Retired Adm. James “Sandy” Winnefeld had barely left the CBS News studio in New York last November when his phone started to blow up.
As a contributor to the network, the retired four-star often appeared to talk about military and homeland security issues. But this time was different. He had shared a deeply personal, recent tragedy and told viewers about a nonprofit that he and his wife, Mary, founded together.
The reaction from viewers was immediate. People cheered him on, others wanted to know how to get involved. Emails poured in from people asking him for help.
Winnefeld had revealed what happened to his son Jonathan, who dealt with anxiety and depression for years and developed an addiction. Jonathan successfully moved into recovery, then died from an accidental opioid overdose in his dorm room at 19. The details of Jonathan’s life appeared in an essay Winnefeld wrote for The Atlantic.
“He knew what he wanted to do,” Winnefeld said of Jonathan in an interview with the Washington Examiner. “He wanted to live. He wanted to help other people and now he can’t. And that’s not fair.”
It’s a story familiar to so many families amid the opioid crisis, a complex, turbulent issue that has led to more than 350,000 deaths since 2000.
The toll is so widespread that it has captured the attention of policymakers on both sides of the aisle, and its characteristics have reframed the conversation on addiction. Lawmakers who once prioritized incarceration and arrests have switched to compassion and treatment. They recognize that recovery often takes several attempts.
As public health and law enforcement officials get to work in their communities, many families have been left struggling with what to do, losing loved ones to addiction and death.
“With the opioid addiction as it is now, it is akin to a war-torn generation of aggrieved families,” said Aaron Hogue, director of adolescent and family research at the Center on Addiction in New York. “The number of people left behind because of it is staggering.”
‘No family is safe’
The Winnefelds’ story doesn’t fit the stereotype of an addiction that preys on the poor and marginalized.
On a hot, sticky day in April, the Washington Examiner was invited to the Winnefeld home in a suburb outside D.C. to discuss their nonprofit, Stop the Addiction Fatality Epidemic, or S.A.F.E. The neighborhood is in a secluded, serene area, where lawns are carefully manicured and flowers pour out over white picket fences. It is home to members of Congress, diplomats, and high-ranking government officials.
Winnefeld, too, has served at the highest levels of government. His career led from the cockpit of F-14 Tomcats to command of the aircraft carrier Enterprise to vice chairman of the Joint Chiefs of Staff, the second-highest position in the entire military. He even advised the crew during the filming of “Top Gun” in 1986 when he was an instructor at Miramar.
He retired almost three years ago after spending 37 years in uniform. He calls his retirement a “transition,” because he had expected to stay in the action by joining boards, advising start-ups, and teaching.
Winnefeld didn’t plan on the personal tragedy that would lead to a newfound purpose, one that he considers not only a national security issue but a way to carry out Jonathan’s wish to help others.
At his home, he ran through his travel schedule with the organization’s executive director, Rosemary Williams. A former commanding officer of Fighter Squadron 211, Winnefeld was back in the ready room, rattling off agenda items as the organization gets off the ground. His workspace had materials for the organization, including pamphlets and T-shirt with its logo.
His work involves fundraising, sharing his family’s story with students, speaking before massive audiences, and traveling to learn about community efforts.
The Winnefelds weren’t spared, despite their social status. Winnefeld sees this reality clearly, which he discussed openly in his Atlantic essay, “No Family is Safe from this Epidemic.”
“It remains an equal-opportunity foe,” said Molly Bobek, director of clinical implementation at the Center on Addiction.
Jonathan’s path toward addiction started with a misdiagnosis of attention deficit disorder; he actually had anxiety and depression. A doctor prescribed him Adderall, a stimulant that can cause insomnia, irritability and restlessness. To come down off the drug, Jonathan self-medicated with alcohol and marijuana, then moved to pills such as Xanax that helped him relax.
Jonathan was a gifted pitcher, but by senior year of high school, his grades were too low to continue playing baseball. He loved the sport since he was a toddler. His parents bought him a Tee-ball set on behalf of his is older brother, L.J., who was also his best friend.
“It was a real blow to him,” Winnefeld said of Jonathan’s inability to continue the sport. “He loved baseball and was good at it and loved being part of a team.”
Jonathan’s recovery and death
A little over a year later, the Winnefelds thought Jonathan was heading toward recovery.
After taking a year following high school to complete an alcohol and drug treatment program, Jonathan was preparing to begin his first year at the University of Denver.
He wanted to be a paramedic fireman, and had just written an essay explaining why: He had recently discovered his purpose was to help people who were unable to help themselves. He referred to himself in the essay as a “former addict/alcoholic,” and shared how he had used his emergency medical technician certification to help a man having a heroin overdose.
