Since last Sunday, when The Buffalo News reported on an epidemic of heroin and opiate deaths in Erie County and elsewhere in the nation, the deaths kept coming. Starting with actor Philip Seymour Hoffman in New York City.
Over the past six days, two more people in Erie County died of likely heroin or opiate overdoses, and two nearly died.
When will it end? And how can this dramatic rise in heroin and opiate deaths, much of it fueled by prescription painkillers, be prevented?
The News last week interviewed a dozen individuals from law enforcement, addiction treatment centers, the medical profession and relatives of drug addicts, and asked them those questions.
The only consensus was that there is no simple answer. Some said more public money is needed to rehabilitate drug addicts early on. Others believe aggressive law enforcement that puts drug dealers behind bars for decades will help curtail the opiate epidemic.
Still others say New York has made a good start with its I-STOP law that requires doctors and pharmacists to log onto a website giving a real-time list of patients’ drug prescriptions to determine if they are abusing opiate pain medicines by seeking multiple prescriptions.
Here are some of their responses:
Catching opiate abusers
Dr. Thomas A. Lombardo Jr. said he initially had doubts about the I-STOP law, officially known as the Internet System for Tracking Over-Prescribing Act, which went into effect last year. He thought it would be just another intrusion, taking time away from treating patients.
But he has found it a useful tool in detecting when a patient wants prescription painkillers for purposes other than treating bona fide pain.
And sometimes the mere mention of going on the Internet is enough to give a drug user second thoughts.
The Amherst orthopedic surgeon cited a man who recently came into his Williamsville office, complaining about aches and pains.
At the end of the examination, the patient feigned a lack of knowledge about pain medication but managed to get his question out anyway.
Could he have a prescription for a painkiller?
“Doctor, you know my sister had a few of those, eh, I don’t know what you call them, hydro tabs or lor-codeines,” the patient told him, obviously referring to hydrocodone and lortabs.
“Are you sure? Do you understand that I am now going to go to a state website and find out your prescription history,” Lombardo responded.
“I think I’ve changed my mind,” the patient quickly said.
Checking the website takes barely half a minute but can give doctors the insight they need to know what is really going on with an individual, said Lombardo, who is president of the Medical Society of Erie County.
Some doctors though, say that while I-STOP halts the ruses for pain pill prescriptions, the answer to curbing the epidemic is far more complicated.
Dr. Paul Updike has worked for years with opiate-addicted individuals as the director of a methadone clinic run by Sisters Hospital. He assists individuals in pain management.
Because opiates profoundly alter how the brain functions, he said it is unrealistic to think that an individual can simply summon up enough willpower, quit cold turkey and stay quit.
But, he added, there is plenty of room for recovery.
“What is the optimal treatment? Well, it is not clear. It would be nice to wean them off. But particularly with opiates, it might be that patients never revert back to normal and may require some sort of replacement therapy indefinitely.
“The way I look at this problem, it is a chronic disease, similar to diabetes or hypertension. Really, if we looked at it like that, you need continued treatment,” Updike said.
Use of methadone and other drugs, he said, can provide mitigation.
And though it might not be a perfect solution, Updike believes such an approach decreases the complications and havoc that full-fledged heroin addicts can cause in the community.
“Medical and criminal costs, the cost to families, would all decrease when the addiction was treated properly,” Updike said.
Another crucial component is better educating doctors on how to prescribe pain medication and understanding addiction.
The State Legislature, in fact, is currently considering a law that would require doctors who prescribe large quantities of pain medication to take a one-time, eight-hour course on the different aspects of addiction.
More resources, Updike added, need to be allocated so that there is a greater capacity for treating the thousands of addicts in Western New York and millions more across the country.
Longer stays at inpatient treatment facilities would go a long way toward improving the chances for long-term sobriety, according to Anne Constantino, president and CEO of Horizon Health Services.
Her organization has inpatient and outpatient facilities throughout the region that specialize in treating drug addicts and the mentally ill. One of the fastest-growing populations among drug users assisted by Horizon, she says, are those addicted to opiates.
At Horizon Village in Sanborn, where there is a 50-bed, general adult treatment unit, patients generally stay for 90 days. But that is not the standard elsewhere, she said.
Fourteen-day stays are becoming more common and that is not enough time, she said, explaining that health insurance companies must approve the lengths of stays.
“People need 90 days for this kind of an addiction, especially young people who are impulsive. Their lifestyle is all wrapped up in this kind of a world, and for them to make the changes necessary to live a drug-free lifestyle, it requires work in every area of their life, and you can’t do that in 14 days,” Constantino said.
Even with 25 additional beds planned for Horizon Village, she said, more are needed.
“On any given day, the 50-bed unit has 80 applications pending,” Constantino said.
There is also another financially related issue that flies in the face of health care reform, she said.
“High deductibles and co-pays make intensive outpatient and inpatient care unaffordable because of the out-of-pocket cost. If a family has a $5,000 deductible on their health insurance plan, the family has to pay hundreds of dollars a week until the deductible is met,” she said.
What often happens is the individual in need of the care becomes disengaged in seeking treatment and eventually ends up overdosing and entering the medical system through the emergency room.
“And that is exactly the opposite of what we are trying to do with health care,” Constantino said.
Prevention in the form of educating people to the hazards of misusing prescription painkillers, public health experts say, is yet another means that could help in fighting the epidemic. And it is more economical.
