Opinion

Now 40, Jennifer S. is a heroin addict from Selden who has used the opiate since she was 13 years old. She’s been clean for years at a time, and she’s been jailed for years at a time. She shoots up three or four times a day and has a husband and a home and a job. Actually, two jobs. She’s an office manager and bookkeeper, and she works for Community Action for Social Justice, the only “harm reduction” and syringe-exchange program on Long Island. Jennifer helps addicts stay alive, people like her who aren’t ready to stop using.
Harm reduction is a big challenge, one made more difficult by a system that focuses most resources on preventing addictions and treating addicts ready to quit. To many, driving resources and compassion toward active addicts feels like enabling. But both the resources and compassion are necessary, because no one’s ready to quit until he or she is ready, and because no one can get better if he or she is dead.
Naloxone, the drug that snaps users out of heroin or painkiller overdoses, plays a big part in harm reduction. Huge strides have been made in Naloxone distribution and training by police departments, municipalities, social services and volunteer groups. Yet overdose deaths continue to skyrocket. In 2015, 3,009 people in New York State died of drug overdoses, and more than three-quarters were attributable to opioids. Tina Wolf, executive director of Community Action for Social Justice, says part of the answer lies in making sure addicts themselves have Naloxone, not just the concerned parents and community members trained in its use. Opioid users are the people who overdose and hang out with others who do. Advocates say that to save lives, government — federal, state and local — should mandate and fund programs that hand Naloxone to addicts when they walk out of a jail, hospital or rehab center. Yet, that’s almost never done.
A peer outreach worker like Jennifer, who didn’t want her last name used, is a great resource, because she can make sure her drug-using acquaintances have Naloxone and know how to use it. And she can work to reduce a variety of other harms for them, too, because opioid addicts face plenty of dangers beyond overdosing.
According to the Centers for Disease Control and Prevention, hepatitis C is the deadliest infectious disease in the United States, killing almost 20,000 people in 2014, with a new wave of infections among those who inject drugs. More than 1.2 million people have HIV, the virus that causes AIDS. These diseases are a plague to people who inject drugs, and the best way to stop the spread is by dispensing free, clean needles and syringes, as well as condoms. With a budget from the state of about $500,000 a year, Community Action for Social Justice isn’t getting to most people who need help.
Wolf and her co-workers also talk to drug users about how to inject safely, and avoid overdoses, infections and vein problems. And when someone is ready for sobriety, they help with that, too. But they also stress the value of helping people maintain their health and dignity even if they are not ready to stop using. 
Those who aren’t ready will use drugs, Jennifer says. Addiction is a disease, and taking risks to get high is a symptom. She says she has tried three times in the past year to get a bed in a detoxification clinic, but none have been available. And when she failed to get sober, she used drugs.
Harm reduction is needed after addiction prevention doesn’t work and before recovery takes hold. Experts say we are not spending nearly enough on it, not talking about it enough, not pushing hard enough to make sure active users stay alive and as healthy as possible. If the rising death toll from opioid addiction is to be reversed, if the most possible people are to recover, that has to change.— The editorial board

Editorials

VPHARM1227

We can help addicts, even those still using drugs

Editorial: We can help addicts, even those still using

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The growth of the opioid crisis has generated an outcry for more resources to fight addiction and provide treatment, and that outcry is working. The availability and use of Naloxone, which can bring users out of overdoses from heroin and prescription pain pills, has mushroomed. And more federal, state and local resources are funding rehabilitation beds; treatments like methadone, suboxone and vivitrol to help addicts stay clean; the fight against overprescription of opioid medications; and the prosecution of drug dealers. 
But all this action is being sought and put in place by experts and advocates who fret even as they labor. Some addicts take a dozen attempts to get clean, or never make it. More than 40,000 people in the United States died from opioid overdoses in 2015, four times the numbers killed by gun homicides or drunken driving. Addiction treatment is both expensive and frequently ineffective. And when the cure is so very difficult to fund and administer, prevention must be a priority. 
We’ve been trying to prevent addiction to cigarettes and alcohol and drugs among young people for decades, with mixed results, but experts say those uneven outcomes can tell us a lot about how to proceed. 
The key message to kids about cigarettes, alcohol and all drugs has been, “Say no.” With cigarettes, it has largely worked. Since 1997, the number of high schoolers who smoke cigarettes has declined from 36 percent to 11 percent. But in the same period, attempts to curb drug use were less successful, and a recent survey showed a growing acceptance among high schoolers of occasional use of even hard drugs. 
The different outcomes seem linked to honesty and hypocrisy. Young people believe smoking kills, and they know adults believe it because adults are quitting — and dying. Since 1980, the rate of American adults who smoke has declined by half. But told that a little drinking or pot will destroy their lives, young people don’t believe it, and they don’t believe adults believe it. They know many adults drink and smoke pot recreationally. And, their thinking can go, if they are being lied to about beer and marijuana, perhaps they are being lied to about heroin and pain pills.
Addiction experts increasingly agree that successful prevention messages don’t tyrannize children with tough love. They don’t group all substance use in the same category regardless of the substance used or the frequency. Strong prevention programs identify kids who are at risk by focusing on traits that can identify 90 percent of such kids as early as middle school: sensation-seeking, impulsiveness, anxiety sensitivity and hopelessness. And they teach those at-risk students cognitive behavioral and coping techniques that can help them address problems and avoid addiction. 
Most addicts begin to develop problems in their teens and early 20s. But the vast majority of young people who try booze and marijuana, or even opiates or cocaine, never become addicts. Programs that try to convince kids that one slip will ruin everything fail. What works are truthful information programs that identify kids who are at risk, and strategies adopted by parents, schools and prevention programs that accept the possibility that young people will try substances and help them decide what to do once they have. These programs need to be in the schools, funded fully and given community support. These messages need to come from parents and teachers. Because as hard as we’re trying to ramp up badly needed addiction treatment, addiction prevention is, in the long run, a much smarter, more loving and more cost-effective way to approach opiate addiction. — The editorial board

