Ricky Klausmeyer-Garcia\u2019s friends struggled to get him addiction treatment, leading to the creation of a law in his name. A year after his death, profound questions remain about how best to help those with substance use disorder<\/p>\n
by\u00a0Katia Riddle<\/a>\u00a0in Seattle<\/p>\n Mon 13 May 2024 15.00 BST<\/p>\n Sitting at his dining room table, Kelsey Klausmeyer, 41, looks at a picture of his late husband, Enrique Klausmeyer-Garcia, known to most as Ricky. He died almost exactly a year ago, at the age of 37.<\/p>\n Kelsey can\u2019t make sense of it.<\/p>\n When they met, Kelsey was awed by Ricky\u2019s story: his long battle with addiction, his years of sobriety, his advocacy for recovery.<\/p>\n Now, after his death and in the midst of a nationwide addiction crisis, the narrative around Ricky\u2019s life is less tidy.<\/p>\n Ricky is the inspiration for a\u00a0Washington state<\/a>\u00a0law \u2013 known as Ricky\u2019s law \u2013 passed in 2017 that enables loved ones and public safety officials to compel people experiencing substance abuse to undergo treatment, even if they are unable or unwilling to do it themselves.<\/p>\n The US has been experimenting with these forced-commitment laws for decades. The debate over their efficacy, practicality and ethicality is seeing renewed urgency in states such as New York, California and Washington, where addiction and severe mental health disorders have become a highly visible and highly political issue.<\/p>\n Ricky\u2019s story brings into sharp relief one of the fundamental and difficult questions that officials in these places are grappling with: to what extent should society override an individual\u2019s rights in the name of saving their life and protecting public safety?<\/p>\n I thought so highly of Ricky, to suffer with that disease and then turn around and do something for the greater good<\/em><\/p>\n Kelsey Klausmeyer, Ricky\u2019s husband<\/p>\n For Kelsey, Ricky\u2019s story is not primarily about public policy. It\u2019s a story of immense personal joy and loss, laid before him in a handful of pictures. Here they are with their dog, Otis, whom Ricky \u201ctreated like our child\u201d, chuckles Kelsey. Here they are in 2022 on their wedding day, both smiling, fit and handsome at a sunny mountain resort 90 minutes from their home in Seattle. Two hundred of their friends and family came to spend three days celebrating.<\/p>\n Here is Ricky with members of his sprawling family. When the couple first started dating, they discovered, remarkably, that they were both from families of nine siblings, both raised Catholic. \u201cWe always thought we were kind of destined in a way,\u201d says Kelsey.<\/p>\n Kelsey grew up in Kansas; Ricky\u2019s family immigrated from Mexico. They met online. Ricky was direct about what he wanted, a quality Kelsey, a naturopathic doctor,\u00a0<\/strong>found attractive. \u201cHe shared that his dream was to have a family, to have kids, have a dog, have a house, have a husband,\u201d remembers Kelsey. Those were prizes neither of them had felt certain were winnable. Together, they brought that picture into focus.<\/p>\n In those early, heady weeks of dating, Ricky was candid with Kelsey about his history with substance use disorder and his journey of recovery. Kelsey was undaunted.<\/p>\n \u201cI just thought so highly of that, for somebody to have suffered with that disease as much as Ricky did, and then to turn around and do something for the greater good like he did,\u201d remembers Kelsey. \u201cThat got me. That was the moment I fell in love with Ricky.\u201d<\/p>\n But within the first year of their marriage, and despite Kelsey\u2019s relentless attempts to help him, Ricky would be gone.<\/p>\n With his good looks, his authenticity, his goofy enthusiasm for life and willingness to be vulnerable, Ricky was a charmer. Kelsey wasn\u2019t the first person to fall for him.<\/p>\n More than a decade before he met his future husband, Ricky met Lauren Davis. Their friendship would become one of the most important relationships in his life, and the driving force behind the involuntary-commitment law created in his name.<\/p>\n The two were in their late teens in 2004, working as assistant preschool teachers in Redmond, Washington. \u201cI had an enormous crush on Ricky and spent several failed years attempting to woo him,\u201d says Davis of their early friendship. Once they\u2019d established she wasn\u2019t his type, Davis became his \u201cwing woman\u201d and accompanied him to gay clubs. \u201cI\u2019m a white girl who grew up in Washington,\u201d she says. \u201cI can\u2019t dance to save my life, but I sure tried.