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The Wrong Way To Fight The Opioid Crisis

The Wrong Way To Fight The Opioid Crisis
Date Posted: Tuesday, February 11th, 2020

Jamie Maynard’s husband, Timothy, abused drugs, and he hit her. In 2012, after four years of marriage, she left him. Jamie and her two small sons moved in with her parents, postal workers who lived west of Columbus, Ohio, in a tidy white house amid soybean fields. Jamie quit her job, at Old Navy, to work as a state-licensed dealer at the Hollywood Casino, which paid much better—nearly three thousand dollars a month, plus benefits. The Columbus press compared the casino’s façade to a “corrections center just waiting for its barbed wire fence to be installed,” but Jamie, who was twenty-three, found the place exciting.

Gamblers often sought out flamboyant dealers who tapped their tips jar and cried, “Tokes for the folks!” Jamie preferred not to be noticed. She liked working the busiest shift—from eight at night until four in the morning—partly because she was less likely to be left standing alone at a gaming table, feeling exposed.

She became one of the fastest blackjack dealers on the floor, but the countless repetitive motions inflamed a rotator-cuff injury from her days playing high-school softball. A friend gave her a “perc thirty”—a black-market, thirty-milligram version of Percocet, which contains the powerful opioid oxycodone. A quarter of a pill allowed Jamie to work in comfort. It also gave her energy and confidence. Timothy had called her stupid, but in the casino job Jamie realized that she had a talent for what she called “instant math.” As her self-assurance improved, so did her tips. In the spring of 2013, she bought a used Chevy Cobalt, cranberry red. Driving it around, she played Taylor Swift on repeat.

Jamie began running a high-limits blackjack table with a fifty-dollar buy-in. She felt guilty watching her regulars risk their savings and, in some cases, lose their homes. Taking a whole perc thirty before her shift eased the discomfort of feeling like an accessory to other people’s misfortune.

In high school, Jamie had smoked marijuana, and at parties someone had always offered pills, including the catastrophically addictive opioid Oxycontin, which Purdue Pharma began marketing aggressively in 1996, when she was seven. Mixing an opioid with the sedative Xanax was said to offer a “Cadillac high.” By the time Jamie started at the casino, opioids were more abundant in Ohio than almost anywhere in the United States. According to Drug Enforcement Administration data analyzed by the

Jamie and Timothy met in 2006, the summer before her senior year. She didn’t realize that Timothy had a drug addiction until he was arrested for stealing. He sobered up in prison. After he was released, Jamie married him. Not long after that, he brought home heroin. Jamie watched him liquefy the dope in a spoon, over the flame from a cigarette lighter, then inject himself with the fluid. The next day, she let Timothy shoot her up: she didn’t want him to leave her. After using heroin for a few months, Jamie stopped; never having heard of withdrawal, she weathered what she assumed was a stomach flu. She had stayed clean all this time—until the perc thirties.

Jamie bought her percs from another user, S., a high-school friend whom she began dating around the time she took the casino job. His mom rented a duplex in the Hilltop, Columbus’s worst drug district. A dealer lived several doors down. S.’s mom allowed her son and his friends to use at her place in exchange for dope.

Perc thirties sold for a dollar per milligram. Jamie’s habit grew to three pills a day—more than six hundred dollars a week. After paying her bills and her parents, Debbie and Frank Barton, for rent and babysitting, Jamie spent the remainder of her salary on pills. One day, when she couldn’t find her next dose, S. suggested heroin as a temporary substitute. (Molecularly, the two drugs are extremely similar.) A hit cost only ten dollars. Jamie prepared the dope on a square of aluminum foil and smoked it. The high lasted all day.

Her heroin dealer lived in another part of the Hilltop. Back alleys crosscut the district, making properties easy to enter via rear entrances. The dealer instructed Jamie to park in the alley behind the bungalow where he lived with his family. Downstairs, he kept what Jamie thought of as a normal home, with nice sofas and a coffee table; upstairs, he worked out of a “trashed” office. Amid the mess were guns and safes. Jamie noticed that the office always contained “the most random” items. Users would trade a four-hundred-dollar television for a fifty-dollar half gram of heroin. Jamie once paid with a chain saw.

