This story is co-published with The River, a regional newsroom from Chronogram magazine.
It was 18 years after Tim Gallagher* first tried opioids that he overdosed.
His first taste followed a medical procedure when he was 14. In his later teenage years, Gallagher’s mother would sometimes give him a five milligram Percocet—a mild opioid painkiller—from her prescription for injuries from excessive workouts or other ailments.
A year after graduating college, Gallagher’s addiction began in earnest. He was living back at home and stealing his parents’ painkillers. They hid them; he found them. They locked them in a safe; he figured out how to break in.
The drugs multiplied and became stronger as the addiction progressed. Gallagher made opioid tea from poppy seeds he bought in 50-pound sacks online, and he regularly drank kratom, a legal drug that mimics the feeling of an opioid high. He was diagnosed with scoliosis and prescribed Percocet. He began taking his dog’s Xanax, the anti-anxiety drug, then added his own Xanax prescription to the mix.
By his mid-20s, Gallagher had to take the drugs simply to avoid the torture of withdrawal. He was stealing painkillers from friends whenever he could and buying OxyContin off the street. When this became unaffordable, Gallagher switched to snorting fentanyl.
The Tip of the Crisis
Fentanyl is an opioid 50 times more powerful than heroin. It is often injected, and it is commonly mixed into baggies of heroin sold around the Hudson Valley.
Fentanyl’s legitimate usage is to relieve pain during surgery. In some cases, it is administered to those suffering from terminal cancer or other crippling diseases in a slow-release transdermal patch. It is synthesized in laboratories, though almost all black-market fentanyl is produced illicitly in China or by Mexican drug cartels, then trafficked into the US through the postal service or transported across the southern border.
Fentanyl is the latest, most powerful opioid to spread across the US, but the opioid crisis can be traced back to 1996, when the prescription opioid painkiller OxyContin came on the market.
OxyContin was produced by Purdue Pharma, which declared bankruptcy in September after facing thousands of lawsuits related to aggressively pushing the drug while falsely claiming it was less addictive than other opioid painkillers.
In response to the opioid epidemic, the federal and state governments began restricting prescription painkillers about eight years ago. Measures include two state laws setting up tracking systems to stop New Yorkers from getting painkillers from multiple prescribers, and a 2016 law limiting initial prescriptions for non-chronic pain to seven days.
However, America was already addicted. The crackdown correlates with what the Centers for Disease Control calls the opioid epidemic’s “Second Wave”—heroin. Heroin overdose deaths in New York rose nearly 600 percent from 2010-2015, according to the New York State Department of Health (NYSDOH).
Fentanyl is the epidemic’s “Third Wave.” The drug was virtually unheard of in the region until five years ago, when it killed 492 New Yorkers, according to the Centers for Disease Control. Two years later, it killed 1,414 people in the state, the last available year of data. But every indication shows that since then, it has gotten much, much worse.
The Opioid Epidemic’s Third Wave
Vin Martello, the coordinator of the Opioid Prevention/Strategic Action Leadership Team (OPSALT) in Ulster County, has the disturbing facts at his fingertips.
In 2015, 25 people died of opioid overdoses in a county of 180,000. Forty-five died in 2016, 42 in 2017, and in 2018, the number jumped to 56, giving Ulster County the second-highest per capita rate of opioid overdoses in the state. The Leadership Team’s goal is to halve the number of opioid overdoses and fatalities by the end of 2021.
Martello points to the large number of legal opioid prescriptions written in Ulster County as one reason for his county’s high rate of overdoses.
“Aside from people who just make bad decisions to experiment with heroin and opioids, the main culprits in all of this are the drug companies,” he says. “There’s no question as to the correlation between opioid prescribing and the opioid epidemic.”
From 2006 to 2012, more than 43 million prescription painkillers were distributed through pharmacies in Ulster County, enough for 33 pills per person per year, according to a DEA database. Painkiller prescriptions peaked in Ulster County in 2015, according to Martello.
Now, fentanyl is the main culprit across the region. Overdose deaths from the drug nearly quadrupled in Dutchess County from 2015-2017, according to the New York State Department of Health. Fentanyl killed more people in the US in 2017 than either heroin or prescription painkillers.
David Zon, the DEA’s assistant special agent in charge (ASAC) for upstate New York, says factories in China are the biggest source of street fentanyl. American distributors buy the drug on the dark web, and send it through the US Postal Service. Mexican drug cartels are the second-biggest supplier, though at least some of the drugs they traffic also originate in China, Zon says. The drugs primarily make their way to the northern Hudson Valley and Capital District via New York City.
As of late November, the DEA’s five upstate New York offices had seized 816 grams of fentanyl in 2019, up from 229 grams for all of 2018, according to Zon.
