—that it was a personal weakness, a failing. The American Medical Association wouldn’t formally recognize drug addiction as a disease until 1987.
Joy understood that addiction could be passed down from, say, father to son. But she didn’t view it as a chronic condition like, say, heart disease or diabetes that required regular care and treatment. She thought it was best countered with strict rules, not coddling.“Mothers were dragging their sons in,” Joy recalled of the Catholic Charities center where she worked. “The first thing I would say is, ‘Mother, get lost!’ That was the philosophy: ‘Get out. He’s going into the program; he’s not holding on to your apron strings.’”
As Jonathan grew into a tall, lanky teenager, early signs of depression appeared. Joy worried that his severe acne, along with what she suspected to be an undiagnosed learning disability, had stymied his self-confidence. She tried to help. She enrolled him in therapy and performed small acts of love; on rough days, she made him his favorite food—tuna salad on a toasted bagel. The family moved to New Orleans in the mid-1980s to be with Joy’s new husband, Norman, and then back to Miami when the marriage fell apart. Joy sent Jonathan to a boarding school in Vicksburg, Mississippi, hoping that the structure would help. But he was soon kicked out for using drugs and moved back to south Florida. There, Joy caught Jonathan smoking pot, stuffing towels under his bedroom door to hide the smell. She took a hard-line approach: Joy warned Jonathan not to use drugs, grounded him when he did, and threatened rehab when the behavior persisted.
None of it helped. In Miami, Jonathan was part of what Julie called the “burnout crew” at Miami Beach Senior High School. “Seven o’clock in the morning, someone would pick us up, and we’d get high on the way to school,” Julie recalled. She remembered walking in on Jonathan in their apartment building’s storage room, where he was hanging out with friends and holding what appeared to be a crack pipe. Julie figured that he was just experimenting.
Joy moved Jonathan to an alternative school, where he eventually earned his GED. When he was 17, she staged an intervention in their living room. Julie was there. So were Jonathan’s grandparents and a recovery specialist who urged him to enroll in a rehab center called the Village. Jonathan walked out that day, upset, but he enrolled at the center shortly after. He stayed for over a year and eventually took a job there, making sure other people in recovery showed up to their meetings. In 1993, he moved to New Haven, Connecticut, to attend Southern Connecticut State University and be closer to a girlfriend. After a year, though, they split up and Jonathan moved back to Miami.
At first, Joy was relieved to have her son nearby. But soon she noticed signs that Jonathan was using again. He started stealing things to pawn for drug money. Not just for pot, but for heroin, too. When he stole a sterling-silver set that had been passed down through the family for generations, Joy decided to cut him out of her life. She even took out a restraining order, vowing to keep it in place until he got his act together. “I didn’t know what else to do,” she said. “Tough love was the prescription.”
One day in 1996, Joy got a call informing her that Jonathan was going through withdrawal. She rushed to his side. Sitting in the emergency room at Jackson Memorial, waiting for a bed to become available, she wondered if her strict approach had driven Jonathan deeper into drug use. She had acted with what she believed were the best intentions, but in doing so she’d limited her ability to step in as his addiction worsened. Now she watched Jonathan as pain coursed through his body—every ounce of him seemed to be screaming for more heroin. She made a silent promise to do whatever it took to help him.
After Jonathan got out of the hospital, Joy attended a meeting for family members of addicts, held in a church recreation room. She’d been there before and found comfort. She sat in the circle and listened to other parents talk about how they had distanced themselves from their children. “If you told the group you didn’t answer a phone call from your son, everyone applauded,” Joy recalled. For the first time, that approach seemed cold, even spiteful. The more she scrutinized the abstinence model—the didactic embrace of sobriety, the callous treatment of those who used—the more uncomfortable she became.
When other people in her life got sick, she offered help. Why should she treat someone with addiction any differently? Joy began trying to meet Jonathan’s needs, whether that meant giving him money, cooking him a meal, or intervening in dangerous situations. One night at 3 a.m., Joy awoke to the sound of the phone ringing. “He was with a girl,” Joy said, “and they were having a fight in a motel.” Joy drove to where they were staying. She calmed Jonathan down enough to defuse things before the police arrived.
