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Treatment Options Present Obstacles As Heroin Abuse Rises in Suffolk County

Posted on 12 March 2014

By Kathryn G. Menu

In an interview this week, Suffolk County District Attorney Thomas Spota praised the East End Drug Task Force for cracking down on heroin distribution in Suffolk County, including a recent bust involving nine men—six from Riverhead, three from East Harlem—who Mr. Spota said were a part of a heroin ring that sold to users from Southampton, Bridgehampton and Sag Harbor, among other East End communities based on information gathered during a years-long investigation.

Mr. Spota said the East End Drug Task Force, comprised of town and village police departments, county police, state police and even the Department of Homeland Security, has been successful because of the cooperative nature of the task force, enabling undercover officers to move within communities other than their own, in an effort to collect evidence and break up drug distribution at the highest levels possible.

“It is unique, very effective and they do a phenomenal job,” said Mr. Spota in an interview Friday. “In this case, we were able to break up a fairly large ring that was based at the top out of Harlem.”

However, said Mr. Spota, while law enforcement is an effective tool in limiting the supply of drugs like heroin, it is not going to be the silver bullet in ending drug abuse.

“We can’t arrest our way out of this problem, that is for sure,” said the District Attorney. “Local taxpayers are also stretched to their limit. This is a public health crisis, we can’t arrest our way out, there has to be rehabilitation options, and the question is where do we get the money. That is what it comes down to.”

According to a report issued in 2012 by a special grand jury empanelled by Mr. Spota, heroin use between 1996 and 2011 accounted for a 425-percent increase in the number of participants in the Suffolk County Drug Court Program. Opioid pill abuse, according to the report, also accounted for a 1,136-percent increase in the number of drug court participants.

In an interview last month, Southampton Town Justice Deborah Kooperstein—one of the founders of the East End Regional Intervention Court (EERIC)—reported that a majority of defendants working through their addiction issues through the EERIC program have abused heroin or other opioids, like prescription drugs.

Heroin arrests have also been on the rise, and between 2006 and 2010 rose from 486 to 1,315, an increase of 170-percent, according to the District Attorney’s office. The report also shows an alarming link between abuse of prescription pharmaceutical opioid and heroin, which for some users became a cheaper—and more easily procured—drug to come by.

“The evidence is that in Suffolk County we have had a 300-percent increase in heroin related deaths according to the county medical examiners office,” said Mr. Spota. “We have to continue to attack this problem. I will not stop and surrender.”

According to data issued by the county medical examiner’s chief toxicologist Dr. Michael Lehrer, there were 28 heroin related deaths in Suffolk County in 2010, which increased to 64 in 2011 and to 83 in 2012 with 82 deaths officially reported for 2013, and more death-related cases from last year are expected to increase that figure.

At the same time, treatment options are available in Suffolk County, but come with their own set of obstacles.

Katherine Mitchell LCSW, CASAC specializes in alcohol and drug addiction counseling and recovery at her practice East End Counseling in Noyac. She also serves as a member of the Sag Harbor Community Coalition—an organization dedicated to bringing drug and alcohol abuse awareness and education into the Sag Harbor School District.

According to Ms. Mitchell, when it comes to treatment options and obstacles, residents of New York State are largely at the hands of their insurance providers, which can be restrictive, and follow a fail-up model in terms of what kind of treatment will be covered.

However, legislation is currently in the works that could change the landscape of rehabilitation in New York State.

Senate Bill S4623, co-sponsored by New York State Senator Ken LaValle, would require insurance companies to cover drug and alcohol treatment programs recommended by health care providers. These programs are routinely denied coverage, according to Dr. Jeffrey Reynolds, executive director of the Long Island Council on Alcoholism and Drug Dependency and Jack Hoffmann LCSW, a clinician and Director of Behavioral Health Providers and Clinical Relations at Eastern Long Island Hospital, the only East End hospital that offers detox and in-patient treatment services.

“The problem today is there is very little access to treatment, there is very little housing, there is very little transportation and insurance companies do not want to spend money on addiction,” said Mr. Hoffman in an interview late last month. “One of the biggest obstacles on the East End when it comes to treatment is access, and language and transportation are big barriers.”