A dabbler uses to get high; a person with an addiction uses to stay well. A lapse in consumption triggers withdrawal. The muscles cramp. The skin crawls. The legs spasm, especially at night. The insomnia is crushing. There are drenching sweats, rattling chills. One heroin user, in a 2016 F.B.I. documentary, said that during withdrawal people are “crapping on themselves” and “puking on themselves”; another user said, “You’ll do anything to make it stop.” Withdrawal can lead to life-threatening dehydration, and often causes uncontrollable crying and suicidal thoughts. Jamie told me, “You’re scared to be sick.”

Her arms became skeletal. She stopped doing her hair and makeup. Her sisters—Kim, a paramedic, and Kristin, a nurse—asked their parents to intervene. Jamie refused to go to rehab, for fear of losing her job and her health insurance. Confessing that she used to take heroin with her husband, she told her family that she had got clean before, on her own, and could do it again. The attempt lasted twelve hours. But Jamie fooled everyone by eating more and paying better attention to her appearance.

She often bought dope on her way to work—the Hollywood Casino was in the Hilltop, on the site of a former General Motors factory. For privacy, she slipped into the restroom of a Taco Bell or smoked in her car, where she stashed fast-food straws and aluminum foil.

Other users were Jamie’s best source of information and help. “If your dealer wasn’t answering the phone, or if they were going to be an hour and you were sick, you’d find a friend to get it, so that you could use quicker,” she told me. Users knew which dealers cut dope with coffee grounds, and who sold only to regulars. If a friend bought heroin on Jamie’s behalf, she reimbursed him or her, and vice versa. Users might “tax” each other: a few bucks, a pack of Marlboros, gas. It was common and expected to “break off a piece,” for personal use.

Jamie limited her circle to people she knew, if only by a first name. She knew a guy who knew a girl named Courtney, who, in the spring of 2015, was looking for Xanax and “subs,” or Suboxone, a prescription medication that helps heroin users get clean by averting withdrawal symptoms. The first time that Jamie and Courtney met in person was at a gas station in the Hilltop. Jamie was turning twenty-six; Courtney was twenty-four. Jamie, who had long blond hair and dimples, was athletic and wore sporty clothes; Courtney, who had dark hair and a heart-shaped face, liked bling and bows, and had a horse named Taco. Both women had chosen full-time employment over college, and came from hardworking families in the Columbus suburbs. Courtney had a direct and lively personality, but she never explained to Jamie how she had got into drugs. Occasionally, they spoke, vaguely, about how they hated the direction their lives had taken, and how much they wished they could change.

Courtney, whose last name was Penix, worked as a nanny in Worthington Hills, a suburb of Columbus. She had a boyfriend who lived near Dayton; on Facebook, she told her friends that she was in the first stable relationship of her life. Recently, she had begun spending most nights with him, then driving to Columbus for work. She started texting Jamie when she came to town. In early March, she wrote, “Hey i know someone with xanax if u ever have anyone that wants some.” Jamie wasn’t interested.

Several days later, Jamie heard from Courtney again: “Hey can u get h.” When Jamie said that she could probably find some, “in an hour or so,” Courtney said, “Damn. U can’t make it sooner?” As they discussed when and where to meet, Courtney said, “I just need to leave my house so my parents don’t question me.” The next night, she told Jamie, “That was some good shit u got.” Jamie asked, “You want more?”

Jamie and Courtney traded calls and texts throughout the month. March 20th: Courtney complained about a “bitch” who had asked her for drugs, and then balked after “I told her either she pays me 25 for em or gives me gas money.” March 22nd: Courtney asked Jamie to cover her for Xanax, but she declined. At the end of March, when no one in the Hilltop seemed to have Xanax, Courtney asked about heroin, noting, “Idk if it will help my withdrawals but I can try I guess.”

In early April, Courtney wanted subs and Xanax but couldn’t leave work. Jamie offered to bring them to her, before reporting to the casino. Courtney gave Jamie her employers’ address, saying, “Just make sure nothing happens please, I have 2 kids here.” Jamie, whose sons were five and three, replied that she would “never put kids in danger.”

Jamie never stole to support her addiction or smoked when her children were around. She tended to respond to Courtney like a patient's older sister. When Courtney nagged her for running late, Jamie didn’t react; when Courtney asked her to leave drugs in an unlocked car, for pickup, she refused. Courtney said that she had recently been robbed at gunpoint, and Jamie worried that she would get herself killed.

