Dateline looks at the painkiller abuse that’s now reached epidemic levels in the US, and could also be heading for Australia.
Airdate: 
Tuesday, April 14, 2015 - 21:30
Channel: 
SBS

Staten Island in New York was the one of the first areas of modern American suburbia… now it has one of the worst prescription drug problems in the US.

For many it started with painkiller prescriptions for legitimate illnesses.

“It felt great, it gave me so much energy, if there was pain in my body, it went away,” Kayla Vitale tells video journalist Aaron Lewis.

“I suffer with scoliosis, I get back pains, and at first I kept using percocet as an excuse.”

But it quickly became an addiction and ultimately an opioid drug overdose.

“I died more than one time… every organ in my body failed,” Kayla says. “My heart, my liver, my lungs, my kidneys and my gall bladder.”

The easy availability of painkillers has left some questioning whether all doctors and pharmaceutical companies have been acting in their patients’ best interests.

“The most obvious culprit is big pharma,” New York’s Special Narcotics Prosecutor Bridget Brennan tells Aaron.

“They’re the ones who pushed it out, they’re the ones who sold the painkillers as non-addictive, they’re the ones who made the money on it, and they’re the ones who took over training doctors.”

A small number of unscrupulous doctors have seen the potential to make money and opened so-called ‘pill mills’… one was recently convicted of writing prescriptions for three million pills in less than two years.

“I knew people that were just going to doctors, multiple doctors, and getting crazy amounts of pills,” former addict Danny Haley tells video journalist Aaron Lewis.

“They pushed it out so much that it got so many people addicted to opiate drugs that it started an epidemic.”

Danny is now a rapper with the White Trash Clan. Their video for My World Is Blue, referring to the colour of oxycotin pills, made them minor celebrities on Staten Island.

But it’s taken years for Danny to deal with his addiction and find peace with his family.

“My family won’t talk to me when I’m using, I’m not a nice person to be with,” he tells the audience at an Addiction Angel support meeting.

Pill Overkill: Q&A with former addict
Former addict and now rapper with White Trash Clan, Danny Haley, answered questions on twitter during our Pill Overkill story - here are some of his replies.

And he’s not alone… the audience listens as recovering addicts, bereaved families and professionals give their own warnings about opioid abuse.

“This is two months of drug deaths,” one speaker tells the crowd holding up a long sheet of paper.

“They range in age from 60 to 16… I can’t pronounce the drugs that are on the death certificates, it’s that bad.”

Opioids now cause more deaths than any other drug in the United States, more than 16,000 in 2010, according to the US Centres for Disease Control and Prevention.

Staten Island has a drug overdose case every five days. Its death rate is three times the national average.

The active ingredient in opioid painkillers comes from opium fields like those in Tasmania.

The state produces the biggest supply of legal opium for pharmaceuticals in the world, according to the Tasmanian Farmers and Graziers Assocation.

Those same poppies when processed differently produce heroin. Painkillers based on oxycodone are very similar to heroin.

So when authorities cracked down on the easy availability of painkillers, heroin addiction quickly took its place.

Aaron finds that getting hold of heroin in Staten Island is not only cheaper than sourcing opiate-based painkillers, but as quick and easy as ordering a pizza.

The Drug Enforcement Administration shows Aaron photos of just some of the ways the drug is smuggled – from inside children’s toys and lollies, to an entire tombstone made of pure heroin.

Heroin-related deaths increased 84% from 2010 to 2012 in New York City.

Opioid prescriptions have also increased dramatically in Australia in the past two decades, according to the National Centre for Education and Training on Addiction.

And with US federal agencies saying a wave of heroin is headed for our shores, there’s now concern over whether the same could happen here.

Watch Dateline's program in full at the top of the page. This story later won a Silver Medal in the New York Festivals TV and Film Awards.

Addiction Help and Support

For help or information about drug addiction, contact the National Drugs Campaign or Narcotics Anonymous.

Anyone affected by the issues in this story and requiring help and support can also contact Lifeline on 13 11 14.

More

Blog: Who's responsible for the opioid epidemic?
In the last five months, there is a question that I’ve been asked over and over again – ‘Who is responsible?’ - writes video journalist Aaron Lewis.

Danny Haley and White Trash Clan recorded a special track for Dateline:

Find out more about the impact of addiction to prescription drugs in Australia, in this edition of Insight:

Accidental Addicts
This week we meet the everyday people who have become unwitting addicts.

