Tag Archives: suicide

As the feds crack down on opioid prescriptions, patients are taking their own lives, doctors are losing their jobs and overdose rates continue unabated.

The Government’s Solution To The Opioid     Crisis Feels Like A War To Pain Patients

By Art Levine

Meredith Lawrence's late husband died by suicide after his opioid pain prescription was severely restricted.

Jay Lawrence, an energetic truck driver in his late 30s, was driving a semitrailer across a bridge when the brakes failed. To avoid plowing into the car in front of him, he swerved sideways and slammed the truck into a wall, fracturing his back. For more than 25 years, he struggled with the resulting pain. But for most of that time, he managed to avoid opioid painkillers.

In 2006, his legs suddenly collapsed beneath him, due to a complex web of neurological factors related to his spinal cord injury. He underwent multiple surgeries and tried many medications to alleviate his pain.

The next year, he began to experience some semblance of relief when his doctor prescribed morphine, one of a class of opioid drugs. By 2012, he was taking 120 milligrams per day.

But this isn’t a story about opioid addiction. Lawrence managed a relatively productive, happy life on the medication for the better part of 10 years.

“This isn’t the life I thought I’d have,” he told his wife, Meredith Lawrence, in December 2016. “But I’m all right.”

Living on disability payments, he could still walk around their two-bedroom trailer home using his cane, take a shower on his own and, on his good days, even help his wife make breakfast.

Then, in early 2017, the pain clinic where he was a patient adopted a strict new policy, part of a wide-ranging national effort to respond to the increase in opioid overdose deaths. 

Citing 2016 guidelines from the U.S. Centers for Disease Control and Prevention, her husband’s doctor abruptly cut his daily dose by roughly 25 percent to 90 mg, Meredith Lawrence said. That was the maximum dose the CDC recommends, though does not mandate, for first-time opioid patients. 

The doctor also told Jay Lawrence that the plan was to lower his dose to 45 mg over the next two months, a cutback of more than 60 percent from what he had been taking.

At the end of that traumatic visit, his wife said, Jay Lawrence’s doctor dismissed their concerns and shared his own fear about losing his license if he continued to prescribe high doses of opioids. (When HuffPost followed up, the doctor declined to comment on the case, citing patient privacy.)

For a month, Lawrence suffered on the 90 mg dose. At times, his pain was so bad that he needed help to get out of the recliner, and when his wife looked over, she sometimes saw tears streaming down his face.

He dreaded his next appointment when his dose would be slashed to 60 mg. In the weeks before that scheduled visit on March 2, 2017, Lawrence came up with a plan.

On the day of his appointment, on the same bench in the Hendersonville, Tennessee, park where the Lawrences had recently renewed their wedding vows, the 58-year-old man gripped his wife’s hand and killed himself with a gun.

Meredith Lawrence sits in the living room of the home in Gainesville, Georgia, that she bought after her husband's death

Dustin Chambers for HuffPost Meredith Lawrence sits in the living room of the home in Gainesville, Georgia, that she bought after her husband’s death.

There are at least nine million chronic pain patients in the United States who take opioid painkillers on a long-term basis. As law enforcement and medical regulatory bodies try to curb the explosion in opioid deaths and the rise in illegal opioid use, they have focused on reducing the overall opioid supply, whether or not the drugs are provided by prescription. 

There’s mounting evidence this won’t work ― that curbing patient access to legal prescription opioids does not stem the rate of overdoses caused primarily by illegal drugs ― and that patients are being denied desperately needed relief. There are also troubling indicators that cutting back on opioids increases the risk of suicide among those with chronic pain.

Some chronic pain patients and advocates have even begun compiling lists of individuals they know who have died by suicide after they were no longer able to treat their pain with opioid medication.

“There is no doubt in my mind that forcibly stopping opioids can destabilize some of the most vulnerable people in America,” said Dr. Stefan Kertesz, a professor of medicine and an addiction researcher at the University of Alabama at Birmingham. “And the outcomes for those folks include suicide, overdose and falling apart medically.”