VPPREVENT1219

Prevention must be a tool in attacking the opioid crisis

Editorial: Emphasize prevention to fight opioid crisis

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At a time when the idea that politicians can get something done has become a joke, there is an area in which action is taking place: the mobilization against heroin and opiate dependency. 
That need was made clearer than ever last week when staggering national statistics for 2015 revealed that drug overdose deaths rose 11 percent to 52,404 — 77 percent of them as a result of overdoses of heroin, painkillers and the synthetic opioids fentanyl and carfentanyl. That means that in 2015, opioid overdoses killed more people than car accidents (37,757) and gun violence (36,252).
Last week, Congress funded the 21st Century Cures Act. It paves the way for more prevention and treatment of addiction, as well as monitoring of opiate prescriptions for pain. President Barack Obama says he will sign the bill and approve $500 million for its first year. That’s a huge advance from this summer, when both chambers passed a bill that included treatment and prevention, but didn’t fund them. 
What changed? Members of Congress went home to run for reelection and found what President-elect Donald Trump was seeing, particularly in swing states like Pennsylvania, Ohio and New Hampshire: communities ravaged by addiction, reeling in pain.
In New York, lawmakers and Gov. Andrew M. Cuomo made significant strides in 2016, passing measures that increase access to addiction treatment, add prevention programs, limit the overprescription of opioids and crack down on insurance-company practices that make needed treatments hard to obtain. But more will need to be done: Federal statistics say there were 3,009 overdose deaths in the state in 2016, a 20 percent increase over 2015.
New York also sought a waiver that could save lives and money if the federal Centers for Medicare and Medicaid Services will approve it. The state wants to use Medicaid matching funds to treat sick and addicted prisoners in the 30 days prior to their release from prisons and jails. The plan would reduce emergency department visits, hospitalizations, overdoses and recidivism, without increasing costs much. Prison health care is already publicly funded, but this would set prisoners on the path of care they’ll need to stay on when released.
In the first two weeks after release, former inmates are 12 times more likely to die than the general population. Much of this risk is attributed to overdoses and other addiction-related problems. They are also quite likely to end up back in jail or hospitalized. But studies show that inmates with addictions fare far better when they set up a continuum of care before they are released, including medically assisted treatments like methadone, suboxone and vivitrol, care coordinators, counseling and rehabilitation programs.
Early in 2017, New York will begin giving eligible prisoners Medicaid cards before release. That did not require federal approval, but beginning and arranging Medicaid-funded treatments before release does. 
New York asked for the waiver this summer, and a public comment period brought hundreds of responses, nearly all positive, from advocates and the public. But no action has been taken, and with a new White House administration and party on its way in, there are fears in the treatment community that the plan may stall. 
That can’t be allowed to happen. On the campaign trail, Trump promised increased addiction treatment. Politicians are grasping the seriousness of the situation. The death totals are heartbreaking.
Combating the opioid epidemic must go beyond party and politics. Approval of this Medicaid waiver is necessary to save lives and money — and to give addicts a real chance. — The editorial board

