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“I don’t think she was a lost cause”: How one Colorado overdose victim fell through the cracks

Even as she lay on a friend’s floor in Wheat Ridge, unconscious from the effects of the drugs she’d taken, Rachel Skanron still had people who believed she could overcome her addictions — if only she could find the right help.

Her father, living on the other side of the international date line, wouldn’t step back and wait for her to hit rock bottom. A former boyfriend in New York had sent her a plane ticket to get her away from the people she used drugs with. And a childhood friend was ready to talk her through any crises, and to fly out to Denver to help if necessary.

They all expected a long road ahead, since Rachel already had spent years cycling through treatment and homelessness. But they remembered the creative, nurturing person they’d known before methamphetamine and fentanyl took over her life, and they wanted her back.

But they’ll never get her back. Rachel died May 3 on that friend’s floor at the age of 34, one of the more than 1,600 people in Colorado lost to drug overdoses in 2023.

Her father, Rick Skanron, knew people could recover from addiction — he’d been there himself. The difference with Rachel, he said, was that her mental health afflictions sapped her of the ability to believe her life could change and the motivation to get better.

“There is nothing available that helps people with mental health issues get to the ‘want’ phase” of seeking recovery, he said.

The Denver Post is telling Rachel’s story after extensive interviews with her friends and parents, and a review of medical records shared by her father, to show how people battling addiction in Colorado can fall through the cracks of the systems meant to help them. Denver-area emergency rooms repeatedly flagged Rachel’s drug history and need for treatment over the last two years of her life, but could never connect her to help. Sometimes they couldn’t find an open bed. Sometimes she left the hospital without telling anyone where she was going. Once, she started treatment, but it lasted less than two weeks.

The majority of people who misuse drugs also have a mental health condition, with about half experiencing depression symptoms and an unknown number of others living with other conditions, according to the Substance Abuse and Mental Health Services Administration.

People who have both a mental illness and a substance-use disorder often struggle to get treatment that addresses all their needs, because most providers still primarily focus on one or the other, said Vincent Atchity, president and CEO of Mental Health Colorado. Mental health facilities often won’t admit people in active addiction, he said.

Skanron believes the only thing that could have saved his daughter was a long period of involuntary treatment, but she never met the legal standard of being a danger to herself or others. Advocates for people who use drugs and those with mental illnesses generally oppose involuntary treatment, because of the potential for trauma and civil rights violations.

“It takes years to get into the densely forested woods of addiction,” Skanron said. “You don’t expect people to get out in five days” of detoxification.

Stability, then struggle

Rachel wasn’t a kid you worried about too much, said her mother, Eileen McAllister, who lives in upstate New York. She was generally happy, dressing up as Disney characters with her brother, and liked to help out with cooking, cleaning and caring for the family’s pets. It was only after she was diagnosed with Lyme disease as a teenager that she started to struggle, she said.

She had depression, anxiety and other mental health conditions for her entire adult life, and had used heroin as a teenager, Skanron said. But she reached stability with the right combination of medications, including benzodiazepines for her anxiety and buprenorphine, which prevents opioid withdrawal. She earned her nursing degree in New York and lived independently throughout her 20s, he said.

Michelle Flotard, who met Rachel when they were 5 and remained in touch until about a month before she died, said her friend had a difficult start in life: her parents both wrestled with substance use, though her father got into long-term recovery, and she started experimenting with marijuana as a preteen. Rachel also had a painful connective tissue disorder. Still, she and Rachel shared good times, traveling to visit Skanron when he was working in the Czech Republic, she said.

James Lechmanski, a boyfriend during some of those good years, said he remembers coming home to find Rachel sanding an old piece of furniture she found at a garage sale or inlaying glass on the surface of a desk to create a piece of art. Rachel had a creative streak, and she liked to fix broken things. She was also a nurturer, planting flowers, seeking out home nursing jobs and taking care of three cats and a dog, he said.

Rachel also had a certain resilience when she was well. They moved in together just days before Superstorm Sandy hit New York in October 2012, Lechmanski said, and she approached living without electricity for three weeks as an adventure. Their relationship lasted only two years, but she was fine after they broke up, he said.

In 2019, Rachel started struggling with suicidal thoughts after a different romantic relationship ended on bad terms, though electroconvulsive therapy (formerly called electroshock) brought those under control, Skanron said.

