[suspenseful music] - This neighborhood is very drug infested.

There's a lot of heroin, K2, fentanyl and xylazine.

- [Simon] Alebert Aponte is a recovering drug addict.

He spent years using and dealing drugs in abandoned buildings in the Bronx, and eventually went to jail for 12 years.

- All right, let's get the show on the road.

- [Simon] Now he works at the Samaritan Daytop Village treatment center, walking the same streets he once to used on, trying to convince addicts to get clean.

Several times a week, he and his colleagues set up in front of the local Burger King.

- Good morning.

- Good morning my brother.

How's everything?

Okay.

Go in.

- Alebert and his team are fighting an uphill battle.

In 2022, there were over 6,300 opioid overdose deaths in New York State, setting an all-time record.

While other neighboring states like New Jersey and Connecticut are seeing their numbers decline, New York's are getting worse.

We're in the South Bronx and this is really the epicenter of the opioid epidemic in New York City, and maybe even the country, because they say that "If the Bronx was its own state, it'd be the number two for overdose deaths after West Virginia."

And we're here with some volunteers who are handing out naloxone kits, which are really saving a lot of lives.

- So this is, what is naloxone, right?

This reverses the overdose.

Only works for opiates.

So it's safe if somebody's having a seizure, which sometimes it confuse it for an overdose, if you shoot 'em up with this up their nose, it's not gonna do anything to them, it's not gonna harm them, you know.

If they are overdosing, this will reverse it and it'll bring 'em back.

They're gonna be pissed off because you just blew their head, you know?

But they don't see it that they were literally dying, you know, and you just saved their life.

- [Simon] So, these packets you hand out to users here on the street?

- Everybody, even non users.

- Users and non-users.

- Okay.

- Students, parents.

- You can save a life.

- Same thing with the xylazine test strips and the fentanyl test strips.

So what we do is once we see that they're getting [indistinct], and they don't know what they're using, we tell them to test their product and consider not using it, or to use very safely.

Never to use alone, carry naloxone, and try to use new syringes to prevent the spread of diseases.

- [Simon] Naloxone, also known as Narcan, is the main line of defense against the increasing overdose rate in New York.

It's become a critical tool now that the opioid drug supply has become flooded with fentanyl, the cheap, synthetic opioid that many users don't even realize is in their drugs.

- So right now we're in the Northeast Regional Laboratory.

- [Simon] This is special agent Frank Tarentino who runs the New York division of the Drug Enforcement Agency.

He sees his number one job as getting fentanyl off the streets.

- The drug landscape's far different than it's ever been before.

It's deadlier than it's ever been before.

Experimentation is really not an option.

When you're using drugs in today's drug environment, you're really playing with your life.

I mean, you're gonna run a high risk of dying.

- Could you break down for our viewers just how dangerous fentanyl is?

- It's what's killing the majority of Americans today.

In fact, the highest cause of death today in the United States is fentanyl.

- Not car accidents?

- More than car accidents.

More than COVID-19.

More than gun violence.

So more Americans are dying between 18 and 45 from fentanyl poisoning.

- [Simon] This is what fentanyl looks like.

Millions of doses confiscated by the Drug Enforcement Agency.

- And this is a lethal dose.

And if you can see very faintly at the bottom of this canister here.

- Yeah.

- This vial, you see a white powdery film.

- Yeah.

It almost looks like there's nothing in there.

- Right.

- And that's enough to kill a person?

- This is a lethal dose of fentanyl.

We're talking about two milligrams that can fit on the tip of a pencil.

It's 10 to 20 grains of salt poured on your kitchen table.

It's the most lethal drug we've ever seen.

It's 50 times more powerful than heroin.

It's 100 times more powerful than morphine.

It's the most addicting drug on the street today.

And when you take this drug and you mix it into all these other drugs, like cocaine and heroin and methamphetamine, then you are essentially making a poison that's killing people.

And they're killing people in an unsuspecting, deceitful way.

