How Did Heroin Overdoses Get So Common in New York City?

Outside his office overlooking a stunning harbor, Michael McMahon was showing me a map of heroin overdoses on Staten Island. It seemed like there were dots everywhere in the New York City borough where, as Richmond County district attorney, McMahon enjoys the mantle of top cop. "People on the North Shore think it's a South Shore problem, and people on the South Shore think it's a North Shore problem," he tells me. "But really, it's all over."

When McMahon took office in January, Staten Island had just capped off a year that saw 38 heroin overdose deaths. And as of this writing with some two months still left, 2016 has already seen roughly 75 such deaths on Staten Island, mirroring a citywide scourge, particularly in the south and central Bronx. Last month alone, nine people died of overdose in McMahon's territory in a span of ten days.

With sales and deaths constantly in the headlines, the oft-lamented "forgotten borough" is becoming better and better known—for heroin. If you speak to virtually any Staten Islander, he or she will likely be able to name someone who has struggled, if not fatally, with opioid addiction. The grim moniker "Heroin Island" has appeared in headlines and TV shows, and funeral florists are now reportedly hammered every week.

Seemingly overnight, the scourge has been woven into the borough's social fabric. With its collection of small-town, mostly white communities, Staten Island seems more in line with New Hampshire, Massachusetts, or even nearby Long Island, where the heroin problem has spun out of control. But this is still New York City, a rich land of universal pre-kindergarten, ID cards for undocumented immigrants, and a long legacy of cops aggressively targeting drug use. How could things get so bad here?

We sat down with DA McMahon to discuss how heroin overdoses became so common in the first place, and what might be done to stop things from getting even worse.

VICE: OK, so walk me through it—how did the problem get to this point?
District Attorney Michael McMahon: Well, clearly, its beginnings are in the opiate pill situation that arose from a confluence of profit-driven big pharmaceutical companies that were pushing opiate-based painkillers, and the medical community that was writing prescriptions for them under the belief that they were not addictive anymore. So you have this sort of opiate-based, pharmaceutical-company-pushed flood of prescription drugs on the market, and they're highly addictive. That's really where the beginning is. And then, add to that a very responsive heroin industry that figured out, Hey, there's going to be a demand for heroin in the United States, so let's get it up there so we can sell it.

The confluence of those two factors together with, I think, a certain segment of our society that is prone to addiction—some, it's genetic, and others try it once or twice, and they're addicted. If you look across America, at some communities where there's a sense of loss and lack of direction, you bring all of those factors together, and you have a very troubling and life-threatening situation.

But why is this such a problem on Staten Island as opposed to Manhattan or Brooklyn?
Staten Island is most like other parts of America where the problem is very severe. This particular drug epidemic is really rooted in more middle-class, more suburban and exurban parts of the country, and predominantly white, I would say. Some education, but not the highest levels of education—so high school and some college is where you see it, but maybe not post-graduate studies. You don't see it there as much. And that speaks to Staten Island. That describes the demographics of Staten Island.

Also, I have a theory—unproven, for sure—but it seems to be more pervasive in communities that somehow have been through some trauma, whether that trauma is the closing of a factory, or the failing of a tourism industry, or whatever it is. You look at parts of New Hampshire, where maybe the tourism industry is off, or whatever. There was also manufacturing, or there's just not a clear path. There's a sense of loss in the community. Staten Island has had two major traumas in the past 15 years: 9/11 hit Staten Island very severely, and then Hurricane Sandy also set Staten Island back dramatically.

So if you look at those factors, you can see that it's a very fertile place for this current flood of heroin sales.

And where do we see it on the Island? And among who, exactly?
What's shocking is that it's really every neighborhood. The other thing we see is that it's a way of using drugs that—I don't know—is different in the past. It used to be in the shadows: under the train stations, or in dark alleys, and in sort of suspect neighborhoods. But now, the people are overdosing in their own bedrooms, their own homes, in cars, in diners, in restaurants, in parking lots. So it's sort of come into more mainstream, in terms of location, which is just a shocking development.

A lot of the deaths are also in that 35 to 55 range. There was a guy a few weeks ago that was born the same year I was born: 1957. It's mind-blowing that it's in all age groups, all demographics, both from racial and ethnic, and financial—it's rich people, it's poor people. Young, old. What we're always coming to terms with is that heroin and heroin-like substances are so accessible and acceptable. Certainly, when I grew up, heroin was always something that was very taboo, and clearly illegal. Other substances were always illegal, but not as taboo. And now, for some reason, it's become less taboo, and it's become more accessible.

What's interesting, too, is that there's this paradox on Staten Island, where you have a heroin epidemic unfolding out in a borough that is particularly known for its strong law enforcement pride. How do those two things coexist?
There's no question that it's really part of what inspires our detectives to want to work on this project, and to work so hard on it. We have bi-weekly updates with the team, and it is quite often that you hear the conversation—that "this is my town, and I want to do something about it." It's either some have had family members, or some have certainly had people in their extended families or their neighborhoods who have been afflicted by this addiction illness. It's part of the overall scene, no question.

