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Aftermath of an overdose: heroin use on the rise in Jefferson County

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This is a story about heroin, but it starts and ends with a pair of black dress shoes.

Harry O. Gonzalez was 22 years old when he died of a suspected heroin overdose in a house on South Orchard Street.

He had been in and out of trouble since he was 16 years old. According to his family and his pastor, he was trying to turn his life around.

“But I think the streets were stronger,” said his mother, Wanda I. Cuatt.

Shortly before his death, Mr. Gonzalez got a job selling Kirby vacuum cleaners door to door.

For his new line of work, he needed a new pair of shoes.

“‘Know where I can get some shoes?’ I said, ‘Call my brother. He’s got like 9,000 pairs,’” said Katherine A. Smith, a family friend and sister of the Rev. Jeffrey E. Smith, pastor of First Baptist Church, 207 State St.

Mr. Gonzalez followed her advice. Two days before his death, he called the minister.

The Rev. Mr. Smith told him that the shoes, black Stacy Adams dress loafers, would be waiting for him at the church.

But Mr. Gonzalez never came to pick them up. Instead, the Rev. Mr. Smith found out that Mr. Gonzalez had died of an overdose in the early morning hours of the day he was supposed to drop by.

“I got the call that evening,” the Rev. Mr. Smith said. “I had the shoes in my office. It was tough for me to see. I took them back upstairs.”

“Heroin is ruining people’s lives. It is destroying families,” Mrs. Cuatt said. “In this Jefferson County, it’s worse than you think.”

Heroin in the heartland

Following a trend that seems to be playing itself out in many rural and suburban areas in the Northeast, heroin has made serious inroads in Jefferson County, according to law enforcement officers, prosecutors, judges, medical professionals and clergy.

In June and July, the Syracuse Post-Standard reported on a spike in heroin overdose deaths in Onondaga County, and the New York Times reported on a rise in heroin use in small cities and towns in New England.

In Jefferson County, the drug, once considered the hardest and rarest, is so widely available that the price has plummeted, according to police.

One of the metrics law enforcement agencies use to determine how successful they are in keeping a particular drug off the street is how high the price is. The higher the price, the scarcer the drug and the more successful the agency.

“I’ve never seen it so low,” said Sheriff’s Detective Perry J. Golden, a member of the Metro-Jefferson Drug Task Force. “It’s a much bigger problem in our area than the average person realizes. And it has been for some time.”

So far this year, the task force has prosecuted 42 heroin-related cases, representing 27 percent of its caseload.

In 2012, the Task Force prosecuted 58 heroin-related cases, representing 23 percent of its total cases — nearly twice what it was seeing just a few years ago.

In 2008 and 2009, the most recent available historical data, the share of its caseload related to heroin was only 11 and 12 percent, respectively.

“It’s been here. It’s always been here,” task force Supervisor Chris L. Cuppernell said. “But over the last two years, there’s been a noticed increase.”

A PIPELINE NORTH

The drug, for the most part, is flowing from larger metropolitan areas into the north country.

“A lot of it comes from New York City, some from Rochester. It filters its way up here from bigger cities. Philadelphia’s a big one,” Mr. Cuppernell said.

In late June, during a traffic stop on a Tuesday afternoon on Route 11 in the town of Watertown, sheriff’s deputies arrested two New York City men in their early to mid-20s and charged them with third-degree criminal possession of a controlled substance with intent to sell after deputies said they found 30 bags of heroin valued at $600 inside the vehicle.

The drug task force got involved in the investigation and arrested a third man, also from New York City, at the Relax Inn on Route 11, where he allegedly was in possession of 562 bags of heroin worth $12,000.

But there’s also a whole contingent of dealers who were born and raised in Watertown or the surrounding area.

“Some people have the impression that, ‘Oh, it’s the bad people from New York City and Philadelphia.’ No. A lot of it is homegrown. Some deal to use; some are ham-and-eggers. It’s here. The drug problem is here,” said Salvatore J. Ciulo, director of the Watertown Urban Mission Bridge Program.

Mr. Cuppernell acknowledged that a good portion of the dealing is done by county residents recruited by outside dealers who set up in hotel rooms or apartments in Watertown.

In April, the Jefferson County Sheriff’s Department and Watertown Police Department executed sealed indictments and arrest warrants on 17 people in the north country. Those arrested ranged in age from 19 to 54 and all entered not-guilty pleas to counts of third-degree criminal sale of a controlled substance and third-degree criminal possession of a controlled substance. Of the 17 people arrested, 16 had a Jefferson County address. One was from Baltimore, Md.

“Since ’85, I’ve seen a vast change. The whole culture of the drugs is changing. You never had Arbor Day sweeps — 17 people dealing that day in 17 different places,” Mr. Ciulo said. “The question is why? How did we get to this?”