The situation in Staten Island has also received coverage in the US press. Read some of the articles:

Related Links

Credits

Transcript

Staten Island is adrift - at the centre of America's prescription pain killer epidemic. Here the death rate due to opioid overdose is three times the American average. More people here die of a drug overdose than in a car accident. Young and old - rich and poor - all now considered at risk of becoming just another name on a death certificate.

MAN: This is two months, two months of drug deaths that we handle. Two months. They range in age from 60 to 16 - doctors and nurses, accountants, students, construction people, firemen.

Everyone in this room has been playing out their own rule in a cautionary tale about a manmade epidemic. A story about how harmless-looking little blue pill can tear even a small and tight-knit community like Staten Island apart.

DANNY HALEY, IN RECOVERY: It was just everywhere, you know, all these kids sniffing pills, and eating pills and shooting pills. It was just, kind of surreal, like. I couldn't believe like how many kids are up in the game over here.

REPORTER: How did it physically feel?

KAYLA VITALE, IN RECOVERY: Physically it felt great. It gave me so much energy. If there was a pain in my body it went away. I suffer with scoliosis. I get back pains and at first I kept using Percocet as an excuse.

REPORTER: Do you remember the first time you took pills?

MARCO DIDONNA, IN RECOVERY: Yeah.

REPORTER: Tell me about that?

MARCO DIDONNA:  2002. There was a fight, you know, a friend of mine got his teeth knocked out. I got hit in the head with a bat. I went to the emergency room, and Vicodin was right there. I went to my doctor. He gave me Percocet and then from there it was just off to the races. I put her through hell. I feel horrible but I can’t beat myself up over it either.

Like Marco and Kayla, many on Staten Island started taking opioid painkillers for legitimate means.

KAYLA VITALE:  Just because someone does it doesn't make them a bad person.

Then there are many others here who have been hooked since adolescence, having thought the first time, anyway, the pills were a bit of harmless fun.

DANNY HALEY:  I just wanted to try every drug, really. I remember at a kid thinking like, smoking pot and this is great. I want to try other drugs. I just want to try them all out.

REPORTER: How early did that start?

DANNY HALEY:  I was, I had smoked crack and PCP at, like, 14 years old.

REPORTER: What was that like?

DANNY HALEY:  It was fun. It was amazing. I loved it.

Danny arrived in High School just as the painkiller epidemic was breaking out. In the last ten years he's become the rapper known, ironically, as Anonymous. Danny and his best friend Gerard are known around Staten as the White Trash Clan, their cartoonish video for their track “My World is Blue’ the colour of Oxycotin pills, turned them into minor celebrities in Staten Island.

SONG: # Blue skies ahead # Are you with me? # Crushed a pill # Rainbow, sunshine # The kill is lifted # Painkiller, Staten Island...

DANNY HALEY: I knew people were just going to doctors, multiple doctors and getting crazy amounts of pills, you know, they pushed it out so much that it got so many people addicted to opiate drugs, that they started an epidemic.

Staten Island was America's first modern suburbia. It still has less than 500,000 residents, mostly Italian Catholic families that go back generations and everyone here knows each other. Monsignor Jeff Conway is a recovered alcoholic himself, who preaches about substance abuse.

MONSIGNOR JEFF CONWAY, SAINT PETER’S CHURCH:  I heard a voice that said, this is the stuff that's killing you, you don't need it any more.

He is often the first person anyone admits their addiction to. Father Conway says that the fact that everyone knows each other has not helped keep things under control. Just the opposite, he says.

MONSIGNOR JEFF CONWAY:  I think it makes it easier for people to get their drugs, for one thing because they know everybody and to know who is using and who is not using.

REPORTER: It's very fast to get drugs here?

MONSIGNOR JEFF CONWAY:  Very easy.

It's not just addiction that people are confessing to. It's also the things they're doing to feed that addiction.

REPORTER: What kind of crazy stuff did you do to feed the habit?

MARCO DIDONNA: Pawn my dead twin sister's jewellery. That's the only thing my parents have left of my sister. That's my twin sister. She was born with disabilities. The people at home are the ones that get hurt the quickest and most. They're the easiest targets. My son is not going to steal from me because he loves me. The addict's mind is, "My mum's the easiest target".