Rachel spent time in hospitals for her mental health and substance use multiple times while she was living in New York, but couldn’t stick with outpatient treatment after each release, McAllister said. She wanted to help people as a nurse, but didn’t seem to understand when she was the one who needed help, her mother said.

“I was so mad (when she wouldn’t go to treatment), because I just wanted her to get better,” she said.

After a stint in residential treatment for her mental health, Rachel moved to Texas to stay with Skanron and recovered enough to start working again, and he hoped she was on a path to stability as 2020 started.

It was only later that Skanron would learn someone she met in treatment had introduced her to methamphetamine.

“It was downhill” after that, he said. “It changed her depression, because she felt good.”

Methamphetamine, a stimulant, produces feelings of energy and euphoria. The drug also changes the brain in ways that make it even more difficult to quit than other recreational drugs, according to the National Institute on Drug Abuse. Unlike people who misuse opioids, those who take methamphetamine don’t have a medication option to help with their cravings.

People commonly use recreational drugs to medicate mental health problems, whether that’s stimulants for depression or alcohol for social anxiety, said Dr. James Besante of the Santa Fe Recovery Center in New Mexico. The strategy works for a while, so people typically keep using those drugs until the negative effects outweigh the positives enough that they seek help, he said.

A new start in Colorado

Skanron said he told Rachel she couldn’t stay at his home if she kept using drugs, so she moved to Colorado for a fresh start in mid-2021. She said she knew people she could stay with, but unbeknownst to him, some of them were friends she used drugs with.

Lechmanski said Rachel told him she thought she’d be able to get treatment more easily in Colorado than she could in Texas, which was the first step toward getting a job and leaving homelessness behind.

“She thought it would be more welcoming,” he said of Colorado.

But the waiting list for housing specifically for women trying to get into sobriety in Denver lasted six months or longer, and Rachel didn’t feel safe in shelters, so she’d bed down on the streets or with friends, some of whom were engaging in petty crime to buy drugs, Lechmanski said. She texted him frequently over the next two years about the difficulties she’d run into in Colorado and her efforts to get some sort of job, even if it was just a part-time cleaning gig.

Skanron sent Rachel money for housing and Lechmanski occasionally paid for a hotel room on cold nights, but during an emergency room visit for suicidal ideation in November 2021, she reported she had been homeless since that February, according to her medical records. She also admitted to regularly using methamphetamine.

The licensed clinical social worker who assessed Rachel at Lutheran Medical Center in Wheat Ridge determined she didn’t have a plan or the means to kill herself, which would have allowed the hospital to hold her temporarily. The hospital did provide her with a dose of an antidepressant she’d previously taken; a referral to the Jefferson Center for Mental Health to get her medications more regularly; a bus pass; and a list of addiction treatment resources.

Those visits became a pattern. People repeatedly stole the backpacks where she kept her medication, so the only option to get refills was to go to an emergency room, Lechmanski said. Without consistent doses, she could never stabilize her brain chemistry, and the feeling of being constantly unsafe made it worse, he said.

“What she went through, it just started compounding itself,” he said.

Dr. Kiara Kuenzler, CEO of the Jefferson Center for Mental Health, said she couldn’t share any information about whether Rachel was a patient there, but that patients who are homeless often struggle to stay in care. Unhoused people deal with barriers like lack of transportation, losing their phones or having difficulty keeping track of days, which make it harder to follow through with appointments, she said.

The center and other organizations have been working to try to increase the number of apartments available for homeless patients so they can begin to stabilize their lives, Kuenzler said. They also are working on getting people into the next stage of treatment immediately, or giving them a safe place to go so they can get support and avoid returning to drugs while waiting for a bed to open up, she said.

“It’s in those gaps that we’re losing too many people,” Kuenzler said.

Asking for help, then running

Rachel sought help again in late March 2022, when she went to Denver Health’s emergency department in what she said was withdrawal from benzodiazepines.

Benzodiazepines are sedatives, and people who use them as prescribed for anxiety can develop dependence and feel sick if they suddenly stop taking them. Medical records show Rachel told staff that she had run out of her prescribed medication and had been buying pills on the street, until she felt “sketched out” because she didn’t know what could be in them. She also reported recently taking heroin and methamphetamine.