She had no textbook, no support group, no friends who understood the complexities of her situation. “It wasn’t something that you talked about,” Joy said. “I was alone.”
Joy had always been a social butterfly, someone who loved cocktail hours and dinner parties. When Jonathan was using, she needed a release more than ever, experiences in which she didn’t have to think about her son. One night, Joy went with friends to Williams Island, an enclave of luxury condos and spas that caters to rich Floridians. With short blond hair that emphasized her prominent cheekbones, Joy, by then in her early fifties, commanded attention. The event she attended happened to be singles night. After some mingling, two of her friends approached her with a question: Did she want to meet a man in the crowd who was lovely and rich? Joy said yes. A few minutes later, a fellow in his mid-sixties, wearing a sport jacket and jeans, approached her. His name was Jack Fishman, and he asked her to dance.
The next evening, they dined at an Italian restaurant. Joy found Jack charming, and the two quickly became an item. To some people, Jack seemed aloof, his wry humor lost under a heavy Polish accent. But Joy enjoyed his insatiable curiosity for the world. They took walks on the beach and traveled everywhere from the Florida Keys to the English countryside. Jack adored her. He was known to say to friends and family, “Isn’t she beautiful?”
Jack’s family was Jewish. They had escaped Poland after the Nazis invaded, securing forged Nicaraguan passports and fleeing over 7,000 miles east to Shanghai when Jack was eight. The Chinese city, occupied by Japanese forces, was known as the Port of Last Resort for providing Jews with safe harbor. Still, under pressure from their allies, Japan forced some 20,000 Jewish refugees into a crowded ghetto. After the war, Jack moved to New York to become a rabbi, but once he arrived at Yeshiva College, he was drawn to chemistry instead of the Torah. He pursued this new love in graduate school, studying under Carl Djerassi, the inventor of the birth-control pill. Over the next three decades, Jack became a widely admired cancer researcher—he was described by one peer as a “scientist’s scientist.”
By the time Jack met Joy, he was an executive for a pharmaceutical company called Ivax, which manufactured and distributed generic drugs. Joy tried to keep track of Jack’s accomplishments in the field—there seemed to be many—but he offered up few details. He had studied estrogen’s link to breast cancer, producing papers that would be cited thousands of times. He had consulted with the world’s top government health agencies. And he had created a variety of chemical compounds and medicines, including one that he called a “miracle drug” for the way it interacted with opioids. Joy was intrigued but didn’t ask him to talk more about his work. Who wanted to discuss the past when they could focus on their golden years together?
Jack kept at a certain remove from Jonathan. He listened when Joy vented to him about her son, but he never became involved in the hard work of parenting a child battling addiction. “He was supportive of me, but he wasn’t warm and fuzzy with Jonathan,” Joy said. “He wasn’t warm and fuzzy with his kids.” (Jack had four sons from previous marriages.)
Joy was the one who took all the phone calls from Jonathan. Mostly they were about his arrests—for petty theft of AA batteries, deodorant sticks, or the occasional bottle of champagne—or something that he needed from her. When days went by without a call, she grew worried that Jonathan was locked up or, worse, that he had died. She would go to Overtown, a neighborhood widely considered to be the epicenter of Miami’s opioid crisis, and show Jonathan’s photo to store clerks and drug dealers. “Have you seen my son?” she would ask.
Joy scoured magazines and academic journals for information about addiction. The more she read, the more confused she became. There seemed to be no consensus about how best to help someone using opioids. “I was heartbroken not knowing what to do,” Joy said. Sometimes, when she felt particularly directionless, she fell into spells of tough love. In May 1998, Jonathan called her while in the grip of withdrawal. Joy asked what he needed. “Some drugs,” he told her. Though saddened and frustrated, she nevertheless offered to help by contacting friends. “I called everybody asking, ‘Do you have any OxyContin?’ Nobody did,” Joy said. Jonathan then asked Joy to buy him heroin. She picked him up and, following his directions, drove to a gas station parking lot. She gave Jonathan $30, he bought the drugs, and then Joy drove him back to her home. A police car was waiting.
