Heroin abuse resurgence called ‘bleak’

TROY—The April 23 Forum on Heroin and Opioid Addiction—moderated by state Senator Kathleen Marchione (R-43rd) and hosted by Hudson Valley Community College—had a tenor of alarm. Almost every seat in the Bulmer Telecommunications Center auditorium was filled when Beth Schuster, Executive Director of the Hudson-based Twin County Recovery Services, said, “I have never seen it so bleak.”

Albany County Sheriff Craig Apple told the event, “Almost everything crime-related has a nexus to heroin.”

Law enforcement officials in Columbia County were less sweeping in their statements about the extent of the problem, but not much. When contacted after the forum, Hudson Chief of Police L. Edward Moore disagreed with Sherriff Apple’s statement, noting that sex crimes and domestic abuse tend not to be related to heroin. But he said, “Heroin is huge. It’s the biggest concern we have in [Hudson] right now.” Lieutenant Wayne Lopez, public information officer for the Columbia County Sheriff’s Office, offered that “a lot of these forcible robberies and burglaries are because of people trying to get their fix.”

Heroin use has been on the rise in the state, and Columbia County is no exception. The I-STOP law, which was signed in August 2012 and included an electronic prescription tracking system to reduce overprescription and doctor-shopping, has been successful in stemming the flow of prescription opioids to street dealers. But the people who became addicted to these drugs have not disappeared and, in part because of the I-STOP law, many have turned to heroin as a significantly cheaper option.

With the average age of heroin and opioid addicts in the area now at 24, one potential response offered was earlier education on the dangers of drug addiction in schools. When asked about the appropriate age to begin educating kids about drugs, panelist Dan Farley, assistant principal at Ichabod Crane High School, said, “You hate to scare little kids with this information, but I’d rather have kids afraid of these drugs. The earlier the better.”

Panelist Dan Almasi, Dual Recovery Coordinator for the Columbia County Department of Human Services, expressed similar sentiments, saying, “It’s never too early.”

The Columbia County Department of Health’s Community Health Assessment and Improvement Plan, a report published in December 2013 on local efforts to reduce drug abuse states, among other things, that “there will be a focus on educating at-risk youth between the ages of 2-21.”
Mr. Farley said that when he finds students with drugs at Ichabod Crane, “the tool that I have to work with is to suspend that student, but I haven’t done a whole lot to solve that student’s problems. I need more tools.”

One of the additional tools proposed by the panel, which Mr. Farley already has at his disposal at his school, is the increased presence of police officers in schools, referred to as school resource officers (SROs). and Columbia County Sheriff David Bartlett, also a panelist, suggested other counties adopt similar programs. Under a program offered by Sheriff Bartlett every school district in Columbia County except for Chatham now has an SRO for at least 20 hours per week, and the Taconic Hills and Ichabod Crane districts have full-time SROs, with the two districts paying half the costs.

Another tactic, endorsed by many members of the panel, is the increased training of members of the community in the use of potentially life-saving drugs such as Narcan, the primary brand name of the drug naloxone, which can be administered in the event of an overdose. Panelist Lisa Wickens, a registered nurse, noted that school nurses are not currently allowed to administer Narcan.

But even concrete proposals like increasing the availability of Narcan are not straightforward. Chief Moore, who did not attend the forum, was concerned about police officers’ legal liability if, for example, they were to administer Narcan to someone who was not overdosing. “I hate that lawyer stuff,” the chief said. Hudson police officers are not trained in administering Narcan, although Chief Moore said it was more important to have people trained in Narcan administration who live and work in areas where response times for emergency medical services are higher than they are in Hudson.
He also stressed the importance of legislation in the state Senate and Assembly (bills S6744 and A8637) that seek to increase the availability of drugs like Narcan and extend Good Samaritan laws that protect people from prosecution if they are reporting an overdose.

Public attitudes are another part of the challenge. A recent survey conducted by the Columbia County Community Health Care Consortium found that only 33% of residents of Columbia and Greene counties view abuse of prescription medication as a condition or disease as opposed to an irresponsible personal choice, and only 30% say the same for illegal drug use. The organization also found that roughly 1,800 adults in the two counties “have a dependence on illicit drugs,” but that “the number of youth is unknown.” The document does not state what criteria determine dependence or how the study arrived at the figure of 1,800 adults, but it does suggest that there isn’t much county-specific data about heroin- and opioid-related health issues, especially among young people.

The state legislature is aware of that problem and the same bills that would extends the availability of Narcan call for the state Health Commissioner to publish “information on opioid overdose deaths, including age, gender, ethnicity, and geographic location.”

The only information available from the state Department of Health is that there were 341 Columbia County residents discharged after drug-related hospitalizations during the three year period from 2009 to 2011, the most recent year for which data are available, with discharges peaking in 2009 and declining slightly in each subsequent year.

Chief Moore said that heroin “comes up on rails, on highways” and that “drugs get mailed.” However, while heroin may arriving in Columbia County from elsewhere, Chief Moore said that “most of the arrests that we have seen recently are local residents,” including a bust in Hudson this winter that resulted in the arrest of 20 people.

Panelists also warned against assumptions about who’s using these drugs. “The profile for heroin users used to be Hispanic males. Now it is young caucasian males and females living in suburban and rural areas,” Ms. Alonge-Coons said.

The current heroin and opioid problem is stretching resources thin in both the law enforcement and treatment communities. Chief Moore said that, of the four detectives on staff in the Hudson Police Department, “one detective is almost completely dedicated to narcotics. Most of my overtime is dedicated to narcotics. I spend the majority of my extra funds on narcotics.”

Ms. Schuster said that “state aid for treatment providers is going away” even as addiction in Columbia and Greene Counties continues to rise. Ms. Schuster also pointed out inadequacies in the kind of care that addicts receive, noting that some addicts use outpatient programs to make connections to new dealers.

One panelist noted that, even if an addict has insurance coverage—and 92% of all people in Columbia and Greene counties do, according to the Health Care Consortium—they may not be able to afford high deductibles or co-pays.

There was a general feeling among panelists that treatment options were underfunded and understaffed, and that addicts are not receiving the kind of long-term counseling that they need.

Medications such as the buprenorhine and naloxone combination marketed most commonly under the brand name Suboxone can be abused, and when doctors prescribe them without the appropriate follow-up care, it feeds the street market for these drugs. Panelist Dr. William P. Murphy of the Chatham Family Care Center said these drugs need to be paired with support systems based around counseling. “The treatment for the disease is counseling,” Dr. Murphy said. “The drug helps them stay in counseling.”

Several panelists noted that black markets have emerged surrounding these drugs, a problem exacerbated by the fact that, according to Dr. Murphy, prescribing these drugs has “become merely a buffer to support [some doctors’] practices.”

Despite the dire warnings expressed at the forum, it is not all bad news. Columbia County is setting the template for efforts to alleviate the heroin and opioid addiction problem with programs like the Columbia-Greene Controlled Substance Awareness Task Force. This program has brought together many local institutions, including Columbia Memorial Hospital, the Columbia County Department of Health, Twin County Recovery Services, and Catholic Charities of Columbia and Greene Counties. The goal of this task force, according to the Department of Health’s website, is “to decrease and prevent prescription drug abuse in the two counties through focusing on practice guidance for prescribers, community prevention, and linkages to treatment.”

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