Rachel didn’t mention knowingly taking fentanyl, but almost certainly ingested some of it, because the far more potent opioid is pervasive in the supply of heroin and illicitly manufactured pills in Colorado and elsewhere. Some other drugs, like methamphetamine and cocaine, also are contaminated, which has contributed to the sharp rise in overdoses.

At some point after she moved to Colorado, the doctors Rachel saw started pushing back against her benzodiazepine prescription, wanting her to taper off the medication, Skanron said. They interpreted her request for a higher dose, which she had taken for years, as drug-seeking, so she either bought benzodiazepines on the street or substituted opioids, he said.

Rachel said she wanted to go to Denver Springs, but the mental health and substance use facility didn’t have a bed available, so the emergency room staff arranged for her to go to Denver Cares for detoxification. She left Denver Health without telling anyone, but came back within 12 hours, complaining of worsening withdrawal symptoms. The emergency department gave her buprenorphine, which can stave off opioid withdrawal, and advised her to go to Denver Cares. She said she would walk there, but the records don’t show her checking in.

In one way, Rachel was lucky: only about one-fifth of people nationwide who have an opioid-use disorder receive either buprenorphine or methadone, both of which stave off withdrawal from more potent opioids and allow a person to function. People who take buprenorphine consistently are about 38% less likely to die of an overdose than those who don’t receive medication.

People who use drugs and health care providers have a “tumultuous relationship” in general, said Lisa Raville, executive director of the Harm Reduction Action Center in Denver. While she couldn’t speak to the treatment Rachel received, people who use drugs often report they feel looked down on and dismissed as not caring about their health, particularly if they previously left because they were afraid of going into withdrawal, she said.

“Attitudes often change if (medical providers) go in and see track marks on somebody,” she said.

People dealing with drug addiction often go through a process of asking for help multiple times before they can follow through, said Dr. Joshua Blum, director of outpatient substance use disorder treatment at Denver Health. He said he couldn’t speak about any individual patient, but giving up drugs is a “massive” life change, and people often feel ambivalent.

“You’re giving up this instant ‘get out of pain’ button that’s been there for so long,” he said.

Providers can’t force someone who isn’t ready to go into treatment, but ideally, they would have the time to talk to the patient and try to motivate them to seek care in the future, Blum said — something that doesn’t always happen in a busy emergency room. They also can offer harm reduction tools like the opioid overdose antidote naloxone and fentanyl test strips, he said.

In mid-May 2022, Rachel went to Denver Cares, saying she wanted to go into a sober living arrangement. Within a few hours, though, she left for Denver Health’s emergency room, seeking pain medication for an eye socket that had been broken when someone punched her a few days earlier.

In the emergency room, she denied any problems with drugs, according to her medical records. The staff determined the eye hadn’t suffered severe damage, and gave her Tylenol and an eye ointment before discharging her back to Denver Cares. She left Denver Cares the next evening with a plan to go to a sober living house, but apparently never checked into one.

No one knew at the time that Rachel had less than a year of life left.

“We can’t help her”

Rachel sought treatment again in March 2023. She went to West Pines Behavioral Health in Wheat Ridge asking for help with benzodiazepine withdrawal, and said she also used heroin and methamphetamine. At the time, the person doing her intake thought she could be an appropriate patient for West Pines, because she was anxious but “motivated.”

Progress notes show she didn’t recover enough to discuss treatment options until her fourth day, and was talking about going into sober living on the fifth day.

Three days later, though, any progress seemed to reverse, and the notes show she wasn’t attending group therapy, as required. Rachel reported anxiety, and the person assessing her believed she was seeking benzodiazepines. She talked at times about sober housing, but seemed unsure how to get it and also talked about returning to living in a storage unit.

To Skanron, those descriptions suggest Rachel wasn’t stable enough to engage in group therapy and other parts of treatment. Withdrawing from opioids, benzodiazepines and methamphetamine all at once isn’t a recipe for good mental health and motivation, he said.

“They said if she’s not willing to participate, we can’t help her,” Skanron said. “If a person is in serious depression, they probably are not going to participate in anything.”

Ideally, providers would build a relationship with a patient over an extended period, so they can figure out if the person needs mental health treatment once drugs are no longer exacerbating or masking their symptoms, said Besante of the Santa Fe Recovery Center. In some cases, people need months for their brain chemistry to return to normal after withdrawal.

