Looking back 10 years ago, Paul LaMora remembers when diagnosing someone with opiate dependence was considered unusual. Today, the diagnosis is typical.
As Outpatient Clinic Director of the Champlain Valley Family Center in Plattsburgh, LaMora has watched these cases climb steadily in recent years. At the same time, the age of opiate users keeps dropping, and the drug of choice is heroin.
Upstate New York is no stranger to the heroin epidemic that has been spreading across the country in the last decade. In December 2013, Clinton County saw its biggest drug bust in history after more than 50 people were charged with illegal possession of heroin and prescription pills among other illicit drugs.
From a law enforcement point of view, New York State Police Troop B Lieutenant BCI Brent Davison said heroin used to be a small part of criminal investigations. Now, it is the biggest part, and it is a problem he does not see going away soon.
“We’re nowhere near defeating it at this point,” he said.
Davison said the driving force behind many crimes now committed across the North Country, including robberies and burglaries, is heroin. For those with opiate addictions, it is sometimes the only way to afford more drugs.
“They do it out of complete desperation,” Davison said. “The majority of those people aren’t doing it because they are professional criminals and want to make a living. They are doing it to feed their drug habit.”
This desperation stems from heroin’s strong withdrawl symptoms, which CVFC Executive Director Connie Wille described as “the worst flu that you’ve had in your entire life.” In the last few years, Willie has seen a substantial increase in amount of people diagnosed with an opiate disorder, many in their early 20’s. 
But if heroin users choose not to steal, the alternative is to deal.
Davison said Interstate 87 between New York City and Montreal is known for being a drug pipeline, and most heroin found in the North Country made its way up from southern metropolitan areas. Between Plattsburgh and New York City, the price of heroin can change dramatically.
Plattsburgh City Police Chief Desmond Racicot said the price for a tenth of a gram of heroin in New York City can cost between $3 and $5. But by the time drug dealers transport heroin from cities to Plattsburgh, the price rises to between $30 and $40 per tenth. Depending on a person’s usage level, Racicot said some users can use 20 to 30 bags of heroin per day.
But, for most people, Racicot noted that opiate addiction almost never starts with heroin — it starts with a pill.
“Nobody starts off with heroin as a recreational use,” Racicot said. “They are using another drug first, and then they get addicted to that drug, and then they end up on heroin. If you start dabbling with prescription pills, best be aware that you are going to get an addiction to the prescriptions. It makes the ice so much thinner to fall through.”
Davison said drastic changes in regulation and composition of prescription painkillers in recent years, such as hydrocodone and oxycodone, could have played a part in heroin’s spread. Before then, prescription drug abuse was more prevalent. When the problem got worse, pharmaceutical companies in the United States had to change the composition of painkillers containing opiates, making it more difficult for abusers to crush pills so they could be snorted, smoked or injected. Additionally, New York state also passed the Internet System for Tracking Over-Prescribing Act in 2012, which mandated that physicians consult a patient’s prescription history before prescribing a controlled substance.
Even with these actions, Davison said eliminating one evil in prescription drug abuse might have led to another in heroin.
“Something that has been around all this time, but may not have been prevalent up here, reared its ugly head, and it became cheaper and easier to get a hold of heroin than prescription pain medication,” he said.
The dangerous difference between heroin and prescription drugs, Davison said, is the lack of control over what heroin can be cut with. On March 18, the DEA issued a nationwide alert that heroin was being laced with Fentanyl, a powerful opiate used for surgeries. Wille said that because Fentanyl is more powerful than heroin alone, overdosing can occur more quickly and easily.
LaMora said opiates, when abused, can compromise a person’s respiration significantly, so the line between getting high and having an overdose is thin. Additionally, he noted the importance of a person’s tolerance and how it plays into treatment. One of the biggest concerns for LaMora is, if a recovering patient resumes opiate use at levels his or her tolerance is no longer used to, there is a higher chance of overdose.
To curb the growing number of heroin overdose deaths across the state, many law enforcement agencies are training officers to use Narcan, an antidote that quickly reverses the effects of an overdose. So far, Davison said Narcan has been instrumental in saving dozens from overdose in the North Country.
SIDEBAR: HOW NARCAN OVERDOSE ANTIDOTE IS SAVING LIVES
Last April, the New York State Senate Task Force on Heroin and Opioid Addiction held several hearings across the state in response to the epidemic. At a hearing held in Plattsburgh, the task force heard testimonies from North Country politicians, law enforcement officials and members of health services, including Wille. Every testimony drew one conclusion — heroin was not letting go.
