Erie County, N.Y., isn't like Erie County, Ohio, on the other end of Lake Erie. In the Ohio county, a petition to throw all heroin users in jail because they cost so much taxpayer money has received more than 170,000 signatures.
And several other Ohio counties see so many opioid overdose deaths that medical examiners there brought in refrigeration trailers to hold all the bodies because they ran out of space in their morgues.
Here, residents still die at a record rate of one a day. As of Wednesday, the county reported 244 confirmed or suspected opioid drug deaths this year.
"Which is not good," said County Executive Mark Poloncarz. "But compared to other communities in the country that are seeing three to four deaths a day, we are doing much better than other areas of the country."
More than $1.5 million in county funds plus hundreds of thousands of dollars in grants have been spent trying to tackle the drug crisis since early last year, in addition to related Medicaid spending and other criminal justice programs.
As local leaders and surviving family members marked International Overdose Awareness Day with a candlelight vigil Thursday evening at the LaSalle Park bandshell, Erie County leaders discussed how efforts to fight the drug epidemic have progressed and what yet has to be done.
Debra Smith, a leader of the county's Opioid Addiction Task Force Family Support and Consumer Advocacy subcommittee, said she still lies awake at night wondering how long she must continue to carry the last message her son posted to Facebook before he died: How many of my friends have to die before the government realizes it has to fund recovery treatment?
"I once again am haunted by that thought," she said. "We're still losing people."
Ten years: That's how long Poloncarz expects it will take before the county's overdose death toll stops being considered a public health crisis, before the number of people dying of fatal overdoses falls and no longer grips the public consciousness.
It's been less than two years since Erie County launched a series of new programs to address the skyrocketing death toll. Not all have fared so well. That leaves county leaders trying to figure out the next steps in the fight against the epidemic.
"It's never easy," Poloncarz said. "There's no one answer."
What's been tried
Early last year, Poloncarz created the Opioid Epidemic Task Force, bringing together players from the criminal justice, medical, mental health, human services, community and family advocacy arenas. Many new programs were rapidly introduced in the following months.
The county contracted with Crisis Services to establish a 24-hour addiction hotline, 831-7007. Its purpose is to establish a one-stop call line that can connect people addicted to drugs directly with treatment services and to provide loved ones with the necessary resources to help support someone wrestling with a substance abuse disorder.
Police chiefs also signed onto the Rapid Evaluation Appropriate Placement program, an initiative to turn local police departments in Erie and Niagara counties into quick access points for addicted individuals seeking treatment.
The county recruited "angels," 100 local resident volunteers who would meet those suffering from withdrawal symptoms at police stations and keep them company until they could be taken to a place for evaluation and treatment.
The county also launched numerous training sessions to help citizens learn to administer Narcan emergency rescue kits, educate doctors about chronic pain treatment and encourage certification for the administration of replacement drug treatment options like buprenorphine.
One year later, the addiction hotline gets mixed reviews. Poloncarz points out that since its rollout last April, 1,817 people addicted to drugs have been referred to treatment, and 88 percent of people who provided feedback called the hotline helpful. Erie County's hotline gets much more use than those in other communities, including Suffolk County on Long Island, he said.
But critics such as parent advocate Avi Israel point to the hotline's shortcomings. Poloncarz's numbers discount people who call the hotline but later fail to show up for follow-up evaluation appointments and placement, as well as people who are seeking inpatient treatment but can't access it locally.
While the hotline is open 24 hours, access to immediate evaluation and treatment is not. And inpatient treatment beds remain in short supply.
"That's always an issue," Poloncarz said. "I'm not going to deny that."
Some county legislators also question the cost – more than $300,000 a year – when on average fewer than 10 people call the hotline a day. Poloncarz responded that the caller-cost ratio should not be the sole determinant of success.
"It's like the suicide prevention hotline," he said. "You really hope people don't call. But if people are contemplating suicide, you really want a hotline for people to call so trained professionals can offer them the assistance they need."
The REAP program and angels volunteer program have been admitted disappointments to those who played a role in launching these efforts. Despite success elsewhere, those grappling with addiction have generally been unwilling to visit police stations to get help. The number of residents who have actually used police stations for this purpose lingers in the mid-teens.
That means that the angels volunteer program has had little to do, despite county recruitment and training of many well-meaning residents. Twenty angel volunteers have been retrained as Narcan kit instructors.
The county discussed the possibility of redirecting these volunteers to hospital waiting rooms, where those in need of substance abuse treatment might be kept waiting for a long time. But medical privacy laws proved a barrier, said county Health Commissioner Gale Burstein and community coordinator Cheryll Moore.
"Once you're in a medical facility, that's a different ball of wax," Moore said.
Poloncarz noted that the REAP and angels programs did not require any significant investment of public money.
The county has been more successful in its community education programs. More than 16,000 emergency Narcan kits have been distributed to residents who have been trained to use them. And the county has hosted programs for health providers to help them properly treat patients with chronic pain.
They have also made more training available to physicians interested in being certified providers of buprenorphine, an opioid medication that curbs cravings and withdrawal symptoms in those addicted to drugs and are looking forward to targeting such training to physicians who treat adolescent and teenage patients, Burstein said.
Poloncarz sits on the National Association of Counties and National League of Cities Opiate Epidemic Task Force as New York State's only representative. He said many communities are calling Erie County to learn about best practices.
Aside from the what the county administration has done, he pointed to drug diversion efforts by the District Attorney's Office and acknowledged new efforts by the Erie County Sheriff's Office to counsel and connect inmates with treatment while incarcerated and upon their release from jail.
The County Legislature has also earmarked a one-time expenditure of $1 million in county savings to provide more resources toward the opioid drug crisis. Half of that money is going toward county drug-fighting and rescue efforts. The other half is being earmarked to community organizations that will provide support to primary care physicians, offer expanded and rural access to opioid treatment and needle exchange services, and create a training program to assist victims of human sex trafficking who are controlled through opioid addiction.
Both Poloncarz and county legislators have expressed an interest in opening up a 24-hour, walk-in emergency stabilization center for residents addicted to drugs. Currently, there is no program that can offer immediate services round the clock. But such a program could easily cost $5 million to get started and would need additional money to keep operating, the county executive said.
"It's very expensive," he said.
He remains hopeful, however, that Gov. Andrew M. Cuomo will make grants available to communities interested in opening such a facility.
Smith, who lost her son Nathaniel two years ago at age 26, said that on balance, she still believes the county is headed in the right direction and should be commended for its efforts.
"For all of the evil coming from this epidemic, and I've seen great deal of evil, at the same time, it's exposed me to a great deal of good, the beauty of people, the concern," she said. "I see the hand of God sometimes, at times when I'm struggling with my own doubt with how this could have happened."