On April 25th, Courtney headed to Columbus for her older sister’s birthday party. Joking that her boyfriend was driving her nuts, she told Jamie, “I’m about to do the rest of these Xanax,” adding that when the pills were gone she’d “be fucked.” Jamie, recognizing Courtney’s fear of withdrawal, replied, “Well worst case scenario I can get you dope and that’ll help.”

Before Jamie could track anything down, Courtney found her own supply of Xanax. She asked if Jamie wanted some. Jamie said, “No I’m good.”

April 27, 2015, was a blustery Monday. Courtney asked Jamie for Xanax again. When an hour and a half elapsed, with no response, she requested “150 worth” of heroin “and a rig,” meaning a needle and a syringe.

Jamie had already planned to use, before her night shift. By 5 p.m., she was at her dealer’s house, smoking. As the dealer measured out Courtney’s share, Jamie checked in, by text. Courtney told her, “I just tried to get more money from those check loan places and they wouldn’t do it lol.”

“Lmao,” Jamie replied. “I just got you $175 worth plus two rigs so you owe me $180.”

They agreed to meet outside a Walmart on Hilliard-Rome Road, a corridor dense with fast-food restaurants and big-box chains. At around 5:20 p.m., Jamie parked next to Courtney’s Dodge Neon, got out, and spent the next two minutes talking with her. When she noticed Courtney slurring her words, she asked her, “Did you just take Xanax?” Combining heroin and Xanax produced the coveted Cadillac high, but every addict knew that the combination was dangerous. Courtney assured Jamie that she hadn’t taken Xanax since the previous night—Jamie believed her when she said, “I’m just sick.”

Jamie thought about how “livid” she’d be if another user, inches away, withheld the substance that would immediately make her well. She handed over the dope. The next text from Courtney’s phone arrived shortly after eleven o’clock. It said, “Courtney has passed away from an overdose.”

At first, Jamie thought that someone was playing a horrible prank, and didn’t respond. The next day, she returned to the Hilltop, and mentioned the text to her dealer. He warned her, “If the police come to talk to you, you’d better not mention me.” Jamie assured him that she wouldn’t. She later told me, “You always hear those stories about people telling who their dealer was, and then their family ends up dead.”

Jamie spent the summer expecting the police to question her about drugs. But what really anguished her was the thought that Courtney might still be alive were it not for their meeting. No longer concerned with her own life, Jamie spent more and more time high on heroin.

On August 12th, she had just begun her Wednesday-night shift when a casino security guard pulled her off the floor. Two plainclothes detectives from the Special Investigations Unit of the Franklin County Sheriff’s Office were waiting to question her. Jamie responded to their small talk amiably, and signed a document acknowledging that she understood her legal rights.

Their initial questions were simple: Where do you live? Are you married? How old are your children?

Then: How did you know Courtney? Through a mutual friend, Jamie said. The older of the two officers, a sergeant, asked, “Did you ever move any other kind of drugs for him, other than Suboxone?” Jamie said no.

“Listen, we’re not here to arrest you for drug trafficking,” the sergeant told her. When was the last time she’d seen Courtney?

“I got a text message saying she was dead,” Jamie said, adding that she’d seen her that day.

“Do you remember what you guys did?”

“She was trying to find drugs.”

What kind of drugs? “Anything to make her well.” Did Jamie “help her out”? Jamie said that she couldn’t remember.

The sergeant told her he needed the truth: “We want to know where the dope came from that you gave to her.”

Jamie couldn’t imagine giving up her dealer’s name. Panicked, she said, “I want a lawyer then.”

The sergeant informed her that she was the subject of a homicide investigation. The charge would be involuntary manslaughter. Under state law, her offense would, like rape and aggravated robbery, be a felony of the first degree.

When Jamie’s parents learned of the investigation, they came to several devastating realizations at once: their daughter had a heroin addiction; her stable job and her improved appearance had been part of a sustained deception; she was in profound legal trouble. A young woman just like Jamie was dead. Frank and Debbie couldn’t imagine what Courtney’s family was going through, any more than they could fathom the idea of Jamie—who had never been in legal trouble—being held responsible for a homicide.

