Heroin overdoses “out of control” in Ulster, but good stats prove elusive

(Photo by Dimitris Kalogeropoylos)

Faced with a spiraling opioid crisis, law enforcement officials in Ulster County are embarking on a major effort to track and map drug overdoses in the region.

The data, they say, could provide early warnings when an especially deadly batch of heroin hits the streets, help cops track down drug dealers and provide a roadmap for the allocation of public health resources. But the plan faces obstacles in coordinating the efforts of police agencies, public health officials and private-sector care-providers.

“Frankly, there’s been more obstacles than successes in the process to date,” said District Attorney Holley Carnright. “But the data I do have shows that heroin overdoses are out of control right now.”

Carnright’s assessment is in line with state figures which show a huge increase in both fatal and non-fatal overdoses from heroin and prescription opioids. According to a 2015 report by the state Department of Health, in 2013 there were 2,175 drug related deaths statewide — an increase of 40 percent from 2009. The report also showed the increased proportion of deaths attributed to heroin, as opposed to prescription narcotics and other drugs. In 2013 heroin accounted for 29 percent of overdose deaths compared to 16 percent in 2009.

Local officials say that the trend has continued upward since then, with what Carnright described as a “huge spike” this past summer. But, despite major infusions of money and resources at just about every level of government compiling accurate and timely data on overdoses has remained an elusive goal.

Currently, there is no statewide clearinghouse for overdose data. Instead, state officials rely on daily reports from hospital emergency rooms on drug related ER visits, coroners’ reports and quarterly reports generated by individual counties. A statement by the state Department of Health said that officials are exploring the addition of new categories, like admissions of the overdose-reversing drug Narcan by police and community members and treatment data from the state Office of Alcoholism and Substance Abuse Services to the overall data collection effort.

With no state funding available to help counties track overdoses, the system relies on a largely ad-hoc effort by county level officials to quantify the extent of the opioid crisis by accounting for overdose cases that never make it to a hospital and providing more detailed information than the health department data.

The sheriff’s task

In Ulster County, the job of tracking overdoses has fallen to the Sheriff’s Department. In January, Sheriff Paul VanBlarcum began issuing overdose reporting forms to every police agency in the county. The one page form asks cops to include details on the location of the overdose, age and sex of the victim, the type of drugs involved and any pertinent information, like the stamps placed on heroin bags by dealers to brand their product. VanBlarcum’s system logged 112 overdoses — 13 of them fatal — in Ulster County between Jan. 1 and Sept. 18 this year. The data will be turned over to a crime analyst who recently began working with the county as part of the federal High Intensity Drug Trafficking Area (HIDTA) program. The program directs resources to local law enforcement to improve intelligence gathering and analysis to combat the drug trade and direct public health resources and education efforts where they’re most needed. Armed with times, dates and locations of overdose incidents, drug busts and other data, analysts can create map overlays and runs statistical models to look for patterns. The resulting analysis can determine, for example, whether a particular “brand” of heroin is being sold in a neighborhood or whether a local park has become a gathering place for addicts.

“The idea is to get everyone around the same table, looking at the same map with the same data and the same goal,” said Chauncey Parker, a former director of the state Department of Criminal Justice Services who heads the New York-New Jersey HIDTA program. “Then you can begin to connect the dots.”

The importance of accurate data on overdoses goes beyond law enforcement applications. Kassandra Quednau of the 212 Coalition, a grassroots group that helps coordinate drug education of prevention efforts in northern Ulster County, said the data could help their group tailor efforts to specific groups and locations. If, for example, a park, gas station or apartment complex was identified as a common overdose location, groups like the 212 Coalition could send outreach workers there or train residents or employees to use Narcan.

“Data is the heart and body of what makes coalitions work,” said Quednau. “It’s how we determine what to focus our energy on.”

Missing pieces

But by relying primarily on data generated by law enforcement, VanBlarcum admits that the overdose tracking effort likely fails to catch a substantial portion of incidents. Many overdose victims are taken directly to local hospitals by friends or family members. In other cases, paramedics or firefighters handle the call and, if it’s a non-fatal overdose, police are never informed. Narcan, which a few years ago was restricted to ambulance crews and emergency rooms, is now widely available to the general public, meaning that many addicts may be revived by civilians and the incident never reported at all.

Andy LaMarca, director of development for Mobile Life Support Services which operates ambulances around the Hudson Valley said that with no centralized overdose reporting system on the local level, whether an overdose made it into tallies like VanBlarcum’s would depend largely on whether police showed up to the call.

“A lot of times these aren’t called in as overdoses,” said LaMarca. “Usually the dispatch diagnosis is just ‘unconscious subject.’”

Ambulance crews and hospitals do report overdose admissions (in aggregate form with no names attached) to the state health department which in turn feeds the information into a database accessible to county health officials. It is unclear, however whether Ulster County’s health department has the data and, if so whether it’s shared with VanBlarcum. Ulster County Health Department chief Dr. Carol Smith did not return multiple calls seeking comment; VanBlarcum said he was still working on coordinating law enforcement’s efforts with the county’s health sector. In addition, records generated by hospital admissions may not contain essential information, like the location of the overdose or markings on a heroin bag, used in the HIDTA data analysis.

New investigator

In a bid to become Ulster County’s central clearinghouse of overdose numbers, Carnright appeared before the county legislature’s Ways and Means Committee last week to request funding for an investigator dedicated to handling the opioid crisis. The new investigator, for whom funding was not included in the 2017 county budget, would have brought together VanBlarcum’s effort to collect data from law enforcement with public health information to create a comprehensive picture of when, where and among which groups overdoses were occurring.

“I think in a lot of respects, [the District Attorney’s Office] is at the hub of what goes on in the criminal justice system in Ulster County,” said Carnright. “That puts us in a position to play a role.”

Carnright said there had been issues so far in coordinating the data collection on heroin overdoses. For example, he said, in the first six months of 2016, Kingston police had not filled out a single one of the overdose reporting forms distributed by the sheriff’s office, something he chalked up to the fact that most medical calls in Kingston are handled by the city’s fire department. Carnright added that some in the health sector had expressed reluctance to share even aggregate data because of patient privacy laws.

“I don’t think anyone is trying to be an obstacle,” said Carnright. “But at the same time, the system is not as complete as it needs to be.”

Despite the flaws in reporting, local law enforcement is moving ahead with its data-driven approach to combating the opioid crisis. The crime analyst assigned by HIDTA to Ulster County recently completed training and is expected to begin crunching numbers soon. In the next year, that data is expected to begin shaping everything from police patrol routes to the distribution of Narcan kits to the assignment of substance abuse counseling services.

“The key is to do the best you can with the data you have,” said Parker. “It’s like a puzzle, sometimes you only have 75 or 80 percent of the pieces, but that can still give you a pretty clear picture.”