VPTREAT1212

Heroin numbers are alarming

Editorial: Heroin numbers are alarming

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In 2007, the company that makes the opiate painkiller OxyContin pleaded guilty to federal felony charges that it misled physicians, regulators and the public about the drug’s addictive qualities and the dangers it posed. 
OxyContin isn’t the only painkiller that caused problems, and manufacturer Purdue Pharma LP isn’t the only company that pushed painkillers. The question is whether the companies can be held for responsible for the opiate-addiction epidemic that is sweeping Long Island and the nation. One answer could be lawsuits, much like the landmark suits more than three decades ago against major tobacco companies.
Suffolk County has filed suit in State Supreme Court, charging that pharmaceutical companies knowingly and deceptively promoted dangerous opiates. The county argues that because it administers Medicaid, purchases health insurance for its employees and enforces criminal laws, the industry’s deceptions are costing it money.
Suffolk is not the first municipality to try such a strategy. So have West Virginia, Chicago and several California counties. The suits could lead to payouts that can help us fight this battle. 
The Centers for Disease Control and Prevention says 165,000 people nationwide have died from prescription painkiller overdoses since 2000, while millions more have become addicted to opiates, including heroin. Suffolk leads the state in opiate addiction deaths, and Nassau County isn’t far behind.
A big part of the problem is overly aggressive marketing of painkillers that downplayed studies showing how dangerous the drugs are. The drugmakers now will have to address the consequences. — The editorial board

VPOPIATE0909

Painful truths and consequences for opiate makers

Editorial: Truths, consequences for opiate makers

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In February, high on heroin, Daniel S. robbed a bank near his Sayville apartment. Unarmed, he handed a teller a note demanding money, but there was a GPS locator in the cash and he was quickly arrested and jailed. Again. 
Daniel, 43, asked that we not use his last name because he does not want to further embarrass family members. In an interview at the Suffolk County jail in Riverhead, he said he had a stable upbringing in Elmont. He had a trade as a union ironworker, and although he struggled with alcohol early, he mostly kept it together until he hurt his back in a motorcycle accident in 2011 and was prescribed painkillers. He became dependent on the pills, and when the doctor cut off his prescriptions, he switched to heroin, and quickly spun out of control. 
In 2012, Daniel was arrested two hours after he broke into a business in Bay Shore and stole a laptop, for which he was sentenced to 18 to 36 months. After his release, he stayed sober for 18 months, then relapsed. Then came the bank. Now he’ll serve 1 to 3 years. He says he plans to work a 12-step program and stay sober when he gets out. But he also fantasizes about scoring heroin as soon as he is released. 
Putting Daniel and other addicted inmates on the right path and keeping them on it is the challenge facing jails and prisons everywhere. They are mostly failing — at a tremendous cost. 
Daniel sent Newsday an impassioned, handwritten letter in April after reading two editorials on the opiate crisis. He wanted to share his view of addiction from jail. He described cell blocks full of drug addicts, many unaware they have problems, and days full of boredom, with far too few drug rehabilitation services that might help prisoners stay out of trouble once they’re free. 
About two-thirds of the nation’s 2.3 million inmates are addicted to drugs or alcohol. Many of the most troubled opiate addicts in the country are in penal institutions, with time on their hands. Every possible attempt to enhance their chances at recovery should be seized. More services are needed in local jails and state and federal prisons, and for prisoners upon release. But perhaps just as important, more data are needed on what works. 
Opiate rehabilitation basically consists of 12-step programs, behavior-modification therapies and medication-assisted therapies, or MAT. MAT includes methadone, a traditional long-term treatment using an opiate that allows addicts to function and controls cravings. Also included are Suboxone, a newer drug that functions much the same way, and Vivitrol, a once-a-month injection that blocks the high of opiates. 
Correctional facilities have too little of all of this, according to prisoners, experts and corrections officials. There are too few counselors and meetings. But the biggest problem is that there are far too few MAT programs, which have been shown to halve the chances of relapse and overdose. Of the 5,000 correctional facilities in the nation, it’s estimated fewer than 100 offer MAT programs. 
The Nassau County jail has three 12-step meetings a day in cell blocks devoted to recovery. Suffolk County is staging a pilot Vivitrol program, as is the state prison system. Nassau tries to set up departing inmates with rehabilitation programs on the outside. Suffolk is trying some innovative anti-recidivism programs with its youngest inmates. 
Everyone’s trying. But jail and law enforcement officials need more funding for treatment, more volunteer help from outside, and more facts. 
There are practically no data to show which methods are best to treat opiate addiction and prevent relapse, for whom or in which combinations — not in the corrections world or outside it. Addressing this lack of data is a top priority. That means funding studies that track the outcomes of different programs, and loosening state and federal privacy laws that make it hard to track such outcomes. If five or 10 years from now we still don’t know what works, it will be a disaster. 
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In addition to adding services in jails, the biggest change that would give addicted inmates a chance at long-term recovery is immediate help when they get out. A path toward that is under consideration. In April, Gov. Andrew M. Cuomo made New York the first state to apply to the federal government for permission to enroll jail and prison inmates in Medicaid 30 days before they are released, giving them access to the services they need and a continuity of care upon discharge, a move Daniel said could make a big difference for him and fellow inmates. Washington needs to approve this change for New York, track the results, and expand it nationally if it curbs relapses and recidivism. 
Daniel and most of the other opiate addicts he’s doing time with are going to get out. What happens after that depends on their choices, but those choices partly depend on the treatment they get. 
If their addictions lead them back to crime, we will all suffer.