“I used to just stay sober because I saw it as something necessary I must do to just live life normally,” he wrote, “but now I see that I must take advantage of being sober in life because so few addicts get the chance to be sober and live life to its fullest potential.”
Jonathan was looking forward to working as an EMT during his first year of college, as part of a medical team on hand to help fans at Denver Broncos games and University of Denver events. The program managers recommended he also receive an electrocardiograph certification, which would have helped him identify heart abnormalities in patients.
To earn the training, Jonathan was taking night classes near Denver Health. The timing worked out well — the program kicked off before the fall semester, and the Winnefelds had a home in Colorado so they were in an area of the country he knew well. The elder Winnefeld had served as commander of North American Aerospace Defense Command.
But the training facility was in a part of town with drug dealers. This is where the Winnefelds believe Jonathan obtained fentanyl, an opioid 50 times stronger than heroin.
A few days after his parents dropped him off at college, Jonathan was found unresponsive in his dorm room bed. His parents were stunned not only because he had been so eager to start college and showed such improvement, but because they learned that fentanyl had been the cause. This was the first time they had heard of him using opioids.
“You wake up every day, no matter what you are doing, no matter what great things you are going to do that day, with this constant background noise of sadness,” Winnefeld said.
Even now, the Winnefelds aren’t certain when Jonathan started using opioids, a category of drugs that not only includes heroin but prescription painkillers such as OxyContin. They knew that in treatment he had been prescribed Vivitrol, which can be given to patients with opioid addiction, but also treats alcohol addiction. When patients turn 18, healthcare providers can withhold more information from families.
Winnefeld now says he believes that when Jonathan submitted his essay he was a week into a drug relapse. He remembers his son complaining of an accelerated heartbeat, and he noticed that he was sweaty and jumpy. Winnefeld thought he had anxiety over starting school, but now he believes he was in withdrawal.
If the Winnefelds had known about his opioid use they would have been more careful, Winnefeld said. He and Mary had planned to enroll Jonathan in a section of the college dorm that would be substance-free, but were told upon arriving that no such segment existed.
“If we had any idea that he had an addiction to heroin, if we had any idea that market was there, we would have just taken much tighter steps to keep him in a controlled environment throughout that whole transition process than we did,” Winnefeld said. “We just didn’t know. We thought we were doing the right thing for him; we just didn’t know any better.”
The Winnefelds had been deeply involved in their son’s medical treatment and tried to help him. Along the way, they learned a lot about addiction, but they didn’t know about the opioid epidemic. After Jonathan’s death they learned just how widespread and horrifying it had become.
Despite all that happened, they believe the situation can be turned around and want to help other families.
“It takes a lot of persistence, love, understanding, and, above all, knowledge,” Winnefeld said. “We had all of those other things, but we didn’t have the knowledge.”
Fentanyl’s effects in the U.S.
The drug Jonathan took, fentanyl, kills more people in the U.S. than any other type of opioid. Like heroin and prescription painkillers, it binds to pleasure receptors in the brain, where it not only dulls pain but creates euphoria. Unlike heroin, it’s much more potent and is made from chemicals, not from the natural opium contained in a poppy plant.
Doctors use fentanyl during surgery as a pain reliever. In the illegal drug market, it can be ordered online and delivered through the mail, coming mostly from China through Mexico and Canada. Drug dealers mix it with heroin or other drugs, promising users a more intense high at a cheaper price.
But often, a person who buys cocaine or heroin doesn’t know it has been tainted with fentanyl. Minute amounts can lead to an overdose.
“Opioids sedate the part of the brain that tells the body to breathe, so people go to sleep and they forget to breathe and don’t wake up,” said Dr. Kelly Clark, a board member for the American Society of Addiction Medicine.
Even though public health officials have largely moved away from messages telling young people to “just say no” to drugs, the opioid crisis has added a chilling reality: If the batch of drugs someone purchases contains fentanyl, a first try can be someone’s last.
Winnefeld said in a recent panel about adolescent drug use that when he talks to students, he stays away from the message of, “Just don’t start,” or, “Just say no.” Instead, he goes with the motto, “Just say k-n-o-w.” He finds students respond well to descriptions about how addiction changes the brain.
Pam McClellan, supervisor of counseling services for Arlington Public Schools in Virginia where Winnefeld has spoken to students, said she has seen schools and the community talk about drug addiction more openly. In classrooms, a substance abuse counselor will describe a drug’s effect on the body and brain, and lay out the consequences of drug use and addiction. They discuss links between drug use and mental health, and teach skills for resilience.
