Deaths from opioid drug overdoses have hit epidemic proportions nationwide. In Minnesota, the struggle with addiction to prescription painkillers and illegal opioid drugs has left families, friends and communities across the state grieving deaths that could have been prevented. Lexi Reed Holtum is one of them.
It was like the plot of a romantic comedy: High school sweethearts reunited, decades later.
Steve Rummler and Lexi Reed Holtum had remained friends throughout the years. She'd go out to see his band, the Gooneybirds, whenever she was in the Twin Cities or when they were touring the West Coast, where she'd moved after leaving Minnesota.
They were both in their 40s when Lexi moved back home. Steve asked her out; Lexi accepted.
"We just fell back in love, really pretty fast," Lexi said. "It felt really safe. It felt really comfortable, and I knew his family and he knew my family. It was kind of like a celebration."
Within a year, the couple was engaged. Lexi and her 7-year-old daughter, Isabella Gerry, moved in with Steve.
Steve's family was big and very close. Lexi said it seemed like he just innately knew how to forge their new family. Steve and Isabella would get so involved in their regular game nights that she'd almost never get a say in the game they played. They'd have contests to see who could make the other laugh more.
"He loved me. And he loved Isabella. And he had the same dreams that I had. We wanted to build our lives together," Lexi said. "I started to be aware of where things were not OK for fostering a healthy family unit. But because there was so much love there, I really thought I could save him and fix it."
'Stopped showing up for life'
Steve had chronic pain from a back injury. As often as every 30 seconds, Lexi said, he might experience shooting sensations up and down his spine or limbs. Doctors at the time prescribed him time-release morphine, an opioid, for the treatment. The Centers for Disease Control and Prevention released advice earlier this year that doctors should avoid prescribing highly addictive opioid painkillers to treat chronic pain.
Like many, Steve had some experimented with illegal drugs like marijuana in college and as part of the music scene. But as an adult, he had no need for illicit substances. He had pills for his chronic pain, pills for diabetes, pills for anxiety and pills for sleep. He began to self-medicate again with alcohol, although he'd been abstaining from alcohol when he and Lexi started dating.
Soon, Steve's demeanor had changed dramatically.
"He just stopped showing up for life," Lexi said. "What happened to Steve is [that] it would be three in the afternoon, and he would be nodding out on the couch."
At the time, Lexi wasn't familiar with what she now describes as "the illness of addiction." She said she felt like she needed to support and protect Steve, making excuses to friends when he nodded off at the table during Thanksgiving dinner — or unintentionally helping to hide his behavior from his family.
Sometimes she wouldn't let him drive his car because she was afraid he'd nod off. But eventually, Lexi told Steve she couldn't live that way. She told him she was afraid the addiction would kill him.
"I'd have a conversation with Steve that he needs to stop, and that we need to change our lives," Lexi said. "And he would promise to wean down and get off of them and not get any more prescription painkillers."
The couple planned vacations so he'd run out of pills. They created schedules for him to stop using. But he always seemed to have enough to get by. He was getting prescriptions from multiple doctors, a practice called doctor-shopping.
Eventually, his loved ones had enough. Lexi, along with the couple's friends and family, staged an intervention with Steve, asking him to get treatment. Lexi said he went willingly to a monthlong treatment program at the Hazelden addiction treatment center in Center City, Minn.
"In my heart, I know that he loved me and my daughter and his family and his friends so much that he wanted to do this for us," Lexi said. "I don't know if he ever got to the point where he believed that he couldn't just take a break and come back and be able to manage it differently."
When Lexi picked Steve up after treatment, she said, he was different. He drove the car and sang Louis Armstrong's "What a Wonderful World."
"His voice had changed really with addiction, it really became kind of flat, and I just remember when he was singing on the way home, just miraculous that he was back," Lexi said. "He felt happy and he had just a sparkle in his eyes."
Soon after coming home, Steve wanted to take a break from his recovery. Within 48 hours, he was falling asleep, nodding out, when he should have been awake. He wasn't showing up for appointments.
"You're telling me that you're not really nodding out, that you're just tired because you stayed up last night and worked," Lexi said. "OK, I don't really believe you. But what do I do with that?"
Then, a month after he returned home from treatment, Lexi found painkillers and alcohol. Steve was there when she found them.
"The astonishing thing is that when you are so steeped in the illness of addiction, even when somebody is holding the bottle of pills in front of your face and saying, here, they're right here, he still tried to lie about it," Lexi said. "He didn't want to lose me, but he couldn't live without those drugs at that moment in his life."
