A white van rattles northward on Staten Island's narrow roads, rumbling past wooded lots and vinyl-sided homes beneath a web of electrical wires and telephone lines. One of its passengers is 33-year-old Kevin Oshea.
On nearly every block, Oshea has a memory.
“These projects here, I could go in and get heroin,” he says.
With the van stopped at a red light, Oshea nods to his left. “I used to meet someone at this gas station to pick up, drop off.” Draining a Red Bull, he cocks his head left and points diagonally across the intersection. “This deli here. I used to get heroin right out of that deli,” he says.
As the van turns right at the light, he straightens up and leans forward. “There’s a street coming up, not this one, the next one – Hodges. I used to have three people on that block I used to do business with.”
“No matter where you go, there's always a place,” Oshea says. He looks further down the road, “Anywhere on Staten Island.”
The abundance of heroin on Staten Island has fueled an epidemic. As of Sept. 1, there have been 61 fatal and 30 non-fatal documented heroin or opioid overdoses in 2016, according to NYPD statistics compiled by Staten Island District Attorney Michael McMahon. But his office believes many go uncounted and that the real numbers are 30 percent higher. In August, a Staten Island hospital official confirmed that there have been more overdoses so far this year than during the same period last year.
Many fear the epidemic is getting worse. And despite national attention, nonprofit community service providers say they may still lack the resources to stop it – a problem compounded by a “data lag” in the city’s health department overdose statistics, which can mean even the most recent statistics are more than a year old.
“We have families where everybody in the family is addicted,” said Diane Arneth, executive director of Community Health Action of Staten Island (CHASI). “The mother, the grandmother, the son, the daughter – the entire family.”
Arneth’s organization, which offers harm reduction and drug treatment services, aids several such families. She said she has seen “multigenerational” addiction many times.
“It’s astonishing what impact this is having,” Arneth said.
Luke Nasta, a Staten Island native who has helped others battle addiction for over 40 years as executive director of Camelot Counseling, said it’s difficult for him to witness the resurgence of heroin on his home turf.
“I consider myself a survivor of the first heroin epidemic. I mean, I was a teenage heroin addict in the 1960s,” Nasta said. “Extremely disheartening. It's overwhelmingly sad.”
The second wave began to build in the mid-1990s. Freely prescribed opioid pills like oxycodone were marketed as non-addictive pain relievers. In reality, these narcotic pain pills were laboratory-synthesized heroin, mimicking the effects of a true opiate, but not actually derived from opium. The prevalence of opioid painkillers in the family medicine cabinet became a health crisis waiting to happen.
Recovering patients became dependent on the pills, family members self-prescribed them, and rebellious teenagers crushed and snorted them. The result was deadly. By 2011, health data showed deaths from opioid pill overdoses were three times higher on the island than in any other part of New York City – a disconcerting disparity with no clear explanation.
After that, legislators and public health officials started cracking down on opioid prescriptions, making it more difficult for people to get ahold of them. Officials celebrated a 29 percent decrease in the number of people dying from pill-related overdoses between 2011 and 2013.
Heroin dealers saw an opportunity. They flooded the market with their cheap and highly addictive dope – taking advantage of a population already hooked on opioids but increasingly unable to buy their pills. In 2014, law enforcement agents seized more heroin in New York City than they had in the previous three years combined. In 2015, agents pulled even more heroin off the city’s streets – recovering 818 pounds in total – and 150 pounds in one raid alone.
Heroin itself has become increasingly dangerous in recent years. Today, it is 55 percent pure – that’s six times more potent than the heroin people used to shoot up, according to Drug Enforcement Agency records cited in a Staten Island Advance report.
And now, fentanyl, a powerful form of synthetic heroin, is increasingly being mixed into street heroin, causing unsuspecting users to overdose.
That has not stopped at least some from seeking out the most dangerous dope on the market. Kevin Oshea recalled a fellow user who would wait two weeks to collect 30 fentanyl patches and then disappear for several days. He once watched the man go through six patches at a time. “Four on him,” Oshea said. “Sucking on one, smoking the other one.”
Bridget Brennan, the city’s special narcotics prosecutor, said, “I think there are misconceptions in some places that there's a safe way to do these drugs, but there isn't.”
“They just aren't safe,” Brennan said. “If you abuse the opioid drugs, you're going to die.”
Heroin is deadlier now than it’s ever been.
According to a state comptroller’s report in June, heroin-related overdose deaths in New York reached a record high of 825 in 2014. During the 10 years before that, the rate of prescription opioid overdose deaths in New York had nearly tripled, while the rate of heroin overdose deaths in the state increased twentyfold.
And it appears to be getting worse.
“It's only now that we know exactly how serious the problem is,” said McMahon, the Staten Island district attorney. It’s “much more than any other person's numbers showed us,” he said referring to the overdoses he has tallied so far this year.
McMahon’s office began tracking the number of overdoses in real time when he took office in January. Shortly after his election, neighbors just down the block found their 21-year-old son dead from of an overdose on their front lawn. When McMahon inquired about the case, he discovered police weren’t investigating overdose deaths and that city health officials could not provide current overdose data.
“How many overdose deaths have we had last year?” McMahon said he had asked city officials. “And nobody knew the answer to that. I realized that not only do we not have accurate data as to what is going on, a great opportunity was being missed in investigating these cases, learning where these drugs were coming from and going after the dealers.”
As law enforcement recovered record amounts of heroin, officials realized they needed more manpower to get it off the streets, but that would cost money the district attorney didn’t have. McMahon used his overdose statistics in June to successfully lobby Mayor Bill de Blasio for emergency funding, adding $3.66 million to the district attorney’s war chest, enough to hire 15 new narcotics officers. Without his overdose statistics, McMahon said, he may not have gotten the funding.
