Westchester Has an Opioid Problem — What Do We Do Now?

Alex Roehner glances down at the small computer mounted next to her driver’s seat. Roehner, one of only two female lieutenants at Yonkers’ Empress Emergency Services, scans the screen, reviewing emergency calls from all over the city, while radios from the police department, the fire department, and her own headquarters squawk. A box of blue plastic gloves is tucked in next to her, and her “bus,” as the 48-year-old calls her advanced life-support ambulance, is loaded with all she needs to open an airway, treat a cardiac arrest, staunch bleeding and — more and more frequently — resuscitate opioid-overdose victims.

Roehner has pushed countless syringes of Narcan (also known as naloxone, a medication that counteracts an overdose) into opioid users. “We’ve all seen incredible things,” she says. “We’ve brought back people who should’ve been dead years ago, and a lot of times, I’ve picked up the same people multiple times in a day.”

Nationally, there were 70,237 drug-overdose deaths in 2017, with opioids being a main driver. President Trump declared opioid use a national public-health emergency in October 2017, and for the first time in history, Americans are more likely to die from an opioid overdose than a car accident. In Westchester, police reported 213 overdoses, 68 of them fatal, in 2018. (Westchester saw 183 reported overdoses in 2017, with 58 fatalities.) Moreover, statistics show an alarming increase in fentanyl use. The synthetic opioid, present in only three deaths in 2017, was a factor in 15 fatal overdoses last year.

Law enforcement officials say those figures don’t tell the full story, because they only reflect police reports. If someone overdosed and was revived with Narcan by a friend or went directly to the hospital, the police wouldn’t be involved. “Take [Westchester’s 173] overdoses and times it by 100 to include people who went to the ER and times that number by 100 for recreational use,” where friends or family administered Narcan, says Chief Inspector John Hodges, who oversees the Investigative Services Department of the Westchester County Public Safety Department. “[Law Enforcement] sees only the tip of the iceberg.”

For the first time in history, Americans are more likely to die from an opioid overdose than a car accident.

The growing epidemic knows no socioeconomic boundaries. Contrary to the stereotype of a drug addict as a toothless, homeless derelict, opioid abuse can be found in the wealthiest pockets of the county, among all ages. Often, parents call 911, mystified by what is wrong with their child, only to learn that they are overdosing on heroin. Other families have frantically tried to get help for their addicted sons and daughters, wives and husbands, only to watch the person they love go through multiple rehabilitation treatments followed by multiple relapses.

Locally, the crisis has hit hardest in Yonkers — Westchester’s largest city — which accounts for 167 of last year’s reported overdoses. And in Yonkers, too, the epidemic is hitting all socioeconomic groups. “I’ve gone from stairwells in projects to Sarah Lawrence College [on opioid-related calls],” says Captain Justin Barbato, former commanding officer of the narcotics unit in the Yonkers Police Department (YPD). “It’s every demographic, from multimillionaires to homeless people in their 50s, right down to kids.”

The city is fighting back on multiple fronts. YPD is taking a three-pronged approach to the health crisis: education, law enforcement, and follow-up with victims for treatment. It partners with hospitals and local drug-treatment centers, federal and state law-enforcement agencies, the county, and with Westchester’s District Attorney’s Office.

Pills recovered by YPD’s HEART program.

How Did This Happen?

Experts in public health and law enforcement say that the root of the current epidemic lay with pharmaceutical companies that aggressively marketed opioids to doctors in the 1990s, playing down their addictive properties. Once prescribed only for conditions like the breakthrough pain of cancer or end-of-life care, opioids became more routinely prescribed for everything from sports injuries to wisdom-tooth removal, the latter two representing a particular danger for young adults.

Last year, Westchester became one of 60 counties in New York State to have either retained counsel or filed lawsuits against pharmaceutical companies. The county is seeking unspecified damages, alleging that the opioid epidemic caused significant increases in spending, including “millions of dollars each year” for law enforcement, prevention and treatment programs, and Narcan training.

