North Fork Fentanyl Deaths Underscore A Dangerous Nationwide Trend

Pictured Above: At an Aug. 15 vigil in Greenport’s Mitchell Park for the victims of fentanyl poisoning the prior week. | George Cork Maul photo

A bucolic summer on the North Fork was shaken to the core by a rapid series of deaths due to cocaine laced with the powerful synthetic opioid fentanyl in mid-August, bringing home a national crisis that is only growing.

Over the course of about a week, five North Fork residents and one Shelter Island resident working in the hospitality industry died after using fentanyl-laced cocaine, while two others were rescued using naloxone (Narcan), an opioid antidote carried by law enforcement and emergency medical services.

The community was quick to react, with non-profits, businesses and the local government organizing public trainings in the use of Narcan and distributing Narcan kits throughout the North Fork, while heartbroken restaurant owners took to social media to warn the public of the dangers of the drugs currently circulating on the streets.

“We are going to interrupt the fun for a second. And please listen up. Our community has just lost five people to drug overdoses, three today alone. There is clearly something bad on our streets right now,” said the owners of Little Creek Oysters in Greenport on Saturday, Aug. 14. “Not preaching, this is about telling everyone we know and love to be extra cautious, call your friends and family and spread the word. This is a human disaster. Gratefully the Little Creek Crew is all here and safe, but we are all just one removed from devastation. Also, please know that every kitchen and restaurant crew in Greenport is crying right now. Be. Kind.”

“Our Greenport Community suffered a devastating blow this week. We live in an amazing area and our Greenport Community is strong, but just like any other place, life is fragile,” said Greenport Business Improvement District President Richard Vandenburgh, owner of Greenport Harbor Brewing Company, in an Aug. 14 post on the BID’s Facebook page. “While our thoughts, prayers and respect for their lives are with those families, we need to do more to engage and be aware. We need to do more to train and be prepared. We need to do more to help where we can and avoid events such as these recent dark days. The BID asks all its members to ensure that contacts and resources are posted in its work spaces and conversations are had with their staff, friends and neighbors that empower people with the knowledge, tools and information that could save anyone’s life from an early and tragic end.”

“The BID will work to bring additional NARCAN training to those members in the village and coordinate speakers to further educate on the legal, ethical and social issues related to this challenge that we all face in one form or another,” he added. “I have always believed that our Greenport Community is incredibly strong and unified when we need to be. Now is the time to once again demonstrate the depth and character of that strength in responding and refocusing on this ongoing challenge that we all are a part of. Let us continue to build Greenport Strong – Greenport Safe.”

The primary signs of an opioid overdose are known by first responders as the “opioid overdose triad,” which includes pinpoint pupils, respiratory depression, and a decreased level of consciousness. Earlier signs of an overdose include dizziness, drowsiness and nausea and vomiting, often followed by decreased muscle tone, cold and clammy skin, low blood pressure and a decreased heart rate. The decreased respiratory rate is the driver of many of these symptoms, as the victim’s body does not receive enough oxygen to sustain their life. Narcan, most commonly administered through a nasal spray, works by counteracting the depressed breathing.

“The Village of Greenport has suffered several tragic, overwhelming losses this past week, and is seeking help to prevent future tragedies,” according to an official statement from the village on Monday, Aug. 16. “Please use our anonymous e-mail service through the official village website: www.villageofgreenport.org for comments, questions or the relaying of information. It is expected that Narcan kits will be available shortly for pick up by appointment at the Village Hall office at 236 Third Street. We will advise once they become available. Also, and most importantly, if you suspect that you, a friend or a loved one are in possession of dangerously laced drugs, please do not take them!”

Southold Town and the Family Service League have organized four Zoom Narcan opioid antidote training classes this week, after which the town will make Narcan kits available. Trainings will be held at 10 a.m. Tuesday, Aug. 17 through Friday, Aug. 20 — the Zoom links can be found here. 

To receive the Narcan kit, call Southold Town Government Liaison Denis Noncarrow at 631.765.5804 after taking the class. The town and Suffolk County Legislator Al Krupski have also organized an in-person training at the Peconic Lane Recreation Center on Thursday, Aug. 19 at 5 p.m. Email Denis Noncarrow at Denisn@southoldtownny.gov or call him at the above number to register.

First & South restaurant in Greenport will host a Community Action for Social Justice Narcan training session, which will include distribution of Narcan kits for distribution on Wednesday, Aug. 18 at 4 p.m.

This was a rare rural instance of harm reduction, a practice in which drug users learn how to stay safe, which had its genesis in the needle exchange programs as the HIV epidemic spread through New York in the 1980s.

The fentanyl crisis is unique among drug crises, in part because many people who die do not know they are being exposed to fentanyl. Because of this, many families who have lost relatives refer to their loved one’s death as “fentanyl poisoning,” not a drug overdose.