Eight days later, when Jamie reported for work, investigators were waiting to arrest her. They confiscated her phone, expecting her texts to match Courtney’s; they swabbed the inside of her mouth, expecting her DNA to align with forensic evidence collected from Courtney’s car.

After Jamie spent the night in the county jail, her parents bailed her out and took her home. Cut off from heroin, she was soon, as she later told me, “flopping on the floor like a fish.” One of her sisters drove her to the emergency room, and Jamie spent the next few days in hospital detox.

Jamie and her family met with Mark Collins, a former Franklin County prosecutor who was now a well-known criminal-defense attorney in Columbus. Jamie’s situation infuriated him. More and more, law-enforcement officials and prosecutors were treating fatal overdoses as homicide cases. Overdose deaths were a tragedy, Collins believed, but they weren’t crimes unless the drugs had been given maliciously. What Jamie needed was treatment, not prison.

Jamie faced a kind of criminal prosecution that takes various forms, depending on the jurisdiction. Such cases have been categorized as “drug-induced homicide,” “murder by overdose,” “drug delivery resulting in death,” and “overdose homicide.” More than two dozen states now have laws allowing prosecutors to bring felony charges against anyone who provides drugs that prove fatal. States without specific legislation, such as Ohio, can indict a supplier under existing statutes: manslaughter, depraved heart, reckless homicide, murder. Potential punishments range from a year in prison to death. According to a recent study by the Northeastern University School of Law’s Health in Justice Action Lab, prosecutors in almost every state have exercised the overdose-homicide option.

Legal experts have traced these prosecutions to the fatal overdose of Len Bias, a superstar forward at the University of Maryland, who collapsed on June 19, 1986, in his dorm suite. Less than forty-eight hours earlier, he’d been drafted by the Boston Celtics.

Bias had taken high-quality cocaine, but politicians and the media nevertheless associated his death with the nation’s burgeoning crack epidemic. The Democrats were trying to retake the Senate, and wanted to prove that they could be tough on crime. House Speaker Tip O’Neill urged Congress to craft forceful antidrug legislation that candidates could cite in their reëlection campaigns. Eric Sterling, then the assistant counsel for the House Judiciary Committee, later recalled that lawmakers drafted the legislation without holding a single hearing, adding, “We did not consult with the Bureau of Prisons, or with the federal judiciary, or with D.E.A., or with the Justice Department.”

That October, Congress passed the Anti-Drug Abuse Act of 1986. It established mandatory minimum prison sentences for a range of narcotics crimes, including a “death resulting” offense involving the sharing or the sale of drugs. Sterling, now the director of the Criminal Justice Policy Foundation, which focusses on failed drug policy, has noted that Congress assumed the legislation would lead law-enforcement officials to target “high-level traffickers.” But America’s prisons soon filled with low-level offenders; illicit drug use and trafficking continued unabated.

Policymakers and scholars eventually agreed that neither harsh penalties nor the threat of them significantly deters drug use and sales. But in the meantime dozens of states enacted their own versions of the federal law, including the overdose-homicide provision. At first, the option went largely unused: the Northeastern law lab recently attempted to chronicle the history of such cases, and found hardly any from the eighties and nineties. But in the past two decades, as opioid addiction escalated and overdoses became the leading cause of death in America for people under fifty, police officers and prosecutors seized upon the overdose-homicide alternative as a new “tool.” Now there are many hundreds of such cases a year.

Like the federal law, the state statutes ostensibly targeted “high-level traffickers” and “repeat offenders.” Some career criminals have been caught in this way. Last year, a New Jersey woman fatally overdosed on fentanyl-tainted heroin; police charged the man who purportedly provided her with the drugs, and also Curtis Geathers, the man’s alleged source. Geathers had multiple priors: in the early two-thousands, he was prosecuted for attempted murder and went to prison for aggravated assault; in 2016, he pleaded guilty to trafficking after police found nearly six hundred packets of heroin, plus cash and crack, in his hotel room.

But, as Northeastern has reported, overdose-homicide prosecutions tend to sweep up minor offenders who are “struggling with addiction and who purchase drugs on behalf of themselves and their peers.” Leo Beletsky, the director of the Northeastern law lab, studied two hundred and sixty-three prosecutions that occurred between 2000 and 2016, and found that about half of the defendants were “friends, family, or romantic partners” of the person who died. In Wisconsin, Daniel Adams, a defense attorney, surveyed a year’s worth of his state’s cases, from 2015, and found that only nineteen of eighty-one defendants were “commercial drug dealers.” In a sentencing memo, Adams defined commercial drug deals as “deliveries that were performed solely for financial benefit—not by another addict/middleman/connection for joint use or to otherwise support their own addiction.”

