In the City’s Opioid Fight, One Size Doesn’t Fit All
Updated: Mar 16, 2018
Johnathan Crupi’s room has remained untouched for four years. On his bed sits a large poster board with a collage of pictures. Strewn across are rosary beads, more pictures and other mementos from Crupi’s short life. It was in this room, in March 2014, that Crupi died of a heroin overdose at 21, while his parents were asleep in the room next door.
Sitting in the kitchen of her home in the Great Kills neighborhood of Staten Island, his mother, Candace Crupi, speaks with sadness, anger and frustration. “It was a tough road, filled with a lot of fighting, ultimatums and anger,” she says. “He had been clean for almost a year, and I think we all had hope that it wouldn’t end this way.”
About 35 miles to the north, a makeshift table covered in pamphlets about opioids and AIDS/HIV transmission is set up, on the corner of Jerome Avenue and Clinton Place in the Bronx. Terrell Jones and Axcel Barboza brave the 34-degree weather one Friday afternoon to distribute syringes, talk to users about services available to them to kick their habits and give them narcan, an overdose-reversing drug.
“I see a mother, brother, sister who’s either struggling or lost a loved on to addiction and think that this could have been prevented,” says Jones, a longtime Bronx resident who works with addicts. “And I’ll do whatever it takes to make sure that it is.”
New York City has been hit hard by the opioid epidemic. Every seven hours, a person died of an opioid overdose in 2016, according to the latest data. More New Yorkers died from opioid overdoses that year than from car accidents and homicides combined.
But, historical differences in drug use, and disparities in race, income and social forces, have fueled two very different epidemics in the city – one exemplified by Johnathan Crupi’s bedroom in Staten Island, another by the outreach to addicts on a corner of the Bronx.
Candace Crupi reaching for Johnathan's memorial card, surrounded by cards of his friends, also lost to the crisis. Photo: Zein Jardaneh
With 31.8 overdoses per 100,000 residents, Staten Island had the highest rate in the city in 2016. According to city data, there were 42 heroin-related overdoses in Staten Island in 2014, the year Johnathan died. In 2016, the number went up to 67, a 37% increase. Like many others on Staten Island, Johnathan’s path towards addiction started with prescription opiates, and culminated in heroin abuse when pills became too expensive.
The Bronx, with 28.1 overdoses per 100,000 residents, has the second-highest rate of opioid deaths. It also has the highest number of overdoses in absolute numbers, with 308 people dying in the Bronx in 2016, about 85% due to opioids. Three of the five city neighborhoods with the highest overdose deaths are in the Bronx. Jones says that in his borough, users are “much older, and mostly minorities who are still paying the price from the war on drugs 30 years ago.”
In 2016, almost 80% of those who overdosed in the Bronx were minorities, and almost 60% were 45 or older. The city’s special narcotics prosecutor, Bridget Brennan, has repeatedly attributed the spike in overdose deaths in the Bronx to the flood of cheap narcotics into a population that has long struggled with addiction.
Each borough’s path creates its own set of complications, and residents and officials are struggling to cope.
The outreach table on the corner of Jerome Avenue and Clinton Place in the Bronx. Photo: Zein Jardaneh
“I can’t tell you how many times we’d send him to rehab,” Crupi, 64, says of her son. “But even with that we’d have to send him off the island because there were no options here,” she says, listing centers from nearby Brooklyn to upstate centers as far as six hours away.
“And when he’d come back, there was little to no support outside the home to keep him clean.”
A 2017 study, conducted by Columbia University’s School of International and Public Affairs, confirms this. Staten Island has three inpatient clinics, only one of which offers detoxification treatment. Clinics are also clustered on the island’s North Shore – a 25-minute drive from the Crupis’ home in the South Shore, where the epidemic has taken a larger toll.
For Crupi, part of the problem is the stigma.
“After we submitted John’s obituary [to the local newspaper], they called us to make sure that we actually intended to include the fact that he died of an overdose,” she says. “It has to start somewhere. We need to talk about it. When you’ve got all these obituaries saying so-and-so died at home unexpectedly at the age of 32, they’re definitely not dying from old age. We weren’t going to lie about it, and we wanted to urge other parents to do the same.”
“Reaching the population of Staten Island has been challenging,” says Bethany Medley, the opioid program manager at the Harm Reduction Coalition, an advocacy group that focuses on health reform pertaining to drugs. “The stigma with using is so high, it borders on denial.”
Since losing her son, Crupi dedicates her time to initiatives that help others on the island struggling with addiction.
“Every year on Johnny’s birthday I hold a public candlelight vigil for everyone who’s lost a loved one to this horrible crisis,” she says. “It’s always surprising to see how many people are impacted by this, how many struggle with addiction with no one to talk to. And we need to talk, and we need to make officials see how devastating this, and that they need to take action.”
Officials in Staten Island have taken note. The Richmond County District Attorney created the Overdose Response Initiative, working with police to investigate overdose deaths as criminal investigations, gathering information about victims to trace the evidence back to dealers.