I mean, people need to take some aspirin sometimes and tough it out a little. Attorney General Jeff Sessions

For a decade or so, government officials in the U.S. have sought to drive down the opioid supply through a range of tactics ― from increased seizures of diverted opioid medications to state crackdowns on “pill mills.” The Trump administration has embraced the hard-line approach.

In late January, Attorney General Jeff Sessions announced a “surge” in Drug Enforcement Administration activity targeting pharmacies and physicians that, in the agency’s view, oversupply opioids. In February, the Justice Department doubled down with the announcement of a new task force that would focus on manufacturers and distributors of opioids. In March, President Donald Trump unveiled a plan to lower opioid prescriptions by a third within three years. And in late June, the federal government arrested 600 people, including 165 medical professionals, for allegedly participating in $2 billion worth of fraud schemes involving opioids.

The Trump administration’s efforts are dramatic even within the context of the CDC’s opioid dose guidelines. The guidelines were originally intended to advise primary care physicians treating chronic pain patients and other pain sufferers. They were urged to exercise caution in prescribing opioids, to use alternatives whenever possible and to prescribe daily doses of no more than 90 morphine milligram equivalents (MME) for new opioid users.

For pain patients like Jay Lawrence who had already been on opioids for years, however, the guidelines simply recommended regularly assessing the harms and benefits of the dosage. They didn’t advise either mandatory cutoffs or any set limits. (The Tennessee Department of Health’s guidelines would also have allowed Lawrence to stay at 120 mg of morphine when prescribed by a pain specialist.)

But “the CDC guidelines have been weaponized,” said Kertesz. The ramped-up enforcement by the DEA and state regulators has led some doctors to choose caution and to overcorrect in their prescribing, lest they lose their ability to practice medicine at all. Kertesz decried these policies as “simplistic” in a definitive new article published last week in the journal Addiction.

In February, Sessions struck a particularly harsh tone by suggesting that the fate of chronic pain patients was not high on his list of concerns. “I am operating on the assumption that this country prescribes too many opioids,” the attorney general said. “I mean, people need to take some aspirin sometimes and tough it out a little.”

Attitudes like that are based on a series of mistaken assumptions about pain, according to Dr. Thomas Kline, a North Carolina-based family practitioner and former Harvard Medical School program administrator. Kline regularly updates a list of pain patients, published on Medium, who’ve killed themselves in the wake of draconian restrictions on pain medication.

“I ask people to imagine the very worst pain they’ve ever experienced in their lives,” Kline said. “And then that they’re denied relief by a doctor with the one medicine proven effective for pain control for 50 centuries.” (Historical records show that people in ancient Mesopotamia cultivated the poppy plant for medical use.)

The CDC guidelines have been weaponized. Dr. Stefan Kertesz

The government’s aggressive focus on doctors and patients is unlikely to address the very real menace of opioid-use disorders and sharply escalating overdose deaths. Fraud ― driven by pharmaceutical company policies ― and diversion ― the phenomenon of prescription medications being sold as street drugs ― initially spurred a wave of opioid abuse in the late 1990s, as some doctors turned their practices into pill mills. But new reports by the CDC and a drug data firm, the IQVIA Institute for Human Data Science, suggest that prescription drugs play a much smaller role in today’s crisis.

The reports show that total opioid prescriptions dropped 10 percent in 2017 ― the sharpest annual decline in such prescribing in 25 years. While opioid prescriptions peaked back in 2010, the studies found that growth rates in opioid-linked deaths, overwhelmingly due to illegal fentanyl and heroin, have skyrocketed in the last seven years.

Indeed, although two-thirds of the 64,000 overall drug overdose fatalities were linked to opioids in 2016 ― the most recent year for which there is data ― more than 80 percent of those opioid drug deaths came from illegal street drugs such as heroin and fentanyl. Prescription opioid drug deaths alone ― excluding methadone ― amounted to less than 15 percent of all drug overdose deaths, or about 9,500 fatalities.

Still, the CDC’s guidelines have triggered restrictive laws in at least 23 states that mandate ceilings on opioid dosage. (Oregon, in fact, is moving to taper dosages down to zero for all Medicaid chronic patients over a year.) That makes relief less attainable for pain patients and threatens the practices of doctors who treat them. These laws have been augmented by the growth of state prescription monitoring programs that use the software NarxCare, which is designed to flag addiction but can also rope in pain patients based on their prescription history and use of multiple doctors.

