My daughter, Giana Natali died from a heroin overdose on January 3, 2014.
Giana was the youngest and quietest of my four children. While the other three were blowing the roof off with boisterous play, Giana would be doing something quietly by herself. She was always very conscientious, keeping everything tidy and organized. I didn’t realise it then, but these tendencies evolved during her life into profound psychiatric disorders that meant she never felt her achievements were good enough. She was always striving to be better at everything.
As a child, Giana had asthma and several allergies that limited her ability to do outside sports, so her allergist suggested she take up swimming. She dedicated herself to becoming the best she could be and was competing at a high level throughout middle and high school. She went to college on a Division I swimming scholarship. Sadly though, as her psychiatric problems became worse, the swimming caused her too much anxiety and she had to stop.
After a year at college, Giana developed severe anorexia. She was hospitalized for a while, where they diagnosed her with major depressive disorder and anxiety. This dogged her for the rest of her life. She did go back to college and graduate with a major in English but then decided to go back again to study to be a veterinary nurse. I remember her getting her first dog at that time and being so happy because as a child she’d break out in a rash if she even touched a dog.
After she graduated, Giana started working in a veterinary hospital. She was very talented and enjoyed helping the surgeons with the operations, but she still had issues with eating and anxiety. She was under the care of a psychiatrist and was medicated. As she couldn’t swim anymore, she started working out with a group of male body builders. I found out later they were injecting an opioid called nalbuphine to reduce the pain that body building causes. I remember finding some of the bottles in her car and realizing they’d come straight from a medical facility somewhere, so someone must have had access.
Thirteen months before she died, Giana made the switch to heroin, and it was all downhill from there.
I learned of her opioid dependency about nineteen months before she died. She took 2 weeks off from her job, checked herself into a hospital and called me from there to tell me what was going on. I’d dealt with alcohol abuse in my family, with my brother and my father, but opioids were something I had no idea how to deal with. I was determined to stand by her. Giana’s employer reluctantly let her go because she had easy access to opioids at the veterinary hospital, but this meant she also lost her health insurance. Treatment was hard to access for someone without insurance, although she did benefit from Continuation of Health Coverage (COBRA) for a time. When that ended, my ex-husband and I spent much of our savings on treatment for her.
For the next year and a half, Giana was in and out of treatment facilities. None helped her to recover because they didn’t treat her psychiatric illness properly and they didn’t integrate the treatment for her mental health and her opioid addiction. They changed her medication every time she went in, but they didn’t use any of the three medications recommended by the American Food and Drug Administration (FDA) for opioid use disorder. I didn’t even know much about addiction medication until after she’d died, when I requested her notes and did some research.
Many of the common treatment plans are based on alcohol addiction and are based in Alcoholics Anonymous’ 12 Steps. Abstinence is one of the targets for those treatment programs, but it was this that killed my daughter. She abstained from heroin for months and lost all her tolerance so when she relapsed after six months, she overdosed and died.
Giana went into an in-patient treatment facility in the fall of 2013 and after 4 months they decided – wrongly in my opinion – to move her to a step-down facility. The day they moved her, the psychiatrist changed her medications and then went on holiday. My mother died a day after that and when Giana came home for the memorial service, I knew she was slipping.
Giana’s death has inspired me to do what I can to help others who are struggling with opioid addiction or know someone in that position. I’ve joined the Advisory Boards of the Behavioural Health Department in Philadelphia and Safehouse Inc. which is a non-profit trying to set up an overdose prevention site, also known as a safe injection site. There are about 120 active safe injection sites in different countries, but none in the US yet. These sites are places where users can bring their drugs and inject under medical supervision to prevent overdose. They also provide medical services as a segway to treatment. People get to trust the staff and are more likely to start treatment as a result.
I’m also part of the Philadelphia Overdose Prevention Network, and in addition to advocating for an overdose site, we’re working to make safe needle exchanges more available and ensure that there’s wider access to Narcan in the community. Lots of sites now have Narcan, even places you wouldn’t expect like the local library and schools. This is a great step forward, but we don’t want to be reversing overdoses on a subway car, we want that person to be well.
Heroin didn’t just take my beautiful daughter’s life. It destroyed everything she had piece by piece. There’s still so much stigma and it prevents people from reaching out and getting help. I always tell people not to let anyone make them feel badly about their situation. If someone responds badly when you reach out for help, move on and find somebody else.
I’m often asked how I stay strong after everything our family’s been through. It’s not easy but I have my ex-husband, with whom I share seven grandchildren and a close relationship, two daughters, and a son, so they keep me busy. I’ve also published a memoir about Giana, called Even If Your Heart Would Listen: Losing My Daughter to Heroin, and I’m currently writing my second novel.
As a family, we did a fundraiser for a memorial bench for Giana and raised eight times the amount we needed, so we gave the rest to a shelter called PAWS that she was affiliated with, and they established an indoor dog playroom in her honour. My grandsons also did fundraisers at their high school because they’re the oldest, so they remember Giana well. We’ve put the memorial bench in a place that was very special to Giana, a park not too far from where she lived where we’d all meet and play with the dogs together. It’s somewhere I go sometimes, just to be.
I know Giana would want something good to come out of what happened to her, and I feel privileged to be helping to make that difference. No one needs to struggle alone.
Geri Lynn Utter, PsyD Perspective Piece: Relapse, Mental Health, and the State of the World As I sat down to write this article, I