“Once they’re no longer using the substance, you can start to put the puzzle together,” he said. “If you don’t treat the underlying mental health condition, you’re probably not going to be successful treating the substance use disorder.”

Withdrawal symptoms can last weeks or months after a person stops using benzodiazepines, so the best plan is a long, slow process of tapering off the medication, Denver Health’s Blum said.

When she was discharged on March 28, Rachel complained of nausea, diarrhea and continued anxiety, and still had no housing lined up. The final notes said she was no longer sedated, but “petulant and oppositional.”

“She was competent to make medical decisions, although I believe if she remained sober for many weeks she would become much more sharp and be more able to manage things. However, she was not holdable,” a psychiatrist at West Pines wrote, suggesting she chose to leave.

Skanron said when he talked to Rachel, though, she didn’t want to leave West Pines. He offered to pay for her to enter a sober living facility, but she refused to go to one where she’d need to live with a roommate. After spending $170,000 on his daughter’s treatment over the years, Skanron didn’t have the money for a facility with private rooms, and isn’t sure it would have helped even if he had.

“To discharge a person who is clearly showing signs of depression, staying in her room, not interacting with anyone, to the street… doesn’t seem right,” Skanron said.

A spokeswoman for West Pines said the facility can’t comment on specific patients’ care.

If a patient isn’t interested in participating in treatment, no one benefits from forcing them to stay, Besante said. At that point, the best thing a provider can do is to determine what help a patient would accept, whether that’s harm-reduction resources or meeting with someone in recovery, he said.

“You can still offer people care even if they’re not willing to engage in recovery treatment,” he said.

A missed flight

Rachel’s records show she returned to West Pines one day after she left, saying she was in withdrawal and had nowhere else to go. At intake, a doctor noted her mood and presentation seemed normal, and said she didn’t require hospitalization.

The Jefferson Center for Mental Health, where Rachel reported receiving care previously, declined to take responsibility for her when West Pines called, saying her withdrawal wasn’t something they could address. The center offers detoxification from some substances, but not benzodiazepines.

Skanron said the staff at West Pines told him that Rachel wasn’t interested in treatment and was just there for a place to sleep. They also advised him not to give her any more money, but he did send her some so she could pay rent to a friend. He couldn’t do much else, because he and his wife live in Australia. McAllister said she had stopped sending Rachel money after she moved to Denver, because she expected her daughter would spend it on drugs.

The arrangement with the friend lasted only about three weeks. Rachel stayed in touch during that time, but her mind wasn’t on seeking treatment, Skanron said.

“All she could focus on was a place to stay and food,” he said.

The Denver area needs more “housing first” options, which get people off the street even if they aren’t ready to stop using drugs immediately, said Atchity, of Mental Health Colorado. Offering wraparound services where people live increases the odds they’ll agree to start treatment and be able to stick with it, he said.

“Nobody gets well when they don’t know where they’re going to sleep tonight,” he said.

Continuing to use drugs can feel like the only option for people who are unhoused, said Dr. Katie Van Stedum, a family physician who works with the homeless population in Denver. For those who don’t feel safe, using methamphetamine to stay awake is a survival strategy, she said.

If treatment isn’t available or a person doesn’t want it, they at least need a safe place to go through withdrawal, and somewhere to stay with support to help them avoid returning to drug use, Van Stedum said. Housing-first developments typically offer behavioral health care and case management, but the number of apartments available doesn’t come close to meeting the need for them, she said.

“If you go back on the street, you’re exposed to all those triggers again,” she said.

Rachel left Flotard, her childhood friend, a message three days after she departed West Pines, saying she was off drugs and wanted to change her life. While in some ways she sounded better, Rachel was clearly struggling with feeling abandoned, Flotard said.

“She was so confused. She didn’t know who to trust or who would believe her,” she said.

After her last treatment stay, Lechmanski invited Rachel to return to New York. He’d sent her a ticket and planned out the first day back: he’d pick her up at the airport and immediately take her to a hospital that he thought would have resources to get her into treatment. Three days before she died, he took a class at the local public library about how to use naloxone, just in case she were to relapse while staying at his house.