And in June, the House of Representatives passed over 50 bills that would establish dramatic new restrictions on opioid prescribing, eliciting alarm among patients and some disability rights groups.

The side effects of the current enforcement efforts are disturbing enough, from patients denied relief to drug shortages to suicides.

No health agency has kept track of all pain-related suicides that may be linked to doctors cutting back on prescriptions. But some preliminary findings from Department of Veterans Affairs researchers indicate that VA pain patients deprived of opioids were two to four times more likely to die by suicide in the first three months after they were cut off, compared to those who remained on their pain medications.

“To protect people, you have to take care of the patient, not the pill count,” said Kertesz, who worked on the VA’s April 2017 study but spoke to HuffPost only as an independent researcher. “The findings suggest that the discontinuation of opioids doesn’t necessarily assure a safer patient.”

Even terminally ill cancer patients are increasingly getting less relief, and there are growing shortages of injectable opioids at local hospitals and hospices, spurred in part by DEA-ordered reductions in opioid manufacturing quotas.

Leah Ilten, a 53-year-old physical therapist who lives in Kennewick, Washington, told HuffPost that as her 86-year-old father lay dying of pancreatic cancer in a hospice, the medical staff ignored her pleas to provide appropriate opioid pain relief, even cutting his dosage in half on the last day of his life. A few days earlier, when he was in the hospital, one nurse explained to her that opioids could lead to an overdose or could potentially cause the man, who lay moaning in pain, to “get addicted.”

“I was horrified,” Ilten said.

In mid-April, the DEA responded to the injectable opioid shortage by lifting production quotas. An agency spokesman told HuffPost that it was “a manufacturers’ problem, not the quotas,” while asserting that progress is being made.

There have been production issues, including Pfizer’s foul-ups with a plant in Kansas. But the DEA’s delay in taking action ― shortfalls were flagged in February in a letter from the American Society of Anesthesiologists and other health groups ― definitely contributed to the shortage, according to Dr. James Grant, president of the ASA. He told HuffPost that quotas were among the factors creating the crisis.

I’m not willing to go back to the state I was in before I started treatment. Anne Fuqua

Faced with the hardline national crackdown on opioid prescriptions, people with chronic pain are trying to raise awareness of the suffering caused by the loss of medications. Some are gathering the names of those patients who ended up taking their own lives, both as a memorial to those who died and as a protest against the health establishment that has seemingly abandoned them. Others are seeking comfort from each other on social media.

Lelena Peacock, who declined to name her southeastern city of residence for fear of retaliation from doctors, is struggling with how to treat the pain associated with fibromyalgia. The 45-year-old found that her social media posts drew other pain patients who turned to her for help.

By her own count, Peacock has thus far convinced more than 70 chronic pain patients to call 911 or suicide prevention hotlines instead of killing themselves.

For Anne Fuqua, a 37-year-old former nurse from Birmingham, Alabama, the motivation for compiling a list of chronic pain-related suicides is to track the damage done by what she sees as policies that have left people like her behind. 

“There’s so many people who have died,” she said. “We have to remember them.”

Fuqua has an incurable neurological illness known as primary generalized dystonia that causes Parkinson’s-like involuntary movements and painful muscle spasms. She started taking about 60 mg of Oxycontin a day in 2000. Her doctor began to limit her access to high doses of opioids in 2014, the same year she started chronicling those friends who had killed themselves or otherwise died after being denied pain medications. Her informal list is now up to roughly 150 people, augmented by lists that other pain patient advocates have compiled.

On July 9, Fuqua joined other chronic pain patients at a meeting at the Food and Drug Administration campus in Maryland to express their fears and outrage at the cutbacks. Sitting in the front row in her wheelchair, she told FDA officials about that list and declared, “I’m not willing to go back to the state I was in before I started treatment.”

Anne Fuqua needs exceptionally high doses to manage her pain because of opioid malabsorption.

Courtesy of Anne Fuqua Anne Fuqua needs exceptionally high doses to manage her pain because of opioid malabsorption.