- [Simon] When dealers secretly mix fentanyl into so-called party drugs like cocaine or pills, it becomes especially dangerous, because people who take drugs socially on a night out don't have the same tolerance level as regular opioid users, they run a higher risk of overdosing.

But even if they don't overdose, they face the danger of inadvertently becoming addicted to fentanyl themselves.

- And I'm really grateful to you all for being here today and learning.

Yeah, thank you so much.

And learning how to use naloxone and reverse an overdose.

- [Simon] Things have gotten so bad, New York City has spearheaded a campaign to stalk every club or restaurant with an overdose prevention kit that has naloxone to try to make it a safety mainstay, like a fire extinguisher or CPR training.

- Narcan is a brand name for naloxone.

So it is the ping pong to naloxone's table tennis, the Kleenex to naloxone's tissues.

So it's just the name for the nasal spray formulation of the drug called naloxone.

And if you want to get Narcan, you can visit nyc.gov/naloxone, and there are tons of resources.

- [Simon] Any venue in New York can request a training session like this one for its staff.

City officials want businesses to feel that stocking naloxone won't mark them out as some kind of a drug den.

- So, what are some examples of some opioids?

- Percocet.

- Percocet, oxycontin, heroin.

- Fentanyl.

- Fentanyl.

Yeah.

Opioids is a huge class of drug that encompasses a lot of different things.

Place your thumb on the side so you don't accidentally press down on the plunger.

Then you wanna put the device inside the person's nostril so that your fingers touch the bottom of their nostril.

Then you wanna press down firmly on the plunger releasing all the medication at once.

So we don't wanna test the plunger, we don't wanna prime it, 'cause all the medication releases at once.

All right, so those are the steps.

Peel, place and press.

Thank you.

[learners applauding] - Maya.

I used drugs for 25 years.

And I sold drugs for 20 years.

And I was always in and outta jail.

And I got sick and tired of being sick and tired.

The day after tomorrow I celebrate 20 years in recovery.

I like this side of the fence better than that side.

- [Simon] The other side.

- Take a card.

You hungry?

You want a sandwich?

- Yes.

- [Simon] Alebert visits this small park in the Bronx several times a week to hand out food and supplies to the homeless.

- Here you go.

- [Simon] This is also where he tries to convince users to go into treatment.

- I always say that you can lead the horse to water, but you can't make him drink.

- Sure.

- But you can hold him there till he gets thirsty.

- [Simon] That persistence pays off.

After weeks of conversations, one man, Ramon Cruz, has finally decided he's ready to try to break the cycle of addiction.

- You wanna go to detox?

- I want to go.

I want Johnny to pick me up.

- So you wanna go to detox?

- Now.

- When you wanna go?

- Now.

- Right now?

- Right now.

- I'll call him to come pick you up.

- Johnny?

- Yeah.

- And do the people out here that you're working with, do they know about your history?

Do they sort of connect with you on that level?

- Alebert and I, we self-disclose.

- Okay.

- We let them know.

- Yeah.

- Some of them, we've done time together, we've done bits upstate, you know.

- [Simon] Wow.

- I know them from the streets.

- [Simon] Do you know what kind of drugs he uses?

- Heroin.

Yeah, yeah.

He's a old-timer from the neighborhood.

And I've engaged with him other times and I'm glad that he decided to go.

- [Simon] Ramon comes back with his suitcase and his best friend.

Alebert is hopeful that today he'll be able get not one, but two people into treatment.

- He just wants to smoke his little butt that he got left, you know?

- He's got that dope he wants to use.

- And he's trying to convince his friend to go with him.

- It's how you survive.

But you can see- - But you need someone else to watch you.

- He's telling you do this for you babe, you know?

- He loves you.

- It's an emotional goodbye as Ramon takes his first steps towards recovery.

This is how getting people off of drugs in New York actually works.

They have to do it person by person, one person at a time.

We just saw these peers come out into a park and try to encourage two people to come to the recovery center with them.

And only one of them decided to go.

But one, they said, is better than none.

- Thank you, Johnny.

I really appreciate you.

- [Alebert] This is Jesus.