Before Joy had left the house, she’d asked Jack to call the authorities. Not wanting to be arrested for helping Jonathan buy drugs, she told the responding officer that she and Jonathan had gotten into a “verbal altercation,” according to the police report. The officer then asked Jonathan if he had a drug problem. Jonathan said he did and that he needed help. Joy watched as Jonathan pulled the heroin her money had paid for out of his pocket. The officer slipped Jonathan’s hands into wrist ties and walked him to the squad car. “I put my kid in jail because I thought it was safer,” Joy said. Better locked up than dead.
In 2000, Jonathan drifted further out of touch as he cycled in and out of jail on a string of felony theft charges. Joy’s life became hectic—she married Jack, then she contracted Rocky Mountain spotted fever from a tick and spent time in the hospital. “Jonathan just wasn’t around,” Julie recalled. “We didn’t know how to get the news to him.” During that period, drug use pushed Jonathan into homelessness. When Joy finally recovered from her illness, she rented Jonathan an apartment in the Miami area and furnished it with second-hand items from Goodwill. She bought him a guitar so he could play music. “I hoped to establish a state of normalcy,” Joy said, “something familiar, something like home.”
Jonathan participated in two offshore trials of ibogaine, a psychoactive drug derived from a West African plant root that some experts consider effective in treating addiction. (It has been fatal in certain instances and is classified as a controlled substance by the Drug Enforcement Administration.) He stayed sober for more than a year after the first trial. After the second, he worked as a driver for a treatment facility and moved in with Ashley, whom he’d met at the trial. Joy invited Ashley’s parents up to New York City, where she and Jack had a second home. They drank champagne and fantasized about a wedding date for Jonathan and Ashley.
Still, Joy knew that with her son, nothing good ever lasted long. “There was no peace,” she said. “You were always waiting for the other shoe to drop.” In October 2003, it finally did, with Jonathan’s death at Jackson Memorial.
Back then, silence seemed like a shield against stigma. Obituaries rarely mentioned that someone had died of an overdose. People chose vague language to describe their tragedies, or attributed the loss of a child, sibling, or spouse to an unspecified illness or a car accident. Joy, though, decided against that: In the obituary she published in the Miami Herald, she was honest about Jonathan’s addiction.
After the funeral, Joy attended a group meeting for parents who had lost their children to overdose. She noticed pictures of the deceased lining a stage. There was a tissue box under each participant’s chair. The sadness of those other parents, and the group identity they’d built around it, was jarring. It seemed to Joy that grief consumed their lives. She didn’t want to end up like that.
Instead, she poured herself into a relationship with Ashley. She treated the young woman like a daughter-in-law, calling her on the phone, catching up during visits to the home she and Jack kept in Miami, urging her to spend time in New York. Then, exactly one year to the day after Jonathan’s death, Joy’s cell rang as she was walking her dogs with Julie in Manhattan. Ashley had died of a heroin overdose. “I hit the ground,” Joy said. “I literally fell down.”
The back-to-back losses left her feeling twisted to the point of snapping. She now understood the impulse some people felt to keep grief private, to never talk about the loved ones who had died. It was too painful, too risky. Her pain surfaced in other ways. She asked Julie to consider naming her third child after Jonathan, but Julie declined—she didn’t want to pass along the weight of her brother’s traumatic life. In conversations with friends and family, Joy criticized President George W. Bush, who she felt prioritized sustaining the war on drugs over funding for addiction research.
In 2006, Israeli pharmaceutical giant Teva purchased Ivax, the company where Jack once worked and now sat on the board. The deal was worth $7.4 billion, in part because the previous year Ivax had formed a partnership with Purdue Pharma to distribute a generic form of OxyContin. It would be prescribed to and abused by untold numbers of people. According to Joy, at the time she was unaware of Ivax’s connection to the unfolding opioid crisis.
The Fishmans cashed in their stock in Ivax—combined, it was worth more than $100 million. They went from well-off to fabulously wealthy. The money couldn’t take away Joy’s sadness, but it provided a distraction—at least for a while.