Fuqua’s own difficulties are compounded by the fact that her body does not respond to even large doses of opioids the way others do ― she suffers from severe malabsorption that hampers her ability to benefit from everything from opioids to vitamin D. Since 2012, she has relied on a strikingly high daily regimen of 1,000 MME of opioids, including fentanyl patches, to manage her pain.

But her physician, Dr. Forrest Tennant, was driven to retire this year after a DEA raid and investigation. The Los Angeles-area physician mailed her a final series of prescriptions, which will run out at the end of July.

“It’s terrifying,” she said looking at her future. “If these were people who had asthma or diabetes and weren’t stigmatized because of opioids, this wouldn’t be allowed to happen.”

Another doctor has quietly stepped forward to continue treatment for Tennant’s remaining patients, Fuqua said, although there’s no assurance that this physician won’t also be investigated in the future.

If these were people who had asthma or diabetes and weren’t stigmatized because of opioids, this wouldn’t be allowed to happen. Anne Fuqua

The raid on Tennant’s home and office last November illustrates the hard-line regulatory and enforcement approach that critics say doesn’t distinguish between pill-mill doctors who deserve to be shut down and legitimate pain doctors who use high-dosage opioids. The wide-ranging search warrant served to Tennant essentially accused him of drug trafficking even though he’d earned a national reputation for deft treatment of ― and research about ― pain patients.

“He’s highly respected and prominent in pain management,” said Jeffrey Fudin, a clinical pharmacy specialist who heads the pain pharmacy program at the Albany Stratton VA Medical Center in Albany, New York, and serves as an associate professor at the Albany College of Pharmacy and Health Sciences. “Most of his patients had no other options, and they came from around the country to see him.”

Tennant was known for taking on difficult-to-treat patients, including those suffering from pain as a result of botched surgeries and other forms of malpractice. His research included innovations in the use of hormones to alleviate pain and lower opioid use up to 40 percent, as well as work on genetic testing for enzyme system defects that lead to opioid malabsorption.

“The DEA can trigger an investigation every time they misapply the CDC guidelines without paying attention to the population the physician treats or issues of medical necessity,” said Terri Lewis, a patient advocate and a Ph.D. clinical rehabilitation specialist with Southern Illinois University who trains clinicians on how to manage seriously ill patients with incurable pain.

Special Agent Timothy Massino, a spokesperson for the DEA’s Los Angeles division, declined to comment on the agency’s approach to Tennant. “It’s an ongoing investigation,” he noted.

Tennant’s isn’t alone. Physicians must now balance their prescribing obligations to their patients with legitimate fear for their livelihoods.

DEA enforcement actions against doctors have risen some 500 percent in recent years ― from 88 in 2011 to 449 last year, according to an analysis of the comprehensive National Practitioners Data Bank by Tony Yang, a professor of health policy at George Washington University. Even though that’s a relatively small number of arrests compared to the roughly one million physicians in the country, such arrests can have an outsized impact.

“They make big news, and they serve as a deterrent for physicians whose specialties require them to use a lot of pain medications,” Yang said. “It makes them think twice before prescribing opioids.”

Meredith Lawrence shows the tattoo she got after her husband'€™s death. The bluejay represents her husband, Jay; a cup of cof

Dustin Chambers for HuffPost Meredith Lawrence shows the tattoo she got after her husband’€™s death. The bluejay represents her husband, Jay; a cup of coffee is the way she loves to start her day; and the quote is “Sail away with me, what will be will be.”

Dr. Mark Ibsen of Helena, Montana, found himself in a five-year battle against the state licensing board that’s still not over ― even though a judge last month reversed the board’s decision to suspend his license because of due process violations. The court has remanded the case back to the licensing board for potential further investigation of his opioid prescriptions, but Ibsen has decided he won’t resume his medical practice.

That’s bad news for Montana, which has the highest rate of suicide in the country, according to the CDC. What’s more, chronic pain-related illnesses account for 35 percent of all the state’s suicides, as a recent state health department study found.

In the course of his fight with the medical board, the 63-year-old doctor said three of his former chronic pain patients have killed themselves after he and other doctors stopped prescribing opioids. The first of those patients died shortly after attending a hearing to show his support for Ibsen.