[indistinct crosstalk] - [Simon] So what's gonna happen next?

- So now he'll go into detox and before he finishes the detox, he said that he wanted to go to rehab and then long-term treatment.

- [Simon] Well, today you led the horse to water.

What are your expectations?

- I learned not to put expectations on nobody, right?

Every individual is an individual, and they make their own decisions, you know?

- [Nurse] Thank you.

So you okay?

- [Patient] Yeah, [indistinct].

- Do you mind just sort of quantifying the crisis for New Yorkers?

- Yes, so our last numbers for 2022 was at over 6,300 New Yorkers died of an overdose.

- Wow.

- So that's about one person dying every 90 minutes.

- [Simon] Dr. Chinazo Cunningham is New York's Commissioner for Addiction Services and the woman leading the state's substance abuse response.

- This is the worst we've ever seen on record.

And that's why we really have to do things differently.

We have to embrace harm reduction, which really focuses on keeping people alive, and reducing the harms associated with substance use.

And we need to make sure that people have access to effective treatment.

And so really bringing the treatment to where people are and reaching those who are at highest risk is now more important than ever.

- And why is fentanyl so dangerous?

- It would only take a really, really small amount for somebody to die.

And it essentially works in that it reduces the drive to breathe so people stop breathing and that's how they die.

- The overdose rate in New York State and New York City is through the roof.

It's going up and it's been going up for years.

At the same time in neighboring states, like Connecticut and New Jersey, the death rate for overdoses has been going down the last couple of years.

What is it that makes New York so much worse?

- Simply put, it's a destination city.

This is the hub, this is where all the drugs come to for further distribution throughout the United States, most likely into the Northeast Corridor.

And this is where the drug cartels are making their logistical hub to further distribute to areas like New Jersey and Connecticut and Philadelphia.

So it goes both north and south and it's fentanyl.

And fentanyl is the most urgent and deadliest threat we have ever seen in law enforcement, and certainly in the DEA.

We're removing a lot of the supply that's on the street today.

Last year alone, we seized 2,000 pounds of fentanyl powder and two million pills.

We seized almost 65 million potential lethal doses here in New York City and throughout the state.

That's saving lives.

[peaceful music] - [Simon] Sam Rivera is something of a rebel.

[peaceful music continues] But it's not the tattoos or the biker gear or the motorcycle he rides to work.

It's his radical commitment to bring harm reduction to New York as his way to save lives.

Advocates of the harm reduction approach believe drug use is a health issue, not a law and order issue.

- How you doing?

You doing okay?

- I got treatment- - Did you get treatment today?

- Yes.

- Good, good.

You feel better?

I can feel it.

I can feel it.

- Sam runs OnPoint, a safe drug consumption site in New York City.

Is this facility unique for the United States?

I've read that it's the first safe injection site in the country.

Is that right?

- First two.

Yes, we have two.

And we really get to prove how this is an important part of healthcare.

I mean, this is what it is.

We have a health crisis.

We don't have people who come in here and use drugs, and feel high and feel good.

They're literally coming in to feel manageable.

- Yeah.

- To get to a place where they feel good enough to even function.

- [Simon] Users can actually bring their own drugs here and shoot them in front of trained monitors who watch to make sure no one overdoses.

In the two years it's been open, they've reversed 1,200 potentially-fatal overdoses.

- If they're going into an overdose, we respond immediately with our crash carts, all this information, how we respond.

As you can see, we have oxygen at the ready.

Again, the goal is to remove enough of the opioid off the brain so that they can breathe and function on their own.

- [Simon] Monitors stand in the middle of the room and use mirrors to observe as many as eight participants using drugs at a time.

When a participant starts to nod, that's when the monitor needs to make sure everything's okay.

And if it's not, they administer naloxone on the spot.

- Even if there's breathing, you wanna check and make sure the person is responding.

They make a decision on if it's time to respond to the overdose, they go into action and decide what's the next step.

- I went in this place about a month ago and I never play scratch.

I bought a $3 scratch-off, won 500.

- [Simon] Patrick Considine is a regular at OnPoint.