VPHEROIN0828

Addicted to drugs in Suffolk County jail 

Editorial: Addicted to drugs in Suffolk County jail 

Addicted to drugs in Suffolk County jail

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Newsday

To whom it may concern:
I am an inmate at Suffolk County Correctional Facility. I have been reading your stories about the heroin epidemic here on Long Island and was wondering why you don’t mention anything about us here. The majority of us inmates are incarcerated due to the fact of us getting and using (heroin).
Our rehabilitation needs are not being met here. Almost no one is referred to treatment. With treatment being cheaper than incarceration, I don’t see why it is not more often used as an alternative to incarceration, especially for non-violent offenders. 
The monster of addiction inside of us is growing stronger and stronger by the day. If you were to ask the average addict in here if they had a problem, they wouldn’t even know because they are not educated about it.
I have been here two months and in that time have crossed paths with hundreds of inmates with drug problems. I have only seen one released to a rehabilitation facility so far.
Warehousing addicts because of their crimes is not the answer, treatment is. 
Remember, we will all be released one day, most of us untreated. 
We are your neighbors, you see us at the supermarket, we are your relatives — brother, sister, mother, father et cetera. You drive next to us on the L.I.E. 
So is it about punishment (warehousing humans) or getting to the root of the problem (treatment)?
Just because you can’t see us doesn’t mean the problem is fixed.
Sincerely,
Daniel S.
Editor’s note: The writer was an inmate at the Suffolk County jail when this was sent. He asked that we not use his last name to avoid embarrassing his family members.

Letters

OPHEROINLETTER0828

How to improve addiction treatment in the Suffolk County jail

Letter: We need more addiction treatment in jails

Jeffrey Reynolds, a 20-year veteran of the battle against addiction on Long Island, wants hospitals to give drugs to opioid overdose victims treated with the antidote naloxone, which both revives opioid users and sends them into pangs of withdrawal.
Reynolds, an expert in addiction and treatment, says that an immediate dose or two of Suboxone, a synthetic opiate, can help users of heroin and prescription pain pills fight cravings, because it can help them stay sober and get a chance at recovery.
As it stands, addicts revived with naloxone often end up using opioids again hours later — and overdosing again.
Reynolds has statistics and the views of most public health officials on his side, because studies show opioid addicts who are treated with only behavioral therapy are twice as likely to relapse and twice as likely to die of an overdose than those being treated with Suboxone or methadone.
But working against the practice of using Suboxone or methadone to help opiate addicts, a protocol called “medication-assisted treatment,” are the weight and history of addiction therapy in the United States. Many leaders in the fields of medicine and law enforcement fear and preach that using one drug to stay sober is no better than being addicted to another. 
The consensus among medical and treatment professionals is that opioid addiction is a disease. Diseases are treated with medicines and scientifically tested methods, which is now possible and effective with opioid addiction. So if opioid addiction is a disease, why is society so often adamant that it must be overcome with only prayer, support groups and behavioral therapy?
Mostly, it’s because of the model of Alcoholics Anonymous.
Since AA’s founding in 1935, its recovery method has become the dominant model of addiction treatment, and not just for the alcoholism. The recovery manual known as the Big Book of AA, the model of total abstinence from addictions and the organization’s 12 steps and 12 traditions have been adapted to help people overcome everything from smoking to anger. 
The AA model involves accepting powerlessness over alcohol and inviting God into one’s life, admitting to and making amends for bad behavior and helping others to recover from alcoholism. Also crucial are the fellowship and support that come from regular meetings with other alcoholics.
AA does not operate or endorse rehabilitation facilities, does not advertise for or seek members, does not ask judges or families or employers to send prospects to its meetings, and does not claim that the 12 steps can help end addictions to anything other than alcohol. And AA embraces the idea that doctors may well prescribe drugs for members or addicts to deal with physical, emotional and mental problems other than addiction to alcohol.
The biggest offshoot of AA is Narcotics Anonymous, which has helped millions of people, but too often stands in opposition to medication-assisted treatment. This animus against using medication to help people recover from heroin and prescription pain addictions is widespread, and can be deadly. Too often, judges who sentence addicts caught up in the criminal justice system, clergy counseling them and families with addiction histories believe only in the total abstinence path of 12-step programs. They dismiss methadone and Suboxone treatments as “replacing one addiction with another.” But recovering opioid addicts who use replacement substances correctly often manage to defeat their craving without getting high. They can hold down jobs, stay out of trouble and care for their families. Often, they can, over time, stop using their replacement substance. But even those who never do generally fare better than active addicts.
Methadone and Suboxone are also inexpensive ways to treat addiction, because they can be used effectively in outpatient programs and combined with free 12-step meetings, rather than costly inpatient rehabs. But in Suffolk County, there is a waiting list of about two months for methadone treatment. And even in Nassau County, where there is no waiting list, experts say a lot more addicts need medication-assisted treatment than seek it because of their own bias against using one drug to get off another. Opioid overdose deaths in both counties have skyrocketed, with 442 in 2015. Using substitute drugs to break the addictions is a crucial and underutilized part of getting a grip on the epidemic. 
Addictions are often both a disease and a behavior, and they require both medical help and behavior modification therapy and support. It’s madness for 12-step devotees to oppose medication-assisted treatment for addicts who want it. But it’s just as destructive to deny or debunk the good 12-step programs can and have done. Either path can help the addicts. And many addicts will need the help found on both paths to achieve their best possible lives.
NA and AA are widespread, free, socially accepted and available for anyone who needs them. That’s not yet true of drug therapies to treat opioid addiction. And that’s a gap addicts are falling through, often to their deaths.