The deaths of pain patients haunt those who treated them and loved them. Meredith Lawrence, who sat with her husband to the very end, said, “It was as horrifying as anything you can imagine.”

“But I had the choice to help him or find him dead someday when I came home,” she added.

Lawrence was arrested and sentenced to a year’s probation for assisting a suicide. Now her goal is to fight restrictions on opioid prescriptions.

“If we don’t stand up, more people will die like my husband.”

If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.

Art Levine is the author of Mental Health, Inc: How Corruption, Lax Oversight, and Failed Reforms Endanger Our Most Vulnerable Citizens.

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That study isn’t without flaws. Veterans die by suicide at higher rates than average ― currently accounting for 20 suicide deaths a day ― so they are not a nationally representative sample. And the VA study, which was released at a national opioid summit in early April, has not yet been submitted for peer review.

But another study, published last year in the peer-reviewed journal General Hospital Psychiatry, looked at nearly 600 veterans who in 2012 were cut off from dosages after long-term opioid use and found similar results. Twelve percent of the vets showed suicidal ideation or took violent action to harm themselves ― a rate nearly 300 percent higher than the overall veterans community.

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IBOGAINE FOR PTSD! The Quieted Rage

Image result for Ibogaine

 

By Damon Matthew Smith

PTSD (Post Traumatic Stress Disorder) is a condition that has had limited progress in the creation of viable treatment options for people afflicted with this despair and rage inducing disorder. Conventional medicine has come up with no long-term answers to the problem, which not only has a range of dangers for the person who has PTSD but also for the society at large.

Time magazine reported in the article WAR ON SUICIDE?, “While veterans account for about 10% of all U.S. adults, they account for 20% of U.S. suicides.” (Gibbs and Thompson) This is a startling percentage, 1 in 5 deaths caused by suicide are veterans of war. Another 1:5 ratio is important to note when discussing the burgeoning problem of PTSD, “Nearly 20 percent of military service members who have returned from Iraq and Afghanistan — 300,000 in all — report symptoms of post traumatic stress disorder or major depression, yet only slightly more than half have sought treatment, according to a new RAND Corporation study.” (www.rand.org) 

This study was the first of its kind to look at this epidemic in all branches of the US military, and its implications are terrifying. This is a mental health crisis that neither traditional psychology/psychiatry nor the VA and military leaders have provided any real solutions as the wars in Iraq and Afghanistan drag on. The situation is dire.

I went to the first War in Iraq in 1990-91 as an Army Combat Medic. It was given the catchy nicknames of first Desert Shield and then, when the US started the air assault, Desert Storm. After coming back stateside, I started to suffer from bouts of rage, severe depression, thoughts of suicide (one botched attempt with pills and a bottle of whiskey), and more and more self-medication with alcohol. When I was discharged in 1998, I was in college full time and had a supportive family and group of friends, but still my alcohol abuse and difficulty containing my bouts of rage and the aftermath of chronic depression was accelerating. I battled through and achieved some academic and personal success, earning two undergraduate degrees and one graduate degree, getting married to my longtime girlfriend, and finding my first adjunct teaching positions. However, I was unable to contain the absolute anger I experienced at the most insignificant triggers. The crying of a baby, the smell of diesel fuel, the sound of a helicopter flying over, the dropping of a metal pan on the kitchen floor, a car following to close, or a dissatisfied boss (lost many a college teaching job due to my PTSD), and I would fly into uncontrollable screaming and yelling fits, at times turning this rage inward, falling to the ground in palsied sobbing and unintelligible babbling. By 2005, I quit drinking and felt this would solve the problem, save me from the growing fear I had of going outside, of my wife leaving me, of being out of control once again, and, most importantly, of taking my own life. It helped, but only temporarily. The rage, depression and suicidal ideation soon began again its assault on my daily life.

Flash forward to today, the end of 2012, and I feel free of this dominating anger and the violent outbursts, my triggers of the past have little effect on my behavior and mood, and for the first time since before my wartime traumas I feel positive and excited about my future. This stunning transformation came out of my experience at the end of this Summer with a substance called Ibogaine. Ibogaine is an alkaloid derived from the Tabernanthe Iboga shrub found in West equatorial Africa and has a long history of shamanic and medical use with tribes of that region. In recent years it has produced media attention due to reports of effectiveness in treating drug addiction and providing opiate addicts with significantly reduced, or at times completely alleviated, withdrawal symptoms during detox.