The office also launched an education program last year to expand treatment options and early diversion opportunities for addicts who are in the criminal justice system. About 90% of people who’ve been to the resource centers had their cases withdrawn, the office reported earlier this year.
District Attorney Michael McMahon established SIHOPE.org, a website and public service campaign that aims to serve people who are battling addiction or who know a loved one who is struggling.
Crupi thinks these efforts are not enough. “Yes, we’re seeing a lot of these campaigns and initiatives. But what are they leading to?”
According to the District Attorney’s Office, overdose deaths decreased 26% last year. “I don’t believe it,” says Crupi, pointing to a section on Johnathan’s bed that has memorial cards of his friends, also lost to the crisis. “All you got to do is talk to people on the island, pick up the paper, read the obituaries… to know that there’s something wrong with those numbers.”
A Staten Islanders Against Drug Abuse sign. Photo: Zein Jardaneh
A similar sense of frustration is shared in the Bronx. But, resentment in the borough about government responses to the crisis runs deep.
Much of the attention surrounding the opioid crisis in New York has focused on Staten Island, even though the Bronx has been hard hit.
“It’s a matter of scale,” says Colin Rehm, manager of research and evaluation at Montefiore Health in the Bronx. “Because Staten Island started at a much lower base line, it may have received more attention.”
Jones says that officials “only started paying attention [to the opioid crisis] when it started reaching white communities in places like Staten Island,” he says “The population in the Bronx is so stigmatized – they think that all users are people of color, and all the negative associations that come with that.”
Medley, the opioid program manager at the Harm Reduction Coalition, agrees.
“With the opioid crisis having a ‘white face’, we’re seeing a lot more city-wide and national action,” she says. “Now it’s all ‘we need more services’ and ‘those poor families,’ when historically I don’t think we’ve seen this level of sympathy in previous epidemics.”
Jones, 61, works with New York Harm Reduction Educators, a syringe-exchange, education and outreach organization. He says he is also a recovering crack addict who worked as a dealer in the 80’s to support his habit. A resident of Hunts Point – the neighborhood with the second highest overdose rate in NYC in 2016 – he carries narcan, an anti-overdose drug, every time he leaves his apartment.
Terrell Jones, a recovering addict, dedicates his life to community outreach in the Bronx. Photo: Zein Jardaneh
“You’ve got people overdosing in bathrooms behind closed doors, but in so many areas in the Bronx when you walk around all you see are discarded needles and drug paraphernalia. There’s nothing hidden about that.”
Jones says the city is ramping up efforts to curb opioid deaths. In March 2017, Mayor Bill de Blasio announced a city-wide initiative to increase the availability of narcan kits, improve access to addiction treatment, and boost police enforcement on distribution of opioids.
But, Jones believes those remedies are inadequate for the Bronx.
“We’ve got to rethink our policies. If they didn’t work for these people in the 80’s, why the hell are they going to work now?”
“These people aren’t using drugs for fun; they’re people who face economic hardship, lack of access to healthcare, education, you name it,” Jones says. “They just don’t want to feel the pain anymore. And distributing more narcan or increasing access to methadone treatment is not going to solve that.”
De Blasio often uses the Bronx as a backdrop for opioid-related press conferences, which also aggravates Jones.
“De Blasio announced the city’s lawsuit against pharmaceutical companies from the Bronx a couple of weeks ago,” he says. “Not that suing big pharma’s going to do anything to help the Bronx, anyway.”
Distrust of public officials and the health care system further complicates the epidemic in the Bronx.
“These people don’t want cut-and-paste solutions that don’t take into account the kind of stressors they have in life,” says Barboza, 49, a syringe exchange and outreach specialist with Jones’ organization, and a recovering addict. “These places they make you feel like shit, like you’re not a human and you’re just a stereotype or a number.”
Axcel Barboza believes that distrust of officials and health systems complicates the crisis in the Bronx. Photo: Zein Jardaneh
One thing that residents of the Bronx and Staten Island can agree on: Unlike previous drug epidemics, this one is less violent.
“Today’s users are a lot less poor, and the drugs are a lot cheaper,” says Mark Kleiman, Professor of Public Policy at New York University’s Marion Institute. “Street heroin is around 1% of its 1970 price, adjusted for inflation.”
“We’re also seeing a huge decrease in street dealing. A lot of the violence associated with previous epidemics was turf wars between competing drug gangs,” he adds. “Now that most deals begin using a cellphone, and take place in a user’s or dealer’s home, that added layer of violence is also removed.”
Crupi, of Staten Island, remains optimistic that a solution is within reach.
“If you asked me six months or a year ago, I’d say there was no end in sight,” she says. She believes that crisis is finally receiving the attention it deserves, and the momentum to fight it will grow.
To an extent, Jones agrees: “It’s infuriating that it had to happen elsewhere for people in the Bronx to finally get attention, but I guess at least it’s finally on people’s radars.”
For now, Jones and Barboza are focusing on what they can do to get users the help they need.
“We’ve got to look out for our own,” says Barboza. “Because if we’re not, who’s going to?”