SOWING THE SEEDS

The seeds of heroin’s rise in popularity were sown more than two decades ago, according to Dr. Brian Johnson, director of addictive medicine at Upstate Medical University, Syracuse.

In the early 1990s, doctors began overprescribing strong opioid-based medication for pain, according to Dr. Johnson.

Eventually, they realized they were “excellent at getting people on opioids and terrible at getting them off,” he said.

The patients, facing horrible withdrawal symptoms, would then turn to drug dealers, Dr. Johnson said.

It’s a theory that appears to be borne out by local evidence.

Canice L. Fitzgerald, director of outpatient addiction services at Samaritan Medical Center, has seen a marked increase in addiction to opioids such as heroin, in part due to patients who have built up a tolerance to pain medication.

Since 2005, the percentage of patients her department treated for addiction to opioids has risen from 3 percent to about 29 percent.

According to Mrs. Fitzgerald, there are two groups of people who are using heroin.

The first group is made up of young people in their late teens or early adulthood who began their drug use by raiding their parents’ drug cabinets or sharing pills with friends.

The second group is made up of baby boomers who, challenged with chronic medical conditions, have built up a tolerance to pain medication and turn to heroin because it provides relief and often is more affordable than the prescription medications they were taking.

Dr. Johnson confirmed Mrs. Fitzgerald’s assessment of the situation.

“Addiction goes across all classes and all economic strata,” said Jefferson County Judge Kim H. Martusewicz, who created the county’s Drug Treatment Court in 2002.

The court offers an alternative path to residents who have committed nonviolent felonies in which drug or alcohol dependency — or both — is an underlying cause.

Kevin A. Heath, a graduate of the Drug Court program, said drug dealers view the north country as a wide-open market where they can peddle their wares and command a higher price than in the bigger cities.

“There’s money to be made up here,” he said.

According to Mr. Cuppernell, dealers can buy a bag of heroin for $5 in New York City and sell it for $25 to $30 in Watertown.

“It’s worth a trip,” Mr. Cuppernell said.

HIGH RISKS

Unlike prescription drugs, heroin does not come with a warning label or with instructions on how to take it, and variations in quality and the substances used to dilute the drug can bring about fatal results.

“They can’t calculate the risks. They don’t know the potency. That good bag could be a bad bag,” Mrs. Fitzgerald said.

Overdose deaths in Jefferson County have doubled over the last two years, according to figures provided by the office of the Jefferson County medical examiner.

In 2011, there were 18 overdose deaths, 15 of those from opiates, including two from heroin and four from morphine.

In 2012, there were 16 overdose deaths, 12 of which were from opiates, including three from heroin and three from morphine.

Thus far in 2013, there have been six overdose deaths. Five of those deaths were related to opiates and three were related to morphine.

The substances linked most to overdose deaths are opioid painkillers such as OxyContin and fentanyl, but the numbers of heroin-related deaths can be somewhat deceiving, according to Vonnice L. Joels, the county’s medical investigator.

Heroin, which is synthesized from morphine, breaks down into morphine and three different compounds called metabolites after injection. Only one of these metabolites, 6-monoacetylmorphine, can be linked positively to heroin.

If there’s a lethal dose of morphine present, “we lean toward heroin,” Mrs. Joels said.

“This will always be a rural area in everyone’s mind, but we have the same problems that an urban city has: drug dealing, stealing,” Mr. Ciulo said. “All of us are going to be affected by it. ... It’s not going away, so we have to combat it.”

About 90 to 95 percent of shoplifting and burglary incidents are drug-related, according to Detective Golden.

AN EVOLVING PROBLEM

The strategy to combat the rise in heroin use may become more complex as new legislation aimed at further constricting the availability of prescription pills is rolled out.

The legislation, officially titled the Internet System for Tracking Over-Prescribing Act, or I-STOP for short, was proposed by state Attorney General Eric T. Schneiderman and signed into law last year.

Once in place, the new law will make it more difficult for people to “doctor-shop” for narcotics by requiring prescribers and pharmacists to search for and report certain data when a controlled substance prescription is issued and dispensed.

That data would then go into an online database that would be updated in “real time” to reflect the most recent purchases.

Health providers, especially those who work in the addiction field, are keeping a close eye on the effects of the law.

“I’m relieved that there’s going to be a system in place, but I’m concerned about the spike in heroin use that we may see,” Mrs. Fitzgerald said.

“There’s an epidemic in Watertown. They call it a problem ... It is an epidemic,” said Damion R. Steele, who was sentenced to up to six years in state prison in late August for trying to sell heroin in December.

“It’s easy to get the drug; it’s hard to support your habit. To find it, it’s one phone call,” Ms. Steele said at the county jail two weeks ago. “If you’ve got good dope, you’ve got people more faithful to you than old ladies going to Catholic Mass, and that’s the truth.”