This might not seem like a lot—it comes to fewer than two pounds—until you take into consideration fentanyl’s strength. The DEA cites studies putting two milligrams as a fatal dose for someone without an opioid tolerance, which means the amount seized in upstate New York is enough to kill more than 400,000 people.
Zon says that about a year ago, the DEA began seeing a new form of fentanyl in upstate New York: pills manufactured to look like prescription painkillers, the anti-anxiety medication Xanax, and the stimulant Adderall. The latter two drugs are often diverted to the black market.
This appears confusing. Why would someone seeking a stimulant like Adderall ever want a painkiller, much less one that might kill them?
“A lot of things don’t make sense in the drug market,” Zon says. “It’s all about making money.”
The DEA is also seeing fentanyl mixed with cocaine and methamphetamine. Some theorize that this is due to cross-contamination during the creation or packaging of drugs. Since fentanyl is so new, and any mixing of drugs happens high up in the supply chain, Zon is only able to hypothesize.
Though fentanyl is more complex to produce than other synthetic drugs like methamphetamine, its cost is minuscule compared to what it fetches on the street. It therefore might make sense to use it to cut other drugs instead of traditional agents, Zon says. Distributors might also be trying to get people using other illegal drugs addicted to fentanyl in order to increase their customer base.
Whatever the reason, the results can be deadly. On November 9 in Kingston, four people overdosed, one fatally, from a powder that field-tested positive for both cocaine and fentanyl, according to the Daily Freeman. The survivors told police they were unaware that fentanyl was in the powder.
Fentanyl on the Street
Hudson Police Chief Ed Moore responds to some aspect of the opioid crisis every day.
Hudson, the only city in Columbia County, is a focal point for drug sales in the region as people from surrounding rural communities come in to buy, Moore says.
“I tell people, every public bathroom in the City of Hudson has been used to shoot up—and that includes our public bathroom,” Moore says, gesturing to the station’s lavatory. “There’s no doubt in my mind.”
Unlike past drug panics, the opioid epidemic, in part because it was accelerated by legal prescriptions, affects people from all socio-economic groups.
A woman making a six-figure salary at an international telecommunications company was recently arrested buying heroin in Hudson. About a year ago, a multi-millionaire in the city was found dead of an overdose, a transdermal fentanyl patch on his tongue.
“They come from all walks of life,” Moore says.
Narcan, an overdose-reversing nasal spray carried by first responders and, increasingly, by members of the public, has been deployed 16 times in the city of 6,200 so far this year, according to Hudson Police Detective Sgt. Jason Finn.
This only encompasses Narcan reversals by the Hudson police, and therefore does not include Narcan deployed by other police agencies, emergency responders, nor private citizens.
Police Chief Moore says his officers are not out to arrest people using drugs, just people selling them, but his frustration with the situation was obvious. He related how one man was revived three times with Narcan in one day. Another time, a young woman was found near the train tracks after she drove there and overdosed one evening.
“In my estimation, she was dead,” Moore says.
The woman was revived with Narcan, but the next day she was at the police station “screaming and yelling, wanting her car back,” Moore says. He rapped his knuckles on his desk. “Less than 24 hours ago you’re essentially dead, then demanding to get your car back?”
Tim Gallagher was alone when he overdosed.
He had lost his social group, sealed himself off from his friends and hidden his use from his girlfriend. He constantly shoplifted and acted “in all sorts of absolutely fucking crazy anti-social ways,” he says.
“That was my life for years. It felt like the room got smaller and smaller and smaller.”
After he could no longer afford black-market OxyContin and Xanax, Gallager began snorting “Mex-Oxys”—counterfeit pharmaceuticals from Mexico packed with fentanyl.
The day of his overdose, Gallagher’s girlfriend dropped him off at his house to get dressed. They were headed to the funeral of a child. He crushed up a Mex-Oxy, snorted it, then walked to the bathroom. He sat on the toilet.
Sometime later, Gallagher woke up on the floor, surrounded by EMTs.
“It felt initially like waking up from a dream, when you start to kind of make your way back to reality,” Gallagher says. “And then I opened my eyes and knew immediately what had happened.”
After Gallagher didn’t respond to his girlfriend’s phone calls from outside, she walked in and found him blue and barely breathing, his pupils distant pinpricks.
The paramedics asked him what happened. Gallagher said he had been napping. The first responders asked him to lie down, but Gallagher cursed at them to leave. The EMTs called the police, who asked to search the house. Gallagher refused, and an officer wrote him a ticket for disorderly conduct. The paramedics took his vital signs, packed up, and drove away with the police, leaving Gallagher and his girlfriend alone in the house.
The couple then got into the car and drove to the child’s funeral.