Governor Cuomo subsequently unveiled several new initiatives in the summer following the senate hearings, including the statewide “Combat Heroin” campaign.
Though Racicot praised the state for its intervention efforts, he said it could be a while before communities, including Plattsburgh, start seeing the effects.
“They’re great, but those are programs that have a very long trickledown effect. The people using heroin in Plattsburgh today aren’t changing their habits because the government put out some kind of new program. People who are using today need to get into a medical program with counseling. Otherwise, they are going to have to use heroin.”
This is where treatment can get tricky, Wille said, especially on the outpatient basis. Unlike inpatient clinics where patients can live in a secure, drug-free environment while receiving treatment, those in outpatient treatment may still be exposed to drugs when they return home. Because there are no inpatient clinics in Clinton County, Essex County or Franklin County, Willie said referring those who seek inpatient treatment is “nearly impossible.” The nearest inpatient clinic is St. Lawrence Addiction Treatment Center, which is about 100 miles away and has limited space.
“There is always a wait list,” LaMora said. “Sometimes people have to wait two to three weeks to get in to a detox. In the meantime, they typically keep using.”
This is why Wille helped put forth a proposal to construct an ambulatory detox clinic in Clinton County where a patient can recover from withdrawal in a secure environment.
“If they need to stay, they can stay, and we can get a full comprehensive evaluation and get them into the right level of care.”
Wille is optimistic that state funding for the project will get moving sometime in the near future. However, she said diminishing opiate addiction will take the entire community acting together.
“That’s law enforcement, that’s treatment, that’s families and any vested person who wants to help reduce the disease and help or community toward health,” Wille said.
Racicot shares the same vision, noting that teamwork between law enforcement and treatment is what he considers the best solution to the problem. The key, he said, is making heroin harder to acquire so users are more compelled to seek treatment.
EDITORIAL: REHABILITATION TAKES COMMUNITY SUPPORT
CAMPUS IMPACT
Vice President of Student Affairs Bryan Hartman said there were three notable cases of PSUC students overdosing during the 2013-14 academic year. Two of those students died, but one was saved through a University Police officer’s use of Narcan.
“We are certainly not immune to this problem,” Hartman said.
A compilation of data provided by University Police showed 15 instances in spring 2012 where used syringes were reported to be found on the PSUC campus — some individually, some wrapped up in bunches of 10 or more.
“With heroin, people aren’t using measuring cups,” said PSUC Alcohol and Other Drug Coordinator Patrick Monette, adding that overdoses are especially common in places such as college campuses, where drug use is hidden.
Despite the North Country’s focus on heroin, Monette said marijuana is the No. 1 drug used by PSUC students, especially during midterms and finals when tensions are high and students feel they need an escape. However, according to an article printed by The Week magazine, a breaking news and current events publication, THC — marijuana’s psychoactive compound — is known to disrupt focus, memory, decision-making and motivation for up to 24 hours.
Though multiple states have approved marijuana use for medicinal purposes, Hartman said it is important for students to remember that, at least in New York, recreational marijuana use is still illegal.
From spring 2012 through spring 2014, 112 instances of marijuana possession and subsequent legal repercussions were reported in the compiled data provided by University Police.
“It’s an increasingly difficult conversation,” Hartman said. “The pendulum is swinging. It’s become very accepted among multiple generations.”
SIDEBAR: POLICE, HARTMAN DISCUSS USING STUDENTS AS CONFIDENTIAL INFORMANTS
PSUC Assistant Chief of University Police Jerry Lottie said the force is fully aware of the growing problem. The implementation of the PSUC Drug Task Force, for example, is an on-going attempt to educate the campus community and prevent future use.
“We are diligently trying to eradicate (the drug culture),” Lottie said.
In terms of overdoses, Hartman said the college reaches out to the student in question to provide support, but there is not typically any disciplinary action levied. If students are charged for marijuana possession or underage drinking, for example, the college will take the necessary disciplinary steps.
“I really don’t see the point in being punitive for the sake of being punitive,” Hartman said. “But people need to be held accountable. We live in a structured society that has guidelines that we need to follow. I respect students who push the boundaries, but we also need to respect society’s boundaries.”
Though he recognizes the prevalence of such drugs as marijuana in college culture, Monette said he believes the growing numbers of students becoming dependent on these substances is concerning, as they are developing habits that are not necessarily healthy.
“These students are not learning how to cope in the real world,” he said. “I think with most students, there is a fear of missing out. To them I would say, ‘Have fun but be safe.’ Think to yourself, ‘What is the healthiest thing?’”
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