BATTLING OVERDOSES

Cognizant of the problem, Jefferson County officials have been trying to find a solution to curb the growth of drug use and the spike in overdose deaths.

Since late May, Jefferson County legislators have been mulling the creation of an initiative that would arm sheriff’s deputies with a new form of the overdose reversal medication naloxone hydrochloride, marketed under the name Narcan.

The drug, when administered, blocks the receptors in the brain that respond to opioid-based drugs such as heroin and reverses the respiratory distress that results in death.

A recently introduced intranasal form of Narcan, which is sprayed into the nostrils via an atomizer, would be easier and safer for deputies to carry.

Deputies often are the first ones on scene in the predominantly rural Jefferson County and should be equipped to deal with an overdose situation immediately, proponents of the measure say.

Narcan already is carried by the 13 Advanced Life Support emergency response agencies in the county.

Jefferson County Sheriff John P. Burns told county legislators that he would not be opposed to the initiative as long as his deputies are taught how to administer the drug.

Watertown city police have, as of yet, expressed no interest in carrying Narcan.

The initiative ran into a roadblock in July after County Attorney David J. Paulsen told members of the Board of Legislators’ Health and Human Services Committee that in order to institute such a program, the county first would have to create a Opioid Overdose Prevention Program sponsored by a health care facility, a physician, a physician’s assistant or nurse practitioner, a drug treatment program or the local health department.

Members from the Jefferson County Public Health Service have been researching the requirements since the meeting and will present their findings to county legislators Tuesday, according to Public Health Director Ginger B. Hall.

Narcan, which has a shelf life of two years, initially would be provided to the county by the New York City-based Harm Reduction Coalition, according to Charles F. Brenon III, director of Jefferson County Emergency Medical Services.

The drug then would cost $22 to $27 a dose.

A LONELY END

As well-intentioned as the Narcan initiative may be, it likely would not have saved Mr. Gonzalez’s life, according to his mother.

Mrs. Cuatt said that according to the coroner’s report, Mr. Gonzalez died sometime between midnight and 2 a.m. His death was not reported until 10 a.m.

“Apparently they touched him and said, ‘You want anything from the store?’ and he didn’t respond. So apparently they went to the store, took all his money; they took everything and then they tried to clean everything up before the they called the cops,” Mrs. Cuatt said.

She doesn’t mince words when it comes to her feelings about the Narcan initiative.

“This drug that they’re wanting EMT to have, I think, is a waste of money,” Mrs. Cuatt said. “When somebody’s shooting up, believe it or not, they’re all shooting up together ... they’re all thinking about getting high and dealing with their own high; they’re not thinking about the person next to you.”

For Mrs. Cuatt, combating the rise of heroin use in Jefferson County will take much more than a drug that will reverse overdoses. It will require a major shift in police strategy.

“They need to be more active in the community. They need to be out there, not at 3 o’clock in the afternoon, be out there and start mingling and get to know who these people are and where are these people coming from,” she said. “Get off those cars and get on the street.”

A former musician, the Rev. Mr. Smith is no stranger to the fast life and the street.

Now 21 years clean and sober, there are very few things that have affected him during his time in Watertown as much as Mr. Gonzalez’s death, according to his sister.

The Rev. Mr. Smith is a bit of a clothes horse. He said that he used to dress well when he was running wild, and now he dresses well when he serves the Lord.

The shoes meant for Mr. Gonzalez are back in his expansive closet in the apartment above his office at First Baptist Church — an apartment from which he can still sometimes see drug deals going down from his kitchen window, where he sometimes yells down to the young people making the same mistakes he once made.

“He wore the same size I did. When he said he wanted the shoes, I thought, ‘Now, what would Harry like?’” the Rev. Mr. Smith said. “He was young; he wanted to be hip and stylish. These are very good shoes. I thought that Harry would look good in these shoes. I saw him with a big smile on his face. He had a very good sense of humor.”

“Everybody loved Harry. Even the COs loved Harry,” the Rev. Mr. Smith said.

“Go talk to the corrections officers. They say, ‘Gonzalez is in town, we’re going to have a good time,’” Mrs. Cuatt said.

The shoes are put away, but the memories remain.

“You don’t know; sometimes I see a crazy phone call, a crazy number on my phone and I pick it up and I hope that it’s him, but it’s not,” Mrs. Cuatt said. “It’s like I don’t believe it still. It’s like this is not happening, not to Harry, not to him. Harry was smart. When he came to the streets he was smart. He wouldn’t do any of this stuff.”

There they sit, on a shelf, the last errand of an unfinished life: square toes, black straps, fabric around the base, black soles, white thread. Smart black dress shoes.

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