By year’s end, though, Joy was staring down a new crisis: Jack was diagnosed with prefrontal dementia. Joy found herself back in the role of caregiver. She decided that, every day, she would allow herself to mourn Jonathan for exactly 15 minutes, while she showered in the morning. She could cry, but once she was out and had dried off, she would turn her attention to Jack. When he forgot an important detail about his life, she reminded him of it. When he repeated stories, she listened as if hearing them for the first time.
One day in 2012, a reporter from The New York Times visited the Fishmans’ posh apartment building—the San Remo, on the Upper West Side—to write a story about how much money its wealthy residents poured into politics. The conversation veered into Jack’s career as a scientist. A detail about Jack’s past made it into the story as a parenthetical: “Jack Fishman, along with his colleagues, invented and patented in the 1960s the drug Naloxone, which is given to people who have overdosed on opioids like morphine and heroin.”
Naloxone was the compound that Jack had told Joy was his “miracle drug,” the same medication that doctors had administered to Jonathan in a failed attempt to reverse his overdose. Those 29 words in parentheses would change the course of Joy’s life.
In the spring of 2013, Joy received a letter from a stranger. His name was Ethan Nadelmann, and he lived a few blocks away from her in New York City. He’d read the article in the Times and wanted to speak to Jack about naloxone. Joy called Nadelmann and arranged a time for him to come over.
Nadelmann was uniquely positioned to understand naloxone’s potential. As the founder of the Drug Policy Alliance (DPA), a progressive organization working to end the war on drugs, Nadelmann was evangelical about harm reduction, a philosophy that encouraged medical professionals, governments, and others to help people facing addiction become as healthy as possible, even if they continued to use. During the AIDS crisis, harm reduction inspired activists to distribute sterile syringes and bleach kits that could be used to disinfect dirty needles. Introducing naloxone to America was another step in the crusade to assist, not punish, drug users.
Better known by the brand name Narcan, naloxone prevents opioids from interacting with the brain’s receptors. If the compound is delivered by injection or sprayed into a person’s nose shortly after an overdose, the blue of a user’s lips will disappear. Pale cheeks will redden. Shallow breaths will deepen. Jack Fishman and his colleagues patented naloxone in 1961, and the Food and Drug Administration approved it for treating overdose a decade later. But it could be administered only by medical professionals, which limited its impact to hospitals and ambulances. By the time a person who had overdosed received treatment from a paramedic or doctor—if they got any care at all—it was often too late for the drug to work.
In the mid-1990s, harm-reduction experts began advocating for the antidote’s wide distribution, so that those closest to drug users could help save their lives. Dan Bigg, cofounder of the Chicago Recovery Alliance, convinced some doctors to quietly prescribe naloxone to heroin users and the friends of people who were at risk of overdosing. In January 2000, Bigg lugged black duffel bags full of naloxone to Seattle for a first-of-its-kind overdose-prevention conference, organized by Nadelmann.
Nadelmann saw naloxone as being to opioid users what an EpiPen was to people with life-threatening allergies—something that should be nearby at all times, just in case. He began lobbying state officials to decriminalize the antidote’s use outside hospitals. The DPA also urged police chiefs around the country to equip their officers with it. Yet opponents in many states, including Florida, were resistant to expanding naloxone’s availability. They believed it would encourage illegal drug use.
Without strong backing from government officials, Nadelmann went looking for private funding. Again he encountered resistance. Many health foundations, steeped in the gospel of abstinence, also worried that naloxone would spur drug use. Nadelmann pitched an oil scion and a rock star who had lost loved ones to overdoses. Neither wrote checks for naloxone advocacy, Nadelmann said—what had happened to them was “so painful, they wanted to run away from it.”
Nadelmann was eager to meet the drug’s inventor and perhaps win over Jack as a patron. But as Nadelmann entered the Fishmans’ apartment, Joy tempered his expectations. She explained that Jack, now 82, could barely remember the names of family members. “Jack’s dementia was far enough along where he couldn’t hold a conversation for more than two minutes,” Nadelmann said. The men briefly connected over the fact that Nadelmann’s father, a rabbi, had also fled the Nazis, but that was as lucid as Jack got during their meeting.
