To find the face of overdose drug deaths in Erie County, head to the suburbs and look for white millennials. White men between the ages of 20 and 40 comprise the single largest death demographic – by far – of the more than 1,000 residents who have died of opioid-related drug overdoses in the past five years.
Moreover, unlike last year, when the greatest percentage of victims lived in Buffalo, this year's death statistics show a greater percentage of victims lived in the suburbs.
"There are more people that died outside the City of Buffalo," said County Executive Mark Poloncarz, a national Opioid Crisis Task Force member. "It seems to be striking white, affluent areas more than any drug epidemic in the past."
On Tuesday, suburban moms and siblings attending a County Legislature hearing railed against the stigma of drug addiction and shared story after painful story of personal heartbreak. Julie Welsted described how she lost one son to a drug overdose in December 2015 and her second son less than a year later – three days after Thanksgiving.
When she found her second son in the hospital, lifeless but still warm, even grief finally seemed to elude her.
"I shook him and said, 'Wake up,'" she recalled. "I just went into shock, and all I remember thinking is that Footprints poem. I'm not walking for me anymore. God's got to carry me."
The stereotype-shattering nature of the opioid drug crisis, both in Erie County and nationwide, has not gone unnoticed by activists in the black community who remember when the crack epidemic swept through low-income, urban neighborhoods in the 1980s and early '90s, leading to a spike in violent crime and homicides.
At that time, the epidemic was treated primarily as a crime and law enforcement issue. Now, however, the opioid crisis is treated as a public health emergency, with family advocates referring to drug addiction as a disease that should not be stigmatized.
"Now, it has become an almost entirely a Caucasian resident/citizen death cycle," said Nathan Hare, CEO of Community Action Organization. "That's why it's being treated as a disease."
But health officials point to other factors that come into play. While both cocaine and opioid drugs can create a feeling of euphoria and well being, cocaine is a stimulant while opiates are painkilling drugs that create a more relaxed, sedating effect.
More importantly, the potent, synthetic opiates now being peddled to users, particularly fentanyl and fentanyl derivatives, are killing more people at a far faster rate than prior drug crises.
National figures show that far more people are dying of synthetic opiate overdoses than are dying from overdoses related to heroin, cocaine or meth. In Erie County, the opioid epidemic resulted in three times as many drug deaths last year than in 2013, and that trend will continue, according to county Health Department figures.
"This is a huge public health crisis, and the president has declared this as an unfunded public health emergency," said Erie County Health Commissioner Gale Burstein. "It's very complicated, and it's going to take awhile to overcome this challenge."
Who is dying
Welsted didn't realize her oldest son, Christopher O'Donnell, had died of a drug overdose until she stopped at his apartment to take him to Erie Community College, where he was a student. She found him under the covers in his darkened bedroom, tweaked his foot, then went to reach for his hand.
But it was cold.
"I couldn't see his face," she said of her 31-year-old son. "God didn't let me see it."
Little did Welsted know that she would lose the second of her three children to the same drug epidemic 11 months later.
Welsted lives in Hamburg. Her sons, ages 31 and 30, lived in Eden and Lakeview at the time of their deaths. They fit the demographic of drug fatalities.
At a recent meeting of the county's Opiate Epidemic Task Force, slide after slide showed how this year's death statistics, like prior year's death figures, break long-held stereotypes of drug victims.
- Whites comprise 83 percent of all confirmed county drugs deaths. African-Americans, who comprise 15 percent of the county's population, account for 10 percent of fatal overdoses.
- Fifty-three percent of drug fatalities involve victims who lived in suburban or rural communities, compared with 43 percent in Buffalo. But the city still claims a disproportionate number of deaths, with 43 percent of fatalities occurring in Buffalo, where 28 percent of the county's population lives.
- A review of all deaths over the past three years also showed high death counts in the towns of Tonawanda, Cheektowaga, Amherst and West Seneca.
- Three out of every four overdose deaths were male, and a majority were younger than 40.
"It is not unique to us," Poloncarz said. "We're seeing it all across the country."
Interactive graphic of deaths by community:
Race and influence
Drug counselors recognize that addiction touches on issues of both mental and physical health. Those confronting harsh daily realities may turn to drugs as an escape, regardless of the tremendous, self-inflicted physical harm.
That motivator does not respect issues of class or race, said Hare, who heads Community Action Organization, a countywide, anti-poverty agency.
But he and other minority activists contend society's reaction to drug addiction is much more influenced by matters of race and class.