According to researchers from the Rand Corporation, in their 2019 paper “Understanding America’s Surge in Fentanyl and Other Synthetic Opioids,” historically, drug epidemics begin with the rapid spread of initiation, mostly among young people. Over time, as the number of users grows and the harms become clearer, the drug acquires a negative reputation. Then initiation ebbs, and society is left to deal with a residual pool of chronic users.” 

“Fentanyl and other synthetic opioids do not follow this script,” they added. “Synthetic opioids are not drugs of initiation for most people, at least in markets in the United States. Fentanyl use does not typically spread by word-of-mouth contact among users; it penetrates markets when suppliers embrace it.”

“Few people who use opioids appear to be looking for fentanyl and other synthetics specifically,” the researchers added. “Fentanyl does not increase the number of users; it increases the number of deaths among an existing pool of individuals who use drugs. Thus, the traditional epidemic framework fails to capture the dynamics of this problem.”

In short, drug users are not typically seeking out fentanyl. Suppliers are making that choice for their customers because fentanyl is cheap, powerful and readily available.

Indeed, cocaine users are not likely to even be aware that fentanyl, a depressant, has been cut into their drug of choice, which is a stimulant. They are also less likely than opioid users to have built up a tolerance to opioids, putting them at greater risk of a fentanyl overdose.

According to National Institute on Drug Abuse statistics,” drug overdose deaths involving cocaine rose from 3,822 in 1999 to 15,883 in 2019… The number of deaths in combination with synthetic opioids other than methadone has been increasing steadily since 2014 and is the main driver of cocaine-involved overdose deaths.”

The U.S. Drug Enforcement Administration has also seen an uptick, with 3.3 percent of cocaine samples tested by the agency containing synthetic opioids in 2020, up from less than 1 percent of the cocaine sampled in 2016.

Clubgoers in metropolitan areas have long been aware of this issue, and there’s even a collective group in New York City called Last Night a DeeJay Saved My Life that focuses on providing medical practitioners to train clubgoers to administer Narcan.

In April of this year, the U.S. Centers for Disease Control announced that “federal funding may now be used to purchase rapid fentanyl test strips in an effort to help curb the dramatic spike in drug overdose deaths largely driven by the use of strong synthetic opioids, including illicitly manufactured fentanyl.”

“We must do all we can to save lives from drug overdoses,” said CDC Director Rochelle P. Walensky at the April announcement. “The increase in drug overdose deaths related to synthetic opioids such as illicitly made fentanyl is a public health crisis that requires immediate action and novel strategies. State and local programs now have another tool to add to their on-the-ground efforts toward reducing and preventing overdoses, in particular fentanyl-related overdose deaths.”

Fentanyl test strips can be used to determine if drugs have been cut with fentanyl, providing people who use drugs and their communities with information about fentanyl in the illicit drug supply so they can reduce their risk of overdose.

There were about 88,000 drug overdose deaths in the United States in the 12 months ending in August of 2020, the highest number of overdose deaths ever recorded in a 12-month period in the U.S., according to data from CDC, and overdose deaths have continued to accelerate during the Covid-19 pandemic.

Closer to home, Suffolk County in late July 2021 announced a new settlement with distributors of over-the-counter opioids, giving the county access to between $87 million and $107 million over the next 18 years to combat opioids.

“We went through a process of changing the way we look at addiction, and it’s about striking that balance between enforcement, treatment, rehabilitation and prevention,” said Suffolk County Executive Steve Bellone in his July 20 announcement of the settlement, the result of legal action the county brought against the manufacturers in 2016.

“The Suffolk County Police Department has done a tremendous job on the enforcement side, putting away dealers and helping slow the stream of drugs pouring into our streets,” he added. “But we knew at the early stages of this epidemic that enforcement was not going to be the key alone to solving this problem not even close. We had to focus and tailor our resources to provide programs and services to help those struggling with addiction, and to help family members recognize the possible signs.”

Mr. Bellone pointed to a new 24-hour hotline the county organized in partnership with the Long Island Council on Alcoholism and Drug Dependence, as well as the Family Service League’s new DASH center, 24-hour emergency drug abuse and mental health crisis center in Hauppauge, as examples of work the county has already done.

 “I think for me, I really became fully aware of the depth of this crisis speaking to the health department early on in the administration, when our police department became the first department wide to be doing Narcan reversals,” said Mr. Bellone. “And the health department was stunned, stunned by the number of reversals that the police department was engaged in in that first year. And that really drove home, how deep and how challenging this epidemic was.”

Suffolk County and Southold Police and the Suffolk County District Attorney’s Office are asking anyone who bought cocaine recently on the North Fork or Shelter Island to dispose of the product and call Southold Police at 631.765.2600.