WATERTOWN — A deadly scourge has seen a noticeable drop this year in Jefferson County.
Statistics coming into the headquarters of the county’s Public Health Department about fatal overdoses linked to opiates are encouraging.
Efforts that may be bringing the deaths down in Jefferson County are multi-faceted. From a coalition containing more than 200 members to just plain personal awareness and responsibility, the tide of opiate-related deaths in the area may be turning in the county.
But at the Meade Street health department offices, the latest numbers are creating no back-slapping, high fives or congratulations. Here, no sighs of relief are heard in the halls, only the echoes of past numbers that raised so many alarms.
But as of mid-August, deaths related to opiate overdoses were at two in the county, according to statistics from the Jefferson County Medical Examiner’s office, compared to a total of nine in 2018.
For this year, one person died from a combination of heroin and fentanyl and one just from fentanyl, comprising the two “opiates” deaths. Another person died from an overdose of another substance, not an opiate.
“Opioid” is often used to describe both opiates and opioids, but there is a difference.
Opiate refers to drugs derived directly from the poppy plant, such as morphine and codeine.
Opioids are synthetic or partially synthetic manufactured drugs that mimic the properties of opiates. Opioids include heroin, synthetic opioids such as fentanyl, and other pain relievers available legally by prescription, such as oxycodone (OxyContin), launched in 1996 and perhaps the name most associated with the deadly overdose epidemic.
Opiates/opioids are narcotic sedatives, highly addictive and affect the brain in the same way. Designed as pain relievers, they trigger the release of endorphins, the brain’s feel-good neurotransmitters. Heroin, which is illegal, is often sought out in place of opioids.
For statistical purposes, the fatal opiate overdose numbers released by the county’s health department don’t make a huge differential between opiates and opioids.
“For purposes of our tracking report, which is not an official document, it’s all lumped under opiates,” said Stephen A. Jennings, public health planner for the Jefferson County Public Health Service.
A NATIONAL TOLL
The north country is part of the national opioid/opiate crisis resulting from the overuse, abuse and prescribing of the drugs. In latest numbers, revised in January, the National Institute of Drug Abuse reported more than 130 people in the United States die each day after overdosing on opioids.
Data released this summer from a federal database maintained by the U.S. Drug Enforcement Agency says that from 2006 to 2012 more than 76 billion opioid pain pills were sold in the United States; that would equal about 231 pills per person in the U.S., which has a population of 329 million.
Data from the Centers for Disease Control and Prevention notes that in 2017, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was six times higher than in 1999.
The CDCP estimates that the total economic burden of prescription opioid misuse in the U.S. is $78.5 billion a year, including the costs of health care, lost productivity, addiction treatment and criminal justice involvement.
“We never exhale,” said Anita K. Seefried-Brown, project director for the Alliance for Better Communities, a coalition now in its fifth year and created to help the Jefferson County community combat drug use and abuse. “One bad batch of fentanyl could wipe us out.”
“And that has happened with communities in the country, so we’re always worried about that,” said Mr. Jennings.
Fentanyl is a powerful synthetic opioid that is similar to morphine but 50 to 100 times more potent. It is often mixed with heroin, cocaine or both. It has become a major part of the illicit opioid market and is linked to a significant part of the opioid-related death crisis in the U.S. Data from the county’s medical examiner’s office shows that fentanyl had 10 confirmed overdose deaths from the drug and its analogs in both 2016 and 2017, with nine in 2018.
For Jefferson County, in 2016 — the highest year for overdoses from data starting in 2000 — there were 23 overdoses, 16 from opiates, of which 10 were from fentanyl and its analogs. By 2017, the number of total overdoses decreased slightly to 18. There were nine deaths related to overdoses of opiates in 2018 and 13 in 2017.
“We can be extremely, cautiously optimistic, but we’re also painfully aware that the factors at play can increase the number, to 20, 30 — pick a number. Those issues are out of control,” Mrs. Seefried-Brown said.
“The number” relates to the grim tally of deaths related to opiate overdoses. It began with a trickle — one death was recorded in 2000. And reflecting national trends, that number for Jefferson County grew to 16 opiate-related deaths in 2016.
But so far this year, the number — two deaths — is encouraging.
“It’s good news in that the efforts that have been put in to address this problem, we believe, are working,” Mr. Jennings said.
