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opioid addiction

Stony Brook University hosts opioid forum featuring health care community

Medical professionals participate in an opioid ethics symposium at Stony Brook University Aug. 3. Photo by Kyle Barr

The opioid crisis has reached its tendrils out to touch every person in the U.S., and the doctors who prescribe those opioids for pain relief see the ethical dilemma; whether they should treat their patients’ pain or not out of concerns of misuse.

At an opioid ethics symposium hosted at Stony Brook University Aug. 3, Dr. Kevin Zacharoff, an expert in pain medicine and a sitting member of the Anesthetic and Analgesic Drug Products Advisory Committee of the U.S. Food and Drug Administration, said a number of doctors no longer prescribe opioids for pain management because of how quickly the repercussions of misuse will come down on them. 

“All the regulatory agencies are coming down and tightening the screws of people in primary care, and people in primary care are saying ‘I wash my hands of it,’” Zacharoff said. “This is all falling on the shoulders of health care providers — when people dying from heroin and fentanyl has overtaken pain medication.”

Dr. Kevin Zacharoff delivered the keynote speech and discussed the effects of regulatory agencies on addiction. Photo by Kyle Barr

The U.S. Department of Health and Human Services reports that nationally 116 people a day died from opioid-related drug overdoses in 2016. A U.S. Centers for Disease Control and Prevention report released in 2016 said that the rate of death from drug overdoses has increased 137 percent and a 200 percent increase in the rate of opioid overdose deaths from 2000 to 2014. 

CDC data shows that regulations on prescription opioids restrained the rise of overdose deaths involving legal drugs, but since 2011 there has been a spike in the number of deaths caused by illicit drugs such as heroin and other painkillers including fentanyl. Zacharoff said he fears that these regulations on opioid prescribing pushes stable patients who could have been using opioids to treat long-term pain into using illicit drugs.

“Prescription drug monitoring programs have made a positive impact, but they have also had a negative impact on health care providers, because it takes a lot of time and energy,” Zacharoff said. “Should we sacrifice our care for patients for the sake of people using the substances illicitly?”

For the past several years federal agencies, as well as state governments, have started to restrict the number of opioids available for pharmacies as well as scrutinizing how doctors prescribe that medication. A large number of federal agencies, such as the CDC, the FDA, the Drug Enforcement Administration, just to name a few, are involved in opioid research and regulations. This is on top of state prescription drug monitoring programs, which make doctors fill out forms on patients, saying whether they informed them of the dangers of the drugs and whether they asked if there was a person in the house with a history of addiction.

In April, Attorney General Jeff Sessions announced that the DEA would propose setting more limits on the numbers of opioids that a drug manufacturer could produce. Prescribing doctors said they have seen multiple problems with a shortage of opioids due to these limits on manufacturing and distribution.

“We are seeing an inability to get our prescriptions filled on Long Island,” said Laureen Diot, a nurse practitioner from East Patchogue.

Though that is not to say there have not been bad actors. In May, Merrick doctor Michael Belfiore was convicted of prescribing hundreds of opioids for profit and for causing the deaths of two men via overdoses. He wrote 5,000 prescriptions for 600,000 pain pills between January 2010 and March 2013, but Belfiore is asking a federal judge to dismiss the case, saying it was the pharmaceutical companies who promoted the drugs while downplaying their risks.

The issue, Zacharoff said, stems from doctors’ lack of education when it comes to pain medicine. A 2011 study in the National Academies Press showed that out of 117 U.S and Canadian medical schools only four U.S schools offer a required course on pain.

“That’s despite the fact that pain is the most common reason people seek medical attention,” Zacharoff said. “Doctors will often say to me, ‘I have to think about hypertension, diabetes, heart disease,’ but pain is more prevalent than diabetes, cancer and heart disease combined.” 

Suffolk County officials are hoping to see a decline in the number of opioid-related deaths this year. In a report presented at the May 31 Suffolk County Legislature’s health committee meeting Chief Medical Examiner Michael Caplan said that if numbers stay low, approximately 260 opioid-related deaths are expected this year — a near 100-person decrease compared to 2017. However, the county will not know the total opioid-related deaths until the year’s end.