VPHEROIN0626

12-step programs not the only way to beat the opioid crisis

Editorial: More than one way to beat addiction

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The reports Thursday that the rock star Prince died of an overdose of opiates provided one more shocking example of the pervasive problem of addiction to heroin and prescription painkillers. It is killing the rich and the poor, young and old, people who have struggled with addiction all their lives and people who have never taken an illegal substance or had a problem before with legal ones. 
Opiate overdoses are killing more people in the United States than car accidents, and three times as many people as drunken-driving accidents. There have been numerous opiate task forces in Albany, but with just a few days left in this year’s state legislative session, there is still no consensus among Gov. Andrew M. Cuomo, the Senate and the Assembly over which laws to enact to combat this epidemic. 
There is still a lot left to uncover about the death of Prince, who was known for avoiding illegal drugs but who also sustained many painful injuries in his career. He saw a doctor the day before he died, was in touch with an addiction specialist, and had to make an emergency plane landing the previous week, reportedly because of an opiate overdose from which he was revived with Narcan. 
But what seems likely in the beloved musician’s death is what seems clear with our system. There is too little urgency and action around a problem that is killing about 75 people in the United States every day. 
There are some clear improvements Albany lawmakers can make. They must force insurance companies to pay for more rehabilitation, and require doctors to cut opiate prescriptions to sensible sizes and counsel patients on their dangers.
Notwithstanding resistance from the drug companies, the medical profession and the insurance companies, those laws need to be passed. Now. — The editorial board

VPPRINCE0603

What Prince drug overdose means

Editorial: What Prince drug overdose means

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Lawmakers nationally and locally are swinging into action to face a crisis that’s terrifying constituents: the skyrocketing number of deaths from addictions to heroin and prescription painkillers. 
Nationally, 28,647 deaths were linked to opiates in 2014, and that number gave the drugs a grisly honor: opiate overdoses have overtaken car accidents to become the leading cause of accidental death in the United States. And on Long Island the numbers are worse per capita than the national tallies. In 2015, 442 people in Nassau and Suffolk died of opiate overdoses, a rate about two-thirds higher than the national average.
But what exactly can lawmakers do to combat the problem? A lot. There are no quick or easy fixes to prevent addiction or to guarantee recovery from it, but stronger policies would help. As deadlines for legislative sessions in Washington and Albany approach, pressure for better laws is building.
And so is pressure to stymie better laws, in some cases. Drug manufacturers don’t want to see pill sales curtailed. Physicians don’t want new education requirements or mandated changes in how they prescribe drugs or talk to patients about them. Insurance companies don’t want to pay more for inpatient addiction treatment or replacement drugs that make it easier for addicts to get clean. And defense attorneys don’t want to see harsher penalties for drug dealers. But these are exactly the things that must happen to get this epidemic under control.
In Washington, the House of Representatives last week passed a bipartisan set of 18 bills that addressed drug trafficking, increased treatment, and protecting addicted minors and veterans. But before they mean anything, those bills must be reconciled with omnibus legislation the Senate approved in March, and funding will have to be provided. 
Even then much of the legislation mandates changes at the state level, where most of the crucial policies are controlled.
In New York, opiate task forces in the Senate and Assembly have wrapped up, and Gov. Andrew M. Cuomo’s task force is set to make recommendations early next month, for legislation that must be passed by the session’s end on June 16. The early battle lines are being drawn by bills the Senate passed last week and the pleas of families and treatment providers all too familiar with the problems.
Among the best proposed measures is one that would make it easier to hold recent overdose victims for treatment against their will. Another big step would be limiting an initial opiate painkiller prescription for acute pain to a five-day supply, keeping a huge volume of unneeded pain medicine out of cabinets and off the streets. More continuing education for doctors and addiction counselors is crucial. Stiffer penalties for serious dealers are a must. And bigger, better anti-heroin education programs in schools have to be mandated, because opiate addiction is so hard to break that preventing it first is the most important step.
A big piece of getting the addiction crisis under control is building the legal and societal framework that’s needed to combat it. That’s the part lawmakers have to get right, right now.
— The editorial board