If there is any chance in turning back what has become a public health crisis, a shameless and honest public discussion about addiction to heroin and its companion pharmaceutical drugs needs to occur, said Erie County Health Commissioner Gale R. Burstein.
“We need to embrace this is as a communitywide health issue, and the first step we need to take is to destigmatize this,” Burstein said. “We need to talk about it and make people feel comfortable about this problem in our neighborhoods. We need to talk about it in a nonjudgmental manner. But people are afraid to come out. It reminds me of people who are afraid to come into mental health care.”
One of the more daunting obstacles, she said, is that the topic being discussed falls under the category of criminal behavior.
“The larger problem here is that it is illegal and there is an even greater stigma,” Burstein said. “It is not just a socially undesirable behavior. It can also be illegal, and you can possibly go to jail. That’s a huge barrier to coming out and seeking care.”
But steps can be taken, such as curriculum in schools teaching about substance abuse and how easily it can happen. The discussions should also happen at home between parents and children with age-appropriate messages.
Another, more immediate, positive action can be taken on the homefront, Burstein said: emptying out medicine cabinets of unused painkillers and disposing of them safely at designated sites throughout the county.
Warning for others
Marie, whose daughter has become addicted to opiates, is in complete agreement with the health commissioner’s suggestions.
After reading last Sunday’s story in The News, the North Buffalo woman felt compelled to share the nightmare that has engulfed her family over the last few years.
Asking that her family’s last name be withheld because of the sorrow and embarrassment she says it would cause if neighbors and more distant relatives knew the truth, Marie said her grown daughter became hooked on painkillers after they were prescribed in 2011 for injuries suffered in a car accident.
Heroin addiction soon followed.
“The word heroin has such a stigma attached to it,” Marie said. “I would think of New York City, homeless people, people in and out of prison, prostitutes, when it came to heroin.”
Her daughter ended up arrested in Amherst during a routine traffic stop when police found prescription medications outside their proper container. The young woman was ordered to enter Amherst Drug Court.
But despite court-ordered treatment, she continues to test positive for opiates in her system.
Marie said she thought her daughter was buying prescription painkillers from drug dealers but was shocked to discover that her child was still able to obtain them, even after the arrest, from a Buffalo doctor.
“I had believed she was getting them from the streets since she was involved in the court system. But I found a purse of hers hidden in the basement with at least 10 empty bottles of pain medication that were being prescribed to her by a pain management facility connected to her no-fault insurance.
“Once I realized this, I contacted the doctor’s office to inform them not to provide her anymore scripts because she was selling them for heroin,” the mother said.
Despite repeated attempts to speak with the doctor, Marie said she is still waiting for a return call.
There is, however, one phone call she hopes she never gets.
“I’m frantic, afraid when the phone rings it will be to inform me that my daughter has been added to the ever growing statistic of heroin overdose deaths,” she said.
Her daughter was released last week after 14 days in county jail as a sanction for violating drug court requirements, Marie said. She is now back in a halfway house with “one last chance to follow her program and stay drug free,” Marie said.
And while the young woman has not been able to maintain sustained recovery so far, Marie said she is certain the only reason her daughter is still alive is because Amherst Drug Court has kept her on such a short leash.
Prison is not the answer for curing drug addicts, according to U.S. Attorney William J. Hochul Jr.
Drug courts, rather than regular criminal courts, are the better way to work with those who abuse drugs, he said.
But imprisonment is fine for those responsible for selling heroin and other opiates that are killing drug users, Hochul.
“If it can be proven that a drug dealer sold opiates that ended up killing a customer,” Hochul said, “the dealer faces federal drug charges that could put the individual away for a minimum of 20 years to a maximum sentence of life.”
Drug dealers need to know that Buffalo police are working closely with Hochul and the U.S. Drug Enforcement Administration, State Police and local police agencies to try to curtail the opiate epidemic, said Buffalo Police Commissioner Daniel Derenda.
“We’re in a crisis, an epidemic right now, and it is just not the city,” the commissioner said of his support for aggressive law enforcement and prosecution. “In January, we executed 50 search warrants involving drugs.”
The opiate epidemic, Hochul said, is something of a different animal compared with the crack cocaine epidemic that hit in the late 1980s and early 1990s.
“What really got crack on the public’s radar was the violence associated with the trafficking of the product. What is getting into the public consciousness with the opiates is the great number of overdoses of people ranging from young children to elderly to famous actors to prison inmates,” he said.
With crack, Hochul said, federal prosecutors made use of the Racketeer Influenced and Corrupt Organizations Act.
“The crack industry in Western New York was controlled by a number individuals, and we were able to use the RICO Act to dismantle entire operations,” Hochul said.
With heroin and other opiates, he said, arrests so far have involved one or two individuals at a time. But that may be because local networks selling opiates have not had enough time to develop, he said.
“It may be that we are at an early point in the timeline,” Hochul said.
Crack addicts often started on another illegal drug, cocaine.
But studies have show that the vast majority of opiate addicts got their start with legal prescriptions for pain medications, the U.S. attorney said.
“The potential universe of heroin abusers is substantially larger than anything we saw during the crack cocaine days,” Hochul said. “Crack was largely confined to urban centers, and heroin from a geographical perspective really has no limitation.”
With this widespread customer base and growing demand, law enforcement officials say, getting the upper hand will be all the more challenging.