In 2014, with federal funding, Pivot Prevention Services, formerly known as the Alcohol and Substance Abuse Council of Jefferson County, formed the Alliance for Better Communities. The coalition’s mission: help the Jefferson County community combat youth drug use and abuse. It now has state, county and federal funding along with private donations.
The Alliance is a multi-sectored coalition of more than 200 members consisting of 12 sectors: law enforcement, youth, youth-serving organizations, religious organizations, parents, civic organizations, businesses, health organizations, media, human service organizations, schools and federal, state and local government representatives.
Many of the elements and people that would make up the Alliance developed key community networks and gained experience and a few years previous to its creation when a rapid response group was organized in October of 2012 to battle another issue.
“We never got to prescription opioids because bath salts and synthetic marijuana hit,” Mr. Jennings said. “It’s really kind of a separate issue. Young people were using these drugs that wouldn’t come up on a drug test.”
Local officials first raised alarms about bath salts, a stimulant drug, in 2012. In 2013, a state law was passed that prohibited the sale, use and possession of the drug, manufactured stimulants similar to methamphetamines.
“In working with emergency rooms and with parents, we learned about people behaving absolutely bizarrely and violently,” Mrs. Seefried-Brown said. “They had to be restrained in the emergency department and watched over and nobody knew what was going on. Parents came in to what was then the Rapid Response group, saying, ‘My kid, who could be 43, was hiding under his bed because he saw dead people coming through the wall.’”
The response group worked with contacts ranging from first responders, parents, law enforcement, the Poison Control Center to Fort Drum officials.
“We all worked together in gathering information very rapidly and presenting it to our elected officials,” Mrs. Seefried-Brown said.
The group lobbied for labeling laws, which require that consumable items bear labels showing, among other things, the manufacturer, the product’s contents and known health risks. A local retailer was a main target.
In the fall of 2012, satisfied with the progress made to counteract synthetic drug use in Jefferson County, the work group dedicated to battling the products moved to a new focus: limiting prescription medication and painkiller abuse.
In 2014, Pivot applied for a Drug Free Community Grant, funded by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services.
“In that application, we changed our name from Rapid Response Workgroup to The Alliance for Better Communities to better reflect its breadth and scope of issues we wanted to address,” Mrs. Seefried-Brown said.
The alliance uses a “theoretical foundation” from the federal SAMHSA, focusing on seven strategies to affect community change. Strategies include enhancing skills through workshops and seminars, reducing barriers to use services, educating the community and modifying procedures and by-laws.
“We follow that to the T and were extraordinarily successful in not only addressing the issue of the bath salts, but as we began adding the issue of prescription drugs and also the illegal opiates like heroin, we continue to follow that schematic,” Mrs. Seefried-Brown said. “That’s what really makes us successful.”
“What’s vital and is contributing to our success to this day is the engagement of law enforcement to help and to change their approach on this issue,” Mr. Jennings said.
For example, Mr. Jennings said that when a local law was passed targeting bath salts, former Jefferson County District Attorney Cindy F. Intschert “carried the ball.”
“The state and feds were working on it, but they were too slow,” Mr. Jennings said. “They eventually caught up. For Jefferson County at the time, it was unique.”
There is a strong presence of law enforcement in the Alliance.
“We have to be able to work with people from all walks of life,” Mrs. Seefried-Brown said. “The beauty of the full alliance meetings is that the DA may sit next to a person she had to put in jail at one time for a crime committed while that person was addicted.”
Law enforcement, Mrs. Seefried-Brown said, has to enforce the law, but “they can also be compassionate.”
“That doesn’t happen in every community,” Mr. Jennings said.
‘DIFFERENT POINT OF VIEW’
Jefferson County Sheriff Colleen M. O’Neill said that enforcing drug laws used to be a black and white issue for law enforcement.
“People who sold drugs — they’re bad and they are still bad,” Sheriff O’Neill, an active member of the Community Alliance, said. “People who are addicted to drugs were also considered bad back in the day. Now, there’s a different point of view. Law enforcement understands now that some of it is an addiction that is so strong and so difficult to overcome, that it’s not just bad people who have addictions. We recognize that more than ever.”
That “different point of view,” she said, is a better point of view.
“Compassion is a good word,” Sheriff O’Neill said. “We understand that people suffer life trials and tribulations. Sometimes it leads to addiction. Many times, it’s a medical condition that leads to addiction.”
