One weekday night in May, members of the Cartigiano family — 35-year-old Mike, his mother, Linda, and his sister, Michele Abreu — headed to Our Lady Star of the Sea Elementary School on the south end of Staten Island, looking for help.
There, Nurse Alicia Reddy hosts a monthly meetup for people struggling with opioids. She calls herself the Addiction Angel. Among the dozen or so people in the room: a nurse recently returned from rehab; a father worried about his son's drinking; and Nicky, who had just given up heroin a few weeks back and was hoping to stay sober. Reddy encouraged Nicky and the nurse to stay "clean," then recommended the father buy urine tests and make sure his son hadn't progressed from drinking to using harder drugs.
The Cartigianos brought Mike hoping Reddy would convince him to check into an in-patient clinic. Just two weeks earlier, Linda found her son in his room, overdosed on heroin, not breathing. After frantically texting her daughter, she got out the Narcan, the medicine that can resuscitate opioid drug users, and called an ambulance. It worked. But it left this family struggling with what to do next.
The Cartigiano family lives in the South Beach-Tottenville neighborhood which has one of the highest rates of overdose deaths from opioid abuse in New York City. Mayor Bill de Blasio announced this spring his administration would invest $38 million annually over the next five years to turn those statistics around.
The investment focuses on training more physicians to prescribe drugs — methadone and another opioid alternative called suboxone — that can help a user stay out of withdrawal while they get off other, more dangerous substances.
Someone who has been addicted to painkillers or heroin could be on the alternative medication, under a doctor's watch, for many years, similar to a diabetes patient or someone with a chronic condition like high blood pressure. Research shows that pairing counseling with these prescription drugs offer users the best shot at recovery.
Diane Arneth is the president and CEO of Community Health Action of Staten Island, a health and social services clinic. As a lifelong Staten Islander, she told WNYC there was a deep resistance in this community to the city's approach, known in addiction circles as medication assisted treatment.
"There is really this very widely held belief that the best treatment for opioid addiction is to send somebody away, to have them be drug free for some period of time, and then to come back and be better," she said.
But the problem with in-patient rehabilitation and the dream of being "drug free," is that eventually people return home and have to face all the circumstances that led them to use in the first place. Arneth said medication assisted treatment can help people as they go about their everyday lives. Still, it's a hard sell. In her outpatient clinic for drug addiction, she has slots for 100 patients; only 35 of them are filled.
At the meeting in the school gym, Mike and his family did not see eye to eye on the best approach: he wanted to try methadone while his mother and sister preferred sending him away. Linda said she doesn't like the idea of treating a opioid-based addiction with another opioid.
"The only thing is one is controlled by the government, the other you don't know what you're getting because you're buying it off the street," she said.
In the end, Mike started taking methadone in secret, traveling to Manhattan for his daily dose, as he worked to get off heroin. And for the time being, his family said they would support him.
With reporting help from Nicole Lewis of The GroundTruth Project. See her reporting on New York's opioid crisis in GroundTruth's latest podcast The Fix.