- I never heard of fentanyl until a few years ago.

And they advertised it on the walls in here as being 100 times stronger than heroin.

There are guys now that want fentanyl.

They don't even want, if you had dope, heroin, and fentanyl, they'll say "Gimme the fentanyl," 'cause it's cheaper.

- [Simon] He says he's been using drugs for years, but that now he only uses at OnPoint.

- When I walked in here, I was flabbergasted.

I said, "What the hell?

This is all legal?"

I never even knew it existed.

They did save my life here once.

You don't remember when you overdose.

It's like you take a nap and you wake up and somebody has to tell you, you know, "Relax, relax.

You're okay now."

But I had overdosed.

That was the one and only time.

But if I had not been here, I might not be here, you know?

- [Simon] These track marks are new.

Patrick says they were caused by xylazine, an animal tranquilizer that's now turning up in heroin in addition to fentanyl.

- I have more than one.

There's one there, that's a few months old.

That's a few months old.

This one's the oldest.

That one, 'cause for a while I was using my hand 'cause I could get to the veins.

- [Simon] How long you've been using?

- I've had enough of it too.

It's been so long that I don't get euphoria anymore.

All I get is not being sick.

So the only time I really do a shot is when I'm here and I let one of the staff assist me because my veins are difficult to get.

So you know, I do it that way.

But I may go around the block and I may buy two bags of this so-called heroin, which I know they test drugs here every Tuesday.

- [Simon] Patrick is talking about a special program at OnPoint where users who aren't sure what's in their drugs can get them tested before injecting or smoking.

The City of New York funds four other drug testing sites around the city too.

- The participant said that the sample felt really strong, so they wanted to get it tested.

- [Simon] Yarelix Estrada works for New York City operating this machine which tests the drugs.

- So in this sample we have somewhere between 13 to 16% fentanyl.

But also taking into consideration that the sample has heroin, it has xylazine, the other things are inactive.

But the combination of those three things would lead to a potentially intense reaction which the person described as having, or it was a really strong reaction for them.

- [Simon] And what's the percentage of heroin in this sample?

- [Yarelix] This has about 23 to 28% heroin.

- [Simon] What would you say to people who are like, "Well, why is the city doing quality control on drugs for people who are using illegal drugs?"

- Mm-hmm.

- "Instead of, you know, shutting it down?"

What would your answer to them be?

- Yeah, so when I first got involved in harm reduction in around 2015, we had somewhere around 50,000 deaths that year across the country.

And as of April of 2021, we had over 100,000.

And I think the shutting it down approach has led us to being in this place where in less than a decade we've doubled the amount of overdose deaths that we've had in such a short period of time.

- [Simon] Sam thinks overdose prevention centers, or OPCs like OnPoint, have to be part of the solution.

- So fentanyl is right now the number one killer.

Anytime it's been over 18, 19%, almost every person who used overdosed, but our team was there to respond.

So it also created a space or creates a space for people to come in and know fentanyl's getting really dangerous out there, I better use it in OPC or I won't be alive.

That's the most crucial response right now, which is why it hurts to know we don't have many more OPCs around the country because we're losing people that don't have to die.

- [Simon] Even with all the protections at OnPoint, Patrick is still afraid his addiction is going to kill him.

- I wasn't afraid of anything until I saw, not the fentanyl, but the xylazine.

When I saw on myself, I had shot three shots on my leg, and from the point of injection, three inches in either direction, it was this long, and it was black and it was hard.

And I thought to myself, "If that's happening," and I didn't miss the vein, "If that's happening to a vein that I entered, what else is this stuff doing to my heart and the rest of my body?

Yeah, it scared me.

I definitely think this stuff is killing people and I don't wanna be one of them, you know?

- [Simon] Even though Patrick believes OnPoint is the reason he's alive today, he says he understands why it's not popular in Harlem, a mostly Black and Brown community.

- There's pros and cons to this place.

One of the pros is it keeps all of the people that are doing drugs and smoking crack, it keeps them in one spot, away from the public.