“On the other hand,” the sheriff added, “anybody who facilitates or enables someone to become addicted, or stay addicted — they are on our radar and they are criminals.”
Overdose deaths are being prevented by the use of Naloxone, carried by officers and other first responders. Naloxone, carried under the brand name Narcan, is a medication approved by the Food and Drug Administration used for the complete or partial reversal of opioid overdose. It blocks opioid receptor sites, reversing the toxic effects of the overdose.
“Every one of our officers and corrections officers carry Narcan in nasal spray form,” Sheriff O’Neill said. “They use it often. All of our first responders, countywide, EMTs and firefighters have access to Narcan.”
More family members and members of the public also have access to Narcan, the sheriff said. The lives saved by Narcan can fly under the radar.
“Narcan works, it’s very effective and it’s never reported,” Sheriff O’Neill said.
The Alliance held its first Narcan training session in July of 2014 at a local church behind closed doors.
“It was a confidential meeting because of the fear of maybe law enforcement coming in,” Mrs. Seefried-Brown said. “The door was not opened until the training was completed.”
Now, Narcan training sessions have been more publicized in the north country as they spread openly to such buildings as public libraries.
Christopher Singleton, Jefferson County Emergency Medical Services’ deputy EMS coordinator, said there is no central reporting when Narcan is administered by various emergency responders.
“A lot of it involves so many of the mechanisms in the community that get it,” Mr. Singleton said. “It isn’t like there’s one system with one supply.”
But Mr. Singleton believes the need for Narcan has seen a decline in recent months.
“It does seem like we are being called to a lot less of these,” he said. “We have our spikes. A couple of weeks ago, we had kind of a run that spiked a little bit for us. It was noticeable but it seems to have gone down. It was only here for one weekend. But I do believe just from what I hear and talking to agencies that this is a problem that is getting better.”
Watertown city police Sgt. Suzanne M. Chartrand said the city department began carrying Narcan in 2016. “2017 was the highest that we’ve seen in our use of Narcan,” Sgt. Chartrand said. “In 2018, we did see a slight decrease but not a lot. As far as this year goes, we’re about the same numbers as we were last year at this time.”
Often, city police are called when one dose of Narcan doesn’t work to revive someone.
“It all depends on what they’ve taken and how much,” Sgt. Chartrand said. “Some of these mixtures are just insane. The stuff is getting stronger and stronger, so you have to use more Narcan. It doesn’t matter how much Narcan we use. It’s not going to hurt the subject at all.”
Mr. Jennings agreed that Narcan is preventing deaths, but also credited another major factor — the establishment of the Anchor Recovery Center of Northern New York.
“Otherwise, we may have seen little to no change or things may have gotten worse, and indeed, that has been the case in other U.S. communities,” he said.
AN ANCHOR IN THE COMMUNITY
The Anchor Recovery Center of NNY opened its doors in Watertown’s Marcy Building in 2017. Operated by Pivot Prevention Services, it offers a safe, supportive environment for people in all stages of recovery as well as their family members. Mr. Jennings called it a “great de-stigmatizer.”
“We meet people where they are at, not that the rest of the community doesn’t,” said Anchor director Wanda Holtz. “But they don’t have to give me all their baggage.”
“Prior to Anchor, there wasn’t an appropriate place to show up, if you were having opiate use disorder and get to where you needed to be,” Mr. Jennings said. “The emergency department isn’t the appropriate place and as a hospital inpatient isn’t the appropriate place.”
“Jail isn’t the appropriate place,” Mrs. Seefried-Brown added.
Treatment at Anchor could include intense months-long treatment at a facility or as an in-patient at one. In 2018, Anchor assisted 28 individuals in that regard, said Ms. Holtz. Those numbers are similar for this year so far.
“What happens is those folks come in and say, ‘I have to get out of here or I’m going to die,” Ms. Holtz said. “That’s usually the way it works. Or, ‘My life is so out of control, that I have to get out of here.’ It’s the desperation they have. It’s kind of nice for us to be able to say, ‘We can’t fix it, but here’s the tools.”
Anchor doesn’t do the referral for the individuals seeking help.
“They do it on their own,” Ms. Holtz said. “It’s almost like a self-referral. They call whatever facility. We help facilitate, but they do it on their own, which kind of gives them an empowerment of taking back some control.”
The substances the individuals seek to defeat can vary, Ms. Holtz said.