I had to travel to Costa Rica because of its illegality in the US ( Schedule I, along with Heroin and Methamphetamines), and was treated by Lex Kogan at the medically supervised Ibogaine treatment center named fittingly– Iboga Path . He required an EKG and Liver Panel blood test before I was allowed to come to his center, which he reviewed with his onsite doctor and medical staff to rule out counter indications for Ibogaine treatment. After my file was reviewed, I received the call that my treatment would be conducted on the 22nd of August and that I would be picked up at the airport by none other than Eric Taub, a central pioneer in the use of Ibogaine since the late 80’s. I have known Eric for 7 years, first meeting him in 2005 after I stopped drinking, then working with him over the years developing his novel but simple idea that no child should be without clean water, nutritious food, safe shelter and a digital age education. You can see our efforts to bring this concept to life by building models for International Cooperative Education and Global Sustainability Awareness and Action at our organization’s website,www.ICANRevolution.org.

After a 35 minute drive through the hills of Costa Rica, I was dropped off at the center. My intake into the center was comfortable and laid back. Lex talked with me for a few hours, assuaged my fears about the experience significantly with his knowledge and hospitality, shown my room where I would be staying for the duration of my experience, and I ate my last meal made up of a myriad of local, organically grown fruit before my treatment in the morning. When I woke up that morning I was instructed to drink water, as much as I liked, because during the experience I would be limited to only a few sips an hour to avoid nausea. I filled up a few glasses, downed them, then made my way outside for a walk before my treatment to clear my head. The mountain air was crisp, as I walked up the hillside road lined with coffee plants and trees filled with tropical birds my mind was all abuzz with what was about to happen. So many thoughts permeated my brain, and as panic started to overtake me I found myself experiencing a low grade anxiety attack. It would be my last.

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Teen who committed suicide had just been told by school administrators that he had ‘ruined his life’ after marijuana bust at homecoming dance

 

https://i2.wp.com/i.imgur.com/yU6jAYU.jpg

  • Hayden Long, a 16-year-old sophomore and quarterback at Geneva High School, was found dead on Monday in his family’s Ohio home
  • He was one of six students questioned and disciplined at the school’s homecoming dance on October 3 for smelling like marijuana
  • Long’s friend, Hank Sigel, wrote an open letter describing the conditions in which they were questioned
  • He described himself and the five teens as honor students and athletes
  • Sigel said that Long was singled out by the three questioners, which included a principal, assistant principal and a police officer
  • Sigel said the students faced a two-week suspension, possible criminal charges, suspension from sports and a loss of drivers’ licenses
  • Long’s mother said she does not blame the school for her son’s death

By Kelly Mclaughlin For Dailymail.com

Published: 13:54 EST, 10 October 2015 | Updated: 16:28 EST, 10 October 2015

Read more: http://www.dailymail.co.uk/news/article-3267766/Ohio-teen-blames-Hayden-Long-s-suicide-school-administrators-students-told-ruined-life-marijuana-bust-homecoming-dance.html#ixzz3oLm3Y0FZ

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Secret Marijuana Farm Beneath Brooklyn Cherry Factory Leaves Many Mysteries

By VIVIAN YEEFEB. 26, 2015

 

 

Arthur Mondella’s alternate life was buried behind a roll-down gate, behind a fleet of fancy cars, behind a pair of closet doors, behind a set of button-controlled steel shelves, behind a fake wall and down a ladder in a hole in a bare concrete floor.

Here, in a weathered basement below the Red Hook, Brooklyn, maraschino cherry factory he had inherited from his father and his grandfather, he nurtured a marijuana farm that could hold as many as 1,200 plants at a time. Here, below the office where he served as chief of Dell’s Maraschino Cherries Company, he kept a small, dusty library and a corkboard pinned with notes. Most of the books dealt with plant propagation methods. One did not: the “World Encyclopedia of Organized Crime.”

