Josh Levine’s death, examined at the simplest level, was the doing of a pill.
Small, round, and as visually unintimidating as an over-the-counter painkiller, the Adderall tablet was first prescribed to somebody not named Josh Levine, somebody who then presumably offered it to the 22-year-old at a Saturday-night party at a Chicago apartment. Somewhere along the line, the pill was crushed so it could be snorted. Once ingested, it went to work promoting a sense of alertness and energy that kept Levine, no stranger to alcohol, completely unaware he was pushing himself far, far beyond his own limits with every sip.
Levine, a 2014 University graduate who had accepted his first full-time job and moved to Chicago just weeks before the incident, was found unresponsive on a sidewalk in the early-morning hours of July 20, 2014. He suffered a fatal, alcohol-induced cardiac episode while walking home alone. Someone had stolen his wallet from his motionless body, and Levine had left his phone behind at the apartment where he had been drinking earlier. Levine’s family doesn’t know who stole the wallet, or who called 911, or whether whoever stole the wallet and whoever called 911 is the same person. The key fob in his pocket that would have opened the door to the apartment he had moved into just days before was the hospital’s only means of identifying him.
Presence Saints Mary and Elizabeth Medical Center, located just northwest of downtown Chicago, called Levine’s property manager, who called a family member.
Levine was declared brain-dead shortly after arriving at the hospital. He was taken off life support hours after his parents arrived at his bedside, having driven through the night from Cincinnati after receiving a concerned mid-morning call from Levine’s brother, who also lived in Chicago, then an evening phone call that he was in the hospital, in the ICU, and things weren’t looking good.
In an early-morning phone call on July 21, the Cook County coroner asked Levine’s mother, Julie Buckner, whether her son had attention deficit hyperactivity disorder.
No, Buckner said, he didn’t. Why do you ask?
He had stimulants in his system, the coroner told Buckner. Amphetamines. Adderall.
No, Buckner told her. He didn’t. Levine didn’t do that kind of thing.
The coroner already knew the facts, but said she would look into it further.
The hospital measured Levine’s blood toxicity upon his arrival. His blood alcohol content, Buckner said, was “astronomical.” When he reached the hospital, he had amphetamines in his system. By the time he was taken off life support a day and a half later, the Adderall was gone, flushed out by a network of tubes and needles and a body that, by and large, was still functioning.
Levine’s cause of death was listed as acute alcohol poisoning, but the records only tell a partial story. Alcohol was only one factor.
A pill cost Levine’s brother and three step-brothers a sibling. It cost the University of Michigan a promising young alumnus, the school’s football team a beloved former manager. It cost West Bloomfield High School a popular substitute teacher. It cost Buckner her son.
Stimulants like Ritalin and Adderall are commonly prescribed to patients diagnosed with ADHD, a condition the American Psychiatric Association has stated affects 5 percent of American children, the population in which symptoms of the disorder typically first manifest.
Given the frequency with which the drugs are prescribed to children and their seemingly innocuous brand names, it can be easy to underestimate the drugs’ seriousness and potency.
But Ritalin has another name, too: methylphenidate. If you came up with a nickname for the chemical compound, “meth” might be a good place to start.
The technical term paints a far clearer picture of the effects of these drugs, which, when taken by someone who has no need for them, can elicit similar responses as the recreational drug found on street corners.
The culture surrounding prescription stimulant abuse is remarkably casual, some researchers say. Those seeking out extra pills from friends with legitimate prescriptions are often unaware of the intense side effects that can develop as a result, even in healthy patients.
“Increasingly, doctors and psychiatrists are recommending that people who are prescribed stimulants take them in private,” said Elizabeth Austic, a postdoctoral researcher at the University who has studied the use of stimulants and opioids in teenage populations.
“One thing I heard a lot in college is the ‘friend code,’ — your friend does you a favor; you’re breaking the friend code if you don’t (give in to their requests for a prescribed stimulant),” Austic said.
Giving a friend an extra dose of a controlled substance, considering its potential effects, is no act of friendship. It’s also a felony, a factor that typically only comes into play once disaster has already struck. Sometimes it’s akin to what happened to Levine. Sometimes, the disaster can be a psychiatric one.
