Handcuffs and lockups are out as the weapons of choice in the battle against the city’s exploding opioid crisis.

The NYPD, in a revision of procedure and policy, has embraced an evolving approach to the city's spiraling epidemic: Keeping low-level addicts alive and out of jail, while still incarcerating big-time drug dealers.

“One of the most overused phrases in law enforcement today is ‘You can't arrest your way out of this problem,’” says NYPD Deputy Commissioner of Operations Dermot Shea inside his office at Police Headquarters.

“It’s very true in this particular case, it really is. There is an enforcement piece to what we see ... But it’s not going to deal (with) the entire problem.”

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Staten Island District Attorney Michael McMahon, whose borough sits behind only the South Bronx in per capita opioid deaths, is among the law enforcers supporting a new way of dealing with those at the bottom of the drug world’s food chain.

“The attitude has changed, and it's a positive thing,” he said. “We have family members or neighbors, relatives and friends who are suffering from this crisis ... Many of the police officers who lived out here on Staten Island, they were personally affected by the crisis.

“And they welcome a new approach. It's hitting their community, their family, their neighborhoods.”

The new normal is apparent in a variety of ways in law enforcement and beyond.

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— The Heroin Overdose Prevention & Education (HOPE) program launched on Staten Island this year to steer low-level drug offenders into treatment instead of jail.

— Quarterly meetings of the RX Stat Operations Group bring together 25 agencies — law enforcement, health officials, local and federal prosecutors and other groups — to the front lines of the fight. The participants compare notes and develop new answers to old problems.

The concept is similar to the COMPSTAT, a data-driven crime-mapping program that helped the NYPD drive crime to historic lows.
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"You can't arrest your way out of this problem," NYPD Deputy Commissioner of Operations Dermot Shea admits. (Howard Simmons/New York Daily News)

— Bronx addicts have access to drug testing strips, ensuring they don't get a surprise hit of the deadly fentanyl increasingly used to cut their heroin or other drugs.

A rundown of how the city is combating the opioid crisis

— A public service campaign will spread word of the state's Good Samaritan law, which allows anyone reporting an overdose (including the victim) to call 911 without fear of arrest.

— Advocates are waging a battle for controversial supervised injection facilities where active drug users can shoot up in a location safer than an alley or an abandoned building.

— Life-saving naloxone is available without a prescription at Walgreens in 33 states, including New York, in an effort to help stem overdoses. About 17,000 NYPD officers are already equipped with the opioid antidote, and the rest of the force will undergo training for its use. City cops saved 80 overdose victims last year on Staten Island using the medication.

The changing approach to opioid abuse comes in response to the sobering statistics in the nation's largest city. From 2000 to 2015, the rates of fatal opioid overdoses - including from heroin and pain pills - tripled across the five boroughs.

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The citywide death totals last year: 1,075 opioid-involved deaths, up from 753 the year before and more than double the combined number of New York homicides (311) and car wrecks (220).

The NYPD believes filling Rikers Island with addicts is not the solution.

“We want to make a distinction between the person that's bringing drugs in, polluting a community, versus somebody who's an addict themselves that's selling to support their habit,” Shea said. “Do we arrest that person? Absolutely, we do.

“But if we have to choose a case, we're going after the case that has a bigger impact. We don't want the drug kingpin, the El Chapo, getting diverted out of the system.”

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Dealing with the problem takes a village of agencies, part of the new approach to the vexing plague. The RX Stat meetings offer a wider range of suggestions and possible solutions, as folks from all sides of the issue share their thoughts.
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Faces of opioid addiction in the Bronx

The meetings are convened by the NYPD, the Health Department and the High Intensity Drug Trafficking Area (HIDTA) program - a federally-funded enforcement initiative run by the Office of National Drug Control Policy.

“In between, there are lots of small meetings,” said Susan Herman, NYPD Deputy Chief for Collaborative Policing. “Everyone’s coming together to save lives.”

Shea cited a pair of cases that underscore the difficulties of dealing with drug addicts who feel like they have no options when it comes to getting help.

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"We had a case where we interviewed somebody," he recalled. "A week later, that person was dead. We have cases where pregnant women, with their significant other - we respond, and he's dead. Same house, eight hours later - now she's overdosed."

The HOPE program is designed to change that dynamic. Drug possession suspects are offered a chance to get clean instead of getting a rap sheet. To be eligible suspects must be arrested for misdemeanor drug possession, provided they have no significant criminal history or outstanding warrants.

A peer coach is teamed with the defendant to steer the drug user to a local recovery center within seven days. If the defendant is determined to “meaningfully engage” in the program within 37 days, the DA declines to prosecute and the case disappears.

Through the first four months of HOPE, 155 Staten Island defendants were offered the option of entering the program, with 89% signing on for the alternative to prosecution. It's still early, but McMahon says that 95% of them are either done with the program or currently involved.

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Shea said the low-level arrests and prosecutions became part of an endless cycle where little if anything was accomplished.

“If you look at what happens on those arrests, no one goes to jail,” Shea said. “You can quote me on that: No one goes to jail. We're trying to break that cycle on our part - on that hamster wheel, continuing the same thing, arrest the same person five times in six months.

“What are we accomplishing here?”
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Bronx paramedic Robert Kelly has a daily firsthand look at the consequences of opioid abuse. (Marcus Santos)

The drug suspects can also provide information about dealers and provide drugs for analysis, allowing police to trace particularly lethal batches of heroin and make arrests. Shea gets a daily report on every drug sale arrest in the city, and the NYPD now investigates every overdose as a crime scene.

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“We've added and are in the process of adding more people in our lab to test all product from overdoses so that we know what's on the street,” Herman said.