In Staten Island, too, there's a lot of insured, because a lot of the city workers live here. You look at other parts, when there's real upticks in applications and receiving of [supplemental] Social Security benefits that include Medicaid, that's where you see the high prevalence of the prescription drugs. And then one things lead to another. As we curtail the access to prescription drugs through state legislation and initiatives, the vacuum is filled by the heroin dealers. Now people are addicted to heroin. Again, it's all the same molecular structure, the opiate molecule, and there you go.

Do these heroin dealers deal just here, or do they also deal to the whole city?
We've had one takedown where we've had some cross-borough characteristics to it, but what's happened with the heroin trade is that it's become very localized, very diffuse. We call it "concierge" level, where you don't have the geographic location, like the street corner, or the house that's known to be where you can go in and get your supply. A lot of it is delivered after a phone call. Orders are placed by phone. People are delivering, as opposed to picking up, or going to locations.

It makes our work a little more difficult because people aren't in possession of the large quantities that they used to be, especially when our penal code sections on drugs are weight-driven. The more the weight, the higher the penalty. So the lower the weight, the lower the penalty. We have dealers who we know are doing a lot of transactions, but when we catch them, they have a small amount in their possession, and it makes law enforcement's work a little more difficult. But what we do know is that it comes to Staten Island many different ways and avenues of delivery, and so, because of where we're situated, going after the supply is an important factor in this, but it's not the only factor. We have to go after the demand as well.

The whole community has to come together, and each part has to fulfill its role. The law enforcement has to go after the dealers and help direct people toward treatment and recovery, but the treatment and recovery community has to be in place and ready to go.

What is your office doing to rein this problem in?
We have the Overdose Response Initiative, which is up and running. When we'd open up overdose investigation files, there would be none, because an overdose death would be treated like an accidental death, or similar to a suicide, in a way. So there'd be a determination that it was an overdose, and the case would be closed. So we determined—for investigative reasons, supportive to the family, and also just for tracking numbers for the public health factor, to understand how severe the problem is—that we'd do these investigations. Now a file is open on each overdose death, and for some of the naloxone [overdose-reversing drug] saves. Again, it's those deaths that come into my jurisdiction, if you will, because the police responded. The police don't respond in the case if somebody overdoses and is taken privately to the hospital, and they expire there, we don't necessarily capture that information, because of HIPAA [the Health Insurance Portability and Accountability Act] and other factors. We estimate that, with our 74 suspected deaths this year, there's probably 30 percent more that we don't know about.

We also have now in place since the first of October a special narcotics trial part in the Staten Island Supreme Court where all the narcotics cases are being transferred. So we'll have a judge who can oversee and bring to trial those cases that are against the actual drug dealers. The court is now directing the resources necessary to allow those cases to be prosecuted and defended, and not caught up with all the other cases that are in the system.

We're also working on—and we hope to have running soon—an early diversion part, so that people, soon after arrest, can be diverted toward treatment and engagement, as opposed to the traditional drug court model now, which is much later in the criminal justice process, usually at the time of sentence. Now it'll be at the time of arrest, to try to get people to treatment for low-level possession.

Looking beyond these initiatives, what else can be done?
I wish, with the waving of a magic wand, that we could cut off the supply that comes to Staten Island. We've met with other levels of other law enforcement, and we keep trying to step up the efforts of interdiction. And we're working with the US Attorney's office, and the special narcotics prosecutor, but I'd like to see that done.

The other thing, without question, is more education on this issue. The best tool in the kit is prevention, and we don't have a mandatory drug addiction curriculum in schools. We should have that. We don't have the public service announcements that we have, for example, with smoking, and the commercials that show people's lungs and what people look like when they smoke. Well, you should see the pictures of what someone looks like when they use heroin for five years—a 20-year-old who ages 75 years in two years when you look at those before and after pictures.

We could have a better public service campaign and education in schools—I think that'd go a long way. And we certainly need more treatment slots, and more long-term treatment. A lot of insurances cover 28 days, which is not going to make any difference whatsoever.

To me, heroin treatment should be a non-partisan issue. It's something affects everyone, and that we all agree is a problem, right?
Let's face it: Drugs, especially heroin and opiate-based drugs, certainly still have a great stigma. Some people still think, Well, OK, it's taboo, and it's not in my world. And yet it's totally become a mainstream problem. I think that's part of it. I think that society hasn't comprehended yet how bad the numbers are. We're talking about more deaths than car accidents and gun shootings combined, yet we're not talking about it on a daily basis, like we should.

So I think there's a lack of total recognition, a stigma, and a lack of comprehension of just how serious the problem is.

This interview has been lightly edited and condensed for clarity.

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