Lexi told Steve that she loved him and still wanted to marry him, but that she and her daughter needed to move out until he got clean. She called on mutual friends and his family for help, making sure they checked on him around the clock.
"I never stopped loving him for who he was, but it was like an alien had taken over his brain and he just wasn't Steve," Lexi said. "I had hope, and I knew he could get back to being Steve if he was just willing to accept the help that could be there for him."
Steve got into a car crash the Sunday after Lexi moved out. He wasn't injured, but police arrested him after they found a baggie of random pills in the car. She later found out that he'd mixed all his medications together in hopes that she wouldn't know which ones were for diabetes and which ones were painkillers. He partly blamed her for the arrest.
"Steve was angry at me and he was ashamed at himself that he couldn't control this," Lexi said. "Steve was just such an amazingly gentle person and he just got very angry. That was so out of character and unusual for him that that was shocking."
Steve got out of jail but ran out of prescription opioids a few days later. Like many people hooked on pain pills, he turned to heroin, which is an opioid and can be cheaper and stronger than pills. He'd met a young man in jail who said he knew where to buy it.
Steve went and bought heroin with the young man. They met two other men and went to a liquor store before going back to Steve's townhouse in Eden Prairie. They drank alcohol and shot up the heroin.
"None of these young men were the kingpin drug dealer, they were all just like Steve, using because they're addicted," Lexi said. "I don't know if they knew that Steve was dying or if they just thought he was nodding out. But they ended up stealing from us and leaving Steve there."
A friend who'd been scheduled to drive Steve to treatment found him dead on the couch the next morning.
'People aren't bringing me casseroles'
Lexi got the phone call when she was driving home from breakfast with friends.
"My friend called me and said, 'Where are you?' And I just kind of knew," Lexi said. "'I asked her, was Steve dead? She said, 'Yes.'"
Lexi drove to the townhouse they'd shared together. It was surrounded by police. A pastor was there. Steve's closest male friends were there. She talked to his parents, but doesn't remember what she said. She just remembers thinking it couldn't be true.
"Even all the times I said to him, you need to get help because I don't want you to die, or you need to get help because you're going to die, I never really believed he was going to die," Lexi said. "I never really believed it."
Lexi's daughter, Isabella, was at her father's house that weekend. They didn't grieve alone. Lexi's best friends huddled around them. And Steve's parents shared their grief. But there were days when Lexi couldn't even imagine how she and her daughter would ever be alright again.
"In the beginning," Lexi said, "there were many, many days where I would hold her while she cried and asked us the question, 'Mommy, why didn't he just listen to us?"
It has taken years for Lexi to accept that Steve's death wasn't her fault.
"Everybody across the country that loses somebody to the disease of addiction goes through this process where you need to walk through really understanding," Lexi said. "It wasn't my fault that he had this disease, and it wasn't anybody's fault. It was a brain disorder that Steve had, and he lost his battle with addiction."
Still, Lexi saw so many ways that the system for dealing with addiction — and opioids in particular — could be improved, from expanding insurance coverage of treatment programs to making medicine that helps users kick their addictions more widely available.
When Steve's parents, Judy and Bill, founded the Steve Rummler Hope Foundation later that year, Lexi joined them.
"Every single demographic and every single county in our state had individuals who had lost somebody like I lost Steve," Lexi said. "We discovered that this was a national epidemic, and that Steve wasn't alone, and that there were opportunities to make a difference in his name."
• Explained: Minnesota's opioid epidemic
Lexi and the Steve Rummler Hope Foundation were instrumental in passing legislation in 2014 called Steve's Law, which expanded Minnesotans' access to a medicine called naloxone, which can revive someone who has overdosed on an opioid.
"This process for me of doing the work that I do with the foundation, in the beginning, it's like, I just needed it," Lexi said. "I needed it to be able to walk through my grief, to feel like there was something I could do to heal. Then I discovered I'm very good at it. I'm good at public policy."
The group has worked to get state funding for first responders across the state to carry naloxone, especially in rural areas where there's little access to medical care. It has worked with hospitals to get naloxone stocked in emergency rooms and has held training sessions on how to administer the medicine everywhere from police departments to living rooms.
Many of the group's supporters have also lost loved ones to overdoses. As part of her job with the foundation, Lexi tells Steve's story all the time. She said it's still hard to talk about, but that his story, blemishes and all, is important because it can help dissolve the shame that drug users and those around them feel about addiction.
"I hear all the time that somebody's child is sick with this disease and they get them into treatment, 'People aren't bringing me casseroles,'" Lexi said. "My child is dying, and they're not bringing me a casserole, and they're shunning me and don't know how to talk about it. That's what we need to change."