If you close this place, they're not stopping.

The one thing that did surprise me is that, it was, I guess a catch-22.

If you walk out the door here and look straight across the street, there's a children's daycare center.

You would not see that in any, and this is, what you wanna call it, racial or anything, you wouldn't see it in a White neighborhood.

you wouldn't see it in a Jewish neighborhood, Italian, you wouldn't see it anywhere else.

But they stick it here because you know, politicians, it's just The Projects.

- [Simon] Patrick, how old are you?

- I'm 58 and I look a lot older because of these drugs, you know?

- OnPoint doesn't just offer supervision for people to safely use their drugs.

It also has a medical team so people can see doctors and even an acupuncture clinic.

But all of that's under threat because of the Crack House Statute, the federal law making it illegal to maintain a property for the purpose of using controlled substances.

In Manhattan, DA Damian Williams threatened to close OnPoint in 2023.

The US Attorney's Office said that you're essentially operating an illegal operation here and you should be shut down.

What do you say to that?

- This is a health emergency in the United States averaging 110,000 overdose deaths in this country.

And politicians are deciding whether or not health officials should address it.

Messages I received as a result, even from people in law enforcement, saying like, "Listen, we see you, we know what you're doing.

We appreciate what you're doing."

- So you're not at all worried that this is gonna lead to you going to jail, for example, as the ringleader of an operation.

- Wouldn't be the first time.

[Sam laughs] No, I'm not.

I'm not worried about it.

And I made a decision, Simon, that if that's what it came down to, then.

My family knows I love these people.

Try not to get emotional.

Yeah.

- It's worth it to you.

- It's worth it to me.

I coined a phrase here where we love on people until they're ready to love on themselves.

And if it means that someone's gonna come in here and arrest me for loving people, and helping to keep them alive, then I guess that's, like you said, it's a risk, definitely a risk I'm willing to take.

- But leaders in law enforcement, like DEA Special Agent, Frank Tarentino, are skeptical that harm reduction can manage the problem on its own.

And the harm reduction folks that we're talking to come from the position that people are gonna use anyway no matter what we say.

And so that if they are gonna use, then we should create an environment where it's safer for them to use.

- I think it's just not okay to use right now because of fentanyl.

It's just not safe.

Fentanyl is not easily detected.

If somebody's just gonna scrape off a little piece and test it with a fentanyl test strip, there's a high likelihood that they missed a hotspot in that pill that is lethal.

So it's not safe to use this idea that fentanyl test strips is the answer.

Experimentation is far different.

It's too dangerous.

Every single drug today on the street is likely to have fentanyl in it and it's gonna kill you.

- Bridget Brennan, New York Special Prosecutor for Narcotics, pioneered a program offering treatment to qualified drug-addicted defendants.

She told us the city's support for OnPoint puts it at odds with the state and the federal government.

The safe injection sites in New York exist in a sort of legal gray area.

Do you- - It's not really gray.

- Okay.

Well, what is the situation?

- Well, they're not legal.

They are illegal, both under federal and state law.

But they're being allowed to exist.

- Well, when you say "They're being allowed to exist," in a sense, you're allowing them to exist, right?

- I guess I could send my investigators out to shut 'em down, but that would not be something I would do.

To me, the city's gonna make a determination and the state's gonna make a determination, the federal government's gonna make a determination of how that's gonna go.

I don't really view it as up to me.

In fact, I don't view it as my responsibility or something I actually should do.

- [Simon] Back in the Bronx, Alebert Aponte is mentoring a session for recovering drug users.

It's been a couple of weeks since we saw him pull Ramon Cruz off the street and check him into detox.

If Ramon completes his detox and gets through rehab, he might need the support of a group like this one to stay clean.

- Tell us what you were saying before, about how that helped you in your recovery.

- Because now I don't smoke crack no more.

Know what I'm saying?

I'm still on methadone.

I'm only on five milligrams.

You know, that never was my drug of choice.

But I'm going on nine years clean.

I'm learning a lot thanks to this program.

You know, I've been, what?

Going on 13 years now.