Still, when Joy invited Nadelmann to talk with her afterward he stayed. Feeling unusually comfortable, Joy began to talk about Jonathan. It was the first time she’d done so with a stranger. She described the havoc all those phone calls had wreaked on her life, the nights that stretched on and on with worry, the many attempts she’d made to help her son get drug-free. “Everything I mentioned, even things like ibogaine, he knew about,” Joy said. “He was the first person I knew that had deep knowledge about addiction. I respected him.”
Between 1999 and 2012, opioids had killed more than 220,000 Americans. Nadelmann was stunned that one of them was the stepson of naloxone’s inventor. “It was extraordinary,” he said. Nadelmann took the opportunity to draw back the curtain on the drug that Joy somehow knew so little about. He described the DPA’s campaign to get it from hospitals into the streets. He talked about how deaths could be prevented, how police officers and drug users could revive people before paramedics even arrived at the scene of an overdose. Parents who had lost children to drugs had recently testified at a federal meeting about making naloxone available over the counter, like allergy medicine. Slowly, doctors were more freely prescribing the drug to those who needed it. Florida, however, was not among the early adopters of progressive naloxone policies.
Quietly, as was her way, Joy was filled with anger and sadness. She knew that Jack had long kept a single vial of naloxone in their medicine cabinet, a memento from his life in the lab. She didn’t know that she could have used it—or, better yet, given it to Jonathan and Ashley to use if either of them overdosed. She already blamed herself for not doing more for her son. Now, as she pieced together the full irony of her family’s story, she marveled at the unfairness of it all, not least that she was realizing the truth at a time when Jack could no longer help her make sense of it.
As she and Nadelmann continued to talk over the following weeks, he encouraged her to help him grow the harm-reduction movement. She could share her story and help spread a lifesaving philosophy. They could get naloxone into the hands of people like Jonathan before it was too late. Few people were better positioned to push that message than Jack Fishman’s wife—the mother of a child who’d died of an opioid overdose and a person immersed in some of America’s wealthiest communities.
Joy saw the merits of Nadelmann’s pitch. Still, she was a private person with a patrician demeanor, someone who had decided to cope with her loss alone, for 15 minutes a day. She wasn’t sure she had the strength to talk about Jonathan often, much less to strangers. She was hesitant about her personal tragedy being the thing people knew about her. “I didn’t want to be a professional victim who was constantly referring to their child, holding a photo of him at age five, saying, ‘My poor son,’” Joy explained.
Nadelmann told her there were thousands of Jonathans across the country, young people tempting fate every time they used. Many of them would wind up dead at the end of a needle unless naloxone and other harm-reduction measures reached them first. “You have a responsibility,” Nadelmann told Joy. “You have to talk about Jonathan.”
Joy spent the following weeks processing the gravity of Nadelmann’s visit and his request. She desperately wanted to talk to Jack about it, to ask the thousand questions racing through her mind. But even if she asked them, he couldn’t answer. In December 2013, Jack passed away.
As Joy descended into grief yet again, it was Julie who took up the banner of harm reduction. She had learned how to administer naloxone, and in 2014, she attended a conference of the Harm Reduction Coalition in Baltimore. She texted photos to her mother of people wearing T-shirts that said, “Keep Calm, Carry Naloxone.” She told Joy about meeting grown men who cried as they talked about how naloxone had saved their lives. When she returned home, Julie told her three boys about Grandpa Jack’s miracle drug. She gifted the youngest a “Got Naloxone?” shirt. “It became part of our everyday lives,” Julie said. “Hearing people express gratitude for Jack’s invention made it more positive than just talking about the loss of Jonathan.”
Joy realized that Julie was right—that she should be cementing Jack’s legacy in the history of harm reduction. She and Jack’s biological children directed money from a family trust to the DPA, which helped Nadelmann cover the cost of training people to use naloxone. The prospect of turning knowledge into action energized Joy. It made her feel like she was doing something for her son. “Jonathan was a victim of an intolerant, prudish, and judgmental society,” Joy said. “I didn’t have the right words before, but I was giving my son his humanity back.”