VPHEROIN0523

Better laws needed in heroin fight

Editorial: Better laws needed in heroin fight

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On March 30, Bridgette Kurtzke died of a heroin overdose hours after checking herself out of rehabilitation at South Oaks Hospital in Amityville. To some extent, she fell through one of the many gaps in a system that has too few beds for addicts and too little awareness of how to access help. But Kurtzke, 28, also chose to go with addicts and use drugs that night. That doesn’t make what happened to her any less tragic, or make the pain her parents, brother and sister are feeling any less real. 
Politicians, treatment providers and communities on Long Island have been overrun by an opioid drug crisis that grew far faster than society could respond. Now a furious game of catch-up is underway. Bridgette’s father, Kevin Kurtzke, of Medford, wrote a letter to Newsday to tell the story of Bridgette’s death. And he, rehab professionals involved in her case and state officials agree that while it’s difficult to apportion blame for her death, it does highlight problems with the system. 
According to Kevin, Bridgette didn’t have addiction issues until a car accident led to back surgery a couple of years ago. Her recovery included pain pills, which led to heroin in 2015. 
Kevin said Bridgette was a loving daughter who mostly worked as a secretary before her trouble started. She was diagnosed as bipolar in her youth and dropped out of Patchogue-Medford High School, but created a stable life as an adult until she became addicted. 
In January, Bridgette took her first try at rehab. She completed a program at South Oaks. But on Facebook on Feb. 3, she wrote, “I was discharged from C.K Post Rehab today, just because of the verbal abuse &amp; threats that I said. But I am remorseful &amp; I said my apologies to the one’s that were owed . . . Hello my name is Bridgette &amp; I AM an addict. Went to my 1st AA Meeting tonight. . .” 
Her father said Bridgette had trouble with authority and could be combative. Over time, her Facebook page reflected her struggle with addiction. One note she posted said, “Sometimes you really need to hit the very rock bottom for you to come out on top. You just wait &amp; see [expletive]!!! I’m going to conquer the Year 2016!! I’m taking my life back, and I’m in control.” 
Out on her own, Bridgette used heroin again, then checked back into South Oaks. She told her parents she had overdosed, was revived with Narcan and was ready to get serious. She began looking into long-term treatment and wanted to go to St. Joseph’s Addiction Treatment &amp; Recovery Center, an upstate facility offering a 90-day inpatient program. Bridgette was released from South Oaks on St. Patrick’s Day, but St. Joseph’s had no room. 
St. Joseph’s chief executive Bob Ross said the bed shortage is due to heroin admissions, which have increased 50 percent in recent years and now include as many as 80 percent of his patients. His facility would not have space for six weeks when Bridgette sought a bed. Ross called her death a tragedy, and said his organization is trying to expand its programs, particularly for women. 
Within a week, Bridgette relapsed and ended up back at South Oaks. Staff there did not return Newsday’s calls for information about her stays. Kevin Kurtzke, himself a recovering alcoholic who understands addiction, said he, Bridgette and her brother, sister and mother were frustrated and confused about how to get her help. 
On March 30, she checked out of South Oaks after several days, lying to her parents about who was coming to get her. She was picked up by the friend of someone she met in rehab, taken to a house in Copaigue that her father said had been the scene of a bust for guns and drugs two days earlier, and was dead of an overdose by that night. Her father wants to know why the house wasn’t boarded up if it regularly saw criminal activity. He also wants to know where the family could have turned for advocacy and advice. 
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New York State has an Office of Alcoholism and Substance Abuse Services whose website enables the public to search for open beds anywhere in the state. It explains programs each facility offers. The agency also has patient advocates who can direct families and addicts to resources, tell them their rights and help them navigate the system. But in an interview, officials conceded that many New Yorkers don’t know that the agency offers that type of help. One official said she had just ordered another 200 brochures to be printed, which sounds like a tiny swipe at a huge problem. Agency officials and rehabilitation professionals also said there is still a shortage of recovery resources, too little addiction prevention and problems with insurance providers denying or blocking coverage. They seek more rehab facilities, and they want changes in laws. In particular, they said a mandatory 72-hour emergency hold for those who overdose on heroin would help addicts get into recovery before they hit the streets in a state of painful opioid withdrawal. 
An investigation into details of Bridgette Kurtzke’s treatment and death is being done by the state. And Gov. Andrew M. Cuomo announced a new task force on opioid addiction on May 10. A key duty will be to propose legislation to confront the addiction crisis before lawmakers end the current session in June. 
Opiate overdoses took 442 lives on Long Island in 2015. And no one is taking the crisis lightly. But the pace of bureaucratic and societal change is proving deadly for people like Bridgette Kurtzke, and heartbreaking for families.

