Staten Island Fights A Painkiller and Heroin Epidemic

Syringes are packaged at a distribution center in The Bronx for drug users. In 2012, Staten Island became the borough with the highest death rate due to drug overdoses. (AP Photo/Bebeto Matthews)

Syringes are packaged at a distribution center in The Bronx for drug users. In 2012, Staten Island became the borough with the highest death rate due to drug overdoses. (AP Photo/Bebeto Matthews)

She tries to hide the burn holes on her living room rug, so that she won’t be reminded of the life she used to lead.

Gina had tried all sorts of ways to use painkillers and re-capture that first high she got. She tried crushing the pills, snorting the powder, and even smoking the powder in a rolled up cigarette. But nothing satisfied her addiction. She depleted her savings, tapped out her credit cards, and sold her jewelry—even her wedding ring.

At the worst moments of Gina’s addiction to prescription painkillers, she had run out of money and began to suffer intense withdrawal. “I was lying on the floor, thinking ‘I’d rather die. Take me now,’” Gina said. She describes the symptoms like an intense cold, plus nausea, sweating, vomiting, itching, and aching. “It feels like your skin’s crawling.”

The horrific experience made her realize the severity of her addiction. She sought out her pain-management doctor, the one who had been prescribing the pills that was sustaining her addiction. But he told her he couldn’t help with her problem.

So Gina went down a list of doctors in the phone book. Some said they had no services that could help her. Others told her they’d already reached the patient quota for the month. At her wit’s end and desperate for help, she told one of them, “If you don’t help me, I’m going to kill myself. You’re going to see my name in the paper and it’s going to be on you.” Finally, the doctor recommended Gina to the outpatient opiate addiction program at the YMCA Counseling Service in Staten Island.

She has been sober for more than 100 days now. Having experienced the worst of her drug addiction, Gina wants to go back to school and become a drug counselor. “Maybe I can stop them. Who better to help them than someone who’s been through it?” Gina said.

Painkiller Addiction

Gina is one among many in Staten Island who are suffering from an addiction to painkillers. She got intervention before her addiction turned deadly, but many in Staten Island have not. According to city health department data, Staten Island was the borough with the highest death rate due to drug overdoses in 2012. In particular, the death rate for painkiller-related overdosing in Staten Island (by borough of residence) was 10 per 100,000, almost three times higher than the second highest rate, at 3.5 in The Bronx.

Gina, 53, first got five-milligram Percocet prescribed for her persistent foot pain in 2010. After years of working on her feet as a nurse’s aide, she had consulted a foot doctor to help deal with her heel spur. Gina, who spoke on condition of not being identified further, said she was taking more than prescribed two months in. She was already abusing the drugs.

But in September 2011, after she fell at work and had to get a hip operation, the addiction became real. She was prescribed 10-milligram Percocet and a Fentanyl pain reliever patch to deal with post-operation pain. Eventually, the 10-milligram pills weren’t enough to feel the high. She bought 30-milligram Percocet—known colloquially as “the blues”—off the street, and took them while still taking what she had been prescribed for the operation and foot pain. By the end, she was taking about 30 pills a day.

“Just one fall ruined my whole life. One little thing in your life that you didn’t expect to happen,” Gina said. “I wasn’t a normal person anymore. I couldn’t even function without taking pills.”

Amanda Wexler, senior program director at the Staten Island YMCA, says that many who become addicted to painkillers, like Gina, are not seeking drugs initially. They were prescribed the drugs for an ailment. But their bodies became physically dependent on them—and they experienced withdrawal symptoms when they tried to stop. Wexler compares the physiological dependency to a baby who is born to a drug-addicted mother. “If they know by taking another pill, another Percocet, whatever it is, that they won’t get sick, of course they’re going to take it. It’s almost human nature.”

She believes that part of the reason many people became addicted is because doctors failed to realize how quickly a person can develop dependency to the drug, resulting in the overprescribing of painkillers.