\u201d<\/p>\n In the next few years, as the two grew into young adults, Davis would become a different kind of wing woman for her friend. Ricky spiraled into a serious problem with alcohol and occasional opioids. \u201cI knew I was feeling depressed,\u201d he recalled years later, in a public radio interview with the Seattle station KNKX. \u201cI was feeling really anxious; most of the time I just wanted to escape all that. I just started to self-medicate and take whatever it took to escape reality.\u201d<\/p>\n The first time Davis called 911 and had her friend taken to the hospital, she remembers his blood alcohol was dangerously high \u2013 she would find out it was at a near fatal level. He was admitted to the hospital\u2019s psychiatric unit. Davis sat with him in his room from 8am to 8pm. She described trying to leave Ricky\u2019s hospital room, \u201chugging him and he wouldn\u2019t let me go\u201d.<\/p>\n Davis and Ricky hiking on Mt Rainier in the summer of 2007. They two met in their early 20s and quickly became friends.\u00a0Photograph: Courtesy of Lauren Davis<\/p>\n This episode set off a corrosive cycle of hospitalization, brief sobriety and relapse. Eventually, Ricky became suicidal.<\/p>\n \u201cI found myself consistently in a position of trying to catch him, before he died, essentially,\u201d says Davis. \u201cIn the course of those two years, he was in the emergency department over 75 times. I was at his bedside for most of those visits.\u201d Numerous doctors told her to plan for his funeral. Davis refused. She would not stand by and watch her friend die.<\/p>\n Ricky\u2019s father had terminal cancer during this period and despite family members\u2019 efforts to help Ricky, his addiction stressed relationships. Davis became his primary advocate and champion.<\/p>\n Watching Ricky\u2019s struggle, Davis was horrified at how little she could do to help him. What she wanted was to put her friend into an addiction treatment facility, because he was too sick to do it himself.<\/p>\n But at that time,\u00a0<\/strong>in 2011, Washington law only allowed for involuntary commitment based on a psychiatric diagnosis, not for a substance abuse disorder. Other states had more expansive criteria.<\/p>\n Davis remembers Ricky on his sixth psychiatric hospitalization. \u201cHe had this young psychiatrist who looked across at him and said, \u2018You know, if we were in another state and I could involuntarily commit you for your addiction, I would.\u2019\u201d<\/p>\n But in Washington state, the doctor said, \u201chis hands were tied\u201d.<\/p>\n American public policy has grappled with the concept of involuntary commitment since at least the 1850s. As many as 14 states had laws on the books before the turn of the 20th century allowing for civil commitment for \u201chabitual drunkenness\u201d. Often, offenders would be locked in asylums.<\/p>\n Over time, enthusiasm for this approach began to fade \u201cbecause of the lack of evidence that the facilities were really able to cure substance abuse\u201d, says psychiatrist and historian Paul Appelbaum, who teaches at Columbia University and studies medicine and ethics. Legislators \u2013 and the public \u2013 stopped supporting the investment. The country saw another wave of these statutes in the 1960s. Today, though roughly two-thirds of states have civil commitment laws that specifically include substance use, many are rarely used.<\/p>\n In part, that\u2019s because there is still little consensus about the efficacy of committing someone to treatment against their will. \u201cThere are almost no data indicating whether it works or for whom it works,\u201d says Appelbaum. Policymakers, he says \u2013 chronically guilty of short-term thinking \u2013 have been reluctant to invest in meaningful efforts to evaluate these kinds of programs.\u00a0Those that have tried<\/a>\u00a0have shown mixed outcomes, and they often don\u2019t measure long-term results.<\/p>\n Many who study addiction and substance use have ethical concerns. Holding someone long enough for treatment to possibly be effective, say some, is immoral.<\/p>\n Dr Liz Frye, who practices addiction medicine in Pittsburgh, explains that substances such as alcohol and opioids hijack the brain\u2019s decision-making abilities. Regaining them can take months. \u201cI have not seen an involuntary hold that would be long enough to help people regain their choice about substances,\u201d she says. \u201cI have a hard time with involuntarily committing someone for that length of time.\u201d<\/p>\n Another complicating factor is that treatment and recovery\u00a0<\/strong>itself can vary widely. \u201cA lot of times, the perception is that everybody needs residential treatment,\u201d says Michael Langer, who works in behavioral health for the state of Washington. \u201cThat\u2019s not true.