“We Can’t Arrest Our Way Out of This”
Police and public health officials say there has been a sea change in fighting drug addiction, especially since the crack epidemic of the late 1980s and early 1990s.
Chatham Police Chief Peter Volkmann describes it as “shifting from a law enforcement crisis to a public health crisis.
“Our messaging is changing. Arrests are not the only answer.”
Volkmann, who freely admits he has been in recovery from alcoholism since his last drink in 1995, runs Chatham Cares 4 U, an addiction recovery initiative that is part of the effort to combat the opioid crisis in more humane ways. Anyone who has a problem with any drug can come to the Chatham Police Station and will be placed in rehab without facing any charges. The Chatham Police will even drive them there.
The program has put 240 people into rehab, 70 percent of whom were addicted to opioids, according to Volkmann.
Another demonstration of how law enforcement no longer treats the crisis purely as a crime issue is how public announcements of drug overdose spikes are made.
During a spike in overdoses, the question is, “How are we going to deal with this as a public health crisis?” Volkmann says. “Because if it was a law enforcement crisis, we don’t tell anybody—we go after the bad guys.”
Police agencies around the US use the Overdose Detection Mapping Application Program (ODMAP), a tool originally developed by the Baltimore/Washington DC DEA that tracks where first responders are called to overdoses.
The national map, which is not available to the public, is updated in real time and alerts local police agencies to spikes in overdoses. Police were alerted to a spike north of Hudson, around the village of Chatham, in mid-October that caused seven overdoses, one fatal, in 24 hours, according to Columbia County Board of Supervisors Chairman Matt Murell.
However, though the public is more open to treating the opioid crisis as a public health emergency as opposed to a crime problem, Volkmann says that a stigma is still felt in the Hudson Valley. Meghan Hetfield, who works for Our Wellness Collective, a network of recovery coaches and resources, echoes that sentiment.
“Frankly, the nature of the crack epidemic being more in the black and brown communities did result in some atrocious behavior and some pretty atrocious reactions, and the fact that this current crisis has kind of made its way into the suburbs has changed the narrative a bit,” Hetfield says. “But what I’m seeing in the really rural communities is that unless the person’s family directly has been impacted, there is an enormous amount of stigma.”
This stigma played out during the push to introduce a mobile clinic into Greene County providing health screenings, STD testing, wound care, Narcan training, and other health services to those suffering from addiction.
Hetfield says that the response on social media was “extremely negative,” with some writing there should be a “three strikes” policy for Narcan reversals—in other words, if a person overdoses a fourth time, they should be left to die.
Martello, the leader of Ulster County’s OPSALT, says that despite the late-October spike, fatal overdoses are down so far this year in Ulster County, with 27 through the end of October, compared with 56 for all of 2018. But there has not been a decrease in non-fatal overdoses.
“This could imply the Narcan is really having an effect,” he says. “There’s no doubt that it is.”
Those interviewed agreed the distribution of Narcan is cutting down on fatal overdoses, but that comes with a complicating factor: It also keeps non-fatal overdoses out of view of public health officials.
Chatham Police Chief Volkmann says that before Narcan was widely distributed to the public, 911 was called when someone overdosed.
“We had statistics on how many overdoses, [then] we gave everybody Narcan,” he says. “Now what’s happening is someone’s overdosing, their friend or family member is Narcaning them, bringing them back to life, and not telling anyone. So, what we’ve done is put the problem underground.”
“People now are having parties where one person doesn’t use and holds the Narcan, in case other people overdose. So it’s not that the problem is going away at all, it’s just being better hidden,” says Beth Schuster, the executive director of Twin County Recovery Services, which has helped people overcome addictions since the 1970s.
Intakes for opioid addiction at the nonprofit, which runs outpatient and residential treatment programs in Columbia and Greene counties, have risen to the point where they’ve matched what Schuster considers the Twin Counties’ biggest problem: alcohol. Among intakes for opioid addiction, Schuster estimates that 60 percent are for injectable street opioids, with the rest from prescription medications.
Though in no way opposed to the wide distribution of Narcan, Schuster says that people are less afraid to use injectable opioids when Narcan is nearby, and people revived by friends or family members don’t have the instant access to recovery services offered by first responders.
Widely available Narcan is especially important with fentanyl in the mix, Schuster says, because, with the rapid onset of this kind of overdose, “you might not get time to get the paramedics.”
Martello also says the flipside of Narcan’s wide distribution could be that people using opioids are less afraid of overdoses.
“But from a harm-reduction point of view, we’d rather have it out there and saving people’s lives,” he notes.
“Harm reduction” is a term often used in public health circles when speaking about drug addiction. The practice focuses on pragmatically improving the health and well-being of people who use drugs, as opposed to narrowly focusing on abstinence-only policies.