One day she wrote Nadelmann an email. “I have this feeling I belong with all of you,” she said. Harm reduction was taking on greater national urgency. The government had tightened the flow of prescription opioids, forcing drug users to seek out more dangerous substances like heroin, fentanyl, and carfentanil. Researchers predicted that if nothing was done to stem the crisis, by the mid-2010s some 200 people would die of overdoses every day. Joy wanted to do more. Nadelmann said she should meet Hansel Tookes. He worked at the very hospital where Jonathan had died.
A 34-year-old medical resident at Jackson Memorial, Tookes was leading a campaign to lift Florida’s ban on syringe exchanges. He had come of age as a gay black man in Miami at the peak of the HIV epidemic and had dedicated his career to studying the virus and its impact. He did so first as a public-health researcher, collecting dirty syringes from sidewalks and under freeway overpasses. He finished medical school at the University of Miami. Now he wanted to open the state’s first syringe exchange, a place where drug users could come for supplies and care, free of judgment.
In late 2015, Joy went to a swanky restaurant in Miami to meet the young doctor. As waiters carried shrimp ceviche and chicken liver crostini to other tables, she waited—Tookes was late. When he finally arrived, the tall, bearded resident was in sea-green hospital scrubs.
Over the meal, Tookes explained that Florida’s opioid death rate had doubled since the early 2000s, due to a crackdown on pain doctors who churned out opioid prescriptions for cash. Miami-Dade County led the nation in new HIV cases, in part because more drug users, unable to get pills, were transitioning to heroin. In some cities, including Miami, a gay black man had a 50 percent chance of contracting HIV at some point in his life. Still, Florida lawmakers had ignored the evidence showing that other states were able to reduce infectious-disease rates and deaths by legalizing syringe distribution. Joy understood what Tookes was talking about: Jonathan had contracted hepatitis C likely through sharing dirty needles.
Tookes knew that stemming the tide of infectious disease went hand in hand with reducing opioid overdoses. The safer drug use became, through sterile needles, naloxone, and other means, the fewer the deaths and the lower the health-care costs.
Joy told Tookes about Jonathan, about how her tough love had evolved into a strategy of supporting him the best she could, how none of it had stopped her son from getting dumped outside a hospital. Tookes was struck by Joy’s candor, the power of her story, and the grace with which she talked about her son. “I’m not easily intimidated or impressed,” Tookes said. “But I was intimidated and impressed by Joy. She had a powerful aura.”
Tookes broached the topic of his push to have Florida’s ban on syringe exchanges lifted. He asked if Joy would be one of the faces of the campaign, if she would tell Jonathan’s story to a wider audience. She wanted to know if he was willing to have his staff and volunteers distribute naloxone. Tookes said he was open to the idea.
Joy left the meeting knowing she wanted to help Tookes—the question was how. She spent the next few weeks thinking about Jonathan. On his best days, her son had been in the trenches, helping fellow users cobble together stretches of sobriety. “There comes a time when you can’t just write a check, where it doesn’t mean anything,” Joy said. “You have to be hands-on.” She contacted Tookes and said as much. Tookes knew exactly where she could start.
Tookes had been lobbying the Florida legislature to eliminate the syringe-exchange ban since 2012, but his opponents had routinely dismissed or outmaneuvered him. Most recently, in 2015, a conservative lawmaker who chaired a subcommittee in the Florida House of Representatives had refused to grant a hearing on a bill legalizing statewide needle exchanges that Tookes helped craft. In response, Tookes narrowed the bill’s scope: The new version called only for a privately funded pilot exchange in Miami. If he started small and showed that sterile needles worked, maybe it would pave the way for more exchanges. And if the pilot program was funded with private donations, including a substantial check from Joy, the bill would be heard by the health and human services committee. Tookes hoped it would be an ideal venue, given that some of the legislators seated on it were medical professionals.
Tookes considered Joy, and the power of her family’s story, to be his ace in the hole. He asked her to speak before the committee, hoping she could secure approval for the bill to go up for a vote in the Florida house. With matters less personal, Joy had little problem speaking before an audience. But this would require the kind of public soul bearing she had long feared. She would have to talk about Jonathan. And what about Jack—would she need to say that her husband could have done more to make naloxone available to everyone who needed it, including her son? Many of her closest friends, had they been in her shoes, would have left those stones unturned. “I was petrified,” Joy said.