There are options for nonopioid pain relief, such as rehabilitative and psychological therapies. Doctors at the symposium said they expect as opioid prescribing ebbs, then other practices or drugs will become more prevalent. While some medical professionals said medical marijuana might one day work as effective pain relief, it not being legal in New York and without the necessary number of tests, the drug is not viable at this moment.

“It’s too early to write the book on marijuana for chronic pain,” said Marco Palmieri, the director of the Center for Pain Management at Stony Brook University. “Some physicians have gotten around this by opting not to test for marijuana [when doing prescriptions]. Whether that’s right, I don’t know. There certainly needs to be more data available.”

Republican Larry Zacarese and Democrat Errol Toulon are vying for the Suffolk County sheriff position. Photo by Kevin Redding

By Rita J. Egan

Both candidates for Suffolk County sheriff will bring more than two decades of public service experience to the position if elected. The race does not feature an incumbent, as current Suffolk County Sheriff Vincent DeMarco announced in May he wouldn’t seek re-election after 12 years in the position. On Oct. 13, Republican candidate for sheriff Larry Zacarese and Democrat Errol Toulon visited the TBR News Media office to discuss their experiences and how they would handle the position if elected.

Zacarese, assistant chief of police and director of the office of emergency management at Stony Brook University since 2009, who is also an attorney, has been a New York City police officer and is currently a volunteer paramedic.

Toulon began serving as a correctional officer at Rikers Island in 1982 and retired as a captain in 2004. For two years he was assistant deputy county executive for public safety in Suffolk and in 2014 he was named deputy commissioner of operations for the New York City  Department of Corrections.

“I’ve been able to learn a lot on various levels inside of a correctional agency, and while that’s not the entire makeup of the sheriff’s department, it is a good portion of it.”

— Errol Toulon

Toulon said he feels from day one he would be able to manage the sheriff’s office effectively and will attempt to save taxpayers’ dollars through technology training and equipment.

“I’ve been able to learn a lot on various levels inside of a correctional agency, and while that’s not the entire makeup of the sheriff’s department, it is a good portion of it,” Toulon said.

Zacarese said he believes his experience would be an asset, especially with a need for capital planning, budgeting and managing grants in today’s tough economic climate, he said.

“My role as an emergency manager at Stony Brook is really broad based,” Zacarese said. “Not only am I involved in the day-to-day operations, planning, mitigation and response and recovery, but I oversee an office that handles all the electronic physical security, design, installation and maintenance for the entire campus, which is over 250 buildings.”

Both cited combating gang activities on Long Island as a priority for the next sheriff.

Toulon said his team at Rikers would gather intelligence from inside the jail as far as calls, visits and social media interactions before incarceration and then would work with law enforcement agencies to gather and disseminate the information. According to him, his team’s work brought down 37 members of the Bloods gang. He said using a database to collect intelligence gathered and sharing it with other agencies is vital in rounding up gang members, and he said he thought his experiences could translate seamlessly to the Suffolk position.

Zacarese is also familiar with combating gang problems. A case he worked on while at a precinct in Jackson Heights involved the investigation of narcotics trafficking by members of the Latin Kings. He said the county lost critical ground in the fight against gangs when the FBI removed two Suffolk County police detectives assigned to the bureau’s joint Long Island Gang Task Force by James Burke, former police department chief, who was found guilty of beating up a suspect and trying to cover it up.

“I have already had conversations and meetings with Homeland Security investigations, with people on the U.S. Marshals’ task force and making sure we have enough people on those task forces,” Zacarese said.

Toulon agreed with Zacarese that in addition to disseminating information, manpower is important.

“Task forces are very important, and keeping our members on these task forces is extremely important,” Toulon said.

“I have already had conversations and meetings with Homeland Security investigations, with people on the U.S. Marshals’ task force and making sure we have enough people on those task forces.”

— Larry Zacarese

The candidates touched on the subject of cooperation with Immigration and Customs Enforcement. Both said while the sheriff’s office doesn’t get involved with immigration issues, it’s important to cooperate with the federal agency. Zacarese said many illegal immigrants are held in jails due to being violent predicate felons and people who return to the country illegally after being deported. The two also agreed it’s important for law enforcement agencies to increase communication with immigrant communities to ensure law abiding citizens do not fear deportation from ICE agents, which makes building cases against gang members more difficult.