The Ulster County Department of Health informs its partners—community recovery centers, law enforcement, outpatient clinics, and others who interact with the opioid-using community—about overdose spikes in an attempt to prevent more overdoses, Martello says.
A Fentanyl Spike
In late October, a huge spike in overdoses hit the northern Hudson Valley centered around the Village of Saugerties. In one weekend, twelve people overdosed in Hunter (population 2,650). The Ulster County District Attorney’s Office issued a press release saying the overdoses were from batches of heroin “tainted” with fentanyl and included images of the logos on the baggies—their “stamps”—to be distributed by the media.
But many people I interviewed agreed the images would only serve to point those suffering from opioid addiction towards these baggies.
John DeSoto*, who lives in Kingston and has used intravenous drugs for more than a decade, lays out what he calls “the stereotypical reaction” by those addicted to injectable opioids when they hear of an overdose.
“People will be looking for that [stamped bag] with the mindset of either, ‘That pussy that overdosed wasn’t shit, I can use more than them,’ or, ‘Oh, that shit’s the bomb, I won’t have to use as much, I get more bang for my buck.’”
Tim Gallagher says releasing the images did not take into consideration the illogical mindset of people in the throes of addiction.
“I think the thing that many people who aren’t addicts don’t realize is that a lot of addicts—they don’t know how bad their problem is,” he says. “They know they have a problem, but it changes the way you think. It alters your barometer for normal.”
Vin Martello says it was difficult to qualify what an individual’s mentality would be, but, “In some cases, unfortunately, because a drug is more powerful, they gravitate to it because it’s a better high,” he said.
The real aim was harm reduction
“You’re trying to keep people from killing themselves long enough to get them in treatment”, Martello said.
Others said the information might help people addicted to opioids make better decisions.
Meghan Hetfield says some people might avoid the baggies either because they consider the drug too strong, or because fentanyl’s psychoactive effects differ from heroin, though she added people in dire financial situations might pursue the baggies because they are the only option they could afford to keep out of withdrawal.
Courtney Lovell, a Columbia County-based recovery coach and author, says the information would cause people addicted to drugs to use smaller amounts of the baggies’ contents to avoid overdosing.
“The ones who are overdosing are the ones who generally didn’t realize that it was pure fentanyl, or that there was any fentanyl in it, and they used the same amount,” she says.
Even after his overdose, Tim Gallagher kept using.
After the funeral, Gallagher’s parents, who were told of the overdose, asked him what he would do now.
“I said, ‘I guess I have to go to rehab,’” Gallagher says now. “There was nothing else to say, there was nowhere else to go.”
This was in late April. Gallagher was student teaching at the time and didn’t want to suddenly leave, so he put off rehab until mid-May.
In the meantime, he continued to snort the fentanyl-packed Mex-Oxys. He also modified his Narcan in hopes it could keep him alive, cutting off the device’s trigger guards so the plunger was unencumbered. He would snort a line and place a nostril above the device with the hope that if he overdosed again, the weight of his falling head would depress the plunger and spray the Narcan up his nose.
“It’s bizarre for me to reflect upon that because I really, really valued my life…I even valued my life then, but I was really fucking sick,” Gallagher says. “That was probably the darkest point of my addiction.”
Gallagher got out of rehab about two-and-a-half years ago and hasn’t used since. He attends NA meetings, where he says his atheistic worldview has not hobbled what the group asks for from its members: a belief in a higher power.
“For me, I start with this idea that I’m not the biggest thing in the universe, so there must be something bigger than me,” he says. “Then I try to think of the things that, for me, promote goodness.”
Gallagher’s higher power is human connection and love—the opposite of what he experienced while in the midst of a closeted opioid addiction.
“Our secrets keep us sick—that’s what it comes down to,” he says. “And we create these prisons for ourselves. When I was using, I was in this invisible jail; the world was this fucking hostile place to me.”
Gallagher didn’t get clean on his own. As the crisis has deepened, more resources have become available to help those addicted to drugs improve their lives.
“I’m far from perfect,” Gallagher adds. “But I’m definitely doing a lot better.”
If you have a problem with opioids or other drugs, reach out. Here is a list of contacts from the Hudson Valley:
Chatham Cares 4 U – (518) 392 3451
Twin County Recovery Services (Columbia Co. Branch) – (518) 828-9300
Twin County Recovery Services (Greene Co, Branch) – (518) 943-2036
Greener Pathways Mobile Clinic – 518-291-4500 Weekends/Evenings 518-822-0090
Woodstock Police (Similar Program to Chatham Cares 4 U) – (845) 679-2422
Ellenville Regional Hospital Project RESCUE – 845-647-6400
Dutchess County Helpline – 845-485-9700
Lexington Center for Recovery – 1-833-515-4673
*These names have been changed to protect the identity of the interviewees.