Empress Emergency Services lieutenant Alex Roehner’s advanced-life-support ambulance is stocked with Narcan, which is administered to counteract opioid overdoses, an occurrence that has become increasingly common in Yonkers.

Doctors, now well aware of the crisis, prescribe opioids far less frequently and for shorter durations. In New York State, prescriptions are required to be electronic, not on paper, allowing for better monitoring of patients. The drug companies, under pressure, have changed formulas for opioids, making them harder to crush and therefore snort.

But with legal prescriptions tightened, people are now buying pills on the street, YPD’s Barbato says. A lot of those pills are fake. “What they’re doing now is taking heroin and fentanyl and pressing them into pills and saying they’re Xanax or some type of oxycodone,” he says. What’s more, police say, those street pills are expensive. Heroin is cheaper and has now moved into suburban and rural areas. People who never imagined themselves as heroin users find themselves addicted.

“You have to go into it thinking you can help one person. You can’t go in thinking you’re going to save the world.”

—Lieutenant Alex Roehner, Empress Emergency Services, Yonkers

The very nature of opioids rewires the brain, says Dr. Raffaele Milizia, medical director of the emergency department at St. John’s Riverside Hospital in Yonkers. The drugs alter the sensitivity level of receptors, and the body gets used to a “new normal.”  Milizia has seen a large increase in accidental overdoses in his ER: In 2018, an average of one severe opiate overdose a week. Even more concerning than the numbers, Milizia says, is that roughly half of these patients are coming in to the emergency department with life-threatening conditions, like unresponsiveness and cardiac-and-respiratory arrest.

Within Westchester, municipal police forces don’t combat the crisis alone. Matthew F. Tormey, chief criminal investigator with the DA’s office, oversees the Opioid Response Initiative (ORI), which operates out of the Westchester Intelligence Center. Launched in 2016, ORI is an information-sharing collaboration designed to coordinate the work of different law enforcement agencies in combating the crisis. Initially, the goal was simply to track the number and locations of overdoses, Tormey says. Now the information is also used to discover patterns and collaborate on investigations.

“A lot of supplies come from the Bronx,” Tormey explains. “There may be one supplier supplying three, four, five communities in Westchester. And that’s important for us to know, from a law enforcement point of view. Five departments could be individually working on the same dealer and not necessarily know. They might have tidbits of information that in silos might not add up to anything, but you put them all together, and maybe you have enough to arrest somebody or generate an even bigger investigation.”

The Westchester County Public Safety Department, in conjunction with the DA’s office, also has  its own Heroin and Opioid Task Force, operating under its narcotics unit. Hodges says investigators use an ever-evolving approach to fight the drug trade, including undercover agents, wiretapping, GPS, and other technologies. They collaborate closely with the Drug Enforcement Agency (DEA).

In March, the DEA and Westchester law-enforcement agencies formed a task force that raided a fentanyl mill in an Ardsley home, seizing roughly five kilograms of fentanyl — enough to kill more than two million people — and six kilograms of heroin.

“When you have a problem as overwhelming as the opioid-and-heroin problem, you have to try everything,” Hodges says. “In law enforcement, we’re trying to tackle both supply and demand. But the problem is multifaceted, and we realize you can’t arrest your way out of it.”

Hodges says that a recent focus has been on diversion — the middlemen between pharmaceutical companies and doctors — as well as on unscrupulous physicians who are helping to get opioids into criminal hands. The team also coordinates with the county’s Department of Community Mental Health.

YPD Captain Thomas Ward (right) and Billy Gleason, a rep from St. John’s Riverside Hospital, follow up with opioid-overdose victims in Yonkers to provide treatment options.

Police Are on the Front Lines

In Yonkers, Captain Thomas Ward, commanding officer of the Youth Services Division, notes with wonder that in 2018, the city had just one homicide but 32 opioid deaths, statistics unimaginable a decade ago. YPD treats overdose deaths not unlike homicide investigations. Barbato says detectives investigate the overdose as a crime, interviewing witnesses and trying to locate sources.