“Right now, we’re seeing a rise in meth (methamphetamine) in this area,” she said. “People have said it’s easy to make, easy to consume and it gets you hooked.”
Illegal “crystal meth” labs are constantly keeping local law enforcement officials busy. Its creation is especially dangerous because of the toxic, explosive nature of chemicals used to make it. McClatchy reported this week that U.S. officials say half of American methamphetamine users suffer from opioid use disorder.
But be it a meth or alcohol issue, Ms. Holtz said Anchor doesn’t define or judge people at the center by a diagnosis.
“If you came here, I’m not going to stop you at the door and ask you, ‘What are you doing here? What are you needing? I’m going to say, ‘Hey, my friend — how are you?’”
At the center, which has four staffers, people have a range of options that include group meetings to meeting with a volunteer recovery coach. There is cognitive behavioral therapy, defined by the Mayo Clinic as, “helping you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.”
Activities include a drumming circle and painting classes.
“Sometimes people need to get out of their own heads,” Ms. Holtz said. “Their addiction, substance abuse disorder, has taken over their bodies and minds. People come in just for a cup of coffee. Some people come in and go for a walk with the rest of us on Friday afternoons for self-care.”
Newcomers are often given a calendar of events. “We might sit and talk with you, we might say, ‘Coffee is on in the other room.’ It’s whatever works for that individual.”
Ms. Holtz said Anchor is just part of the web that helps those with addictions in the area, including alcohol addiction.
“We probably helped with the decrease, but in reality, it’s everybody,” she said, such as Northern Center for Independent Living, law enforcement, Credo Community Center for the Treatment of Addictions, local hospitals and others.
“It’s the relationships built within this community that I think makes it work,” Ms. Holtz said.
Mr. Singleton, of the county EMS, said that the EMS department and the general EMS community has been developing a closer relationship with agencies such as Anchor.
“They feel very good that we’re there to do our job and we can essentially pass this off to agencies like Anchor who will continue that,” he said. “It’s much like when we take a patient to the hospital. We’re not just leaving them. We’re leaving them in care of another professional who continues that care. For overdoses, we just haven’t had that.”
This team approach succeeds because of trust, he said.
“We have a lot of trust in other agencies,” Mr. Singleton said. “We trust the police, we trust our fire services partners. They do their job, we do our job. The Anchor and these other community agencies are part of that team.”
‘LESS IS MORE’
The Alliance for Better Communities has also had success in working with pharmacists in getting the word out about the possible dangers of accidental overdoses. The state’s I-Stop law, enacted in 2013, has also helped on the prescription front. Among the law’s requirements: practitioners must consult the state’s Prescription Monitoring Program before prescribing, requires dispensing data be reported in “real time” and requires electronic prescribing. The law can prevent a patient from “doctor shopping” in order to load up on prescriptions.
“When the statewide I-STOP legislation passed — when limiting the amounts of opioids prescribed by physicians and providers in emergency departments, and the ability of pharmacies to check an individuals’ prescription history, you see heroin use increase beginning in 2014 and become a leading cause of OD deaths, while prescription drug OD deaths decline,” Mr. Jennings said. “But in 2016, you see a rise and the beginning of a shift to fentanyl being the lethal toxicology.”
Sheriff O’Neill said, “I think the doctors are also understanding that less is better as well. A responsible physician would prescribe the least amount of pain medication to somebody that needs some relief from an operation or dental work.”
Mrs. Seefried-Brown has personal experience in such an outlook. As she recovered from shoulder surgery several months ago, a doctor, who initially didn’t know her profession, told her that she was only going to be prescribed a five-day opioid prescription and that she should not ask for more.
Mrs. Seefried-Brown welcomed that conversation and opted out of any opioid prescription.
“Those are changes in conversation that probably would not have taken place that way maybe five or six years ago,” she said. “That’s why we cannot take credit for success. It’s taken everybody to work in collaboration to reduce these numbers.”
The Mayo Clinic says that the most important step one can take to prevent opioid addiction is to “recognize that no one is safe, and we all play a role in tackling the grip these drugs currently hold on our loved ones and communities.”
“It’s almost impossible to break that addiction,” Sheriff O’Neill said. “It can be done, but it’s really hard. The partnership between law enforcement and all the agencies and entities that serve the community have worked together to educate people how dangerous it is and asking community members who aren’t addicted to have compassion. Don’t stigmatize people who are addicted to anything, because it could be you, or your family member.”