DANNY HALEY:  Right now I could be dead broke and I won't go to my mum's house and break in a window and steal things. When I was in active addiction it felt like I had to do that.

BRIDGET BRENNAN, SPECIAL NARCOTICS PROSECUTOR: As a prosecutor and a homicide prosecutor at one time I prosecuted cases where people have killed their loved ones because they stood between them and their drug.

REPORTER: Did you ever steal? Did you ever do anything you regret now - because most people have?

KAYLA VITALE: Yes. The reason a lot of people did a lot of drugs their first time, I've opened doors to people and I wish I wasn't the one who opened the doors.

Kayla and her friends could always get pills - opioid painkillers were being so over produced and over prescribed they were never hard to get, illegally or illicitly.

MARCO DIDONNA: When you go into the pharmacy, I was getting, you know, from one doctor, 180 Oxycontin, with insurance, they cost $3. There was no oversight. Zero oversight. If you go to another doctor, the easiest way is to go to a pharmacy and pay cash. I did that seven times - seven doctors, seven different pharmacies.

REPORTER: You don't mean you did that search times in total? You did that seven times a week?

MARCO DIDONNA: Seven times a week. Every Monday was doctor, pharmacy day. I did that for ten years.

JAMES HUNT, SPECIAL AGENT, DRUG ENFORCEMENT AGENCY:  Unfortunately there have been some professionals, pharmacists, doctors, who have entered into the illegal drug trade. In small numbers, they get overtaken by greed, doctors and pharmacies included, and they're in it for the money.

DEA Group supervisor William Tyrell is taking me to the site of one of the worst so-called pill mills located in Bronx.

WILLIAM TYRELL, DEA GROUP SUPERVISOR:  This is the location we surveyed for over a year.

He led a team which busted this medical clinic, where every day between 60 and 100 sudo-patients would come to pay for illicit opioid painkiller prescriptions.

WILLIAM TYRELL:  When I pulled up here, I was immediately like, this is what 100% pill mill, that really the worst of the worst, looks like.

These surveillance photos give an idea of how many people waited every day to see one crooked doctor operating out of this store front.

WILLIAM TYRELL:  This place would have 50-60 people easily on the side walk, cars double-parked across the street.

This single doctor, Robert Terdiman, was convicted of writing phoney prescriptions for more than three million pills in less than two years.

JAMES HUNT: I get the greed factor, the violence. We get all that. I don't get a doctor who went to medical school, who took an oath to help people and who is guaranteed to make a decent living, resorting to this. This is just unmitigated greed.

BRIDGET BRENNAN:  What we know in narcotics prosecutions is that the bigger the supply, the bigger the demand. So the more of those addictive pills there are out there, the more addicts there are going to be.

But it wasn't just crooked doctors prescribing all these pills. In many cases it was a doctor who was just in too much of a hurry.

DOCTOR WILFREDO VELEZ, PHYSICIAN: You might be able to see a patient in five minutes in a busy practice, in and out and I’m afraid some of my colleagues, we didn't want to spend that time. It is important.

MARCO DIDONNA:  I had seven doctors. One said basically that Oxycontin - is this a bandaid? It's not going to solve the problem. That was the first time when I met with him. Nine years later he's still prescribing them to me.

I spoke with highly respected doctors who were surprised that patients have reported experiencing opiate withdrawal after a regular 30 day prescription.

DANNY HALEY:  If you are going to take these pills for a month, say you get a monthly prescription, your body is going to get addicted to it and you will have physical withdrawals. They should come off the bat and say this. This is what is going to happen.

The active ingredient in opioid pain killers comes from here - the opium poppy fields of Tasmania, which farm almost half of the world’s legal supply of opioid derivative. These are the same poppies, when processed differently, produce heroin. Part of the problems is that in America a great deal of what a doctor knows about the medicines they're prescribing comes directly from the pharmaceutical companies that make them. The advantages of a product are aggressively marketed while too often the risks of the drug are merely mentioned, contributing to the alarming over-prescription of the best marketed painkillers.

BRIDGET BRENNAN: The most obvious culprit is big Pharma. They are the ones who pushed it out. They are the ones who sold the painkillers as non-addictive. They're the ones who made the money on it. They're the ones who took over training doctor so that we now get a 30-day supply of Percocet for a toothache.

