Sheriff looks to prevention and treatment rather than just enforcement

The Enterprise — Melissa Hale-Spencer
Buses that serve as traveling classrooms flank the entrance to Voorheesville’s middle school last Wednesday evening as people gather for a forum on heroin. Inside the buses, a path marked by yellow footprints takes visitors first to “gateway drugs” like marijuana, then to methamphetamines and opioids, and finally to a jail cell.

ALBANY COUNTY — Albany County deaths from heroin overdoses have doubled, according to Sheriff Craig Apple. “We’re more likely to maintain sobriety when we receive support from society,” the sheriff said at a Sept. 13 forum. “I was a lock-’em-up guy 10 years ago. We lost.”

He spoke to about 100 people who had gathered at Voorheesville’s middle school to hear from a series of  experts on the scourge the sheriff said has “been plaguing our community.”

Apple opened his forum with a moment of silence “to remember the people we’ve lost in the epidemic ... hundreds locally, probably tens of thousands nationally.”

Apple said there were people in the crowd “who had lost a loved one” to heroin as well as people who had family members in jail, battling addiction.

“Forty-eight months ago, we put our hand on the panic button,” said Apple, noting the dramatic rise in addiction across the county.

“It’s everywhere,” he said.

Overdoses are up 22 percent from 2015 to 2016, the sheriff said. “It’s the number-one cause of death of Americans under the age of 50.”

Across the country, sales of prescription opioids rose 300 percent between 1999 and 2008, according to the United States Centers for Disease Control and Prevention.

Last year, I-STOP legislation went into effect in New York State, requiring doctors to send prescriptions electronically directly to pharmacies rather than writing them on paper. The name I-STOP is an acronym for Internet System for Tracking Over-Prescribing Act and was meant to keep abusers from going from doctor to doctor and then filling their prescriptions for opioids at different pharmacies. Criminals had used the paper prescriptions as a form of currency.

“We’ve gotten off the pills and pushed everyone to powder,” said Apple.

From Jan. 1 of this year up until the date of the forum, Sept. 13, there were 25 fatal overdoses in Albany County, Apple said, and there are another 60 cases currently being analyzed for toxicology.

In the same time span, there were 90 non-fatal overdoses and hundreds that went undocumented, he said.

“Deaths have doubled in Albany County,” he said.

The majority of heroin is produced in Afghanistan, Apple said. Bags of heroin sell for $10 to $20 in Albany County, he said, and bundles sell for $80 to $100.

“Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants,” according to the National Institute on Drug Abuse, part of the federal Department of Health and Human Services.

People inject, sniff, snort, or smoke heroin, the institute says, noting that heroin enters the brain rapidly and binds to opioid receptors on cells located in many areas, especially those involved in feelings of pain and pleasure and in controlling heart rate, sleeping, and breathing.

Prescription opioid pain medicines such as OxyContin and Vicodin have effects similar to heroin. “Research suggests that misuse of these drugs may open the door to heroin use. Nearly 80 percent of Americans using heroin (including those in treatment) reported misusing prescription opioids first,” according to the institute.

“Heroin is highly addictive,” the institute says. “People who regularly use heroin often develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects.”

“You keep chasing and chasing for that high,” said Apple.

He noted that New York’s Good Samaritan Law, which began in 2011, “allows people to call 9-1-1 if they witness an overdose … No one is charged. The goal is to save a life.”

The sheriff went on, “People are mixing stuff in bathtubs and sinks.” Unlike with prescription drugs, which are made in laboratories, the homemade drugs can have lethal elements in the mix.

Apple stressed that the stigma of addiction must be set aside. “So many people don’t come forward because they don’t want to be labeled a drug addict,” he said. “They feel embarrassed or ashamed.”

He noted that addicts who seek help will be recovering for the rest of their lives. “We’re more likely to maintain sobriety when we receive support from society,” said the sheriff. “I was a lock-’em-up guy 10 years ago. We lost.”

Enforcement alone isn’t enough, said Apple. “We’re out there every day,” he said of police since there’s “heroin on almost every corner.” He mentioned a recent arrest in Colonie of a dealer selling $28,000 a day of heroin from Brooklyn.

Other necessary components are prevention and treatment.

Apple said that Albany County’s jail was one of the first in the state to start treating inmates for addiction. The Addictions Care Center of Albany, he said, counsels inmates in a voluntary program. The sheriff’s office also works with Catholic Charities.

Jennifer Vitkus, director of community education for The Addictions Care Center, stressed for the crowd, “Addiction is a progressive chronic disease. If it’s not treated, it can be fatal.”

