Heroin use has gotten rural, and whiter after authorities leaned hard to cut down on prescription opiates making their way to the streets. In no place has this rung more true than Ulster County.

Woodstock, NY has a history it can’t escape. Forty-seven years after the last tab of brown acid was consumed in Bethel, this sleepy upstate town (and its neighbors) have a different drug casting a shadow on the mountains: heroin is here. It never really left, but in the last four years a perfect storm created a radical increase in the number of users, addicts, ODs and deaths from the drug. The problem is not centered or worse in Woodstock, it just happens to be the town with a legendary name. It’s also where I live.

There are 20 towns in Ulster County extending from New Paltz to Marbletown, Kingston, Ulster and Saugerties. In total, less than 200,000 people live here. Many are part-timers who come up from New York City on weekends to enjoy the unspoiled mountains, recreation and laid-back atmosphere.

To the casual visitor the area looks like most hamlets on the Hudson River between Manhattan and Albany. Land stretches out far and wide. The businesses tend to be small sole proprietorships. Antique shops, art galleries, restaurants and tourist-friendly destinations abound. Once, these communities thrived when corporations like IBM employed white-collar professionals. That changed in the 1990s when IBM left, and no significant employer came in to take its place.

The economy of Ulster County is precarious. The main businesses—colleges, ski areas, hotels, restaurants and bars—have strong seasonal fluctuations. During snowy winters, some mountain towns thrive. In the summer, the population swells with tourists. But by this time in March every year, everyone who can, leaves for warmer shores. The rest of us tough it out one grim, grey day at a time, keeping our fires burning and praying the pipes don’t freeze. These are normal day-to-day issues of life in the rural northeast.

The opportunities for young people are different in areas like this than they are in an urban environment. There are few companies offering jobs that pay a living wage. Most people are working at more than one occupation, and tend to have a small business of their own as well. This is not the cause of addiction. The stress of financial insecurity on families and individuals is another story. There is a sense of scarcity in these parts, more palpable than any other place I have lived. Particularly in winter months, it gets bleak. Restaurants close down until spring, and many stores are not open on the slower days of the week. While the national story of economic growth blares on a monthly basis, evidence of such growth is not visible in these communities.

The Problem

Heroin has become a significant problem in all of New York’s upstate counties. Statistics from NIDA show heroin use has gotten rural, and whiter. The stereotype of heroin as an inner city problem for people of color has been flipped on its head. The average American heroin addict is 25-years-old, white and living in a suburban or rural locale. Further evidence of this phenomenon comes from hospitals, treatment centers and morgues in Ulster County. The incidence of overdose, hospitalization or death from heroin use has increased 12-fold from 2011. Data on heroin overdoses and deaths lag behind the current year. With this in mind, I interviewed doctors, treatment centers, law enforcement, the district attorney’s office, the fire department and the county medical examiner. I spoke to some people who requested anonymity, and others who did not. The goal was an attempt to understand the rapid spread of heroin addiction in this county and what is being done to address the problem.

Ulster County District Attorney Holley Carnright said, “You can be a 50-year-old accountant or 14 and in the 10th grade…” Heroin addiction knows no socioeconomic or demographic borders. Then there are recent sobering statistics: in Ulster County, 70% of drug arrests were for heroin or opiates, up from 30% in 2012.

Nationally, heroin use has about doubled since 2007, going from 373,000 to 669,000 users in 2012, according to SAMHSA. Heroin overdose deaths have spiked in the northeast, increasing 211% from 2010 to 2012, according to the Centers for Disease Control and Prevention.

There’s a sad irony noted by police, addiction specialists and users. Authorities leaned hard to cut down on prescription opiates making their way to the streets. Interconnected databases allowed pharmacies to see any controlled substance scripts written in the state of New York. Pharmacists partnered with local police, and violators with forged scripts were arrested. Physicians were informed if their patients were obtaining medication from multiple sources. The tactics worked so well that drugs like OxyContin and Vicodin became harder to source and their prices skyrocketed. At the same time, a flood of cheap heroin hit the same streets. Some addicts made the jump from prescription drugs to heroin, based on cost and availability. It’s a scene that’s played out in the war against drugs time and time again.

While that explanation makes some rational sense, it doesn’t address the “why” that surrounds addiction. Heroin has always been available in these parts according to sources in law enforcement. It became more available when criminal entrepreneurs from other cities realized they could increase their profits significantly by making a day-trip north. Mere availability doesn’t explain the large number of addicts who are on the streets first thing in the morning in order to get their doses sorted for the day.

Asking questions about heroin addiction provides no neat answers. Statistics that measure death and overdose come from public institutions, and only tell a small part of the story. No one I spoke with attempted to minimize or deny the scope and effect of heroin addiction in the county. Everyone is aware of the problem, coming to actionable conclusions about fixing it is a different proposition.

The individuals spoken to for this story all have a slightly different perspective on the problem. Law enforcement has a job, which includes arresting drug dealers. But even the most senior undercover narcotics detective I spoke with understands that it’s impossible to police addiction out of existence. First responders in this county are armed with Narcan, and the drug is credited for saving two lives the very first day it went into use. Even so, someone who overdoses and is revived by Narcan cannot be forced to go to treatment. Some who are brought back from the brink, come to angry that their high was ruined, the last thing the user recalls is that he/she was okay.

Drug court has been active here since the late 1990s. Nonviolent drug offenders, who are addicts, are offered comprehensive treatment and a structured program of accountability. Drug court offers an option to incarceration, but also requires a serious level of commitment. Those who fail will go to jail. It’s a strong incentive, but some addicts prefer prison to random drug tests, participation in treatment and following the rules required to stay in the program. These tend to be addicts who do not believe they can ever stop using. Clearly drug courts are moving in the right direction, treating addicts as human beings who are capable of making better choices when they are supported and encouraged. It is also far less costly to treat addicts rather than locking them in jail cells.

The Waiting Game

There are several treatment facilities in Ulster County. The one thing they have in common is that they all have waiting lists. The same goes for physicians who prescribe Suboxone for outpatient detoxification. It’s clear that a large number of people who need and want help to end their addictions are not able to access care. I spoke with one young woman who described a close friend who is an active addict and goes to work every day. He is desperate for help, but can’t afford private treatment and is on a waitlist for a publicly funded option.

Funding Additional Education and Treatment

In talking with law enforcement, I inquired about the endgame for the cash and property confiscated in the many drug raids that occur here. I wondered if those funds could be put towards education and additional treatment centers. While some of the money eventually returns to the county and, in theory, goes to treatment and education, the timeframe is lengthy. On top of that, every entity involved, from local to regional and federal gets a piece of the revenue.

Another interesting fact was mentioned by the DA’s office—some school boards and parents resist drug education programs. While that may sound counterintuitive, one must remember that the county is extremely liberal. Some parents associate these programs with the failed War on Drugs. Additionally, drug awareness seminars were traditionally delivered by law enforcement. A police presence sends a far different message than one coming from a recovering addict. While it may sound like an ideal plan to bring in such individuals, the continued stigma of drug addiction and the reaction of certain parents and board members makes this too difficult a task to accomplish. Read more “the fix”…