Being brought back from the brink of death isn't always a life-changing moment. Just ask Ben Francis.
He overdosed on street drugs three times.
The last time, he took a shot of what he thought was heroin. Twenty seconds later, he was unconscious on his couch with his lips turning blue. His dealer pulled out a Narcan kit and revived him. Then he left Francis with a small stash.
"I woke up and just carried on as if it was just another day," said Francis, 30.
It should have been a wake-up call. But those at risk of dying from their addictions are often least likely to agree to treatment right after being revived from an overdose. So the Erie County Department of Health has embarked on a new strategy to entice overdose victims into accepting help – by waiting. The initial results are promising.
Health officials are using police data-mapping software as a way to find high-risk drug users. They get detailed police reports about overdose victims who have been revived with Narcan, and then after a day or two, a peer counselor reaches out and offers to help the drug users get into treatment right away.
Department of Health officials point out that shortly after a rescue drug is administered, overdose victims feel terribly sick and often suffer from memory loss. So it's not the ideal time to sell them on the benefits of treatment programs.
"Think about after you've had a heart attack," said Medical Care Administrator Cheryll Moore, who oversees many of the Department of Health's addiction treatment efforts. "Twenty-four hours later, you feel like crud."
"They're not in the best mental state," said County Executive Mark C. Poloncarz. "They're angry and disoriented. They're coming out of that high. But you give them that 24-hour period or 18-hour period and you contact them afterwards, and you tell them, 'You know you died last night, or you were near death. We can offer you help so you never have that happen again.' That's the idea, and what we find is that people do take you up on it."
Promising pilot program
The pilot program began in September with the Cheektowaga Police Department.
Of the 23 residents whom police revived with Narcan and 12 others referred by police because of their criminal activity, 19 agreed to enter treatment within 60 days of first being contacted a peer counselor.
Waiting for people addicted to drugs to see the light is like a life-and-death game of chance. So far this year, 88 Erie County residents have died of suspected or confirmed overdoses.
Too many drug users refuse treatment after they're rescued by Narcan.
Francis said he "felt like garbage" after his overdose revival. But after the Narcan wore off, he felt better and went to bed.
"The thought had always crossed my mind that I wanted to stop using," he said, "but the biggest thought was that I was relegated to a life of using and drinking until I die. Because it does feel pretty inescapable at that time."
After an overdose crisis passes, "the fog has lifted a little bit," said Commissioner of Health Dr. Gale R. Burstein.
Francis, who has been clean for two years, attested to the benefit of waiting a few days to contact someone who has overdosed. In the immediate aftermath of being rescued from death, a user feels sick, embarrassed and defensive.
"If I was brought back, hospitalized, and came home to everyone confronting me, or even at the hospital confronting me, I'm immediately going to close down and refuse," he said. "I'm feeling very vulnerable at that time. You've been exposed."
Finding overdose survivors and getting them to agree to treatment has been hard.
Hospitals keep records on those coming through their detox units, but privacy laws prevent them from sharing that information. But police departments are not bound by the same restrictions. Police reports on overdose response calls handled by officers or paramedics are a matter of public record.
The Department of Health capitalizes on that information.
Officers in all but five police departments in Erie County carry naloxone, known by the brand name Narcan, a rescue nasal spray designed to revive users who overdose on opioid drugs. Only West Seneca, Orchard Park, Lackawanna, the City of Tonawanda and Town of Tonawanda do not. In Cheektowaga, police have responded to more than 400 overdoses over the past three years. Of that number, 38 resulted in deaths.
"The most frustrating thing about this, is that we were responding to the same people numerous times," said Lt. Brian J. Gould, supervisor of the Cheektowaga Police Department's Crisis Intervention Team. "We would go administer Narcan. We'd take them to the hospital. They'd be in the hospital for two to three hours. The hospital would make sure they weren't going to die and send them home."
But the cycle would repeat, prompting Narcan-carrying officers to complain.
" 'Why do we have to keep going back? This is stupid,' " Gould's fellow officers told him. " 'If they want to keep using, it's their choice.' "
Gould felt something more needed to be done to break the cycle. When he talked with members of the Erie County Opiate Epidemic Task Force, he urged the county to allocate more resources to personal outreach.
"Stop putting money into programs for people to come to," he said. "They're not coming. If we tell you who these people are, can't you send somebody?"
Cheektowaga began using a software system called ODMAP. The program was originally designed to help police and health officials uncover overdose patterns and recognize when a particularly dangerous batch of street drugs was leading to a geographic spike in overdose deaths.
