The number of opiate-related deaths in Erie County last year broke the 200 mark and is expected to double from the previous year, once all of the fatalities are confirmed.
An analysis of the 201 confirmed deaths shows that the epidemic continues unabated and cuts across the county’s cities, suburbs and rural areas.
When the backlog of toxicology tests for suspected drug overdose deaths dating from early October through December is completed, health officials estimate that the number of fatalities will rise to 264. Some in law enforcement say the number could hit 300.
In 2014, there were 128 opiate-related deaths.
“The staggering reality is that if we continue at this pace of doubling overdose fatalities each year, we will lose a thousand lives to heroin in 2017,” State Police Maj. Steven A. Nigrelli said. “This is not a neighborhood problem. This is a crisis for society.”
And if the opiate antidote Narcan had not been administered more than 450 times by Buffalo police officers and firefighters, the toll could have been five times higher.
“We are at epidemic levels that we have never seen before,” Buffalo Police Commissioner Daniel Derenda said. “The problem would be much worse if we hadn’t implemented our Narcan project back in 2014. Hundreds of lives have been saved.”
In making the case that the epidemic is widespread and shows no signs of abating, county Health Commissioner Dr. Gale R. Burstein released statistics analyzing the 201 confirmed overdose deaths:
• A disproportionate number, 174, were white. Black overdose fatalities numbered 14; Hispanic, 10.
• A disproportionate number, 90, were Buffalo residents. Suburban residents accounted for 80 of the dead, while 17 lived in rural communities and the remainder were homeless or lived outside the county.
• The average age of those who died was 38. The oldest person to die of an opioid overdose was 83, and the youngest was 17.
Many family members who have lost loved ones to the epidemic say the addiction began with prescription pain medications given for legitimate medical reasons. But when the prescriptions were no longer refilled, the individuals turned to the streets for much cheaper heroin because they had become addicted.
How many followed this path compared to people who simply took drugs for thrills? Health officials say that is hard to determine because of a lack of data.
“Nobody starts with heroin, they start with the pill. When the pills run out, that is when they turn to heroin,” Jodie Altman said of young addicts treated a her West Seneca facility, Kids Escaping Drugs.
The I-STOP factor
Burstein said she blames the crisis on a cultural change among health care providers and their patients that occurred in the 1990s in treating pain. Aggressive marketing of potent pain medications by the pharmaceutical industry and its lack of transparency in failing to “disclose the addictive risks” also contributed to the epidemic, she said.
But fewer people are “doctor shopping” to obtain multiple prescriptions for painkillers, according to state Attorney General Eric T. Schneiderman.
In addition, doctors are writing fewer prescriptions for commonly prescribed opioids.
These reductions are attributed to I-STOP, a law that created a computer data base requiring doctors to consult a real-time prescription monitoring registry to make sure an individual does not already have a prescription for the medication. Pharmacists also are able to check the registry.
But the I-STOP law may have had an unintended consequence in connection with the rise in heroin deaths.
A 50-milligram opioid from a painkiller prescription can cost $50 or more on the streets. The cost of a bag of heroin is about $10 and available on many street corners or drug houses.
As fewer prescribed painkillers are available, addicts turn to drug dealers.
“I think it is mainly the cost. People are switching over to heroin because it is just cheaper,” said John P. Flickinger, resident agent in charge of the U.S. Drug Enforcement Administration’s Buffalo office.
Combine that with the fact that dealers are boosting the strength of their wares with fentanyl, Flickinger said, and “the bottom line is it is causing more deaths.”
A recent article in the New England Journal of Medicine, according to Burstein, reported that the trend toward heroin had begun before I-STOP and other regulatory policies to curtail prescription pain medication misuse.
Whether or not I-STOP has affected the availability of prescription painkillers, more young people are consuming heroin, said Altman, campus director of Kids Escaping Drugs.
“They are absolutely turning to heroin and the number of deaths keeps going up,” Altman said. “That’s because the heroin is out there. Everything is so accessible. And they aren’t getting pure heroin. They are getting it with fentanyl, and that’s what’s killing them.”
‘Super labs’ push fentanyl
Fentanyl, an opioid usually reserved for cancer patients, often dominated the toxicology test results performed on those who died in 2015. Eighty-seven of the 201 deaths were attributed to fentanyl. The previous year, 29 people died from fentanyl.
Large quantities of the fentanyl flooding the United States are coming from “Chinese super labs,” according to Flickinger, who pointed out that those foreign facilities do not operate under the strict rules governing production at U.S. pharmaceutical companies.
The Chinese labs produce their own versions of fentanyl that end up in the hands of drug dealers who then either sell it as heroin or mix it with heroin in order to attract customers in search of a more intense high as their tolerance increases, law enforcement officials said. But that pursuit often ends in death.
There’s another contributing factor for heroin’s popularity, Flickinger said. “Mexican cartels are specifically flooding the market in the Northeast with stronger, purer and cheaper heroin,” he said.
The number of deaths attributed to heroin or heroin mixed with fentanyl last year totaled 90; compared with 72 in 2014.
If not for the antidote Narcan, police and health officials say the epidemic would have caused more than 500 deaths in Erie County last year.
The county Health Department conducted numerous Narcan classes last year and has scheduled many more for this year to train first responders and citizens how to notice an overdose and administer the antidote, which blocks the effects of the opiates.
Additionally, one national pharmacy chain, CVS, recently announced it will soon start selling over-the-counter doses of Narcan, also known as naloxone, in New York State. Other local pharmacies are also looking into stocking the antidote.
While the antidote may save lives, Burstein still blames overprescribing of painkillers for the cause. “It is really important that health care providers are practicing safe pain-management prescribing practices and are able to screen individuals who may be misusing opioids,” she said.
That process begins with providing medical students, dental students, nurse practitioner and physician assistant students with proper clinical training. “That’s where they learn to practice their profession,” Burstein said.
In addition, she said more doctors need to be certified to prescribe suboxone, a medication used to wean addicts off of opiates. On both those fronts, Burstein said, her office is helping to facilitate changes.
There are doctors who need to be more cautious in their approach in prescribing painkillers, said Dennis C. Galluzzo, executive director of the Pharmacists’ Association of Western New York.
“I still think that there are doctors that need to be more diligent and more educated. Believe it or not, I believe there are people who are being maintained,” Galluzzo said of addicts receiving painkillers. “There has to be an increase in programs that prevent addiction and help addicts with treatment. Addiction is a disease just like alcoholism.”
Galluzzo, who owns and operates an independent pharmacy at Klein and Hopkins roads in Amherst, said the association is looking into ways to sell Narcan in their stores, as well.
“We’re trying to get a few stores involved in selling Narcan,” he said. “If people have someone addicted in their home, they can at least save their lives.”
The final numbers for the 2015 death toll from opiates are expected to be completed by spring, Burstein said. But she does not see the epidemic sending soon.
“It took us awhile to get here,” she said, “and at this point, it is going take us awhile to end the opioid addiction epidemic.”