“We are part of the explosion of much more open communication; there are many more events and opportunities that everyone seems to want to provide to educate each other,” McClellan said.
Addiction’s toll
A lot of people become addicted to substances in the same way Jonathan did, as a way to alleviate mental health difficulties. Others experiment with drugs at a time when the teenage brain is still developing and is deeply susceptible to addiction.
But a third pattern has been especially pronounced during the opioid epidemic. People have become hooked on painkillers after receiving prescriptions from a doctor, then they switch to heroin, which has become inexpensive and easily accessible.
The nature of the opioid crisis has shifted the debate around addiction treatment, though medical professionals have for decades referred to addiction as a chronic brain disease.
“We understand addiction as a biological, emotional, psychological, and social phenomenon marked by strong compulsions,” said Bobek from the Center on Addiction.
Treatment can be lifelong, and has many levels, including counseling, peer support and drugs to ease the pain of withdrawal.
“You don’t look to have people recover from addiction the way they recover from a broken bone or respiratory infection,” Clark said. Instead, she likened it to managing conditions such as diabetes.
The experience will be different for everyone. Some undergo treatment in a facility and others keep up with medication through outpatient programs. Patients may try several times to recover, or overdose several times and be revived by the medication naloxone.
“Our hope about recovery may sometimes create a wish that someone can pursue treatment and then have these challenges go away,” Bobek said. “We do really understand this problem to be one that is chronic where relapse is always a part of it.”
The Winnefelds are getting the word out about how difficult it is to not only find treatment for addiction, but also pay for it. They spent $300,000 for Jonathan’s treatment and had difficulty finding an available facility.
“We were lucky to find, and pay for, treatment for our son — not an easy task,” said Mary Winnefeld at a House Energy and Commerce Health subcommittee roundtable about the opioid crisis. “Many others are not as fortunate … out-of-pocket payment is completely unrealistic for most American families.”
A newfound mission
The Winnefelds believe that treatment worked for their son, but fissures began following the transition out of treatment. They hope sharing what they have learned can not only help other families avoid similar heartbreak, but can help to reverse the opioid crisis.
S.A.F.E. Project US is nine months old, and by this summer will employ about 20 full- or part-time team members.
Much of the work focuses on learning from communities and seeing where they can support them. They attended an event with families in North Carolina who lost a loved one to an opioid overdose and are working to unite their communities. “What do you wish you knew then that you know now?” Mary asked those gathered.
In Colorado, the Winnefelds gave their input to law enforcement officers as they developed programs to help drug users get treatment while making illegal drugs less available. The High Intensity Drug Trafficking Area program, or HIDTA, a drug-prohibition enforcement program, played a part in the projects.
“They are the complete package in terms of being able to be of assistance with this issue,” Chelsey Clarke, strategic intelligence unit supervisor for Rocky Mountain HIDTA, said of the Winnefelds. “They are knowledgeable and well-connected, and they put things together in a meaningful way. Unfortunately, they have the personal side, too.”
During the first weekend in June, the Winnefelds were in Houston for the National Association of Drug Court Professionals, the world’s largest conference on addiction and the justice system. S.A.F.E. awarded scholarships for three law enforcement professionals to attend and share what they learned with colleagues.
In July, the Winnefelds will receive an award and share their story at the Association of Recovery in Higher Education conference, also in Houston. The organization encourages colleges to hire staff members who specialize in substance abuse and can run programs to support students who are either in recovery or seeking recovery. The goal is to help them succeed academically and in other areas of college life.
“Just having the admiral go out and speak articulately about the issues does a lot because there are still a lot of misconceptions and a lot of opinions that need to be changed. He commands a lot of respect,” said Tim Rabolt, director of community relations and strategic advancement for the organization.
During Memorial Day Weekend, Schmidt Peterson Motorsports placed S.A.F.E. logos on two of its IndyCar entries for this year’s Indianapolis 500.
S.A.F.E.’s symbol contains six stars of different colors, representing the six “lines of operation.” Aside from family outreach and support, the organization’s different elements include raising awareness about the opioid crisis, supporting prevention programs and the development of pain treatment that isn’t addictive, encouraging efforts by law enforcement and the medical community to prevent overdoses and remove illegal drugs, backing restrictions on the availability of prescription painkillers, and providing information and resources for people to find programs for treatment and recovery.
The Winnefelds believe that these factors will help communities, and the country, to treat the crisis as the national emergency it has already become.
Through it all, they remember and honor their son.
“You wanted to live. You fought the good fight. You finished the race,” Winnefeld said in Jonathan’s eulogy, a line that draws from a biblical passage on enduring hardship. “And although you ultimately lost your battle, you will now help win the war.”