Every time police respond to an overdose, they put a pin on the map and indicate whether the overdose was fatal and whether Narcan was administered. Cheektowaga officers also leave information with the victim indicating a counselor will follow up with them.
Then they gather information from the victim or friends and family about how the person could best be reached and include the information in the report. The Department of Health then follows up.
"We're allowed to share police records," Gould said. "And that's what we're doing."
Antonio Estrada used drugs for much of his early life, through his early 20s. Now 61, he works as a peer counselor in the Department of Health. As part of the pilot project with Cheektowaga police, Estrada followed up with those revived by Narcan.
In the beginning, he tried to meet face-to-face with everyone and received an initial escort from police officers. But many of those who overdosed have jobs during the day, so it became easier to call, he said. He often gets a warm reception when people learn he is a former drug user.
"I let them talk," he said. "Once they're comfortable, and once you're comfortable with them, you'd be surprised how much they share."
From the time Francis was prescribed Lortab for a sports injury in high school to the day he settled on his couch with drugs and a bottle of vodka in January 2016, his addiction to opioid drugs and alcohol seemed to be all that mattered.
The once-outstanding high school student and musician became a college dropout who held a job for years until 2014, when all he did was drink and use. Eight stints in detox didn't deter him. By 2016, he said, he had sold all his guitars and had nothing left but his bed, a 12-inch TV and a few changes of clothes.
But settled in with his drugs and booze on Jan. 6, 2016, Francis suddenly took stock of his life.
"A lot of addicts call it a moment of clarity, where one can step back and see the bigger picture," he said.
Francis is now employed at a hospital and preparing to go to college in the fall. He serves as a peer mentor and volunteers at a South Buffalo community center.
Curtis Stipp, 25, didn't need much convincing after the first time he overdosed. The Middleport resident was taking Suboxone during the week to hold a job but reverting to street drugs on the weekends. His parents found him unconscious in his bedroom in March.
"When the EMTs got there, my dad's there and he's crying," Stipp recalled. "And I've never seen him cry in my life."
After being hospitalized and jailed for a short time, Stipp went into a 28-day rehab program at Terrace House and is awaiting a transfer to a three-month treatment program at Horizon Village. The Erie County outreach program didn't apply to him because he is a Niagara County resident, but Stipp said talking with someone who has lived through drug addiction makes a big difference.
"People who do outreach should experience what you've experienced," said Stipp, who said he personally knows at least 15 people who have died of overdoses in the past year.
Francis now uses Suboxone to treat his addiction. Stipp takes Vivitrol, a monthly injection available to people who have already been through detoxification.
They hope the Erie County program can help more people with addiction find their moment of clarity before it's too late.
Unlike Stipp, many others don't consider overdosing a wake-up call.
Some refuse treatment or make weak promises to call back but never do, Estrada said. They refuse to answer the door when Estrada visits.
Estrada stays in touch with those who refuse initial assistance and reaches out again at least once a month. Sometimes, it takes a relapse for someone addicted to drugs to take Estrada up on his offer to help, he said.
"I just don't try to be forceful," he said. "You can't tell somebody 'you'd better' or 'you have to.' Those are two things that turn a client off."
Estrada is most successful with those who tell him they either don't know how to get help, or have already gotten help but have been unsuccessful in staying off street drugs.
That's when Estrada can offer more options and get them into treatment right away. The offer usually surprises drug users.
"When they try to get help on their own, it doesn't happen quickly," he said.
Erie County contracts with Crisis Services to offer a 24-hour Addiction Hotline, 831-7007, meant to provide rapid access to treatment services, but Estrada said many don't use it or simply recall their own unsuccessful efforts in the past to get themselves treatment. Estrada serves as a personal bridge to treatment for them.
Low cost, high reward
The Cheektowaga pilot program has a fairly low cost so far. Police officers already provide the data in the course of doing their jobs. And Estrada is already employed by the county to offer peer counseling.
The county is now working on ways to get more peer counselors and more communities to participate in the program, health officials said. A $100,000 federal grant to the county covers the cost of peer counselor training and supplies.
So far, Evans, Depew, the Town of Hamburg, Village of Hamburg and the Town of Lancaster have committed to work with the Department of Health, said Moore, Erie County's medical care administrator. It's also being slowly rolled out by the Buffalo Police Department, starting with B District.
For officers like Gould, the new program offers hope to overdose victims and those trying to save them.
"Had you asked me this last year," he said, "I would have named three or four people where we're just waiting for them to die."