Even in healthy patients, amphetamines can induce psychosis and other severe symptoms, according to a 2012 study published in BMC Psychiatry, a peer-reviewed psychiatric journal. More vulnerable patients, such as those with personal or family history of psychiatric issues, can be susceptible to developing symptoms even at small doses.
Symptoms for this form of psychosis can include visual hallucinations, insomnia, anorexia, and delusional parasitosis, in which victims come to falsely belief that their bodies are infested with parasites.
But the side effects of stimulant use, or the adverse effects of combining the drugs with alcohol, are often unrealized in users until the worst has already occurred.
Worse, Austic said, those who do suffer adverse side effects sometimes fall off the radar. A college student who developed symptoms of psychosis after taking stimulants might take a semester off for health reasons or drop out of college entirely, making it even less likely that their peers would be forced to come to terms with the issue’s prevalence.
Instead of a college freshman learning about their roommates’ substance abuse issue, that freshman might simply find him or herself with a double room to themselves, Austic said.
“Growing up, whenever I heard of someone who died from an overdose, you don’t take it seriously, because you think, ‘My friends aren’t like that,’ ” said Ben Eilender, a fellow football manager and 2014 University graduate and lifelong friend of Levine’s. “All it takes is one bad decision. Or one bad night.”
Levine, a member of Theta Chi Fraternity, was the type of person who could be found regularly at parties and bars. He drank a fair amount, his friends say, but not more than anybody else in his social circle.
Levine was as much a momma’s boy as he was a frat boy. He kept his mother in the loop about every aspect of his life.
“Way too much,” Buckner said with a laugh. “He told me way too much.”
He worked part-time at Rick’s American Cafe, a famous hotspot for college nightlife in Ann Arbor. Not wanting to choose between a raucous 21st birthday celebration and a night with his family, Levine settled for both: he brought his parents and siblings to the bar at 611 Church Street.
Levine wasn’t known for being an out-of-control type, for overdoing things, for being the person whose level of intoxication drew eyes from across the room.
“He’s kind of the poster child,” Buckner said. “He was a frat boy who could drink, but he wasn’t an alcoholic. He wasn’t a drug addict. By all accounts of him using Adderall, it was not a regular thing for him.”
Jake Miller, another University alum who was a close friend of Levine’s and shared a house with him in the months following their graduation, agreed. Levine, he said, wasn’t the type to have drawn attention to himself simply by having overindulged.
“That’s why it’s so surprising,” Miller said. “He was never the kid who was out of control, who you had to take care of. He was more likely taking care of someone else.”
While several of Levine’s friends and the University student population at large were generally aware of the dangers of drinking — and maybe even held an abstract understanding of the dangers of co-ingestion — such an outcome was unthinkable.
“I think anybody who’s lost a friend to drinking or drugs has had their experience change,” Miller said. “Of course you know it’s dangerous. You’ve heard stories. But you don’t really think that when you’re going out tonight, somebody could die. That isn’t something that occurs to you.”
In the aftermath of her son’s death, Buckner started the Josh E. Levine Foundation, a nonprofit which honors Levine’s memory by bringing to light the rarely discussed issue of co-ingestion.
The organization’s slogan is ominous: “It’s Fun Until…”
The goal, Buckner says, is to save lives — to bring the issue close enough to home that those considering using stimulants or any other drug alongside alcohol think twice.
“Please don’t co-ingest ANYTHING with alcohol,” the foundation’s Facebook page wrote on April 14, which would have been Levine’s 23rd birthday. “Adderall, Xanax, Percocet, Red Bull, anti-depressants, etc. Have a game plan in place when you drink to quit while you still have your wits.”
But Buckner isn’t fighting this issue alone. Wolverine Wellness, a subdivision of University Health Service, has also been front and center in increasing proactive efforts to prevent students’ abuse of stimulants and sleep aids, both when they’re being used as sleep aids and when they’re being abused alongside alcohol.
There’s no quick fix.
The University’s 2014 National College Health Assessment showed that 10 percent of undergraduate students reported having used amphetamines in the 12-month window before taking the survey, an uptick from 9 percent in 2010, the last year the survey was performed.
A smaller but still substantial percentage of students self-reported having used sedatives like Xanax and Valium — 5 percent of undergraduates in a 12-month window.