VPHEROIN0515

Falling through the gaps in the addiction treatment system

Editorial: Addicts falling through the gaps

VPHEROIN0515_WEB

Second in an occasional series. 
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The Nassau County Police Department has substantially increased its response to the heroin epidemic overtaking Long Island. It’s not working, and the problem is steadily getting worse. 
“We keep adding and adding to what we’re doing,” said Thomas Krumpter, the department’s acting commissioner. 
His was the first major department in the nation to train every officer in the use of the anti-overdose drug Narcan. He pointed to more patrols and undercover operations, prevention measures in schools and the recently formed Long Island Heroin Task Force as ways his department is battling the scourge. 
“We are not winning,” Krumpter said grimly about how it’s going. “We’re losing right now.” 
The problem is threefold: not enough prevention, obstacles in the way of law enforcement and not enough access to drug treatment. New programs and laws are needed. From 2009 to 2013, Nassau County lost 128 people to heroin-related deaths, the fifth-highest county total in the state. Suffolk had 337 heroin-related deaths in the same period, the highest in the state. But the rate of fatal heroin overdoses in Nassau has doubled since 2013 to more than 50 a year. 
From the 1990s until a few years ago, the nation was flooded with easy access to prescription opiates such as Vicodin and OxyContin. When authorities realized how much damage prescription opiate addiction was causing, the State Legislature passed new laws cracking down on prescriptions, lowering black market supply, raising prices and creating a demand for cheap, high-quality heroin mostly from from New York City. And every number associated with opiate addiction, from deaths to treatment admissions to arrests to emergency room visits, has skyrocketed. 
Nassau County District Attorney Madeline Singas promised in her election campaign last year to make the addiction scourge a top priority. She and Krumpter are seeking a new state law that would mandate that anyone revived from an opiate overdose with Narcan be placed on a 72-hour hold for hospitalization and evaluation. And it would require health insurance companies to pay for it. With such laws in place, those who suffer an overdose would have a fighting chance at finding a path to treatment before drug withdrawals force them to use heroin again. The timing is urgent because addictive cravings can begin within an hour or two after the administration of Narcan. 
Meanwhile, Singas has diverted $585,000 in forfeiture funds to Maryhaven’s New Hope Crisis Center in Freeport to allow it to take new admissions around the clock. It’s an innovative use of the money. Drug addicts don’t necessarily have their moments of clarity and seek help during office hours. Both Singas and Krumpter support tougher laws that draw a clearer line between heroin users and dealers, getting help for the former and stiff sentences for the latter. Bills mandating those changes have been introduced in Albany, and drawing a clearer line between victims and vultures would be a big improvement. 
Creative and aggressive law enforcement is a critical component in fighting the addiction menace. But the real key is prevention. Young people most of all have to be convinced that even dabbling in heroin or other opiates is unacceptable and frighteningly dangerous. 
Opiate addiction is difficult to treat. Drug interdiction is frustratingly difficult to pursue. Getting a handle on the heroin problem is mostly about stopping use before it ever starts. — The editorial board