One day in February 2015, Joy walked down the halls of the Florida State Capitol, the sparkles on her navy blue blouse glistening in the fluorescent lighting. When she entered the room where the committee hearing took place, it was packed with lobbyists and concerned citizens, there to debate the needle-exchange bill and other measures. As she waited her turn to speak, lawmakers and speakers spent two hours debating the merits of everything from medical marijuana to insurance reform. Finally, the committee took up the Infectious Disease Elimination Act and called Joy’s name.
She gripped the dais with her right hand, stood up straight, and glanced toward the lawmakers. She hadn’t prepared a speech, but she knew what Tookes needed from her. That didn’t include talking about Jack if she didn’t want to, if she wasn’t ready. She just needed to tell Jonathan’s story and emphasize how a program like the one Tookes envisioned would have helped her son, how it could help others.
Leaning slightly toward the microphone, she said, “My son, Jonathan, died of a heroin overdose.” Digging her left thumbnail into the tip of her finger, she looked ahead, trying to appear confident, as if she’d done this before. She tripped over a few words but quickly recovered, explaining how Jonathan had stolen needles, not because he was a bad kid but to take care of himself. “To get needles, you need a doctor to write the prescription,” she explained. “You need money to pay for the needles.” She noticed some of the lawmakers nodding their heads.
“I know that all of you know someone—a relative, a friend—who is an addict. This is going to be a program where not only will they get clean needles, but they’ll be educated [about] opportunities for rehab,” Joy said. To close her remarks, she referred back to the key tenets she’d learned from Nadelmann and Tookes. “It’s called harm reduction,” she said “We want to see less overdoses, less cases of AIDS, less cases of hepatitis C. Thank you.”
Joy sat back down. “I had a feeling of accomplishment,” she recalled, “that I did my job. I hoped it would mean something.” A few other guests offered their support for the bill. There was little opposition, in part because of how lean the bill had become through Tookes’s effort to appease conservative lawmakers. Then the committee members debated among themselves.
When the vote happened, it was so quick and simple that Joy could hardly believe it. The bill passed and was sent to the legislature. A few weeks later, Tookes called her. He was ecstatic. After years of opposition and excuses, the bill was becoming a law. Governor Rick Scott had signed it, and it would be in effect by the beginning of the summer. Joy, Tookes said, had broken the logjam.
Joy and Tookes worked together to open the exchange, becoming friends and confidants in the process. They were an odd couple—a gay black millennial who did yoga and traveled the country to see Mariah Carey concerts, and a Jewish grandmother with multiple homes who loved rescue dogs. When Tookes’s mother passed away, Joy took him and his partner out for dinner on difficult, lonely nights. When Joy posted on Facebook about missing Jonathan, Tookes reminded her that she was loved. When they weren’t swapping stories over crab legs or glasses of champagne, they were calling or texting each other.
Tookes handled the logistics of opening the exchange, which would be housed in two renovated shipping containers set up near Jackson Memorial. Joy drummed up support. She wrote a personal check for $50,000 and helped raise another $150,000—enough to fund the exchange’s first year of operations. She told a Miami Herald reporter that she missed Jonathan’s bear hugs and that the exchange would allow other mothers to keep hugging their sons. In the interview, she pulled out a single-dose, nasal-spray bottle of naloxone. “I always have it,” she told the reporter. “Everyone should.”
Tookes sent mothers who had lost their children to speak to Joy. “They would be desperately searching for catharsis,” Joy said. She listened, comforted them, and encouraged them to channel their grief into supporting harm reduction.
The exchange opened on December 1, 2016, World AIDS Day. Things were so busy from the beginning that it wasn’t until the following March that Tookes was able to hold a press conference announcing the program. A gaggle of reporters, doctors, and police officers were there. Standing behind the podium, Tookes said that his team would offer free naloxone to anyone who needed it. He had another announcement, too, something he hadn’t yet discussed with Joy—the exchange’s mobile unit, which traveled the city helping people in need, would be named after Jonathan.