Though preventative efforts are largely important in keeping a handle on campus health issues, organizations like Wolverine Wellness find themselves searching for a “sweet spot” that balances spreading awareness with the fear of lending an air of social acceptability to the abuse of a particular drug, said Wolverine Wellness director Mary Jo Desprez.
Desprez, using the hypothetical of heroin use in undergraduates, said broadly spreading the word about abuse of a particular drug abuse pattern can do more harm than good.
“Even if there were only five (users on campus), you still want to do something,” Desprez said. “And you don’t want to norm it. You don’t want to do a big campus campaign that says, ‘Don’t do heroin,’ because then all of a sudden, everybody’s like, ‘Is everybody doing heroin?’ It’s still only five people.”
Instead, Desprez said, the University needs to be “nimble enough to do those targeted interventions” on smaller populations of students who’ve developed an abusive habit without resorting to widespread measures that essentially concede the commonplace nature of certain substance abuse patterns, like AlcoholEdu.
At the same time, many say there’s a mentality issue on campus that has yet to be addressed.
“There’s two pockets of misuse,” Desprez said. “One is performance aid. We have this culture here of, ‘gonna stay up all night, gonna write the paper, gotta focus, everybody does it.’ The other pocket of worry, which I think Josh fell into, is co-ingestion with the idea of keeping the party going longer.
“I think the perception that (a stimulant is) a good study aid sort of dwarfs the reason it’s a prescription drug. It does come with these huge health issues and concerns.”
A study co-authored by Sean McCabe, another University researcher who has studied the practice of prescription drug abuse and stimulant-alcohol co-ingestion, showed that male undergraduates were twice as likely as females to use unprescribed stimulants for nonmedical reasons. White students were more likely to take unprescribed stimulants than any other racial demographic.
About 13 percent of students living in fraternity or sorority houses misused prescription stimulants, compared with about 4 percent of students living in off-campus apartments, according to the study.
Another study co-authored by McCabe study showed that 6.9 percent of undergraduates self-reported having used abusable prescription drugs alongside alcohol in the previous 12-month span.
Perhaps more disturbingly, the study reported, “nonmedical users of prescription stimulants were over six times more likely to report frequent heavy drinking than their peers who did not report nonmedical use of prescription stimulants.”
In other words: those who can least afford to drink heavily are often those who do it most.
“Josh wanted to be a teacher, and he wanted to be a coach,” Eilender said. “That’s what his mom is doing, trying to help kids, trying to save a single life. That’s what shines through for me the most, because that’s what Josh would have wanted.”
Buckner said though she certainly wasn’t obligated to publicize the manner in which her son died, she felt compelled to.
“There was no question that I needed people to know what happened, because it was so frightening to me,” Buckner said. “I had no clue that kids were abusing adderall as a party drug. I did not know about this issue of co-ingestion.”
The message, whether it’s through the foundation’s work, the simple fact of Levine’s death, or both, is having an effect. Levine’s friends approached Buckner at his funeral to tell her that though they had co-ingested previously, those days were over.
Others didn’t have to say a thing — Buckner said she could tell just from the look in their eyes. It also took her son’s death for Buckner to realize exactly the type of person he was — as charitable and selfless as he was, he’s also remembered for being charitable and selfless in the most understated way possible.
“I can’t tell you how many girls told me that he would walk them home at night,” Buckner said. “That he would literally give them the coat off his back if they needed it. To hear that those were the type of things that he was doing was pretty breathtaking.”
In the months before his death, Levine had worked as a substitute teacher at West Bloomfield High School and had thoughts of becoming a credentialed teacher.
“What happened to our family was cataclysmic,” Buckner said.
The cataclysm isn’t over. Barely a year has passed since Levine’s death, and Buckner knows there’s still work to be done.
“When you walk around (Michigan’s campus) on a football Saturday, it’s just unbelievable,” Buckner said. “Now the kids, I heard, will snort Adderall first thing in the morning,” allowing them to drink unimpeded throughout the day.
This Saturday, and on hundreds of Saturdays in the years to come, students will wake up early, and they’ll drink. Buckner isn’t much of a drinker herself. She’s not thrilled about the alcohol — in and of itself, the binge drinking is its own health issue, one that isn’t discussed enough on college campuses across the country.
But if Buckner has her way, maybe — just maybe — they’ll stick to alcohol, and have a plan to quit drinking while they still have their wits. She’s taking things one step at a time.