Lee Hoffer, a medical anthropologist at Case Western Reserve who studies local heroin markets as “complex adaptive systems,” identifies this subset of users as “brokers.” He has written that “a buyer trusts the broker to make a purchase and return with drugs; a broker trusts that if they do so the buyer will reward them. In this way, brokering is a ‘favor’ and an economic service.” One prosecutor told me, “Yeah, we call that a drug dealer.” But Hoffer argues that dealers “invest in a quantity of drug to resell,” or they “juggle”—buy illicit substances and repackage them into smaller quantities for resale.

Crucially, brokers do not profit from their role. Jamie’s finances worsened the entire time she used heroin. Having borrowed against both her paycheck and her car title, she owed creditors thousands of dollars in high-interest loans. She scored some free drugs, helped some people who were also struggling with addiction, and made it through another day without withdrawal.

No one has formally documented how many Americans are going to prison in overdose-homicide cases, but the nonprofit Drug Policy Alliance found that, between 2011 and 2016, media references to such prosecutions rose by more than three hundred per cent. Northeastern’s study showed that Pennsylvania appears to lead the country; Ohio runs second, with at least three hundred and eighty-five cases in the past two decades. In December, five legal scholars, including Beletsky, asked the Ohio Criminal Sentencing Commission to reassess the state’s use of overdose-homicide prosecutions. In one exchange with the commission, the scholars urged accountability that is “proportionate to culpability.”

The sentences can be outlandish. In 2015 in Louisiana, Jarret McCasland, whose girlfriend fatally overdosed, was found guilty of second-degree murder and automatically sentenced to life in prison without parole. Nearly two thousand people have signed a petition arguing that McCasland is being punished “for being addicted to opiates,” and that the verdict is a “slap in the face to all who seek help from this painful disease.” The judge said that it bothered him “tremendously” that he had to impose a life sentence. McCasland’s appeals attorney later said, “The court was right to be troubled by a law that equates poor judgment with murder.”

In Florida, in 2017, Jamie Nelson, a drug user, gave another user, Tracy Skornicka, a ride to find Nelson’s dealer, in exchange for several dollars’ worth of heroin. After Skornicka overdosed and died, Nelson was charged with first-degree murder. The state could have put her to death. When Nelson’s lawyer, Jeffrey Leukel, succeeded in getting the murder charge dismissed, prosecutors in Seminole County had Nelson indicted for manslaughter. Leukel told me that, for the prosecutors, “it’s more important to them to save face than to do the right thing.” Nelson, who was also charged with distribution, now faces a possible thirty years in prison.

Prosecutors and law-enforcement officials are holding conferences and online seminars to explain how their colleagues could pursue overdose-homicide cases. Defense attorneys, meanwhile, are scrambling to learn how to respond to such prosecutions. Northeastern recently published the second edition of a defense “tool kit,” an eighty-six-page manual inspired both by prosecutors’ increasingly enthusiastic embrace of the approach and by anecdotal reports of ineffective defense counsel. The tool kit advises defense lawyers to scrutinize autopsy reports, death certificates, and toxicology results: many opioid-overdose deaths involve multiple drugs, raising “significant” questions about cause of death. In Pennsylvania, the tool kit notes, some deaths have been reported as overdoses “with no toxicology reports.” One county coroner, after the death of a friend’s son, began classifying all fatal heroin overdoses in his jurisdiction as homicides.

Politicians have often been opportunistic in their championing of overdose-homicide law. In his sentencing memo, Adams, the defense attorney in Wisconsin, wrote that many state prosecutors criminalize addiction as a way to “show action” in the face of the opioid scourge. In 2017 alone, legislators in at least thirteen states proposed new laws. That year, a Florida sheriff warned, in a video that went viral on social media, “If our agents can show the nexus between you, the pusher of poison, and the person that overdoses and dies, we will charge you with murder.” The sheriff was flanked by four officers wearing body armor and balaclavas. President Donald Trump, who has called for drug dealers to be put to death, has not directly addressed overdose-homicide cases, but in 2018 Attorney General Jeff Sessions declared that prosecutors “must consider every lawful tool at their disposal”—including the death penalty.

