In some ways, New Paltz might be seen as reflective of the nation as a whole. Classically conservative and liberal values are pitted against each other, the concepts of “progress” and “small town” are compared and contrasted, and residents with different viewpoints often have little or no contact with people who hold a different point of view. So too is it with heroin addiction; the problem is on the rise coast to coast, the inpatient drug treatment in Austin has it especially rough and New Paltz is no exception. While it’s a serious problem, it’s also a nearly invisible one: signs of use are hard to detect in all but the worst cases, and addicts themselves can be exceedingly good at hiding their drug use.
Heroin is an opioid painkiller, thus a close relative of prescription drugs such as oxycodone (Percocet), oxymorphone (Opana) and hydrocodone (Vicodin). For people with serious and chronic pain, opiates can completely transform one’s quality of life. Those analgesic effects come with conditions, however: it’s easy to build up a tolerance to them, easy to develop a dependence, and withdrawal can be incredibly painful and difficult. The New Paltz Times spoke with three people about their drug abuse, and each of them found their way to heroin by first trying an opiate painkiller pill.
“Opiates are the strongest meds for pain management,” said Dr. Steven Weinman, who started FirstCare Medical Center in 2007. “That’s a big problem.” Weinman said that his urgent care clinic has gained a reputation for being incredibly stingy prescribing those powerful drugs, out of a concern that they will end up being sold on the black market. “Our narcotics policy is one of the strictest in the state,” he said. Urgent care facilities are often targeted by drug seekers, he explained, and “we knew that when we opened up.” Not only are there very limited supplies on site, no prescriptions are written without checking the state database of prescriptions to see what other doctors have written first. “They know that we’re not the place to come for drugs, but we are the place to come for treatment.”
The downward spiral
Manipulating doctors into writing prescriptions is something “Rachel,” a 29-year-old New Paltz resident, got very good at ten years ago. “You learn what symptoms to say you have,” she explained. “If they offer the drug you’re looking for right off, you act like you’re not sure, but reluctantly agree. If they suggest something else, you lead the conversation. ‘I had a friend’s mom who had a lot of pain, and she took something that really helped. I think it started with a … C?”
Weinman is familiar with the kind of symptoms some might present to get specific drugs. It’s typically something that’s hard to test, like headaches or back pain. “Some people get 150 pills a month,” he said. “A couple of local doctors have gotten in trouble. One had to close his practice last month.”
FirstCare offers opiate addiction treatment mostly using the drug Bunazail, which is an open derivative itself and is used to minimize the withdrawal symptoms. Weinman prefers it to the better-known Suboxone, because to his knowledge it can’t be converted into a drug that makes its users high, while Suboxone can. In fact, Suboxone itself can make someone high if they haven’t developed an opiate tolerance, but it’s still a less profound affect than what is experienced on methadone, which is used in much the same way. Another drug now being used for treatment is Vivitrol, which is injected monthly, making it easier for medical professionals to control access to it.
Short-term treatment for opiate addiction is essentially “medically assisted withdrawal,” according to Elissa Pierse, a detox counselor at Health Alliance of the Hudson Valley, formerly Benedictine Hospital. That means a patient must be actively in withdrawal, and someone still high on heroin can’t start the therapy yet, and must wait through “a lot of pain and suffering” first. People in that state “usually don’t make it to us,” she explained. “They find a dealer on the way.” From what she’s been told by her patients, most of them got their first taste of an opiate via a prescription, or by taking it from their parents.
Tyler, 21, was well aware of how popular opiate pills were even as a young teenager. He was selling them on the street before he was 15, and at first he’d smoke or snort them mostly out of convenience. “I wasn’t really into it, but I liked getting high,” he explained. In his crowd, though, “Most people preferred pills, because they thought they weren’t as dangerous” as heroin, which he understood would also get you higher. The first time he was offered heroin, he turned it down, but a friend he was with agreed, so they snorted it together. “Once we tried it, it didn’t seem as crazy as it was made out to be, so we thought that was a bunch of BS. We started doing a lot of heroin,” he recalled, and “eventually, that’s all I wanted to do.”