A program called SHARP, which stands for Sheriff’s Heroin Addiction Recovery Program, started in the jail in 2015. For Albany County, the average recidivism rate — inmates who return to crime after release from jail — is between 42 and 45 percent, Apple said. Nationally, he said, the recidivism rate is 75 percent. For inmates who lived on the SHARP wing of the jail, Apple said, the recidivism rate is 15.5 percent.

So far, the SHARP wing has been just for male inmates but the sheriff said a female wing is being started as well.

“Some moms and dads have called to get their kids arrested,” Apple said. “They’re in a safe facility.”

When inmates are being discharged, they are offered a shot of  Vivitrol, a brand name for naltrexone, which blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse.  

“You can’t get high. You can’t get drunk,” said Apple. “It’s good for 28 days,” he said, terming Vivitrol “almost a miracle drug.”

On prevention, Apple encouraged parents to look for symptoms like their kids nodding off, having a change in skin color or track marks, or developing craters on their faces. He also said to be alert for missing electronics and jewelry, sold to feed a habit.

Apple advised parents not to be concerned about an invasion of privacy when checking on their children. “I’d rather have my son or daughter angry at me than an overdose in the backyard,” he said.

“Let it be known it won’t be tolerated in your house,” advised Vitkus. “Look through bedrooms and Facebook pages … it’s OK,” she said.

Nichole Charbonneau, family support navigator for The Addictions Care Center, said, “Nobody should have to go through this alone.”

On the front lines

Dr. Michael Dailey, from Albany Medical Center where he is the director of Prehospital Care Services and also chief of the Division of Emergency Medical Services, told the crowd, “We thought outside the box because the box wasn’t working.”

Earlier this year, a Physicians’ Response Team was formed; doctors from this team go directly to the scene of an emergency, which helps with life-saving care and reduces the stress on first responders.

“Addiction happens by mistake,” the doctor said. “Opioids tend to be a faster slide than others.”

He explained how opioids are necessary for pain management in a hospital setting, for instance, after surgery or after an emergency like a severe laceration. Dailey said of patients, “When they leave the hospital with that barrel of Percoset, that’s when things can go wrong.”

Dailey described a bill that could be helpful, allowing a pharmacist to manage drugs for a patient, filling just part of a prescription and telling the patient to come back for more pain pills only if needed.

He also spoke of the importance of getting rid of unused opioids.

And he likened the experience of first using opioids to a “first kiss.”

“You’re chasing the dragon, trying to get that high back,” said Dailey. At the end, he said of addicts, “They’re just trying to feel better.”

Stephanie Lao, executive director of Catholic Charities Care Coordination Services, spoke of the importance of “meeting people where they’re at.” she said, “The key is recognizing that change doesn’t happen overnight.”

She said that, if Dailey had seen someone with an overdose or Apple had interacted with someone on drugs, “We may show up.” At that juncture in their lives, addicts may be ready to seek help, she said.

“We don’t just wait until people decide they are ready for services,” said Lao. “We continue … until perhaps they are ready to explore what not using would be like.”

Ed Fox, Harm Reduction manager at Catholic Charities, said that, in the last three years, his program had trained about 11,000 people to administer naloxone, the life-saving drug that stops the effect of opioid overdoses. The number of reversals is in the 500 range, he said.

“We do trainings in the middle of the street … in our mobile unit … in the jail,” Fox said.

From January 2016 to the first week of September, the sheriff’s emergency medical services have had to administer naloxone 27 times in the Hilltowns, Amy Kowalski, an investigator with the Albany County Sheriff’s Office, told the Enterprise earlier.

Fox said of Narcan, a brand name drug of naloxone, “Narcan kicks the opiate off the receptor. It’s safe … It absolutely works provided you get to the person in time.”

He also said, in administering Narcan, “You’re not enabling, you’re giving someone a chance to survive. You need to get the person to the emergency room.”

Fox went on, “It’s very common for people to be mixing drugs … One of the big risk factors for opiate overdoses is what’s in the drug itself.” He mentioned fentanyl, a potent opioid that can be mixed with heroin and lead to an overdose.

Fox noted there have been “demographic shifts” in the use of opioids. “Rural heroin is a huge thing, like the Hilltowns,” he said.

Fox also spoke of Catholic charities’ Project Safe Point, which offers sterile needle and other services to prevent the spread of diseases like Hepatitis C and HIV as the heroin epidemic continues.

“People will be successful in treatment when they’re ready for treatment,” he said.

OASAS

The state’s Office of Alcoholism and Substance Abuse Services oversees about 1,000 prevention, treatment, and recovery programs,  Rob Kent, general counsel for OASAS, told the crowd. Every year, the agency oversees treatment of more than 230,000 New Yorkers, he said, and during the last school year OASAS provided over 330,000 prevention services to students.