Another issue is the increasing appearance of fentanyl, a drug 50 times more powerful than heroin, in other drugs like Xanax, cocaine and heroin. One-third of last year's 90 Staten Island overdose cases involved fentanyl, said McMahon - who expects that number to hit 50% as more numbers come in.

Even more powerful opioids are appearing. Carfentanil, used to tranquilize elephants, is 10,000 times more potent than morphine. It’s often mixed with heroin or other drugs. The similarly lethal synthetic U47700 - also known as ‘Pinky’ or ‘U4’ - comes in tablets or powder. It was linked by the end of last year to nearly 50 deaths, including at least 30 in New York state.

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Tino Fuentes was a heroin dealer back in the mid-‘80s, when the drug was so pure it was often cut with baby laxatives - a move that kept customers alive and provided the dealer with more product.

Fentanyl is now the choice for dealers to make their heroin supply last longer.

The reason is simple: Greed. Fentanyl is cheaper than heroin, giving the sellers more bang for their buck - and the users a potentially lethal blast.

“The dealers, really - it's a money proposition,” Shea said.

Heroin or fentanyl were responsible for 970 of the city's 2016 opioid overdose deaths, according to the Health Department.
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Tino Fuentes stands in front of the St. Ann's Corner of Harm Reduction in the Bronx where he was the director of syringe access program. (Anthony DelMundo/New York Daily News)

“Heroin users are getting drugs and they don’t know what's in them anymore,” said Daniel Raymond, policy director at the Harm Reduction Coalition. “The results are increasingly lethal.”

St. Ann’s Corner of Harm Reduction, where Fuentes was until recently the director of the syringe access program, has long provided testing for HIV/AIDS and hepatitis, and educational workshops and a variety of support groups.

Beginning in January, the center rolled out its latest service: distributing test strips to drug users in what was believed to be a first of its kind program.

Addicts could use the 6-inch strips, typically meant for urine drug tests, to find out exactly what was in their dope. A single line on the strip sends the warning signal: Fentanyl.

Fuentes ran a field test when the strips first arrived.

“On my own time, I went out to different spots and got heroin,” he said. “Out of six bags, five of them tested positive for fentanyl.”

Not every addict heeds the warning.

Vincente Estepa, 47, started using heroin two decades back when he was in his 20s. The Bronx man said some users, rather than dodging fentanyl, will go in search of heroin laced with the super-powerful opioid.

"Everybody wants to cop whatever's killing people," said the Bronx man. "It sounds crazy, but that's the way it is."

Brett Wolfson-Stofko, a John Jay College of Criminal Justice instructor and drug overdose researcher, is among those urging the city to go even further by establishing supervised injection facilities, known as SIFs, to provide a safe haven for drug addicts. Users can take drugs under medical supervision at such locations.
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Housing units at Rikers Island's George R. Vierno Center on Thursday, February 23, 2017 in Queens, N.Y. (James Keivom/New York Daily News) (James Keivom/New York Daily News)

The controversial facilities — two were recently approved to deal with the opioid crisis in Seattle — cut down on overdoses and the spread of disease, he said. The Washington state city reports an opioid overdose roughly every 36 hours, and would become the first U.S. city to open an SIF.

The plan is somewhat reminiscent of a memorable episode of the HBO series "The Wire," where a Baltimore police supervisor creates "Hamsterdam" — a designated free zone for the drug trade to operate.

Wolfson-Stofko, who has relatives battling addiction, specifically cites the increasing amount of fentanyl now sold in other street drugs as a prime reason for the facilities.

“As a society we habitually choose to restrict services for people while they're actively using drugs,” he wrote to the Daily News. “At the same time, we all agree that someone cannot turn their lives around if they're dead. There is an urgent need for services that keep people alive and healthy until they are willing to go into treatment.”

New York City Special Narcotics Prosecutor Bridget Brennan supports such measures as clean needle distribution and increased naloxone availability.

But those approaches do little to address the underlying crisis, she said.

“We can never expect those kinds of solutions to help us reduce overdose rates overall and decrease the number of people who are becoming addicted,” Brennan said. “To do that we really have to decrease the supply of addictive drugs on the streets.”

Some experts say attitudes about addiction need to shift even further if the opioid crisis can ever be contained.

“Historically, addiction has been seen as a moral failing so it’s been treated completely differently than other medical conditions,” said Dr. Chinazo Cunningham, a primary care doctor and addiction specialist at Albert Einstein College of Medicine and Montefiore Health System.

In Cunningham’s perfect world, many things would change. Two major shifts that she would like to see: More addicts treated by primary care doctors with enhanced training in treating addiction, and loosened restrictions allowing users to more easily obtain medications like methadone and buprenorphine.
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Kelly's medicinal toolkit. (Marcus Santos)

The result: less stigma, more access.

“We know from decades of research that medication-assisted treatment is the most effective way of treating this,” Cunningham said. “It’s not so different than treating high blood pressure or heart disease.”

Everybody involved acknowledges there's no panacea for the complicated crisis, even as they work toward live-saving answers.

How NYC's opioid epidemic plays out in the Bronx

“People who would have been arrested in an era before are not being arrested now,” Herman said. “Are they getting what they need? Are they getting treatment? Are they getting housing?

“What are they getting now that will keep them on the right path?” she says before her voice trails off. “We’re doing as much as we can, but ... ”

NYPD colleague Shea says there's no crystal ball where law enforcement can peer into the future and see the solution.

“I wish I could paint a rosy picture,” he said. “I can’t. If I was going to give you a time frame for the future - three months, three weeks, six months, we’re going to knock it down X percent - I’m not going to be able to tell you that today.

“I can tell you we’re doing a lot more and we have concrete plans.”