Both candidates said they want to work on getting more help for those with substance abuse problems while incarcerated, which may decrease the chances of being arrested again.

“There are people who are leaving the correctional facility without so much as a business card for a social worker or any outreach programs [now],” Zacarese said.

Toulon said while substance abusers are seen by a medical staff to be treated, he agreed when prisoners leave the jail, they need assistance with finding housing and jobs.

“What I propose is creating a resource map so in each particular town we would know where those particular resources are for an individual so when we give them a card or give them the information they would be able to connect and have someone in the sheriff’s they can call and be that conduit,” Toulon said.

Both agreed that combating the drug problem, especially opioid overdoses, needs to be a priority in the county. Better tracking of overdoses; where they are happening, how they’re happening and deaths due to overdoses to identify where people need help, were areas each candidate brought up as meaningful first steps. Zacarese said he believes in enforcing the laws on the books and “strict enforcement for the suppliers, help for the people who are there in the middle and giving them long-term treatment options.”

Toulon pointed out that increasing monitoring of physicians who dispense pain management is also needed and fostering communication with communities “to actually acknowledge the problem that our family and friends are having so that we can get the correct treatment for them.”

Suffolk County leads New York State in deaths related to heroin and opioid overdoses. Graphic by TBR News Media
Suffolk County leads New York State in deaths related to heroin and opioid overdoses. Graphic by TBR News Media

Suffolk County has a drug problem. And while it may be broken news, this is not breaking news.

Heroin and prescription opioid-related overdoses and deaths are increasing yearly across the nation, state and county, according to all available data, but the overall conversation lacks focus, those close to the issue have said. One Long Island man whose line of work leaves him with little insulation from the problem said it is worse than most would imagine.

Dan Moloney, who along with his brother Peter owns six Long Island locations of Moloney Family Funeral Homes, said in an exclusive interview that he believes the problem facing Suffolk County deserves a harsher spotlight. Moloney, who has an unenviable front row seat to the horrors that come from the addictive and powerful substance, said the problem reached a tipping point for him in 2009.

After a funeral for a Rocky Point student who overdosed, the Moloneys decided to try to use their platform to deliver an important message. They had posters made up with the words “Some kids are dying for a high” in bold letters on top of an image of a flower arrangement with a card that read, “With Deepest Sympathy, The class of ’10.” Below the image, the funeral director’s message read in part: “The last thing we want to see is a death that could have been prevented. Help us make sure we don’t.”

The Moloneys tried to distribute the posters to school districts around the Island, though they couldn’t find any takers.

Maloney’s Funeral home still has stacks of this poster. Photo by Alex Petroski
Moloney’s Funeral home still has stacks of this poster. Photo by Alex Petroski

“Nobody wants to talk about it,” Dan Moloney said. “Nobody wants to hear from the funeral director.”

On the surface, in Suffolk County, it would appear heroin abuse is a daily conversation in one way or another, from politicians sponsoring initiatives to news outlets covering arrests and overdoses, to firsthand accounts from former addicts in various forms.

Moloney said he wouldn’t agree — not only is the problem receiving too little attention, he said, but also the wrong people are doing the talking.

“Are people sitting in the bleachers talking about the heroin problem?” he said. “But if their kid had some sort of disease, they’d be talking about it. They’d be doing fundraisers to help them find a cure.”

The two go hand-in-hand — heroin and opioids — or at least they should, Moloney said. Heroin is an illegal and highly addictive version of an opioid, according to the Centers for Disease Control and Prevention. However, statistics reporting deaths related to one or the other are not always paired.

The CDC’s website said health care providers wrote nearly a quarter of a billion prescriptions for legal opioids in 2013. Supply and demand for prescription pain medication doesn’t always dry up at the same rate. When the prescribed pills are gone and the desire for more lingers, the cheaper, stronger drug becomes a logical alternative.

In 2013, New York State’s Internet System for Tracking Over-Prescribing — Prescription Monitoring Program, also known as I-STOP/PMP, went into effect. The system works as a registry for practitioners to consult and track dispensed prescription histories for patients. The program has restricted supply of opioids to addicts, though it has done nothing to curb their demand. No tracking system exists for the neighborhood heroin dealer.