Earlier this year, Yonkers Police and the DEA Task Force conducted a sting in which they seized eight kilos of heroin, more than 800,000 street doses. The prior year, authorities discovered a massive drug mill operating in one of the quaint Sweetfield Circle homes near Tibbetts Brook Park, a typically quiet Yonkers neighborhood. Police found 13 kilos of cocaine, 19,000 glassine envelopes of heroin, and 813 pills that were being made to sell as oxycodone. Barbato says that multiple cartels are involved in the drug trade and that gangs are also dealing. Most suppliers are unconnected.

“…the problem is multifaceted, and we realize you can’t arrest your way out of it.”

—Chief Inspector John Hodges, Westchester County Public Safety Department

The breadth of the epidemic takes a toll on those fighting it. For Barbato, the professional became personal last year, when his team responded to a fatal Sunday-morning overdose call. The 29-year-old victim was his niece. Like so many families, the Barbatos had tried repeatedly to get her help. “We spent a good part of 15 years trying to get her clean,” he says. “Multiple, multiple rehabs.” The investigation, he adds, was “the one last thing” he could do for her.

Several Yonkers police officers told stories of frustration about reviving the same victim multiple times in a day. In many cases, the last call ended in fatality. “The first time, it took three shots of Narcan to bring her back,” says Captain Andrew Lane, describing a young woman from an affluent neighborhood. “The last time, there was no saving her.”

Narcan, which is available over the counter in New York State, has itself become problematic, say both EMTs and police. While there is no question that the antidote has saved lives, it is not a treatment for addiction. And some drug users have come to depend on being rescued, even going so far as to have a “designated driver” (a friend with Narcan) on hand while using, in case of overdose. “Now people feel like they’re free to do as much as they want, because there’s less fear of dying,” says Captain Patrick A. Rooney, commanding officer of the YPD’s Emergency Service Unit. Roehner adds, “It almost makes the argument that Narcan is enabling these people. They call it ‘the wake-up drug. I’ve had people wake up and say, ‘Well, we know that you guys will come.’’’

Roehner can sound tough on victims, but she understands them all too well: She was an addict herself. Clean for more than six years, she wears a bracelet under the sleeve of her uniform jacket that reads “Drug Survivor.” Sometimes Roehner reveals her past to someone she’s revived. “I survived a horrible addiction. I’m healthy; I’m here; and I’m capable,” she says. Being open about her recovery gives people hope, she believes. “You have to go into it thinking you can help one person. You can’t go in thinking you’re going to save the world.”

The Yonkers Police Department’s approach to the epidemic, known as the Heroin Enforcement and Assistance Response Team (HEART), is overseen by Captain Ward and emphasizes prevention and treatment, as well as enforcement. At least once a year, an officer visits every high school to do a presentation on opioids. The Community Affairs Department also tries to educate parents to clean out their medicine cabinets and throw unneeded pills in drop boxes. Last year, the department collected 380 pounds of pills, says Ward.

To encourage treatment, Ward and his team follow up with every overdose survivor in the city. A person who overdoses is not charged criminally. (New York State also has a Good Samaritan Law, so if a friend or family member calls in an overdose, they will not be arrested for possession.) Ward visits the victims’ homes, bringing along a representative from St. John’s Riverside Hospital’s Behavioral Health Services Department, to talk about treatment options. Responses run the gamut, Ward says, with some saying the overdose was an accident and that they aren’t addicts. Others claim they are already in treatment. Too often, however, people dismiss help and then show up on the fatality list. “It’s upsetting,” says Ward, “but at least the addict and/or their family members will appreciate that the Yonkers Police Department was offering help.”

Treatment for Opioid Addiction Takes Time

More than two-dozen programs in Westchester offer drug rehabilitation, varying in approach, effectiveness, and cost. Even people with insurance have difficulty getting coverage for full treatment, and some rehabs have waiting lists. Last year, the county received a grant from New York State to open a 24-hour addiction-and-mental-health center. The center, which is still in the planning stage, would serve White Plains, Rye, Port Chester, Harrison, and parts of Greenburgh, Scarsdale, and Mamaroneck.