They do more for me than my own family, you know.

- Mm-hmm.

That's right.

- And I consider this program as my family, come every day.

I don't have to, but I choose to come every day, because this program's keeping me clean, you know?

It's really keeping me clean.

- [Simon] That's good.

That's good.

- [Alebert] I'm glad that you got a good peer support network.

- Yeah.

- I see the way you'd be interacting with everybody else, you know.

- [Simon] Ramon is doing detox with another organization, but as far as Alebert knows from an acquaintance who works there, he's still in treatment and doing well.

Alebert's hopeful he'll be able to find out more about his condition if and when Ramon checks out.

Carlos Ramos is one of Alebert's recent success stories.

He's been in recovery since April.

- I like to come here every day.

I come here Monday through Friday.

Sometime when I finish my group, I stay here, you know, until I get a little tired and I just go home.

But the fentanyl, it keeps me off my heroin choice, 'cause I used to love it, you know?

But now I don't even think about it.

- We use contingency management, where we reward changed behaviors that promote recovery, you know?

And they're two of our shining stars.

- Despite the best efforts of nonprofits like OnPoint and New York's overdose deaths keep breaking new records every year.

While in neighboring states things are actually getting a little better.

Take Connecticut, which saw a decline of nearly 5% year-on-year.

Or New Jersey, which recorded an even sharper decline of almost 7.5% in 2022.

Things are still pretty rough though.

Nearly 2,900 people died of an overdose in New Jersey.

[sirens blaring] [upbeat music] New Jersey's overall overdose fatality rate is going down.

But here in Camden, it's actually still going up.

So the university hospital system here has come up with a new program to try to change the situation.

We're following an ambulance crew today to see how that works.

[sirens blaring] We get our first call of the day.

A man has been found unconscious behind the Speedway gas station.

- Turn him over.

- Hey, bud, how you doing today?

You okay?

- [Eric] There were times where we could see an overdose at the beginning of our shift and then see them again before we left for the day.

- [Simon] The EMTs here offer overdose victims a drug called buprenorphine, also known as Suboxone, which is usually used like methadone to help regular users stay off of opiates.

- Once the patients have the buprenorphine on board, they are staying sober now for the next 24 hours.

And it might give them the ability to make better choices and actually get into treatment.

This gentleman, he didn't qualify for pre-hospital buprenorphine.

I think buprenorphine can benefit him, but it's gonna have to be done in the clinic.

- Traditionally you overdose, someone calls 911, hopefully, EMS shows up, they breathe for you, they give you a medication called naloxone, which reverses your opiate overdose and helps you breathe again.

And then that was kind of the end of the playbook.

We could offer you a trip to the emergency department where they may or may not have care options for you, or we could release you back into the public.

And more and more people were taking the second option, of just going back out on the streets, to either use or whatever else they were gonna do.

- How are you?

[indistinct crosstalk] - [Simon] Dr. Gerard Carroll, who works in Camden for Cooper University Healthcare, became frustrated with the situation where he was seeing the same overdose patients brought in again and again, and feeling like there was nothing he could do.

- When you overdose and we give you naloxone, there's this awful side effect, we often precipitate withdrawal, right?

When people are dependent on opiates, not having them makes them physically sick and mentally even worse.

And it's really a huge motivator and miserable part of the experience of addiction.

And we thought, "Hey, we can treat this withdrawal, and get you onto care."

- [Simon] Dr. Carroll's idea was simple.

After reversing an overdose, why not offer patients the suboxone, a safe, synthetic opiate to deal with the effects of the withdrawal, in order to put patients in a state of mind where they could consider going into recovery, instead of desperately seeking their next heroin dose.

- Can you hear me?

- It's been really amazing watching these EMT crews work because we've been following them on call after a call.

An overdose has happened every couple of hours, and so far, I don't wanna jinx this one, but they've been able to revive every single person that they've dealt with.

Paramedics can't just administer suboxone, they have to get consent.

And that in itself is a challenge because most users aren't exactly thinking clearly, and they don't always know what the medication is, or how it can help them.

