Police, doctors, parents, educators fighting drugs but losing the war

The Enterprise — Michael Koff

“This is nothing short of hell,” says Lisa Wickens, of heroin addiction and the struggle to get addicts appropriate care. Albany County Sheriff Craig Apple, looking on, says the rate of recidivism in heroin addicts is so high because of gaps in the treatment process. Sending addicts to jail, says Apple, won’t solve the problem.
 

The Enterprise — Michael Koff

Dr. Don Doynow demonstrates how Narcan, an opiate overdose antidote, is administered with an atomizer to the nasal passages. The substance is absorbed through the mucus membranes and reverses the effects of opiates in one to two minutes.

The Enterprise — Michael Koff

Grieving mother Maryanne Rappaport, whose son, Adam, hanged himself in Albany County’s jail last month while he was withdrawing from heroin, looks to Sheriff Craig Apple for answers. Rappaport approached Apple after he appeared on a panel at Wednesday night’s heroin and opiate education forum.
 

The Enterprise — Michael Koff

Frustrated by a lack of answers: Assemblywoman Patricia Fahy says she was hesitant to host a heroin and opiate education forum because she doesn’t have a solution to the problem. Raising awareness, she decided, could help find the answers.
 

The Enterprise — Michael Koff

Keith Stack, executive director of the Addictions Care Center of Albany, says prevention and treatment are the keys to turning the heroin epidemic around.

GUILDERLAND — Five panelists at a heroin and opiate education forum on Wednesday agreed that the war on drugs is being lost and the biggest problems are with prevention and treatment.

“No community or neighborhood is immune,” said Assemblywoman Patricia Fahy, who hosted the forum at the Guilderland Public Library, in her opening remarks. “Heroin abuse knows no bounds.”

Fahy said she had initially been hesitant to hold the forum, after library Director Timothy Wiles reached out, because, she said, of her “frustration at not having enough answers.”

But, she said, without raising awareness and continuing education on the issue, there would continue to be no answers.

Keith Stack, the executive director of the Addictions Care Center of Albany, who is in recovery himself, talked statistics.

The United States makes up 5 percent of the world’s population, said Stack, but consumes 80 percent of the world’s prescription narcotics.

Prescription narcotic abuse, he said, is often where heroin addiction begins.

People, particularly young people, are prescribed painkillers for an injury or medical procedure, and become addicted. Then, once the prescription runs out, they resort to buying the narcotics illegally, or stealing them from people’s medicine cabinets.

If that fails, said Stack, these addicts turn to heroin, because it is cheap, readily available, and has the same effect as a prescription narcotic.

Prevention

There are two keys to turning the heroin epidemic around, according to Stack — prevention and treatment.

“We need to start earlier with the education,” said Stack. “We need to normalize the discussion on alcohol and drug use and abuse.”

The Addictions Care Center of Albany is the only provider in the county to offer prevention education in the schools, but, he said, “We can only do so much with the resources we have.”

Thomas Lutsic, the principal of Guilderland High School, said his district does try to work with students on prevention.

“We do a lot with making good choices,” said Lutsic. “Once a child has decided that putting something into his or her body in order to feel better is a good idea, we have started down a bad road.”

The image of “the junkie” also needs to change, said Lutsic.

There used to be television commercials depicting the typical “junkie,” he said, and it was always someone middle-aged and living on the streets.

“It can touch anybody at any time and kids need to realize that,” said Lutsic. “No one ever says, ‘When I grow up, I want to use heroin.’”

The resources that teenagers have today make it much easier for them to access drugs, he said. They have cars, money, and instant connections with hundreds of people through social media.

“We also need to remember that adolescents are still figuring out where they fit into this world,” said Lutsic. “Some kids start self-medication due to mental-health issues or as a coping mechanism, and others do it for fun or to fit in.”

What the school does, the principal said, is monitor the behavior of students, and reach out when there are signs of trouble.

“You don’t have to work in education long to realize that behavioral changes can indicate a problem — changes in grades, attendance, or social status,” said Lutsic.

Once the school reaches out to a struggling student, and sometimes to the student’s parents, as well, it can be easier to address underlying issues before they lead to more destructive behavior, he said.

If a student brings drugs to school, the consequences are severe, said Lutsic.

“It’s not that we don’t want to help,” he said. “But, we also don’t want that behavior at our school.”

Karen Carpenter-Palumbo, the former commissioner of the state’s office of alcoholism and substance abuse services, was in the audience at the forum, and stood to address the modern parent’s role in getting ahead of the issue.

“You can’t be a cool mom,” she said. “Zero tolerance for beer and for pot.”

“I’m not a cool mom,” said Carpenter-Palumbo. “It doesn’t bother me.”

She described driving to the library for the forum and seeing teenagers she recognized walking down Western Avenue near Stuyvesant Plaza.

“I got on the phone and I called their parents to see if they were supposed to be doing that,” she said. “This is what you have to do — you call the house where the party is to see if the parents are really there, you follow your kids with your car to see if they’re where they say they are.”

Treatment

The Addictions Care Center of Albany does have residential and outpatient treatment programs.

“Treatment does work, but heroin is a very challenging drug,” said Stack.