\u201d Often the best course of treatment, says Langer, is outpatient, or medication-based.<\/p>\n Ordering someone into treatment is just based on a delusion that there\u2019s somewhere for them to go<\/em><\/p>\n Keith Humphreys, addiction researcher<\/p>\n But staffing and funding for treatment facilities of all kinds is in short supply, and getting someone to a short-term treatment facility, with or without their consent, is only a first step on a successful path to recovery. Incentivizing and supporting the individual\u2019s choice to maintain treatment is an equally critical part of the process. That can only happen with a robust and well-funded system that includes many different pathways and interventions.<\/p>\n \u201cI think people imagine there\u2019s this whole massive treatment system,\u201d says Keith Humphreys, who studies addiction and public health at Stanford University. The truth is, he says, most systems across the country \u2013 privately and publicly funded \u2013 for treatment of addiction are frail and underfunded and can\u2019t accommodate the demand, even from those who are pursuing it voluntarily.<\/p>\n In the United States,\u00a0a recent report<\/a>\u00a0shows that 43% of people willingly seeking treatment for substance use were unable to access it. \u201cOrdering them into treatment is just based on a delusion that there\u2019s somewhere for them to go,\u201d says Humphreys.<\/p>\n Police check on a man who said he has been smoking fentanyl in downtown Seattle. The addiction crisis sweeping US cities has raised complex questions about how to get people treatment.\u00a0Photograph: John Moore\/Getty Images<\/p>\n Lauren Davis helped to save her friend. In turn, he laid out the path for what would become her life\u2019s work.<\/p>\n \u201cI started to tell his story to anyone who would listen to me,\u201d says Davis. Some of the people she demanded listen to her were legislators. They helped her introduce a bill for what became Ricky\u2019s law.<\/p>\n After he eventually found his own way into treatment and long-term recovery, Ricky too became an advocate for his bill and Davis\u2019s work. \u201cIf this law would have been in place back when I was in active addiction, I believe that my journey would have been cut that much shorter,\u201d he would say in the interview with KNKX. \u201cFor a lot of addicts, they want to stop but they can\u2019t. You could have loved ones tell you to stop. You could have all these consequences being behind your actions, and yet you won\u2019t and can\u2019t stop.\u201d<\/p>\n The law amended Washington\u2019s existing rule to allow for short-term, involuntary commitment not only for psychiatric disorders but also for those related to substance use. That meant people \u201cgravely disabled\u201d by addiction \u2013 and considered a danger to themselves \u2013 could now be committed against their will.<\/p>\n It designated tens of millions\u00a0<\/strong>of dollars to creating a kind of holding place for detaining people under the law; there are now close to 50 \u201cRicky\u2019s law\u201d beds in four treatment facilities across the state.<\/p>\n But today, who needs these beds \u2013 and how to get them there \u2013 is not always clear.<\/p>\n \u201cSomeone who comes into the emergency department intoxicated on any substance who is a danger to themselves could be referred right off the bat under Ricky\u2019s law,\u201d says Paul Borghesani, medical director of psychiatric emergency services at Harborview medical center, Seattle\u2019s public hospital. \u201cPractically, that doesn\u2019t happen.\u201d<\/p>\n The reasons are numerous, says Borghesani. Often after 12-36 hours in detox, people who were previously at risk of great harm to themselves \u201cappear much calmer\u201d. Many even say they plan to quit using. This puts the clinicians in a bind, he explains, forcing them to reckon with a philosophical question: is someone a danger to themselves if they claim not to be?<\/p>\n The law is also dependent on a team of mental health professionals called designated crisis responders, employed through state contracts with regional behavioral health agencies and counties. These responders are deployed when someone \u2013 often a loved one, community member or medical provider, though it can be anyone \u2013 requests an evaluation of an individual in a substance use-related crisis. It\u2019s at the discretion of these crisis responders to decide whether that individual is in enough danger, or endangering others enough, to commit them to a treatment facility \u2013 sometimes for just a few days but up to several weeks.