- So at that point it's really like kinda game on for our paramedics.

This is a new skill, and it's not just doing, it's selling, right?

And it's a weird word, but you have to convince someone that you're there for them, and this is a stigmatized group that has not been done any favors in the healthcare system, so there's a lot of distrust.

And I have to convince you in that short period of time that "Hey, you're probably starting to feel lousy.

I think you're gonna feel worse.

I can make you feel better."

And I have to explain all of that.

- We're taking you over to the hospital, okay?

[patient mumbles incoherently] - Where they give you some Narcan.

- Mm.

- You look like you're in withdrawal.

Do you feel like you're in withdrawal?

- Mm.

- Yeah.

Have you ever heard of suboxone before?

- Mm-hmm.

- Do you use it?

- Yeah.

- Yeah?

Okay.

Do you want some right now?

- Mm-hmm.

- Yes?

- [Simon] Even on the best of days, it's hard for an opiate user to choose to go into rehab.

But after an overdose, the withdrawal symptoms are just unbearable.

The suffering this patient is experiencing, it's hard to watch.

[patient groaning] So you start to understand how little hope there is that someone going through this is going to then go into a program cold turkey.

- We had great success with just a small number of patients.

And the amazing thing is, everyone's gotten better.

No one's gotten worse.

Of those patients, about 35% go to their follow-up, like long-term appointment, and 25% stay in treatment 30 days.

So I don't think this is a cure to the opiate crisis, but I think this is another piece of the puzzle.

It's pretty exciting for us.

- [Simon] So a quarter of the patients who agree to take the suboxone are still in recovery a full month after having their overdose reversed by paramedics.

In a world with depressingly low rates of recovery from opiates, that's a big win.

- It's nice to actually be able to treat a patient's withdraw.

That's not something we ever had the ability to do prior to the buprenorphine being on the truck.

In the past, we would give the patient Narcan, breathe for 'em, and when they would wake up, we'd attempt to talk to them about getting services.

However, the withdrawal would hit and the patients would just walk away looking to treat it themselves.

- So why can't EMTs in New York offer the same treatment being used in New Jersey?

Do you think there is a reason to hope that this new treatment will be introduced to New York as well?

- Some of the ways that we're doing that include working with emergency rooms and making sure that if somebody shows up to an emergency room, they can get started on buprenorphine that day.

- But there's no sort of coordinated push to try to implement a program where EMS people would immediately administer suboxone after an overdose.

- I mean, so it is now possible through, it's called the New York Matters program, where if somebody comes across somebody in the field, they can get a medical prescriber right then and there on a tablet.

- Mm-hmm.

- And that person can then assess the individual and prescribe that medication at that time.

- I see.

Okay.

So it seems like it's a little bit more difficult because in New York you have to have a doctor prescribe it, rather than an EMS person just give it to you.

- So there has to be a doctor's prescription, period, or a healthcare providers prescription.

So I'm not exactly sure how New Jersey is doing it, but there is somebody that's prescribing that medication.

- [Simon] According to Dr. Carroll, New Jersey simply added the medication to the long list of medications paramedics can already administer as part of their regular duties.

- So paramedics already carry lots and lots of lifesaving medications.

Naloxone is the one we mentioned before.

They carry fentanyl, ketamine, very dangerous controlled substances that are very lifesaving, important medications.

So it was really in New Jersey, just a matter of convincing and showing the need to the state that they could do this.

And it was just added to the paramedic formulary.

And this is being done in lots of states.

Again, you know, each state has their own regulations and so some are having more or less trouble with this.

But I think last check it was over a dozen, but we're headed probably toward even 20 states who were gonna start allowing this in some areas.

- [Simon] Some officials argue that advanced harm reduction programs like this one in New Jersey won't put a dent in the rise of overdose deaths without getting dealers off the streets.

New York's Special Prosecutor for Narcotics, Bridget Brennan, said that "Law enforcement doesn't have the tools it needs any more."

- There's been a different approach for the street-level dealers.