"If the legislators and police felt accountable to the African kids who get caught up in this stuff, then you'd see a different response," Hare said. "But the response you get is that they think these are bad people anyway."
The crack cocaine epidemic in the 1980s and early '90s — which primarily affected poor, urban, minority residents — led to an escalation in crime. That included a shocking 90 homicides in Buffalo in 1994.
The crack epidemic and resulting crime wave prompted a "War on Drugs" at state and federal levels that led to a heavy law enforcement crackdown that filled the courts and jails. Back then, addicts were called "crackheads."
This time around, Hare said, white parents – many with stories about their high-achieving and athletic children – are the ones stepping forward to demand change and pressure politicians to address longstanding problems related to drug treatment and access.
"When it's happening to these Caucasian people, you have people bending over backward to figure out a way to save Johnny," Hare said. "You don't see that same effort to save Jamal."
Debra Smith, head of the family and community advocacy committee of the Erie County Opiate Epidemic Task Force, acknowledges the opioid epidemic has become more of an issue for white, middle-class people.
She motioned to the group of suburban moms who spoke out at Tuesday's budget hearing. Many were mothers who had enrolled their children in athletic activities, she said.
"When they got injured, we had good insurance," Smith said. "We took them to doctors."
For some victims, like Smith's son Nathan, legally prescribed opioid painkillers were the first step to addiction.
Grief is not private when it comes to this drug crisis. Instead, parents are leveraging their personal pain to push for change — in how people view those with substance abuse disorders and how those people should be treated.
For the past three years, once-dry Erie County budget hearings have transformed into somber and tear-laden events, a testament to the duration and toll of a public health crisis locally and nationally.
Welsted told Erie County legislators about her two dead sons. About how her soul seems forever frozen. Unlike the deep, wracking sorrow she felt when her first son died, she's lived with a certain emotional distance since her younger son, David O'Donnell, died after snorting fentanyl in a parking lot and collapsing in a bar after 1 a.m. the Sunday after Thanksgiving.
Every night, Welsted looks at her son's pictures on her family room mantels, presses a kiss to her fingers and touches each of their urns before she goes to bed. One day, she said, she'll finally be ready to say goodbye, but that day hasn't yet come.
"I don't want to face this," she told The Buffalo News. "I'm used to being strong. This is the only way I can be strong. I'm not pretending it didn't happen, but I can't accept it yet."
After sharing personal stories, parents and siblings demanded that local lawmakers continue to do everything possible to support life-saving efforts and expand access to treatment for those struggling with addiction. They also submitted a petition with more than 1,500 signatures.
"There is no dignity in a community that watches their women bury their children," said Smith. "You are an honorable body with capable minds. We ask your help."
Welsted is not celebrating Thanksgiving at her house this year. She's going to her sister's house. Her own family traditions bring back too much pain.
"The only thing that's good about all this is, I'm not afraid to die," she said. "I'll be with my boys."
Change in tone
As drug addiction and overdose deaths have spilled into the suburbs, attitudes and conversations about drug abuse are changing. More acknowledge the drug problem as a public and community health problem, and addiction as an illness, not a moral failing.
"How high does the death toll have to get before we can all join together and address this public health crisis, because we are on a terrifying trajectory. We cannot remain passive," said Mark Bucsek, whose brother died of an overdose. He added, "We must break the stigma of addiction and continue to support those who are suffering."
People addicted to drugs are no longer called "junkies." Even terms like "addict" or drug "user" has been discouraged from use.
To further destigmatize addiction, various health and mental health organizations have issued detailed guidelines meant to emphasize the disease, not the person. A person addicted to drugs is not a "drug abuser," for instance, but a "person with a substance use disorder."
And just last month, instead of declaring a new "war on drugs," President Trump declared the opioid epidemic a national "health emergency."
Locally, Poloncarz and Burstein, the county health commissioner, point to the strides they've made to curb the death toll, which appears to be leveling out somewhat after a sharp spike in deaths in 2014. That includes expanded training and distribution of the rescue drug Narcan, and greater emphasis on buprenorphine as a medication-assisted treatment.
"We've really been aggressive about saving lives," Burstein said.
Poloncarz added that while Erie County is expected to again exceed 300 deaths from overdoses this year, the county's proactive efforts are keeping fatality figures from continuing to climb as sharply as in other counties.
Much of that is due to the new focus on prevention and treatment, he said.
"It think there's a greater awareness than in the past that addiction is a health and mental health issue," he said. "If you're planning on arresting your way out of the opioid epidemic, you're going to fail."
That understanding has been long in coming, Hare said.
"It always should have been talked about as a health problem," he said.