The city’s Department of Health and Mental Hygiene has long been responsible for tracking overdose statistics, and a spokesperson noted the agency even tracks “drug-related emergency room visits on a daily basis in order to identify trends that require coordinated response.” For example, last April, the department issued an advisory warning of the “dramatic increase” in the number of 2015 citywide drug overdose deaths.
But the agency often takes many months to compile and release the data. The most recent figures were 18 months old when City & State asked for newer data in late July. City health officials explained then, however, that more time was needed to ensure publicly released statistics would be accurate and could not say when the 2015 numbers would be ready – although 10 days later, the department released the data. The statistics showed a 158 percent increase in heroin overdose deaths citywide in 2015, but a slight decrease in such deaths on Staten Island.
McMahon doubts the accuracy of the data compiled by the health department. “If you look at it, if someone dies from a heart failure, even though it was caused by ingestion of drugs, it’s not recorded necessarily as a drug case,” McMahon said. “So there's some underreporting there.”
McMahon said the health department’s 2014 report showed 74 total opioid overdoses, which he believes is undercounted by 50 percent. “And right now, the way we're running (in 2016), it is probably going to be double that, if not more.”
City health officials expressed confidence in the department’s data and said that the medical examiner determines how to classify deaths. But there’s no disagreement about current heroin and opioid overdose trends from the city health department.
“This is an increasing problem and I think we predict it will increase for 2016,” said Dr. Hillary Kunins, who leads the city health department’s alcohol and drug use bureau.
Staten Island’s medical community has created a sophisticated database capable of producing real-time heat maps of exactly where overdoses are happening, with the ability to drill down on patient medical history. “It's really cutting-edge. Nobody's really doing it in New York state the way we're doing it,” said Joseph Conte, executive director of the Staten Island Performing Provider System, the local planning group for New York’s Medicaid redesign project, known as the Delivery System Reform Incentive Payment Program, or DSRIP.
Conte confirmed that the death toll for heroin and opioid overdoses will rise this year, according to the hospital data, but he offered a silver lining.
“We see more people in treatment this year than we did last year,” Conte said. “So (that) trend is very positive.”
Much of the information in the system is confidential under patient privacy laws, but it enables Staten Island hospitals to boil down this wealth of information into some actionable intelligence for the nonprofit addiction and recovery service providers.
And accurate, timely data is crucial to reaching people in need.
“We're trying to understand more of the trends in real time using hospital data, using district attorney data, and then we'll have a better sense of where we are with this,” said Adrienne Abbate, executive director of Staten Island Partnership for Community Wellness (SIPCW). “I think the challenge is connecting people with treatment.”
SIPCW has served as a backbone for the coalition of drug treatment and recovery service providers, public health officials, law enforcement, politicians and other stakeholders in the community. The confederation provided the first community training session with naloxone, the emergency opioid overdose antidote, and led the successful campaign to have NYPD officers carry the lifesaving nasal spray.
Together, SIPCW’s partner organizations have lobbied state and city government to expand existing anti-addiction services and create new ones for Staten Islanders addicted to opiates, bringing in millions of dollars. The city plans to spend $25 million to combat overdose deaths, according to health officials.
And yet, there’s an unshakeable sense among nonprofit leaders that it may not be enough. There hasn’t been any funding for recovery until now, according to Arneth, who runs CHASI.
The nonprofit was recently awarded $1.75 million to create Staten Island’s first recovery center. The new project will provide crucial support and counseling to current drug users, their families and people struggling to fight addiction. But that money is only enough to keep the center running five days a week with limited hours.
“We can’t tell (drug users) to be in crisis during business hours,” Arneth said. “We’re really looking for resources to keep this open 24 hours a day … so we can respond when people need it.”
From the perspective of Nasta, who heads Camelot’s addiction recovery centers on the island, the government is providing perhaps a tenth of the funding needed to end the crisis.
“This is a forest fire,” Nasta said of the heroin epidemic. “What are you doing? Dumping bottles of water from an airplane?” he asked. “Waiting until there's no forest left?”
“I’m not hopeful. I’m sorry, I can’t. I can’t be hopeful. I’m the battlefield medic,” said Nasta. “He brings in and tries to restore the life of those disabled by the war. But then, they may have to go back into the war.”
Kevin Oshea’s battle has landed him in a court-mandated recovery program at Camelot. He began wrestling with addiction when he broke his wrist and a neighbor handed him his first oxycodone pills to help with the pain. His dependence on the drugs grew slowly over time.
But when his mother died in 2013, he went on a three-year binge. Oshea crushed and snorted 200 pills a month, and sold 100 more to support his habit. When he couldn’t get pills, Oshea smoked heroin. When his fiancée found out, she left him.
For years, Oshea stole from his family and even hawked his mother’s jewelry to pay for the drugs. His father eventually called the police.
“It got to the point where he’d had enough and he pressed charges on me. They arrested me – which saved my life. ‘Cause if he didn’t have me arrested I’d probably still be using heroin, or be in the ground.”
Law enforcement agents, legislators, health officials and nonprofit partners believe their extensive efforts to diminish the accessibility of opioid pills are stopping the epidemic from spreading to a new generation of potential addicts. But they are still struggling to reach people who are already addicted before it’s too late.
“You can’t keep selling and doing drugs forever,” Oshea says. “I had a long run, but everybody’s game comes to an end.”
Oshea is alive, but like many others he bears the invisible scars of his drug abuse.
“I used to live up here on the hill by Wagner College with my fiancée,” he says, looking out the window of the van.
She doesn’t know he’s in recovery now, but they talk occasionally.
“You can’t heal everything overnight,” Oshea says.