<\/p>\n But waits are long for these responders; some advocates for those struggling with substance use disorders report enduring weeks before a designated crisis responder arrives. Sometimes that\u2019s time they don\u2019t have.<\/p>\n Another reason Borghesani says the law isn\u2019t used: hospitals are busy. \u201cPhysicians are rightfully very eager to keep people flowing through the emergency departments,\u201d he explains. \u201cSo they might look at this as something that would just take a lot of time and not be beneficial.\u201d<\/p>\n Despite these obstacles, Ricky\u2019s law is put to regular use in Washington. According to the Washington health authority, the state has been admitting roughly 700 people annually to substance-use facilities under Ricky\u2019s law.<\/p>\n That number does not reveal how many people have elected to stay in recovery after their forced detention \u2013 a fact that makes it hard to say with certainty how effective it has been in galvanizing sustained recovery.<\/p>\n In 2024, the complex questions raised by Ricky\u2019s law \u2013 and what helpful, compassionate addiction policy actually looks like \u2013 are more relevant than ever across the country.\u00a0Recent CDC data<\/a>\u00a0shows a stunning national rise in alcohol-related deaths; more than 11% of adults had alcohol use disorder at some point in 2022, according to the\u00a0National Institutes of Health<\/a>.<\/p>\n A far more visible catastrophe of addiction is playing out in US cities overwhelmed in recent years by cheap, synthetic fentanyl. In Washington\u2019s King county, home of Seattle, there were more than 1,000 overdose deaths in 2023, a nearly 50% increase from the previous year. Whole blocks are taken over by people buying, using and selling fentanyl. Arguably any one of these people is a grave danger to themselves.<\/p>\n Some outreach workers and medical providers on the frontlines of this problem would like to use the law to help this population, but say it\u2019s not currently possible.<\/p>\n \u201cWe get stuck in this place of: what do we do?\u201d says Cyn Kotarski, the medical director with a program called CoLead that helps people with housing and treatment. Kotarski often sees people with abscess wounds, days away from becoming septic. But with long waitlists for designated crisis responders, there\u2019s no way to reach people in these crisis moments. \u201cThe option quite literally becomes: they stay outside until they die,\u201d she says.<\/p>\n Frye, the addiction-medicine expert, says the problem is one of more than resources. The US, she says, needs an entirely new orientation to addiction treatment to underpin public policy, one that embraces methods such as harm reduction. \u201cWe have to stop being the moral police of people,\u201d says Frye.<\/p>\n Public health addiction crises like the one that Seattle is battling, she argues, would be better addressed by tackling the surrounding problems \u2013 housing crises, trauma and mental health issues that give rise to substance use disorders. She imagines coupling this approach with accessible, compassionate therapeutic outpatient settings.<\/p>\n \u201cThe best way to help people reduce or stop using substances is to put the patient in the driver\u2019s seat,\u201d she says. \u201cAnd we as healthcare providers are working towards helping them identify their own reasons to want to come back and quit.\u201d Forced captivity, she argues, doesn\u2019t meet that criterion.<\/p>\n But even Frye acknowledges a utility to saving a person\u2019s life in certain circumstances without their consent. Sometimes her own patients are facing imminent death otherwise. \u201cTransporting someone to the hospital involuntarily, getting that condition assessed, and helping make the hospital stay tolerable for the person \u2013 that\u2019s warranted,\u201d she says.<\/p>\n The exact circumstances in which to make this call are hard to define. Maybe impossible.<\/p>\n We get stuck in this place of: what do we do? The option quite literally becomes: they stay outside until they die<\/em><\/p>\n Cyn Kotarski, medical director with CoLead<\/p>\n Inspired by her work creating Ricky\u2019s law, Lauren Davis decided to run for office, and was elected as a state representative in 2018. She has focused her policy efforts on expanding the state\u2019s fragile system of treatment for substance abuse, an endeavor she continues today.<\/p>\n Davis acknowledges Ricky\u2019s law needs course correction to be more useful, and she agrees that even if it\u2019s improved, the law is not enough to adequately address the scope of addiction in places like Seattle.