Three months in, Tyler started experiencing the withdrawal symptoms that, more than anything else, keep people returning to heroin time and again. While they can start out relatively mild, he described them at their peak as “hours of pain … 72 hours curled up in a ball. After that, you just want dope,” because that’s what’s going to make the pain go away.
“David,” 30, also had his first taste of opiates in the form of pain pills, while he was in high school. “I was part of a rebellious crowd,” he explained, and he had a connection that could get him Percocet, Oxycontin or Vicodin “free or cheap.” Injecting a drug intravenously was something he “never thought in a million years” that he’d do; “We thought they were the dirty ones.” However, as he developed a tolerance, “it became an economical thing” to move to first snorting heroin and then injecting it. “I was using one or two bags at a time, and a friend said that if I shoot one bag, I could be high all day.”
Whether it was something in his physiology, the drugs he was taking, or just luck of the draw, David didn’t get sick from heroin for quite some time, and suffered none of the intense muscle and bone pain, nausea, diarrhea or depression that can come from trying to quit. “Aside from the negative effects, it’s really awesome,” he said, and if it weren’t for what it does to the body and mind, he might still be using today. On heroin, David found that he was more sociable as well as energetic, and could either be the life of the party or an unstoppable cleaning machine. He even took a job performing heavy manual labor, and started each shift with heroin to make the work easier. “I was a pretty functioning drug addict,” he said, and because he was holding down a job, he didn’t destroy relationships like so many addicts do, by robbing friends and family to get more heroin.
That’s part of what makes heroin addiction such a challenging problem: it’s more difficult to detect than, for example, marijuana use or alcohol intoxication. It generally creates a sense of relaxation which might appear as drowsiness, but more pronounced signs — such as weight loss, chronic runny nose, increased sleep and a more hostile personality — can take time to develop.
For Rachel, the heroin high brought a sense of peace, calming her body so that she could experience something that felt like “intense meditation,” nearly an out-of-body experience. Even after she transitioned from pills to heroin, she was concerned about dependency; her personal rule was never to use more than two days in a row, because it seemed like after the third day, “it was all over.” Even with that safeguard, however, Rachel eventually found that she’d “crossed lines I thought I would never cross.” One of those lines was into using intravenously; she met someone who was trusted by a friend that was willing to inject them both the first time. “He must have gotten dirt on the needle or something,” she said, “and it nearly cost me my arm.” The dose was also strong enough that both she and her friend passed out in the abandoned house where they’d been injected; the man who did the deed simply left them to their fate. She’s still got a scar inside her elbow as evidence of that night.
Tyler also learned that there’s little loyalty among addicts. He recalled a time that he’d overdosed in someone’s car, and slipped into unconsciousness. “They tossed me out of the car, and I woke up laid out in my driveway,” he said. Another time, he watched uncaring as someone overdosed beside him on a couch. “He sat down next to me, and all of a sudden his head shoots back and he goes into a seizure. All I did was sit there and watch him, no feeling, no care in me because I was on heroin. I didn’t want to do anything about it. He died like three times in the ambulance,” but was successfully revived.
Overdose deaths and Narcan
Overdose deaths are one of the most visible impacts of heroin use. The street drug can vary widely in its strength; a recent batch that was cut with the synthetic opiate fentanyl had a reputation for being particularly lethal. That kind of news can actually attract addicts, however; some might be confident that they are less likely to “do it wrong,” while others might actually be trying for a fatal overdose. That’s how it was for Tyler, who remembers “sitting there with dope in my hand, crying, wondering why I couldn’t stop, and why no one would help me.” He attempted suicide at least 15 times without success. “You can shoot ten bags and just wake up,” he said. At one point, he and a friend gathered all the heroin they could and rented a room at the 87 Motel (which has since been demolished), where each injected the other with what they thought would be a fatal dose. “It was murder, not suicide, and we thought that was funny,” he said. Neither attempt was successful.
A breakthrough in saving users from fatal overdoses is naloxone, or Narcan, which when delivered by aerosol spray through the nose will temporarily arrest the effects and allow time for proper medical treatment. It’s now standard issue for most police departments in New York, and New Paltz’s finest have already used it to successfully revive eight people. Good Samaritan laws mean that when police are called in the case of an overdose, they won’t arrest the people involved, although they will confiscate anything that’s contraband. That’s something that Tyler experienced firsthand: a friend of his overdosed while they were using at his parent’s house, and that time, “I didn’t hesitate to call the police,” saving his friend’s life.