DOCTOR WILFREDO VELEZ: You often see patients who require narcotics for their day-to-day care. It is difficult for us to discern whether it's something that they truly need still at this point or something that they may be misusing or abusing. We come upon that issue almost on a daily bases.

JAMES HUNT:  All that needs is one dealer's marketing is differentiated from another dealer's. They put marks on the bags.

In 2013 New York law-makers took action. They introduced a program called iStop, to track prescribing across all doctors in real time.

DOCTOR WILFREDO VELEZ: Before we prescribe we have to check a website to make sure this patient has not previously received it from another provider a week ago, two weeks ago. More importantly, the patients now know that.

MARCO DIDONNA:  Since the pills were hard to get, so that means the price goes up, you know - Supply and demand. The easier thing to get was, in my eyes, heroin - cheaper and it was more easily available. All the pill dealers became heroin dealers.

That is when the pill epidemic became a heroin epidemic and things went from bad to worse.

GERARD KELLY aka INCITE, MUSIC PRODUCER: Here in Staten Island it's an epidemic. You know.

REPORTER: How easy is it to get drugs?

GERARD KELLY: Very easy.

REPORTER: How easy?

GERARD KELLY: Too easy. Pick up a phone or...

REPORTER: You told me that it's as easy as getting a pizza?

GERARD KELLY: Absolutely.

So I should haven't been surprised when a few minutes later a car pulled up outside and I was called over to the window. Like almost all opioid addicts on Staten Island, Gerard started with pills and is now hooked on heroin.

GERARD KELLY: You see, when I'm high, I'm happy. When I'm not high, I'm suicidal, or I'm like, I don't get fucked up and then I'm like I want to kill myself, I'm happy when I'm high, you know?

BRIDGET BRENNAN:  We saw those who were addicted to the pills shifting over to heroin, because heroin is a lot cheaper. There is a huge supply of heroin that is coming up into the United States from Mexico, frankly more than we've ever seen before.

JAMES HUNT:  This is actually a prosthetic leg that had 1200 grams of heroin smuggled into the country in it.

All of these are real smuggling containers for heroin, all from actual DEA busts, from suitcases to lollypops, to tombstones made of pure heroin, all smuggled into a market primed by the opioid painkiller epidemic.

BRIDGET BRENNAN:  Those who have defined heroin and are distributing heroin are piggy-backing on that addiction.

This is the sight of a recent DEA heroin bust. This kind of volume is something that Australian authorities are now being told to expect. Opioid prescriptions have tripled in Australia in the past 10 years and US federal agencies say a wave of heroin is headed for Australia's shores. On Staten Island the move from pills to heroin came with surging rates of overdose.

KAYLA VITALE: I died more than one time. They had to actually put a pacemaker on my heart because my heart would not work on its own. I ended up in a coma for three weeks. Every organ in my body failed - my heart, my liver: my lungs, my kidneys and my gall bladder. My friends said I woke up screaming that I couldn't see and I couldn't hear. Unfortunately I am now blind in my left eye and deaf in my right ear and I have severe hearing loss in my left ear.

DANNY HALEY:  You ask anybody on Staten Island if you know someone that overdose, recently they know somebody.

A year ago Johnny Crupi died of an overdose right here in this room. His parents, Candace and her husband, Barry Crupi, were both home when it happened.

CANDACE CRUPI:  I was watching TV and he came in and gave me a kiss on the cheek and he went to bed and then the next morning I woke up and he was dead.

BARRY CRUPI:  He had a bag of heroin - he had one bag? I don't know.

CANDACE CRUPI:  He had a bunch of bags stuck under him.

BARRY CRUPI:    We didn't find any needle.

CANDACE CRUPI:  These are from the funeral.

Many families try to hide the fact of an overdose but the Crupis were proud of their son's long struggle to get off opioids, even as he slipped from pill addiction to heroin and finally to overdose.

BARRY CRUPI:  I don't think my son ever would have went straight to heroin, I don't think any of these kids will go straight to heroin. They're taking these pills, they think there's nothing to them, they're prescription pills, so they feel that they're safe. They take them and then they have to take more and more and more and they get too expensive and they go to the heroin. Once they are on the heroin, it's very hard for them to get off it.

As the scale of Staten Island's opioid problem comes into sharp relief, people are starting to come out from behind closed doors. Tonight Alicia Reddy has organised a community support meeting for more than 500 Staten Islanders. Danny, Kayla, Marco and Candace are all here. Everyone here has come looking for help or willing to help, including dozens of recovering addicts. They stepped forward to offer real-life warnings about opioid abuse.