When the I-STOP registry was put in place in New York State last year—requiring all doctors to register their patients’ prescription history—health officials noticed that Staten Island had large numbers of prescriptions for opiates, Wexler explained. “For example, somebody would go to the dentist and have a root canal, and they leave with 180 [-milligram] Vicodin or 180 [-milligram] Percocet, which is a crazy amount. It would take months to take that amount. But people were taking them very nonchalantly.”

Gina agreed that doctors prescribed painkillers quite liberally, often without asking many questions. Gina easily went from doctor to doctor getting her painkillers. When they asked whether she experienced withdrawal symptoms, she began to lie.

“They would ask, are you having problems sleeping? Are you having night sweats? Are you having tremors? They never come out and say do you feel like you’re addicted to these pills?,” Gina said. At the nursing home where Gina worked, a relative of a resident even provided her with bags of painkillers when the relative noticed Gina had foot pain.

Chris Tarulli, 29, is another member of the YMCA program. He bought painkillers from his union delegate at work, who was selling his prescription drugs. His drug-using friends, from whom he also bought drugs, got painkillers through doctor-shopping, too.

The painkiller addiction is expensive to maintain. A pill off the street typically costs $25. Wexler noted that one reason why this kind of addiction is rising among well-to-do suburbs in Staten Island is because of the drugs’ high costs. “We’re definitely seeing a more significant amount of use on the South Shore. That’s more likely socioeconomic. People just can’t afford it in the poor neighborhoods,” Wexler said. The latest census data shows that median household income in most South Shore neighborhoods is higher than in North Shore neighborhoods. For example, a census tract in the North Shore neighborhood of Randall Manor has a median household income of $26,891, while the median household income in the South Shore neighborhood of Prince’s Bay is $100,350.

Gina estimates that she spent roughly $1,500 each month on buying pills. She’s glad to finally be leaving the addiction behind her. But she is now afraid of taking pills of any kind, even her blood pressure medication. “I won’t let a pill pass through my mouth, because I’m afraid of getting addicted,” Gina said. “I associate taking pills with getting high.”

Transitioning to a Heroin Addiction

With the implementation of I-STOP, it wasn’t as easy for people to go doctor shopping for painkillers anymore. The drug dealers had trouble getting the pills to sell on the streets. To satisfy the same craving, some people began turning to heroin, which was considerably cheaper than painkillers and easy to find on the street.

Heroin and painkillers both derive from the opium poppy plant, providing a similar high. But painkillers are relatively safer than heroin, which is often cut with different substances. “Heroin can be cut with a dangerous drug, but you always know what’s in pills. You know they’ll all be the same,” said Anthony, a member of the YMCA opiate addiction program who chose to identify himself by his middle name in order to speak more freely about his experience. Anthony, 28, transitioned from painkillers to heroin about five years ago. He first got hooked on painkillers in 2006, after a game of football with friends led to a bad rib injury. At the time, the hospital gave Anthony shots that failed to stop the pain, so Anthony turned to drug dealers he knew to get painkillers. He soon became addicted to them.

One day, Anthony was withdrawing from the painkillers. He called up a dealer to buy more pills and stop the withdrawal symptoms. But the dealer told him he ran out of “blues,” and could offer him heroin instead. The dealer told him, “It’s the same thing. It’s opiates. If you do the heroin, you’re not going to be sick no more.”

Anthony felt an incredible high. “It got me hooked right away. I remember walking on the grass, feeling like I was walking on fucking water.”

For $100, Anthony could now get 12 bags of heroin, instead of just four pills. It was a deal he couldn’t resist. By the end of his addiction, Anthony was using 20 bags of heroin a day. “I’m lucky I’m not dead,” he said.

For heroin-related drug overdoses in 2012, Staten Island had the highest death rate—10.2 per 100,000. Just two years earlier, in 2010, the death rate on the island was 3.5. Wexler of the YMCA says the dramatic increase is because of people’s transition from painkillers to heroin, because the latter was cheaper, had a similar effect, and was easier to find.