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Much about the hidden operations of Mr. Mondella, 57, who shot and killed himself on Tuesday as investigators found his marijuana plants, remains frustratingly out of reach for his family and friends. Investigators do not know how he distributed the marijuana, how long he had grown it or who helped him. Most baffling of all are Mr. Mondella’s reasons for hiding his operation under a business that was, by all accounts, healthy and growing — and for taking his life so suddenly when he was caught.

On Thursday, the day of Mr. Mondella’s private wake, the company said the cherry business would go on. Major restaurant chains that bought Dell’s cherries, including Red Lobster and T.G.I. Friday’s, said their menus would be unaffected. But at the offices of the Brooklyn district attorney, Kenneth P. Thompson, the focus was on untangling what part of the business was cherries, and what part was marijuana, at the red-brick factory on Dikeman Street.

“We’re looking at the actual connections between marijuana and the factory and whether or not some portion of the cherry business there really was an effort to mask the marijuana operation,” said a law enforcement official close to the investigation, who asked not to be identified because the inquiry is continuing.

Given the thick scent of cherry processing and the large amount of electricity the factory would naturally consume, the official said, “it’s a very convenient place to be” to mask both the odor and the power needed to cultivate the marijuana plants.

Yet because the basement labyrinth was so well concealed, it seemed plausible that the cherry factory’s regular employees were unaware of their boss’s secret. Mr. Mondella may have been the only person with access to the garage where he kept several luxury vehicles and the entrance to the basement, the official said.

Still, the scope of the operation made it unlikely that Mr. Mondella was the only person involved. Spanning about 2,500 square feet, the underground complex included an office, a large grow room, a storage area, a freezer for the harvested plants and an elevator. A network of 120 high-end growing lamps shined on the plants with intensities that varied depending on each plant’s size; an irrigation system watered them. Investigators recovered about 60 types of marijuana seeds.

The investigators had never seen a larger operation in New York City, the official said.

“The way you have to set that up, there’s got to be plumbers and electricians working off the books who are very sophisticated,” he said, “and it wasn’t Arthur Mondella, as far as we know, that had that kind of skills.”

Investigators first received a tip about Mr. Mondella and illegal drugs about five years ago, he said, but nothing came of it then.

As part of a separate investigation into allegations that Dell’s was polluting Red Hook’s water supply, the district attorney and the city’s Department of Environmental Protection decided to search the factory for files on environmental infractions. It was during that search on Tuesday that they stumbled on the marijuana operation. (The pollution investigation is still active.)

The drug inquiry is still in its early stages. But the official said investigators were looking closely at whether the operation had ties to organized crime. Mr. Mondella would have required help to maintain the farm and distribute his product, the thinking goes, and an organized crime syndicate could have provided it.

To Mr. Mondella’s family and friends, the revelations about his hidden operations have been “aberrant and shocking,” Michael Farkas, the lawyer representing the Mondella family and the management of Dell’s, said in an interview.

The company was considered among the largest producers of the cherries in the country. Although many cherry suppliers were disappearing around the time that Mr. Mondella took over the business in 1983, the market appears stable now, thanks in part to maraschino cherries’ popularity abroad, said Robert McGorrin, the chairman of the food science department at Oregon State University, where the current method of processing the cherries in brine, rather than alcohol, was developed in the 1920s.

Law enforcement officials are just as perplexed about Mr. Mondella’s motives. Though investigators are sorting through a substantial bounty of evidence, they have no hope of gaining access to the data on Mr. Mondella’s iPhone 6, which, like other new-model iPhones, is encrypted with a user-created code that even Apple says it cannot unlock.

“No one seems to have had any clue that this was going on, and there certainly didn’t seem to be any strange or traumatic circumstances that would’ve explained this,” Mr. Farkas said. “The business was not doing poorly; the business was doing very well. We were unaware of any major problems in Arthur’s life. Somebody knows — but we’re all waiting for answers here.”

Correction: February 26, 2015
An earlier version of this article misstated the size of the underground complex where marijuana was grown. It was 2,500 square feet, not 250.

A version of this article appears in print on February 27, 2015, on page A20 of the New York edition with the headline: Secret Life and Business Surface, Along With Many Questions.

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