VPHEROIN0425

Nassau admits it isn’t winning heroin fight

Editorial: Nassau isn’t winning heroin fight

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Matthew Murr, a 25-year-old from Garden City, had been struggling with drug addiction for years. He was administered the “wonder drug” naloxone after a heroin overdose at the halfway house where he was staying in Brooklyn. One week after he was revived with naloxone, he died of another overdose of several opiates. He was alone in a Brooklyn boardinghouse. 
The young man’s mother and father, Denise and Art Murr, describe him as “the good kid” every parent in the neighborhood was glad to have around. Trouble started during high school and increased during his brief attempt at college. Drugs and alcohol sank their hooks into Murr. 
They never let go. 
Naloxone, also called Narcan, is an easy-to-use innovation that is practically miraculous. It counteracts the opiate in a user’s system, whether from heroin or prescription pain killers, by blocking and even reversing its deadly effects. But it also blocks the drugs’ desirable and, to an addict, necessary effects. 
Its promise is that an addict, spared, now has the opportunity to achieve health and sobriety. The tragedy is that such a chance often doesn’t materialize, and death is merely postponed. 
“We had a guy we administered Narcan to three times in a week in 2014,” Nassau County Acting Police Commissioner Thomas Krumpter said. “The third time he died. We have 25 or 30 cases a year of administering Narcan to individuals multiple times.” 
When heroin users wake up from naloxone, they are sick from their overdoses and go into withdrawal. Drug users revived with naloxone are generally taken to hospitals to be examined, but not admitted. In New York, they are frequently released just a few hours later, as they are beginning to suffer shakes, severe stomach pain, muscle cramping and overwhelming depression. Addicts often begin seeking drugs to counteract the withdrawal, which to them feels like a serious illness. Sometimes they die of an overdose the same day. 
Through six rehabs, endless promises, psychotherapy and recovery attempts, Matthew Murr never found long-term sobriety. After overdosing and being administered Narcan, he left that halfway house in Brooklyn in 2011. His parents said he always left any given treatment option after a relapse, on the theory “it hadn’t worked.” 
<h3>Problems begin after an overdose</h3> 
The spread of naloxone on Long Island is a blessing. But as we have seen, it isn’t going to stop the spread of opiate addiction. 
There’s a lot more to be done, by everyone from families to teachers to police officers to doctors, to deal with this complex and insidious problem that defies easy solutions. Better and more addiction prevention programs, an even greater crackdown on drug trafficking, and more access to drug treatment facilities are the challenges we are failing to meet. 
The problems just begin when an overdose ends. For parents, spouses and friends, an overdose might be the first they hear that a loved one is using heroin or other opiates. And they quickly learn that the chances of getting immediate help are slim. 
The heroin epidemic on Long Island is overwhelming, and our response is falling woefully short. From 2009 to 2013, 337 people died from heroin overdoses in Suffolk County, the most of any county in the state. That’s nearly 30 percent more deaths than drunken driving caused in the same period. 
Nassau County, whose 128 heroin-overdose deaths were the fifth-highest number in the state during the same period, has a serious problem, too. The county has done more to meet the challenge, yet Krumpter says it is still losing the battle. 
Nationally, heroin and other opioids were linked to 28,647 deaths in 2014. Fatal opioid overdoses have quadrupled in the United States since 2000. 
There’s a lot of damage to undo. Experts say the seeds of the opiate epidemic were planted in the 1990s when doctors specializing in pain management began to argue that there was an epidemic of untreated agony in the nation, and advocacy organizations began to argue for expanded prescribing of opioids. This corresponded with a push by drug manufacturers for painkillers such as Vicodin and OxyContin to be used as everyday treatments. 
Marketing campaigns downplayed the addictive dangers of the drugs. Doctors would often prescribe 30, 60 or even 90 pills to deal with conditions that needed serious medication only for a day or two. This flooded the nation’s medicine cabinets with opiates. 
Many patients got addicted. Some fell victim to the prescriptions, others to a black market flooded with cheap pills. And now that states are cracking down on prescription drugs, fewer pills are making it to the street, and prices have shot up, making inexpensive and easily obtainable heroin the drug of choice for many addicts. 
<h3>Response must improve</h3> 
Opiate addiction is particularly serious among the young, those for whom heroin and opiates don’t hold the stigma felt by earlier generations. 
We are trying desperately to fight the epidemic, yet our response is largely failing, from hospitals to treatment facilities to support groups to law enforcement to schools to families to communities. 
It has to improve, at every level. 
&nbsp; 
This is the first in a series of occasional editorials on the scourge of opioid and heroin addiction. Tomorrow, we will comment on efforts by Nassau County to tackle the problem.

VPHEROIN0424

Long Island is losing the battle against heroin

Editorial: LI is losing the battle against heroin

Murr

Confronting the Curse: Long Island's heroin and opioid battle

Long Island's heroin and opioid battle

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