A drug user is most vulnerable to overdosing when he relapses after being sober for a certain period of time, explained Christine McLaughlin, a counselor at the YMCA program. And relapse is often a part of the recovery process, because it is difficult for users to completely come clean after years of abuse. After a period of sobriety, the body’s tolerance to the drug is lowered, so if a drug user takes the same amount of drugs as he did before, he can easily overdose.

“It’s actually a valuable tool to relapse during recovery. You can look back at the mistakes you made and see how you can change it.” But McLaughlin also makes sure that recovering addicts understand the dangers of overdosing during relapse. Just since March, the YMCA program has already lost three clients to overdosing.

At the YMCA, the treatment program is split into two phases. Phase one is devoted to educating the addicts about their addiction, about how to stay clean, and how to identify triggers that can lead one to return to drugs. This phase lasts 90 days and addicts meet three times a week, in addition to an individual session every week. After this period of sobriety, recovering addicts go into phase two, in which they learn how to deal with everyday stresses now that they have begun new lives. Members meet two days a week. YMCA has also started a new program, in which members are given doses of Suboxone, along with the therapy sessions, to prevent them from feeling withdrawal symptoms.

Tarulli, Gina, and Anthony are all in this program. McLaughlin explained that usually, people in this program have attempted to come clean before, but failed. That is the case with all three, who all have a history of using drugs recreationally—cocaine, marijuana, ecstasy—prior to their opiate addiction. The Suboxone program introduces medication in the hope that they can recover successfully this time around.

The Road to Recovery

Anthony has stopped using heroin since last November, and recently found a job working at Verizon. But he realized that the lure of his addiction is still there. He’s afraid that with the work pressure and new income, he may turn to drugs again to feel less anxiety.

“You’re not even starting over, you’re starting, period. Because all those years where you made drugs your number-one priority, now all of a sudden, you have different goals. You have different things you want to achieve. It’s all the things I should have done coming out of high school, I’m starting to do now. It’s tough realizing how much time you’ve wasted,” Anthony said. He now hopes to become a drug counselor so that he can helps others who have become addicted to the drug abusing lifestyle and think it’s too late to reform.

Having witnessed people around him die, lose their families, and ruin relationships because of their addiction, Anthony is grateful that he has been given a second chance at life. “If I can be a symbol of hope for people because I’ve been there, I’d be happy doing that,” he said. “I think this is what I was meant to do.”

Anthony is also working hard to mend relationships that were destroyed when he was an addict. “When you’re sick, you do disgusting things for drugs. Things that I never, ever would have done if those didn’t come into my life.” He regrets his days stealing and scheming to get his hands on more drugs. He’s now trying to earn back people’s trust, but it’s been difficult because people assume he will go back to his addiction.

Tarulli also got a new job, and is working out how to begin his new life. “At first, it’s like what’s the point of doing this? Being clean, doing nothing. But you slowly realize, you can go look for a job, try to meet a girl, save money.”

Gina is worried that she will miss the thrill of that first high she ever got, and try seeking it out again. “I’m still looking for a rush to fill it, something to fill my time with,” Gina said.  “If I don’t stay busy, I constantly start thinking about getting high. That’s why I want to go back to school.”

A task force was recently created in the New York State Senate to address the rise in heroin and opiate addiction.

Opiate addiction treatment should be made more widely available, said Gabriel Sayegh, New York State director at Drug Policy Alliance. Because of the increased advertising for painkillers to consumers in recent years, patients frequently request these drugs from their doctors, leading to the over prescription of painkillers all across the country.

“When you crack down on those opioids but there’s not a simultaneous effort to expand the availability of opioid treatment, then you’ve got a problem,” Sayegh said. Changes will have to occur at the local and federal level to make treatment more accessible. For example, oftentimes, a treatment program would recommend a recovering addict to enter their program, but the insurance companies would refuse to cover the costs. “If we want to make the cycle stop, we should make treatment available and remove all the boundaries.”