Suburbs and small towns in middle America may be the poster children for the opioid epidemic, but there was an equal storm brewing five miles south of Manhattan.
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Andrew Winslow is constantly surrounded by people with addiction. As a staff member and recovery coach at Carl's House, a nonprofit addiction resource center in Staten Island, Winslow spends his days counseling people, connecting them with treatment, and planning sober social events.
As a person recovering from addiction himself, I wanted to know if it's difficult to be constantly interacting with people in the thick of addiction. People who may not be ready for recovery, or may have drugs on them at that very moment. But he said it's actually a blessing.
"It keeps things fresh for me," Winslow, 31, tells me. "I'm quick to block out all of the bad memories and horrible things I've been through. But seeing people in the throes of active addiction really keeps it at the forefront of my mind, and makes me realize that this could be me again in an instant."
Winslow's story is achingly familiar; In his 20s, he got hooked on prescription opiate painkillers, and when those became too difficult to procure, he moved on to heroin. One of the lucky ones, he sought treatment, and came out alive and 14-months sober. It's a narrative that has unfolded hundreds of thousands of times across America since the opioid epidemic began to spread in the early 2000s, often without such a happy ending.
But while much of the coverage and policy around this issue has positioned it as a suburban or small-town, middle-America crisis, the same storm darkening the heartland was brewing in America's largest city. Staten Island has the highest rate of drug overdose deaths of any borough in NYC, and highest in the state when those deaths specifically involve prescription painkillers. Its per capita drug overdose death rates rival the worst-hit areas of the country. In 2016, Ohio's Montgomery County—often cited as the overdose capital of the US—had an overdose death rate of 42.5 deaths per 100,000 people. Staten Island's was 31.8. (For context, the overdose drug rate for Queens that year was 12.2.)
But Staten Islanders are a rare breed. A mix of New York grit and deep community ties has led police, doctors, judges, people addicted to drugs, and families to come together to tackle the problem from all angles. It's working, and Staten Island's progressive approach is now being adopted across the city, the state, and the country.
Staten Island wasn't going down without a fight.
The spread of opioid addiction in Staten Island was as insidious as many other nodes of the epidemic. Young people were becoming addicted, overdosing, and dying, but families—worried about social stigma—were not outspoken about what was happening. So those on the front lines began quietly spreading the word.
It started with local funeral directors, who as early as 2012 began discreetly raising the alarm with Staten Island government and police officials that they were seeing an increase in opioid-related overdose deaths, many of which were not reported.
Police were noticing it, too. Along with more reports of overdose deaths, police were regularly finding heroin and opioids on individuals arrested for unrelated offenses, like breaking-and-entering or trespassing. Edward Delatorre, the NYPD borough commander for Staten Island, was appointed in 2013 and identified this trend right away, commissioning a report that found arrests where the person was also carrying prescription pills rose from about 40 arrests in 2010 to over 500 in 2012.
The community was also starting to take action. In 2011, the Staten Island Partnership For Community Wellness, a nonprofit health organization, started a project to specifically address youth and young adult substance abuse: the Tackling Youth Substance Abuse Project, or TYSA. In 2013, the NYPD began distributing naloxone—a drug that can reverse the effects of an opioid overdose—to officers in Staten Island.
Still the addiction continued to spread, the deaths continued to rise, and as addicts began to switch to heroin, it became obvious that more needed to be done. In the fall of 2015, a few weeks before Michael E. McMahon was sworn in as the District Attorney of Richmond County (coterminous with Staten Island), his neighbor's 22-year-old son died on his parents' lawn.
"I knew this family. I saw this young man grow up," McMahon tells me while we sit in his office overlooking the New York harbor. "It was a terrible tragedy."
In his first month in office in January 2016, McMahon asked to see the folder for the investigation into the young man's death—only there wasn't a folder. Drug overdose deaths were considered closed cases of accidental death, and weren't investigated further.
So McMahon sat down with Delatorre and the chief of detectives to change the protocol. They all agreed that overdose cases should now be treated as a crime, with an investigation, evidence gathering, and tracking where the drugs came from. The protocol was brought into place at the end of February, and was retroactive to all overdose deaths since January 1, 2016.
"By May, we realized that the numbers were much higher than anyone was saying," McMahon says. "As we tracked each case, by May or June we realized we had 50 deaths."
These investigations are only inclusive of overdose deaths that are called in to police. If someone checks in at a hospital, for example, while overdosing and dies, it's typically not reported to police. Still, the Staten Island NYPD's investigations track fairly closely with the health department's official numbers. Police investigated 90 fatal overdoses in Staten Island in 2016. The health department recorded 116 overdose deaths in Staten Island for that year.
As of August this year, the police have opened investigations on 65 overdose deaths in Staten Island, according to the DA's office.
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But along with keeping better data, the DA and NYPD have been working to make officers better equipped for dealing with overdoses. Many officers in Staten Island carry Naloxone, and are trained to administer it, resulting in 125 Naloxone saves so far this year, according to the DA.
Police aren't the only ones trained to use Naloxone, either. TYSA regularly has community training sessions to teach families, business owners, and teachers how to identify an overdose and administer the drug.
"A lot of people assume this encourages use instead of trying to prevent it, but it's about lessening the risk of a harmful behavior," says Jazmin Rivera, the TYSA program manager. "There are people who are going to be actively using, so this makes sure that those people remain alive until they get to a point where they're able to engage with treatment."
Rivera is the first to point out, though, that harm reduction is no silver bullet, and it takes a multi-pronged approach that includes prevention and rehabilitation to tackle this issue. A volunteer program connects recovery addicts with individuals being discharged after drug-related hospital stays. The peer mentors try to convince the addict to seek treatment instead of just going home, and 44 percent of people take them up on it.
Places like Carl's House try to help connect addicts with resources for recovery, and is entirely run and operated by recovering addicts. This is to help curb stigma or fear about seeking treatment, while also showing that it's possible to come out the other side.
Carl's House was founded by Marco DiDonna, a recovering addict himself. He and his brother Massimo, who helped him set up the charity, knew that the best way to help addicts is to provide a space where they know the person on the other side of the desk understands.
"We said, 'Let's hire people who have walked a mile in an addict's shoes,'" Massimo says. "People need answers to questions that, unless you're a recovering addict, you are not going to know."
Marco's turning point was a 2014 arrest, a pivotal moment that can often be a catalyst for change for addicts, if they're given the opportunity. McMahon identified this as well, and established the Heroin Overdose Prevention & Education program, or HOPE. Under the HOPE program, low-level drug offenders can opt to seek treatment instead of jail time. If they prove that they spent 30 days "meaningfully engaged" in treatment, the DA declines to prosecute, and the individual has no record. Since it launched earlier this year, 152 people in Staten Island have completed the HOPE program and had their cases withdrawn.
Each of these efforts, individually, are not enough to change the tide of the opioid epidemic. But by approaching the problem from every possible angle, and being creative about solutions, Staten Island has inspired other communities that a progressive approach might be the only hope. The NYPD has started distributing Naloxone to officers across New York City. Many of the initiatives that sprouted in Staten Island are now mirrored in Mayor Bill deBlasio's plan for tackling the opioid epidemic.
We won't be able to determine if these efforts have been enough to save lives and make a dent in the burrough's staggering overdose rates until statistics are released early next year. In the meantime, advocates like McMahon are always on the prowl for the next tool they can add to this fight.
"It's a problem that really challenges the wellbeing of our country more dramatically than anything else I can think of," McMahon says. "I would call it domestic issue number one."
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