Often, he said, the proper level of care is not received from the start.

“Private insurance companies do not approve the appropriate level of treatment the first time,” said Stack. “What tends to get approved are very short bouts of treatment.”

Stack explained that, in order to make a difference, an opiate addict needs intense, round-the-clock, inpatient treatment for at least 30 days.

Five-day stays in a residential facility are most often approved, said Stack, and, a stay so short in length hardly makes a difference at all.

For the first five days in treatment, an addict is going through withdrawal, and detoxing is such a hard physical process that addressing any of the emotional aspects or underlying issues is nearly impossible, said Stack.

“We literally have to beg insurance companies to extend treatment,” said Stack.

Beyond the insurance problems, there is a lack of facilities. Stack told of the bureaucratic morass that has delayed a 16-bed halfway house for women that was approved in 2007.

Stack said it will be 2015, eight years after the approval, before the residence can be occupied.

Lisa Wickens, a registered nurse and parent, knows firsthand how hard it is to get an insurance company to pay for treatment.

Her son, who went to Guilderland High School and graduated with high honors, is a recovering addict with two years of sobriety.

She noted that, while the problems with substance abuse began when he was in high school, there were none of the traditional warning signs Lutsic spoke of.

He had high grades and nearly perfect attendance.

“I just want to reassure parents out there that might be feeling guilty that they missed something,” said Wickens. “No, maybe you didn’t miss anything; sometimes you do all the right things and it just happens.”

Her son’s spiral downward began when he was 16 and he came home drunk, said Wickens.

Not wanting to take any chances, she brought her son to the pediatrician, who told her that it was just a phase that he would grow out of.

“I wasn’t happy with that answer,” said Wickens. She found him a counselor and started sending him to an outpatient treatment program.

When he was 17, her son began smoking marijuana, and she immediately sent him to Narcotics Anonymous meetings.

He went off to college, and, within two weeks, he was admitted to a psychiatric ward, because he had begun cutting himself.

Wickens said she brought her son home and tried to get him into an inpatient treatment program, but was told by her insurance company that he did not qualify.

“They basically said he hadn’t failed enough,” she said.

Her son enrolled in Hudson Valley Community College, and one day, Wickens received a call from the school informing her that he had stopped breathing, and asking her which hospital she would like him to go to.

He had overdosed after placing a piece of a Fentanyl patch under his tongue.

After he was released from the hospital, Wickens once again tried to get him into residential treatment, but, once again, was told he didn’t meet the qualifications; he would need to go through more outpatient treatment first.

Wickens found a doctor who was willing to use medication-assisted treatment for her son. He began a drug called Suboxone, which reduces cravings and limits the potential for overdose.

“It was working,” said Wickens.

However, the doctor moved out of state, the Suboxone treatment stopped, and Wickens’s son overdosed again.

“I had to pull out all the stops and finally got him approved for five days of inpatient treatment,” said Wickens.

After that did not work, Wickens extended her home equity loan and took her son out of state, to North Carolina, where she was able to get him into a residential program.

“Today we have two years sober and we have a confident, married son,” said Wickens. “There is hope, but there is so much work to be done.”

She has been working with state legislators and said 12 pieces of legislation were passed in June; one of those pieces of legislation will require that insurance companies implement a review process for addiction cases, preventing them from flat-out denying treatment.

Stack said he hopes that further legislation will entirely change the model of care for addicts.

“Right now we have an acute model of care rather than chronic,” he said. “There is no after-care, which is what we need.”

Jail is not the answer

Craig Apple. Albany County Sheriff, said the rate of recidivism in heroin addicts is “very high” because of the gaps in the treatment process.

There are roughly 800 inmates in Albany County’s jail, and Apple said approximately 25 percent of them are addicts.

“But we’re not a treatment facility; we are a corrections facility,” said Apple.

The sheriff described situations where a person commits a crime, often to fuel his or her addiction, and, while in the jail, can detox and receive methadone treatment, but, once released, the person is back out in the world, with no resources.

“There’s nowhere out there for these people to go,” said Apple. “Having addicts come and go in the jail is not going to solve the problem.”

Insurance coverage needs to be extended, he said, so addicts can get the help they need.

Guilderland Chief of Police Carol Lawlor confirmed that the heroin epidemic is a very real problem in Guilderland.

“It is most definitely here,” she said.

In the past year-and-a-half, there were 17 heroin overdoses, and seven of them were fatal, she said.

The Guilderland Police Department was the first in Albany County to have officers carry Narcan kits. Narcan is an overdose antidote.

Dr. Don Doynow, the town of Guilderland’s emergency physician, demonstrated how the Narcan works using an atomizer on a dummy. The substance is sprayed into the nasal passages of the addict and absorbed through the mucus membranes. The effects of opiates are reversed within one to two minutes.

A Guilderland paramedic used a Narcan kit within the past few weeks and saved a life, said Lawlor.

Anyone can be trained to use Narcan and can be provided with a free kit after completing the training; there will be a Narcan training held in the Empire State Plaza on Dec. 2.

“We are not even remotely close to winning this battle,” concluded Apple.

“We’re not winning the war,” agreed Lawlor. “But, we’re fighting.”

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