“Besides the denial associated with addiction, insurance companies are the biggest barrier,” said Dr. Reynolds. “The quick math is odds are if someone doesn’t get into treatment they are at increased risk of overdose; a fair amount will end up in Suffolk County Jail, or on Medicaid. That person has now vanished off the insurance company rolls.”

While Dr. Reynolds allowed that many plans do offer out-patient or in-patient coverage, however limited, and an appeals process is often available, although waiting for care, or approval for care can sometimes be the difference between life and death.

“I have had a young person standing before me at 6 p.m. and they are dead the next morning,” he said. “If immediate treatment had been available, that might not be the case.”

Dr. Reynolds notes that most coverage recommends weekly counseling to start, followed by out-patient treatment that slowly progresses towards in-patient treatment, regardless of what a healthcare provider recommends. While the gold standard for in-patient treatment is 28 days, often, said Dr. Reynolds, insurance may only cover as much as a week of in-patient treatment. Without the ability to pay privately for in-patient care, an expensive service, that person is discharged and leaves with a high risk of relapse. Dr. Reynolds said he hopes the pending legislation in the senate changes that.

The bill, current in the state senate’s insurance committee, would not only require insurers to cover drug and alcohol abuse and dependency treatment, but it would also place the authority over that patient’s recovery program in the hands of health care professionals, rather than insurance companies. This would include the kind of care necessary in each individual case, as determined by a health care professional, but also the duration of care.

Both Mr. Hoffman and Dr. Reynolds said the other issues related to care revolve around access.

“There is less funding, fewer patient beds, fewer slots open, we don’t have enough sober homes, we don’t have enough drop-in centers for youth, we need more 12-step programs,” said Dr. Reynolds. “There is not enough help and this problem is only getting worse.”

At Eastern Long Island Hospital, services for addiction recovery include a detox program as well as in-patient and out-patient care. Mr. Hoffman said the key is combining education and treatment.

“There is no ‘one plan fits all’,” said Mr. Hoffman.

While detox is not necessary for opioid abuse—unlike alcohol or barbiturate abuse, which can cause acute withdrawal leading to seizure and sometimes death—Mr. Hoffman said for those who can afford to pay for it, or find coverage for detox, it is a benefit.

“You might not die detoxing from opioids, but you might wish you would,” he said of withdrawal symptoms. Prescription drugs like Suboxone and Vivitrol can also help ease withdrawal, said Mr. Hoffman, although he added that was not a formal endorsement of either drug. Talk therapy and group therapy, he said, was a critical step in any treatment program.

Mr. Hoffman added there are a number of rehabilitation facilities on the East End, that may not offer services for severe detox, but have in-patient and out-patient care including The Seafield Center in Westhampton Beach, Phoenix House in East Hampton, South Oaks Hospital in Amityville and St. Charles Hospital in Port Jefferson.

“And we all work together,” he said. “If they come to us at Eastern Long Island and need longer treatment, we will try and get them into one of those centers. There are a lot of places that offer service, but there is still not enough.”

The other issue, added Mr. Hoffman, is getting individuals, as well as whole communities, to understand and accept addiction issues are very real and likely exist in their own backyard.

“There is no limitation when it comes to the demographics of drug addiction,” said Mr. Hoffman.

Drug abuse, he added, often begins around the age of 12. Parents, said Mr. Hoffman, are often shocked to discover their child has a dependency issue.

“It’s different for different place across the Island,” said Dr. Reynolds, “but the notion that heroin has hit our suburbs is something that has taken people a long time to acknowledge and wrap their arms around.”

The connection between the increase of heroin use and opioid abuse through prescription pills, added Dr. Reynolds, cannot be ignored. I-Stop laws, aimed at reducing prescription drug abuse through an online monitoring system that connects physicians and hospitals, has made it more difficult for prescription pill abusers to gain access to those drugs. With street heroin often more easily acquired and affordable at as little as $10 a bag, Dr. Reynolds noted there are many heroin abusers who did not start off feeding their addiction with that drug, but may have began with what was readily available in an unlocked medicine cabinet or through a prescription for an injury.

While the recent heroin ring bust announced in late February by the Suffolk County District Attorney’s Office might impact the supply of heroin available to users on the East End, Dr. Reynolds said the impact would likely be temporary.

“Heroin is Long Island’s cash crop right now,” he said. “I do think that when we see something like this there is an impact on the supply, but the truth is there is a huge market here.”



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