Moloney said one of his business’s facilities held funerals for three heroin overdose victims in just one day earlier this year. The closest comparison he could come up with to a public health concern inflicting that much damage in one day is a car crash that kills a vehicle full of people. He said that in some years, only two to three motorcycle-related deaths occur over the course of entire summer, which the public tends to find alarming, but that pales in comparison to heroin- and opioid-related deaths.

The difficulties in securing relevant and timely statistics on overdose-related deaths in New York State has contributed to undermining the understanding of the severity of Suffolk County’s problem, according to Moloney.

“Are people sitting in the bleachers talking about the heroin problem? But if their kid had some sort of disease, they’d be talking about it. They’d be doing fundraisers to help them find a cure.”

— Dan Maloney

“New York State is terrible,” he said about the state’s demographic record-keeping, which is an insight few could offer outside of the funeral business. “Three years down the road — the latest data you have is from three years ago. With the technology we have today, there’s absolutely no reason for that. And I know from colleagues that I have in other states, when you can’t get the information about how many deaths occurred in a certain place for two or three years, or what they were — because all of that is tracked — I just think the data that’s out there is antiquated and the situation is worse than the data they’re using shows.”

Father Francis Pizzarelli, director of Hope House Ministries in Port Jefferson, has been a regular contributor of insight and opinions regarding heroin and opioid addiction among young people in Suffolk County for about as long. He, like Moloney, said the problem is likely worse than anyone in the county realizes.

“The level of denial among parents continues to be deeply disturbing,” Pizzarelli wrote in a April 2016 column featured in this newspaper. Alcoholics Anonymous and Narcotics Anonymous, “which are a vital lifeline and network in our community for those working on recovery and wellness, have to worry that drug dealers are now waiting outside these meetings to prey on men and women in early recovery.”

Pizzarelli said his tipping point, much like that of Moloney’s, came in 2009. So far, though, he added, it has not been enough.

Suffolk County Police Commissioner Tim Sini said in May there were 103 fatal heroin overdoses in Suffolk County in 2015. New York State Comptroller Tom DiNapoli (D) released a report on June 9 saying there were more than 200 deaths in which heroin or opioids played a role in Suffolk County in 2014.

Regardless of how and when the deaths are identified with a specific cause or a contributing factor being opioids, one thing is clear to Moloney: the number is higher than we think.

According to the Suffolk County Police Department, since the act of administering the medication Narcan to reverse an opioid overdose became commonplace in August 2012, more than 630 saves have been recorded through Sept. 22.

In addition to conflicting stats, Moloney said an issue that he encounters is the stigma parents feel about losing a child to an overdose and what it might suggest about their aptitude as a parent. Most of the time, parents decline to immediately identify a heroin or opioid overdose as their child’s cause of death, he said. In fact, Moloney estimated that nine out of 10 parents whose child died of an overdose don’t address the issue and the cause isn’t added to a death certificate until about three months later, when lab reports are complete.

“It almost creates an environment where there doesn’t have to be an acknowledgement —not publicly,” Moloney said. “Of course there’s a lot of shame.”

Suffolk County's drug problem will be discussed at a public forum Oct. 1. File photo by Erika Karp

Opioid addiction will be the topic of discussion at a community forum on Saturday, Oct. 1 at Stony Brook University. The free event, titled The Opioid Epidemic, will be hosted by the group Scientists for Policy, Advocacy, Diplomacy and Education at the Charles B. Wang Center Theatre from 4:30 to 6:30 p.m.  Hear from policy experts, community leaders and scientists on how to combat this growing threat to our community. A series of short presentations will be followed by a round-table discussion with community participation. Refreshments will be served.

Speakers will include state Sen. John Flanagan (R-East Northport), State Sen. Ken LaValle (R-Port Jefferson), Suffolk County Deputy Sheriff William Weick,  Director of Adult Inpatient Services at Stony Brook Constantine Ioannou and Columbia University Assistant Professor of Clinical Neurobiology Jermaine Jones.

Attendees are encouraged to bring excess or expired medication for the “Shed the Meds” disposal program. Narcan (opioid OD antidote) training is available after the event for selected pre-registered participants.

Free parking is available at the Administration parking lot across from the Wang Center.

For more information or to register online, visit opioidepidemicforum.eventbrite.com or call 267-259-7347.

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