“I knew she’d be coming with a lot of baggage,” he said.

Rachel couldn’t make the initial flight, because she was trying to get belongings she’d stored with someone else, including a cast of a pawprint from one of her cats, Pickles. The rest of the things were replaceable, but after several years on the streets, fighting to hold onto her belongings, it was hard to leave them behind, Lechmanski said. Flotard heard a slightly different version of events, that Rachel was trying to get back a laptop someone had stolen and wasn’t sure how to get on a plane since her driver’s license had gone missing.

They’ll never know whether Rachel would have survived if she’d gotten on the flight.

“Right until the end, she was fighting”

Overnight on April 30, the same day Lechmanski had taken the naloxone class, someone found Rachel in an altered state of consciousness in a hotel room and called an ambulance. At Swedish Medical Center in Englewood, the emergency room staff determined her blood sugar was low and gave her a dose of dextrose, which revived her. After she woke, Rachel told staff she hadn’t had anything to eat or drink in several days, but had used benzodiazepines, heroin and methamphetamine.

Rachel did receive buprenorphine in the hospital. But the emergency room discharged her about eight hours after she arrived, with no apparent follow-up plan beyond a list of drug treatment resources. A spokesman for Swedish Medical Center said he couldn’t comment on specific patients.

Buprenorphine treatment is difficult to sustain without a stable place to stay, Van Stedum said. Health care providers aren’t always willing to provide more pills if someone steals a patient’s backpack, which happens frequently to people living on the street, she said. And while switching to methadone, which people take daily at clinics, solves the problem of lost or stolen medication, it comes with a different set of challenges.

“You have to be pretty dedicated to be on methadone,” she said.

Rachel’s medical records don’t state if anyone offered her naloxone to take home from her last visit. The Naloxone Project, which distributes the opioid overdose antidote, has pushed for hospitals to offer it to anyone at risk for an overdose, even if that wasn’t what brought them to the emergency room.

Not everyone flagged as being at risk of overdose will die from their drug use, of course, but emergency rooms and other providers have an opportunity to intervene when patients do admit any type of illicit drug use, since other substances sometimes contain traces of fentanyl, said Don Stader, chair of the Colorado affiliate of the Naloxone Project. Stader said he could only comment on general best practices, not the care any individual received.

Of course, naloxone only helps if someone is with the person who is overdosing, and that person is able to recognize what’s happening and intervene.

Rachel went to a friend’s house in Wheat Ridge on the morning of May 3 and laid down on the floor, according to a coroner’s autopsy report. The friend reported she was snoring for a time, but stopped at some point. The friend realized Rachel wasn’t breathing and called 911, but it was too late. Emergency medical responders pronounced Rachel dead at the scene.

People who don’t know what someone’s snoring sounds like can mistake the death rattle for a sign that the person is sleeping peacefully, said Raville, of the Harm Reduction Action Center. Those who have experience with overdoses know to try to wake the person and to administer naloxone if they can’t, but those who don’t know are often left with trauma from finding a friend or loved one after they’ve stopped breathing, she said.

The autopsy report attributed Rachel’s death to the combined effects of fentanyl and methamphetamine, with pneumonia in one lung as a contributing factor. Like all autopsies, it doesn’t opine on what could have prevented the death.

Almost a year after losing Rachel, Skanron thinks the only thing that might have saved her was if she could have been committed to a facility to treat her mental health conditions and allow her brain to stabilize off drugs, probably over months rather than weeks. But people can’t be committed against their will unless they are in imminent danger of suicide or hurting someone else — a standard Rachel never met, even as she put her life at risk every time she used drugs that could contain fentanyl.

McAllister agreed that Rachel’s best chance would have been if her family could have taken control and forced her to stick with treatment.

“Maybe she could have beaten this whole thing,” she said.

Lechmanski isn’t sure what could have helped her. Maybe a doctor could have better managed her medications. Maybe the right therapist could have helped her work through the pain she carried. Maybe he could have done more. Maybe he did too much.

Sometimes, Lechmanski takes pictures of the perennials Rachel planted in their garden more than a decade ago and sends them to Skanron. They remind him of her artistry and nurturing — and that she had much still to give.

“I don’t think she was a lost cause,” he said. “Right until the end, she was fighting to preserve her normal, and to work, and to get out.”

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