“One-hundred-and-forty people die every day from the opioid epidemic,” Kent said, referencing numbers from the Centers for Disease Control and Prevention In 2014, he said, 1,710 New Yorkers died from opioids. By 2015, that number had ballooned to 2,185.

Kent likened the circumstances leading to the dramatic increase to “the perfect storm,” which resulted in the 200-percent increase in deaths from opioid overdoses.

The factors include prescription opioids being “handed out like Chicklets,” he said. One in five New Yorkers had an opioid prescription, Kent said.

This was coupled with easy access to inexpensive heroin. Further, insurers blocked access to treatment, he said, and, on top of that, “The stigma is unbelievable.”

Kent described a meeting he had attended during which an advocate for people with mental disabilities commented that addicts, unlike the people he was advocating for, suffered as “a matter of will.”

In response to this so-called perfect storm, Kent said, OASAS has new funding for treatment programs, adding 4,000 new opioid treatment slots since 2013. There are also new programs, he said, involving “family navigators,” “peer engagement,” and “adolescent clubhousses.”

Last year, the United States Surgeon General said that one out of 10 people with diagnosed substance abuse problems get help. That means that nine of those 10 don’t, Kent pointed out.

Kent said that anonymous surveys have shown 90 percent of high school students say they can easily access drugs and alcohol. He said, further, that 70 percent of high school students who have been treated for addiction relapse when they return to their schools. But a new program with recovery high schools specifically geared for students who are battling addictions has a relapse rate of 30 percent.

“There’s no time to fight,” Kent said of factions battling between treatment and harm reduction.

He projected a photograph from the New York State Police crime laboratory of a tiny amount of fentanyl, a fraction of the size of the penny pictured next to it.  It was headlined, in capital letters, “The New Enemy!!!!”

“That’s how much it takes to kill someone,” said Kent. The fentanyl can be mixed with anything from marijuana to heroin, he said. “There’s no quality control..”

He concluded, “There’s no time to sit in board rooms and figure out the perfect solution ...You have to figure it out while you do it.”

Peggy Bonneau, director of Health Initiatives for OASAS, told the crowd to look to the agency’s website, www.oasas.ny.gov, for answers. She also highlighted a “referral source line” — 1-877-846-7369 or people can text HOPENY — which is updated daily and available “24/7,” she said.

“We know it’s scary,” she said of dealing with addiction; she recommended videos on the OASAS website that deal with a variety of topics and are developed for different age groups.

Stopping the stigma

Kent concluded by describing a documentary to be released this month called “Reversing the Stigma,” which tells the story of New Yorkers who “do amazing things when they recover.”

Kent said, “It’s one of those documentaries where everyone doesn’t die at the end.” He summarized the message: “Get help. You can recover.”

Both of the politicians who had spoken near the start of the forum had also talked of the importance of overcoming the stigma associated with addiction, and the silence that often comes with the stigma.

“It’s not easy to get people together and admit there’s an opiate problem,” Albany County Executive Daniel McCoy said. “People have to talk about it when a loved one passes away, not just for healing but for education.”

He commended Project Orange, a program that Albany County started this spring. Named for the color of prescription drug containers, the program allows patients to return unused drugs to their pharmacy in an envelope certified by the national Drug Enforcement Administration.

McCoy, the father of three, said, “We can tell you when a beer is missing in the refrigerator” but he asked how many people count the pills in their medicine cabinets.

“You should never, ever ever have your kids on oxycodone,” said Cheryl Nunamacher from the gallery.

“That’s right,” agreed McCoy. “Eighty percent end up on heroin.”

“It’s right here in this little town, in this little village, in this little school,” said State Senator George Amedore of heroin. He went on, “Thank you to the moms and dads, brothers and sisters who lost a loved one … You are trying to be part of a solution. We need all hands on deck.”

He lauded a law that funds Narcan for school nurses and other legislation that limits the number of opiates that can be prescribed to a seven-day supply, after which there is a reevaluation. He also said that insurance coverage for treating addictions is being expanded.

Amedore went over a “three-pronged approach” to dealing with the opioid crisis: prevention, education, and treatment.

“We need to ramp up the enforcement effort,” said Amedore, noting that Laree’s Law had passed three times in the Senate but was “hung up” in the Assembly.

Named for Laree Farrell, of Colonie, who was 18 when she died of a heroin overdose in 2013, the bill would have increased penalties for drug dealers when a sale leads to a fatal overdose.

Amedore advocated going after “the big-business drug dealers.” He urged, “Stop the flow but also offer the hand of compassion and encouragement to those bound by addiction.”

He concluded, “We have to remove this stigma … We can cure this disease.”

Sheriff Apple ended the formal presentations with these words, “We want to start the conversation … We’re in it to win it.”

 

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