WOMAN: Every 5 days in Staten Island, somebody is overdosing from opiates.

Candace Crupi is asked to speak about her son's passing.

CANDACE CRUPI:  He had dreams just like everybody else. There’s no yay at the end of Johnny’s story because he didn’t make it, he died last March.

BARRY CRUPI:  The pharmaceutical companies have to know that all these pills aren't going to people with those symptoms. I mean, all of a sudden there's a rush like that for these pills? They just keep pushing them out and pushing them out. I mean it's their bottom line. They're making money and that's all they're concerned with.

While many opioid painkiller manufacturers refused to reply to the question of responsibility, Perdue, makers of Oxycontin, did provide some answers in writing. They say they take the abuse and misuse of opioids very seriously. Perdue are a leader in what's called abuse deterrents, making pills harder to crush, snort or inject, as well as creating extended release formulations to minimise the chances of overdose.

However abuse deterrents don't make opioid painkillers any less addictive. They don't make opiate withdrawal any less severe. In fact, many of the next generation of abuse deterrent pills contain even more opioid pay load, as much as 24 times that of a single Vicodin pill.

Perdue maintains their products are critical tools for pain management and that the responsibility remains with the doctor and patient to manage the serious risks of use, including the risk of addiction. Many people, including within law enforcement, have said that does not go far enough.

BRIDGET BRENNAN:  I would like to force them to wake up and understand and acknowledge the significance of the harm that they have caused and to fix it -to try to fix it.

Danny Haley knows just about everything there is to know about drugs on Staten Island, including how to escape them.

DANNY HALEY: I'm also a magician.

He's had a substance abuse problem since he was a child. Technically he's a polyaddict, but Danny just calls u himself a junk box junkie.

DANNY HALEY: That was fair, right?  I was smoking crack, heroin, methadone, Xanax, Adderall, PCP, drinking liquor, all the same shot. It's never enough for somebody like me, you know.

Amazingly, Danny managed to get off all of that and he's been clean and sober for the last year-and-a-half.

DANNY HALEY:  That's the end of the card trick.

He's writing a new track about his recovery.

DANNY HALEY: It's coming along sick.

SONG:  I'm clean right now, I got my whole hood proud. I got the good sound rocking. So... I sold my soul to the devil and the price was cheap.

The track is about how it took him overdosing twice in a single day to start his recovery.

DANNY HALEY: I was in a hospital. The doctors had to bring me back to life. I woke up, four days later, I was in a coma for days. The doctors told my parents I would be brain dead for the rest of my life. They were shocked when I woke up.

PAUL HALEY:  I came to the hospital and he had tubes down his mouth and his nose and it was just by the grace of God that he indeed did survive.

And that view of Danny in the hospital bed was Paul's first view of his son in years. Paul had long since told Danny that he wasn't welcome as long as he was using.

DANNY HALEY:  Hey dad, how are you?

PAUL HALEY: Good to see you.

Paul Haley is also a recovered addict, having generations of substance abuse is pretty common in Staten Island. With both of them sober, they're closer than ever.

REPORTER: Are you proud of them?

PAUL HALEY:  Indeed. Absolutely, yes.  My other two daughters have graduate degrees from major universities. However, I'm more proud of Daniel and him being in recovery.

DANNY HALEY:  My family won't talk to me when I'm using. I'm not a nice person to be with. Now my family is back in my life... I went from 18 months ago I'm on my bathroom floor in a foetal position crying because I'm so miserable. I wanted to stop but I couldn't and here I am, I got tears of joy coming out my eyes, you know. So thanks for everybody, you know, if anybody is struggling right now, people of the people standing here, we'd be glad to help them, anybody else in that situation now. Thanks.

Just before Danny got sober, he wrote a track called Bottomless Pit about just how low he had sunk. Danny is a self-proclaimed junk box junkie who died twice in a day and still managed to climb out of that pit. So he means it when he says call him. If you need some help doing that, too.

 

Video Journalist
AARON LEWIS

Story Producers
AARON THOMAS
CATHERINE SCOTT

Camera
AARON LEWIS

Associate Producer
CALLISTE WEITENBERG

Editor
AARON LEWIS

14th April 2015