Yonkers is already home to one of the largest and most comprehensive treatment systems in New York — the Behavioral Health Services Department at St. John’s Riverside Hospital. The program offers a variety of treatments, including specialized tracks for men and women, adults and adolescents, those with psychiatric disorders, and those in the criminal-justice system.

Recovered glassine bags of heroin at Yonkers Police Department’s Property and Evidence Section.

The hospital offers several entry points for treatment. A 72-bed medical inpatient detoxification unit treats both drug and alcohol withdrawal. Patients spend an average of three to five days in a hospital bed, getting medication to help with withdrawal. But detox is only a first step. From there, a patient can move to inpatient rehabilitation, a 69-bed program for drug and alcohol treatment. In 2018, roughly 8,000 patients were discharged from St. John’s inpatient program. The combined outpatient program provided more than 165,000 visits. The treatment approach is eclectic and includes cognitive-behavioral therapy, 12-step programs, and counseling.

“It’s almost like a boot camp,” says John Slotwinski, senior director of service development for Behavioral Health Services. “It’s a very intense, concentrated intervention, with lots of groups. The program looks at psychiatric issues, if patients need medications. As the drugs get out of their bodies, what emerge are the underlying issues that need to be addressed with individual therapy to break that cycle of addiction.”

St. John’s also has four different outpatient programs — two in Yonkers, one in Mount Vernon, and one in White Plains — offering day rehabilitation and day- and evening-clinic treatment. Drug therapy to help with withdrawal from opioids is available. Buprenorphine (known as Suboxone and Subutex) blocks the affected receptor sites and can help with recovery. Other patients receive methadone. The hospital also has two programs in the Westchester County Jail.

““I could use 50 more people for narcotics, working seven days a week, 365 days a year, and there’d still be plenty of work to do.”

—Chief Inspector John Hodges, Westchester County Public Safety Department

In the larger treatment community, there is controversy over best methods. Medical research has shown that recovery rates are improved by the use of the kind of medications St. John’s offers. But many rehabilitation centers use an abstinence-only approach. Roehner points out the irony that Big Pharma now profits from selling drugs that treat the very crisis it created.

Recovery is not easy, regardless of the treatment approach. The nervous system needs to heal, and most recovering addicts are fragile and have great trouble dealing with stress. “It’s important not to blame patients who are relapsing, because for some patients, this is a fatal illness,” says Nancy Magliocca, associate vice president of Behavioral Health Services. “Our focus is on having compassion for all patients, including patients who are relapsing, and then to celebrate the patients who have recovered.”

What’s the Prognosis?

Sadly, at this point, optimism is limited. According to the CDC, on average, 130 Americans die every day from opioid overdose. “It’s scary to think of the magnitude of this problem,” says Dan Minerva, vice president of operations at Empress. “It’s growing every day. Will we ever get our arms around it?

Hospital officials say that the epidemic is only getting worse. “It’s important to emphasize how powerful these opioids are,” says Slotwinski. “They hijack the brain. It takes away the pain of poverty, adolescence, relationships, and mental illness, and in the process, it takes over the nervous system. First there’s the seduction of the high, but after a while, it’s just to maintain, to avoid the pain of not using. It’s a devastating illness.” Opioids, he adds, cause neurological impairment that stops people from learning from their experiences.

Certainly, the efforts in Westchester — improved data collection and tracking, collaboration among law enforcement, encouraging treatment, educating communities — help. But battling a drug that temporarily takes away a person’s physical and emotional pain is no easy thing. Right now, the end is not in sight. Chief Inspector Hodges puts it this way: “I could use 50 more people for narcotics, working seven days a week, 365 days a year, and there’d still be plenty of work to do.”

Kate Stone Lombardi is the author of THE MAMA’S BOY MYTH: Why Keeping Our Sons Close Makes Them Stronger. She was a regular contributor to The New York Times for 20 years and for seven years wrote a popular column, “County Lines.” Her work has also appeared in The Wall Street Journal.