On the other hand, because Narcan results in the body going into immediate withdrawal, Tyler said he’s seen people refuse it. “It’s better to be a dead addict than a live one,” he explained. It’s never been used on him, but he thinks that given its effectiveness and ease of use, it should be issued to heroin users so that they won’t just bolt when a friend ODs, like what happened to him. For that to be effective, however, the victim would still have to be transported to a hospital right away, lest the overdose symptoms return without treatment.
David watched more than one person nearly overdose, “but I didn’t think it would ever be me … or care,” he said. Like Rachel, his strategy was to limit his use to avoid dependency. “Other rushed to do two to three bags, but I wouldn’t,” he said. “I amazed my friends, because there were gaps when I stopped for a time. I didn’t think I was an addict.” That changed for him after a friend inherited a sum of money and spent most of it on crack cocaine and heroin. “We were speedballing for six months,” he said, referring to the practice of loading heroin and cocaine in the same syringe for intravenous delivery. “That’s when I started getting the physical addiction symptoms. It sucks. You get really depressed, flu-like aches, sweats, dry heaves and spasms in the muscles.” Leg spasms and pain are among the worst withdrawal symptoms; David — whose father had also been addicted, and let him come home to get through the worst of it — found that only by repeatedly kicking a pillow could he get that restless energy out of his muscles.
Even as his legs couldn’t stop moving, David recalls that his body was losing strength, and quickly. A few days after one relapse, he tried lifting weights and found that perhaps half of his strength had been erased.
Many attempts to quit are not successful, because it’s more than the physical withdrawal that drives cravings for heroin. Most addicts find that withdrawal is more painful each time they attempt it, and the symptoms come on more quickly, but David — who has since gone on to a career in physical training and nutritional counseling — said that the psychological aspects are much more daunting. That’s similar to Tyler’s experience; at least once he relapsed simply because he and another recovering addict joked that they could be doing heroin at the moment, which was enough to send them looking for some. Both men also unsuccessfully tried leaving the state to escape the temptation of familiar people and locations, but David said that it’s a futile effort.
“I was just running away from my problems,” David said. “I relapsed as soon as I got back to New Paltz.”
Tyler, who has gone through rehabilitation three times, didn’t wait that long to relapse; he was kicked out of a halfway house for using. Having no trace of heroin in his body was never a barrier to restarting the habit; he spent two months in jail for a drug-related offense, and was high within hours of his release. Nevertheless, he’s decided that New Paltz is — for him at least — a dangerous trigger, and he’s relocated to a suburb of Albany, where he’s gainfully employed and has his own apartment. “You can’t force someone to get help,” he said. “You have to wait for them to hit rock bottom, or they’re just going to go back to using as soon as they can.” At last count, he’s been clean for 120 days.
That psychological craving to use again can be difficult to overcome, because it mimics the physical symptoms of withdrawal. Tyler likens it to a demon, one that manipulates his behavior towards using again and, when successful, takes him over completely. “You make that decision to use, and he’s running you again,” he said. “When it takes over, you would rob your own mom to get high again. You know it’s wrong, but you’re two different people, and the one in control doesn’t care. You would even get high if you know it means you’re on the way to jail.”
Recent overdose deaths are addressed at forum
A forum about these concerns was held last week at the New Paltz Community Center, inspired by recent overdose deaths in the community. Attendee Walter Shuster spoke about growing up in New Paltz and becoming addicted to a non-opiate drug. “There’s a lot of focus on opiates right now,” he said. “It was never my drug of choice, but it was for my friends.”
Forum organizer Fern Quezada also grew up here; the 33-year-old recalled having 17 friends addicted to opiates when she was in school, some of whom fatally overdosed or committed suicide. “None of them had anything in common,” she said, dismissing the idea that opiate addicts fit a certain profile in terms of age, gender, race or socioeconomic status. “If someone finds [the common thread], I would love to know the answer.”