<\/p>\n \u201cDo we just massively scale up Ricky\u2019s law to address the scourge of fentanyl on the streets of Seattle?\u201d she says. \u201cNo.\u201d<\/p>\n Instead she\u2019s focusing her current efforts on building a robust system of treatment that addresses comprehensive needs including housing and access to medications like methadone and Suboxone that can be provided over the counter to treat addiction. This effort also includes expanding a recovery navigator program, in which outreach workers build trust with people on the street and help them access resources \u2013 willingly.<\/p>\n Still, she firmly believes in the potential and power of Ricky\u2019s law in certain circumstances. She\u2019s seen it work first-hand, saying: \u201cAt the end of the day, I believe without a doubt that it has saved lives, that it has changed lives, that it has restored families.\u201d<\/p>\n By late 2020, Ricky had been sober nine years. Then came an episode that would test both Ricky\u2019s relationship with Kelsey and the law created in his name.<\/p>\n Kelsey recalls coming home one day from work and finding his then boyfriend passed out in the stairwell of their condo. Kelsey believes the pandemic triggered the relapse. Ricky had built a network of friends and family in the world of recovery, support that quickly dissolved in social isolation.<\/p>\n \u201cI had heard him talk about what active disease looked like,\u201d says Kelsey. \u201cWhen it showed up, I was like: \u2018Oh my God, what is happening?\u2019\u201d<\/p>\n During that event, according to both Davis and Kelsey, Ricky\u2019s law worked the way it was supposed to. He was put in a temporary, involuntary hold. After a number of days of sobriety, says Davis, her friend re-emerged. \u201cHis brain came back online. He was able to make healthy choices,\u201d Davis recounts.<\/p>\n Kelsey says: \u201cHe chose our life together.\u201d Kelsey worked to help Ricky gain access to a residential treatment program.<\/p>\n It was more than two years later, after he and Kelsey were married, that relapse came again for Ricky. To Kelsey, it seemed out of the blue. Ricky had gone back to school and had a new job working for an organization supporting recovery for others. \u201cWe were really living the dream we always wanted,\u201d he says.<\/p>\n He wonders if his husband was suffering from a kind of existential vertigo. \u201cThe only way that I can make sense out of it is that sometimes when things are so good, it\u2019s the fear of losing it,\u201d he says. \u201cThat\u2019s what Ricky would talk to me about sometimes.\u201d<\/p>\n This time, in post-pandemic 2023, systems of emergency and crisis support were stressed. Kelsey spent hours on the phone trying to make the legal and healthcare wheels turn in his favor. One night, worried that Ricky was literally going to drink himself to death, he drove his husband to the emergency room. The following day, when there was a staff change, says Kelsey, \u201cthe attending physician was going to just release him back out onto the street\u201d.<\/p>\n \u201cI would beg and plead with healthcare staff, police officers. I would say: \u2018Ricky\u2019s law is literally named after him,\u2019\u201d says Kelsey.<\/p>\n After Kelsey finally had him committed, Ricky became far less reachable, even after days of forced withdrawal and sobriety. At one point, he fled all the way to Oregon, out of the reach of his own law. Kelsey spent nights with no idea where he was. \u201cI really can\u2019t see anyone living on the side of the street or under an overpass without thinking about Ricky,\u201d he says.<\/p>\n Eventually, Ricky ended up in a residential treatment facility in a Seattle suburb. He went there willingly; Kelsey was expecting to see his husband the next day. Instead, Ricky was found dead.<\/p>\n The cause of Ricky\u2019s death is under investigation. Kelsey is now suing the facility, alleging wrongful death.<\/p>\n Kelsey\u2019s faith in the law named for his husband remains steadfast, as does his belief in the power of recovery. \u201cFor anyone dealing with this,\u201d he says, \u201cplease know there is hope.\u201d<\/p>\n That optimism has not made his first year as a widower easier. It\u2019s been \u201chell\u201d, as Kelsey describes it. \u201cI just miss him.\u201d<\/p>\n This story is part of a reporting fellowship sponsored by the\u00a0Association of Health Care Journalists<\/a>\u00a0and supported by the\u00a0Commonwealth Fund<\/a><\/em><\/p>\n <\/p>\nSeventy-five hospital visits, and increasing desperation<\/h2>\n
A contentious history<\/h2>\n
Ricky\u2019s law takes shape<\/h2>\n
New dilemmas for a new crisis<\/h2>\n
A devastating turn of events<\/h2>\n