It was around 10:30 p.m. and Liana Wright was settling into bed in her Pitt Meadows, B.C. home when her two dogs began frantically barking downstairs. She asked her husband to investigate.
Minutes later, he started screaming her name and when she reached him, Liana saw her adult daughter, Amanda Wright, crumpled and unresponsive on the kitchen floor.
Liana, a coroner and former emergency room nurse, sprang into action, starting CPR. She knew exactly what was happening. She'd been to many homes where someone had died of a drug overdose and her daughter's purple face, pinpoint pupils, and lack of pulse were all telltale signs.
She had also witnessed what drugs had already done to Amanda, who had been using since breaking her vertebrae in a car accident when she was 19. She got addicted to the oxycontin she was prescribed for the pain, eventually turning to street oxys and then fentanyl.
The night of her overdose, Amanda got a flap of fentanyl from a dealer who came to the family house. She snorted it in the bathroom.
Amanda, 29, didn't die that September night in 2017, but her mother estimates it was about 10 minutes before she took her first breath. She now she lives with permanent brain damage, and suffers from memory loss and struggles with day-to-day tasks.
It is unlikely she will ever be able to live independently or hold down a job.
"She's Amanda with the dimmer switch turned down a bit," said Liana.
The forgotten victims
Amanda is one of the casualties of the opioid crisis the country has no statistics on; the people who did not die from an overdose but suffer permanent brain damage.
More than 4,500 people have fatally overdosed in B.C. since the opioid crisis was declared a public health emergency in 2016, but there is no comprehensive data on the victims living with chronic brain injuries, ranging from mild damage to requiring around-the-clock care.
And that care can be costly.
Dr. Keith Ahamad, addictions specialist at St. Paul's Hospital in Vancouver, estimates it would be more cost effective to prevent overdoses by providing users with a safe drug supply, rather than care for people with overdose-induced brain injury victims long-term. He would like to see politicians put more resources into prevention.
"It's quite shocking we are three-and-a-half years into an overdose public health emergency and our elected officials in charge of our health and well-being have not made a move to regulate the drug supply," Ahamad said.
The weeks after Amanda's overdose were dark times for the Wright family.
Amanda was alive, but she was not the same. She couldn't remember how to brush her teeth or take a shower, and she stared blankly at her mom when asked basic questions.
"Are you having trouble coming up with an answer?" Liana Wright would ask after prolonged pauses. All her daughter could do was nod her head back at her.
Liana paid for private out-patient care at The Watson Centre for Brain Health in Burnaby, B.C. because of long wait lists for brain recovery programs at public hospitals and clinics. It cost $1,600 per month to keep Amanda in the program, which focuses on cognitive, physical and emotional healing.
Amanda spent six months participating in exercise, meditation, and counselling and re-learning basic writing and computer skills at the Watson Centre. After six weeks, she was able to converse with her mom again.
Two years later, Amanda has not regained the gregarious personality that her mother remembers. Liana has renovated a room in her home with the expectation her daughter will live with her forever.
Psychiatric nurse Malcolm Jenkins manages the neuropsychiatry unit at St. Vincent's Langara, a complex care facility in Vancouver where he works with people suffering severe brain damage due to an overdose.
"Some of our folks require up to five people to assist with care because they're so compromised," said Jenkins.
Providence Health estimates it costs at least $2,000 a day per person to deliver that level of care. Many of the patients are under 50 and will need permanent care for the rest of their lives.
Ahamad, who is also a clinical researcher at the B.C. Centre on Substance Use, said people who have drug-induced brain damage can struggle with increased impulsivity and judgment, which also makes it harder for them to recover from their addiction.
He said the cost of care in the unit Jenkins works in will pale in comparison to future expenses governments are facing associated with drug-induced brain damage due to the current opioid crisis.
"Those costs are a fraction of the criminal justice and health costs we're going to see in this tsunami coming at us with these more mildly brain injured people that can't fit into society," said Ahamad.
To hear the short radio documentary with Amanda and Liana Wright produced by Jodie Martinson for CBC's The Early Edition, click on the audio link below: