Editor's note: This is the first in a three-part series focusing on the region's struggles with the growing opioid addiction epidemic. On Monday, we addressed the strategies that different communities are trying in order to stem the tide, while Tuesday's story will focus on the efforts of local grass-roots groups.
James DeSantis sat outside of Villa Italia in downtown Schenectady and took a drag on a cigarette.
With Lou Christie’s “Two Faces Have I” playing through a speaker above, he attempted to explain the euphoria of a heroin high.
“Have you ever had a major success in your life?” DeSantis asked, tapping his hands on the metal table with each word. “You remember that feeling? You felt light and happy and excited? That feeling of accomplishment you only get a couple times in life? That’s what you get from shooting a bag of dope.”
DeSantis, a graduate of Scotia-Glenville High School, was prescribed hydrocodone painkillers in 2003 for a nerve condition. He progressed to abusing OxyContin, stealing pills from his father’s medicine cabinet.
Access became difficult, so at age 31, he tried snorting a bag of heroin. He was hooked. In July 2016, he overdosed on a bag of heroin laced with fentanyl, surviving only because he’d built up a tolerance to the drug.
DeSantis, now 33 and clean for 10 months, is in recovery and spreading the word about the drug he said takes away second chances.
“This is a real issue in this town,” he said. “And it’s only going to get worse.” Deemed the public health crisis of a generation, opioids — painkillers and heroin in particular — have ravaged communities throughout the country, cutting across socioeconomic lines and killing 91 Americans per day, according to the Centers for Disease Control and Prevention. The problem has been exacerbated as suppliers add fentanyl, a more potent, synthetic and often deadly opiate, to the heroin they sell.
The epidemic is evident in Schenectady, where city police respond to at least one overdose a week. Naloxone, commonly known as Narcan, was administered in Schenectady County at least 275 times in 2016 to reverse overdoses, according to data from the state Department of Health.
Elected officials have, in recent years, funneled resources to combat the problem, and law enforcement agencies have refocused their efforts to target mid-level dealers. Those who have been through the system see its flaws, and those who work in the system see a constantly evolving problem that requires multifaceted solutions.
“This really is a national epidemic the likes of which we haven’t seen,” said Michael Kettle, regional director for Conifer Park treatment facility in Glenville. “We’ve just never seen the extent of overdoses we’re seeing. Everybody’s being affected by this.”
Recovering heroin addict Erin Wiggins. (Peter R. Barber)
A painful progression
Erin Wiggins broke her shoulders in 2011. To cope with the pain, a doctor prescribed her “a ridiculous amount of opiates,” including OxyContin, she said. A short time later, she was abruptly taken off the medication and began experiencing withdrawal symptoms.
To alleviate those symptoms, she began buying pills from street dealers. That lasted from 2011 until 2015, she said, when Wiggins turned to heroin as a cheaper alternative to achieve the same high.
“I used to be repulsed when I saw a needle. I was a person who looked down on people for that,” said Wiggins, a Utica native who lives in Schenectady. “And guess what; I turned into that.”
Wiggins’ story is a fairly common one among heroin addicts. Doctors over the past decade or so began overprescribing powerful opioid painkillers for patients dealing with chronic ailments, coping with end-of-life maladies or recovering from surgery, said Schenectady County District Attorney Robert Carney.
Carney ruptured his Achilles tendon a couple of years ago and was given 40 hydrocodone pills for the pain, he said. He took one and threw the rest away.
When Schenectady Police Chief Eric Clifford had his wisdom teeth removed 30 years ago, he took a few Tylenol pills for the pain. When his son had his extracted, a doctor prescribed Lortab, an opioid painkiller that contains hydrocodone and acetaminophen.
Similar opioids, such as OxyContin, Percocet or Vicodin, are highly addictive. Patients can get hooked on pills and will begin “doctor shopping” in an effort to obtain a new prescription. Doctor shopping refers to making multiple appointments with multiple physicians until the addict finds one who will provide a fresh prescription.
In 2013, New York state implemented the I-STOP Prescription Monitoring Program, which allows physicians to access a digital database to see when each patient was last prescribed a controlled substance.
The system brought an unintended consequence, though. As addicts found it harder and harder to acquire pain pills, many turned to heroin, which can be bought for a fraction of the price and provide the same high.
“It does put us in a very awkward situation,” said Dr. Robert Dach, who works in Ellis Hospital’s emergency room. “We do have I-STOP that we’ll refer to, and then it becomes a judgment call on the part of the ER physician for whether they feel it’s appropriate to continue these chronic medications.”
Dach does not believe he has seen an instance in which a patient intentionally injured themselves to acquire more opioids. However, patients who come in with an expectation of leaving with a prescription can sometimes become belligerent, he said.
A certain number of patients also sell their prescribed painkillers to others, something Dach acknowledged but said is difficult to prevent. The best defense is limiting the number of pills prescribed, he said.
The Ellis Hospital ER handles more than 200 patients per day, he said. Many have broken bones or other painful conditions. Many receive prescriptions for pain pills, but Dach disputes those prescriptions lead directly to heroin use.
“That’s a pretty big leap,” he said. “From an ER standpoint, I think it’s important we treat acute pain appropriately.”
Lt. Gov. Kathy Hochul (fourth from left) and co-chair, Commissioner Arlene Gonzalez-Sanchez, convene a meeting of the Heroin and Opioid Abuse Task Force, Capital Region Session, at Proctors' GE Theatre, in May 2016. (Marc Schultz)
Fighting an epidemic
Last year, the Schenectady County Sheriff’s Office executed 25 search warrants, completed 175 drug buys, seized about $200,000 in cash and arrested more than 80 people in connection with various drug investigations.
About half could be attributed to the heroin epidemic, said Sheriff Dominic Dagostino.
“The way I view this: For [dealers], this is a business,” Dagostino said. “We don’t want to be a business-friendly community with respect to heroin.”
Both the Schenectady Police Department and the Schenectady County Sheriff’s Office have, in recent years, seen a rise in overdoses and heroin-related crime. Both departments have dedicated drug units, but they see the problem as a public health crisis, not just a law enforcement one.
City and county law enforcement officials have placed an emphasis on going after mid-level dealers, as department leaders believe arresting addicts won’t solve the problem.
Carney, the district attorney, said judges generally aren’t looking to incarcerate addicts or dealers who sell to abet their own habits, though they take into consideration whether an individual also possessed weapons or has a violent or criminal history.
The sheriff’s office in January announced it will expand its drug unit. Though the county legislature has been supportive, a lack of resources remains Dagostino’s biggest hurdle, he said.
Even if he received funding for 10 new investigators, however, it would take five years to hire those individuals and see them develop into competent drug investigators, he said.
“We’re not going to solve this problem in a year’s time,” Dagostino said. “We knew going in this was going to be a slow build.”
The issue has caught the attention of lawmakers, as rarely a week goes by without an announcement about funding, task force formations or initiatives targeting opioids.
U.S. Sen. Charles Schumer, D-N.Y., stopped in Schenectady in April to tout legislation that would increase resources at the border to prevent fentanyl from flowing into the country. U.S. Sen. Kirsten Gillibrand, D-N.Y., is co-sponsoring a bipartisan bill that would limit opioid prescriptions to seven days.
At the state level, a senate Task Force on Heroin and Opioid Addiction was formed in 2014. From 2011-14, the state budget dedicated an additional $22 million to addressing the problem, and in the most recent budget, $214 million was appropriated for treatment, recovery and prevention services, said Sen. George Amedore, R-Rotterdam, who co-chairs the task force.
Gov. Andrew Cuomo, in his State of the State addresses in January, shared a six-point plan to combat the opioid epidemic. It included establishing 24/7 crisis treatment centers, adding fentanyl to the state’s controlled substances list and creating recovery high schools, which provide secondary education to individuals recovering from substance abuse.
Heroin use has a ripple effect that manifests in different ways. More children are left in the hands of Child and Protective Services when their parents succumb to drug use. More police time is spent handling larcenies and burglaries committed by addicts to feed their habit. Even convenience stores lock up their bathrooms to prevent drug users from using them as private places to get high.
The greater the number of individuals dealing with addiction, Amedore said, the greater the cost to the community socially and economically.
“There’s so much to be done, but there’s not one solution,” he said. “This is a war we face every day, and it takes everyone in the community to be involved in this.”
Recovering heroin addicts Megan Briggs, Erin Wiggins and James DeSantis. (Peter R. Barber)
Local treatment options
Through the doors of New Choices Recovery Center at 302 State St., visitors are greeted by a half-dozen framed posters.
One displays a quote from author J.K. Rowling: “Rock bottom became the solid foundation on which I rebuilt my life.”
Another shows waves crashing against a cliff with the word “Determination” printed in all caps.
New Choices sees 1,300 patients per year — at least half of whom display some level of opioid dependency — and it is the main treatment service provider in Schenectady. The city, like many communities, lacks the resources to provide detox beds for addicts who are ready to begin that process.
The treatment system is, in some ways, a flawed one, according to those who have been through it. And those who work in treatment warn it is a complicated task.
“I seriously believe this: If you can overcome an addiction, there’s very little in life you can’t accomplish,” said Stuart Rosenblatt, executive director of New Choices. “My Ph.D doesn’t even compare with someone who’s been able to turn their life around and overcome addiction. It’s that insidious and difficult.”
New Choices provides comprehensive treatment through its daily outpatient clinic and rehabilitation programs. Those in recovery participate in counseling, therapy and case management, where they meet with a clinician to get personalized care.
The facility is the only provider of community residential services in Schenectady, meaning it offers housing for a number of recovering addicts participating in the outpatient program.
New Choices averages one clinician for every 25 clients and hosts about 110 support group sessions per week. That, plus crisis management, drug testing and paperwork, creates a heavy burden for staff to shoulder.
“It’s not for everybody,” said Laura Combs, clinical director at New Choices. “The clients can be challenging. But it’s also extremely rewarding, because people get a little taste of success, and it’s very powerful to be a part of that in people’s lives.”
The system is not one-size-fits-all, as certain patients require more attention and want more hands-on help, while others are eager to get out of treatment and back into the world. Striking a balance is difficult, particularly when many arrive with mental health issues, a history of abuse, poverty or other challenges.
Some in recovery say they were unsure where to even seek help in the first place. Some must cope with waiting lists before getting into treatment. For others who graduate from a treatment program, the transition back to independent life -- a job, a home and other responsibilities -- can be jarring.
“There’s way more support when you first get clean,” said DeSantis, a New Choices resident himself. “When I break the cycle at first, I’m way more determined to stay clean than six months down the road when I’ve been clean for that long and I have all kinds of changes at once.”
To combat this, New Choices is one of two agencies in the state to offer “wraparound care,” meaning the clinic is able to provide a limited amount of support and supervision once an individual has graduated from its recovery program.
What Schenectady lacks, however, is an inpatient or detox facility. The nearest one is located in Glenville, at Conifer Park, and the next-closest is in Albany at St. Peter’s Hospital.
The lack of access to beds is not unique to Schenectady or the Capital Region. It is frequently cited as one of the most significant barriers to treatment, particularly for those in rural areas who must cross county lines to find detox beds.
“Probably less than 5 percent of those that are addicted actually find their way into treatment,” said Kettle, the Conifer Park director. “There’s a window of opportunity that presents itself very quickly, but if you can’t accommodate them at that moment, they won’t come in for treatment.”
Conifer Park houses 225 beds licensed by the state Office of Addiction and Substance Abuse Services. Of those, 37 are for detox and 188 are for adult rehabilitation.
In addition to psychosocial treatment, which includes counseling and case management, there is medical treatment. Qualified physicians can prescribe Suboxone, a drug that contains Naloxone and can help curb opiate addiction, or Vivitrol, which blocks opioid receptors.
However, recovering addicts, treatment providers, law enforcement officials and others nearly universally agree that the most pervasive hurdle to recovery is the stigma of addiction.
Whether it’s pride, shame or lack of education about how addiction is a legitimate disease, many addicts fail to seek proper help because they don’t feel comfortable doing so.
“You’re not going to find anybody who said being a junkie was their dream when they grow up,” said Wiggins, who has two young kids and is pregnant with a third. “We’re smart, caring, compassionate people. But we look in the mirror, and we literally see monsters. And we carry that with us -- that shame and that guilt.”
Those who live in local halfway houses note their locations — tucked away in Mont Pleasant and Hamilton Hill, neighborhoods associated with accessibility to drugs — and see that as a continuation of the stigma. Neighbors don’t want to be confronted with addiction, so those in recovery are housed in less-visible parts of the city, they reason.
The conversation around heroin, and around addiction in general, must change to make significant progress, said clinicians, recovering addicts and local leaders.
“People are ashamed to get into treatment; they’re ashamed of their recovery,” said Wiggins, who has been clean for four months. “All you hear about with heroin is death. We need to hear about success stories. We need role models (for recovery), is what we need.”