That year, the National District Attorneys Association, in its first white paper on the opioid crisis, urged law-enforcement agencies and prosecutors to “treat every overdose death as a homicide and assign homicide detectives to respond to these scenes.” The paper’s authors argued that “the potential of being charged with homicide” provided an “added incentive for a dealer to cooperate with law enforcement and provide other actionable intelligence for broader distribution networks.” State prosecutors can exert leverage by threatening defendants with the prospect of federal charges—the mandatory minimum federal sentence for overdose homicide is twenty years. Jared Shapiro, another attorney for Jamie Nelson, in Florida, told me that investigators have the mistaken “impression that they can charge low-level offenders and get them to flip, creating a crumbling pyramid in which El Chapo types will fall.”

Hoffer, the Case Western anthropologist, said that, as the opioid crisis drags on, the overdose-homicide approach has become “low-hanging fruit.” Collins, the Columbus defense attorney, told me that such prosecutions promote a grotesque misreading of the complexity of addiction; it is obscene, he said, to equate overdose deaths with “hard-core murder cases.”

Franklin County, the most populous in Ohio, sits at the center of a state geographically primed for multidirectional trade. Interstates 70 and 71 connect to Denver, Cincinnati, Cleveland, and Pittsburgh. Columbus, one of the fastest-growing metropolises in the Midwest, has been called Test City, U.S.A., because so many retail and fast-food companies try out new products there. It’s been said that if you “raked America together you’d find Columbus.”

In the late nineties, a Mexican drug faction, the Xalisco Boys, identified Franklin County as a promising market for black-tar heroin, which resembles chips of coal. Sam Quinones, the author of the 2015 book “Dreamland,” describes the Xalisco Boys as “our quietest traffickers” and “our most aggressive.” Couriers move in and out of the Columbus area, renting apartments with cash. Testifying at a 2017 congressional hearing, Mike DeWine, who was Ohio’s attorney general at the time and is now the governor, compared buying heroin to ordering a pizza: “You get it in half an hour, and you are going to get it cheap.” After Ohio shut down the pill mills that proliferated with the advent of Oxycontin and other opioids, users found a ready substitute in heroin.

Illicit drugs are often cut with other substances. With heroin, adulterants include the potent painkiller fentanyl and the tranquilizer carfentanil, which is used to sedate elephants. Fentanyl surfaced in the Franklin County drug supply around 2014, and by the next spring Ohio was leading the nation in fatal opioid-related overdoses. Since 2015, more than fifteen thousand Ohioans have died from taking such drugs.

In March, 2015, Franklin County’s new coroner, Dr. Anahi Ortiz, created a fatality-review board, to scrutinize each unintentional-overdose death in her jurisdiction and identify gaps in the system. She told me, “I brought law enforcement into the room. I brought public health into the room. I brought treatment centers into the room. I brought the public defender into the room.” The reforms led to important improvements, including the increased use of Narcan, an injection or nasal spray that can immediately reverse a heroin overdose.

Yet Franklin County’s problem kept growing. By April 27, 2015, the day that Jamie and Courtney met in the Walmart parking lot, Ortiz’s office had already handled a hundred and twelve opioid overdoses that year. Users were overdosing at home and in public; two people had drowned (one in a bathtub, the other in a garden pond). A man had overdosed behind the wheel of his Honda Civic while parked outside a Pier 1.

One of Ortiz’s close advisers on the review board was Rick Minerd, the chief deputy of the Special Investigations Unit at the sheriff’s office. Minerd, who considers himself “the least coppy cop you’ll ever meet,” has an M.B.A., and prefers innovative problem-solving to car chases. Ortiz’s review board inspired him to find his own creative angle on the overdose epidemic.

Traditionally, cops have viewed drug users as criminals, and arrested them; the opioid crisis convinced them that drug addiction could happen to anyone, including their own family and friends. Minerd was among those who realized that law enforcement needed to play an aggressive role in outreach and treatment.

Source: newyorker.com

Date Posted: Tuesday, February 11th, 2020 , Total Page Views: 304

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