Joy was floored. Tookes thanked her for her support and urged her to speak to the crowd. “I’m sorry [Jack] is not with us today to see what a miracle drug he created,” she said. When she mentioned Jonathan, her voice trembled and cracked slightly. She vowed to be a “spiritual mother” to people who came to the exchange. “This is a place where a drug-addicted person can come, not be judged, not be called slang names, and be accepted as a human in need,” Joy said. “We welcome them here. We look at them as full human beings.”
After years of feeling alone with her grief, Joy had found her tribe. She locked eyes with Tookes and hugged him. He’d helped her turn Jonathan’s life into more than a tragedy. “You can’t live with that sadness all the time,” Joy said later. “Holding on to that pain is destructive.”
Joy returned every few weeks to volunteer at the exchange. As wary visitors entered the shipping containers, she greeted them warmly at the front desk. She was direct but never dismissive—that old psychology professor of hers had been wrong. She instructed people to count off the number of dirty needles they had brought in and to throw each one into the trash. She took them to a corkboard affixed with various gauges of needles. After people chose their preferred size, Joy filled their orders. In brown paper bags, she assembled sterile syringes and cookers, tourniquets, lighters, and condoms. She directed anyone who wanted to be tested for infectious diseases or to seek treatment for addiction to Tookes’s office. And she told everyone who’d listen about naloxone, urging them to take doses of Jack’s drug wherever they went.
Her work was a far cry from what she once did with Catholic Charities, telling mothers not to coddle kids struggling with addiction. She insisted that regular patients stop referring to her as Mrs. Fishman. To them she became Mama Joy.
The Fishman family does not receive any profits from sales of naloxone. Jack developed the drug for a commercial firm and never renewed the patent. Today, his antidote is available from pharmacists—without a doctor’s prescription—across the country, and it’s covered by most health-insurance plans. Yet access to naloxone isn’t where harm-reduction advocates want it to be. They criticize politicians who still preach abstinence and drug companies that have raised the price of the antidote. They continue to ask the FDA to approve naloxone for over-the-counter purchase, which the agency has failed to do despite publicly acknowledging the good it would do. As a member of the DPA’s national board, Joy is involved in pushing for greater naloxone availability nationwide.
When policymakers aren’t standing in the way, harm reduction works. One day in September 2019, Joy sat behind the exchange’s front desk, waiting to hand Jack’s drug to anyone who needed it. Since opening, the exchange had collected 360,000 dirty syringes, provided medical treatment to 1,200 people, and helped 200 patients detox. An estimated 1,450 overdoses had been reversed. Earlier that day, the drug had saved a patient found splayed out on the sidewalk near the exchange.
According to the most recent data available, opioid-related fatalities dropped in Miami-Dade County in 2017 for the first time in five years; in other Florida counties, death tolls continued to rise. Those statistics are among the evidence that’s helped convince state lawmakers once skeptical of harm reduction to support the cause. In the spring of 2019, the Florida legislature voted to allow any county that wanted a syringe exchange to open one. By early 2020, officials in five additional Florida counties had lifted local exchange bans, clearing the way for future harm-reduction services from Tampa to Tallahassee. Still, most counties have yet to follow suit, and the ban on using public funds for exchanges remains intact. For her part, Joy continues to donate money to Tookes’s exchange.
There’s a whiteboard at the exchange that, on the September day when Joy was volunteering, had a message scribbled on it: “It’s important to meet people where they’re at, but not leave them where they’re at.” She knows the mantra well. In her life, it applies to more than just Jonathan, Ashley, and the patients at the exchange. She has a boyfriend, a man named Ken Peters. In December 2018, one of his two sons fatally overdosed. Rather than leave him where he was, consumed with grief, Joy offered support and guidance. She remembered how hard it was after Jonathan died when someone would ask how many kids she had. She urged Peters to always make space for both of his boys. “Just say, ‘I have a son, and I lost another son to overdose,’” she told him.
Peters carries those words wherever he goes, along with a dose of naloxone that Joy gave him.