And so that's pretty open now, and it's hard to really develop a deterrent to that because often in the areas where we see that drugs heavily trafficked, we will be focused on arresting the street-level dealers.

But they will be arrested three, four or five times before they're actually going to see any kind of a penalty.

And so we aren't able to use those kind of supply reduction tools in a smart way.

Even in those areas where we know the guy who's dealing outside the McDonald's, fentanyl is responsible, probably, for all these overdoses that are happening 100 yards away.

The people that are seen selling there, they will say to the cops sometimes who arrest them, "I'll be out before your paperwork is done."

And they're right.

- Four to five arrests before facing jail time?

That's because in 2019, New York reformed its bail laws, so that only Class A felony drug offenses are eligible for bail.

This means that street dealers are released from prison while they await trial without posting bail.

Proponents of a law and order approach to dealing with the drug problem, would argue that part of the reason New York's numbers are so high is because New Yorkers are, quote, "Soft on drug dealers."

- We are not gonna arrest our way out of this.

You know, this is a medical condition and it requires a public health approach and medical treatment.

We have seen what the war on drugs has done in this country, and we have seen Black and Brown people incarcerated at extraordinary rates.

We also know that incarceration for people with addiction is not the way forward, that it does not help with their addiction.

Treatment helps with their addiction.

And that is what we're focused on.

- Well, what's your response to people like the OASAS Commissioner who says, "We're not gonna arrest our way out of this drug problem?"

- Well, I'm not talking about arresting our way out of the drug problem, but we can't Narcan our way out of it, we can't treat our way out of it, and we can't campaign with information campaigns our way out of it.

You need to use all the tools in your toolbox and that's one of 'em.

- [Simon] This is Heriberto Diaz.

Three years ago, a court offered him the opportunity to come here to Exodus, a rehabilitation program for offenders in Harlem, as an alternative to incarceration.

- I got in a little bit of trouble with the law.

I had an assault on the first degree with a cop.

And I went to court and the court offered me a program for alternative, and I said, "Yeah," 'cause anybody wants to get out of jail.

So I took that as a joke at first.

You know what I mean?

I didn't want to participate.

I was on and off on drugs for the past, more than 20 years now.

Now I'm clean.

For the past three years now I've been clean.

It took me down some ugly path.

And I thank God that it's over with.

- [Simon] Bail reform has had the unintended consequence of making cases like Hiberto's increasingly rare, because without the threat of jail time, prosecutors have lost the leverage to coerce drug offenders into treatment.

In fact, according to the Times Union newspaper, "The use of drug courts in New York City has declined by over 80% since the sweeping changes to the state's bail and discovery laws in 2019."

- The drug courts were aimed at offering people who were charged with crimes that they would otherwise be serving time on, and their crimes were motivated by addiction issues, offering them the option of treatment.

And usually it was residential treatment.

And if they completed the program successfully, then their case was dismissed.

It's very difficult to in interest anybody in, certainly residential treatment programs, especially now when they're not looking at an incarceratory sentence.

Or they're not, you know, they're not in-- they're not facing bail, they're not looking at potentially awaiting trial while at Rikers.

- [Simon] Hello.

- [Sue] Hi, how are you?

- Hi Sue.

Nice to meet you.

- You too.

Hi.

- [Simon] It's a very different picture in New Jersey.

- These were pictures that they had done for me, like Christmas a long time ago.

I don't even remember what year.

- [Simon] Here, drug dealers who are proved to have sold a fatal dose of fentanyl can get the kind of prison sentence usually reserved for a capital offense like murder, as Sue MacGuigan knows all too well.

So she was already using at the point that this photograph up here was taken?

- This one?

- Yeah.

- Yeah, yeah.

'Cause it was outta high school.

It was Memorial Day weekend.

She must've texted her like 60 times that day, starting at like 4:30, 5 o'clock in the morning.

We had a barbecue to go to at my mom's house, so Shannon didn't see her until six o'clock that evening.

Evidently gave her some of what she had.

That was the end of that.

And then evidently this young lady died three days later.

She got 12 years.

And she was not a dealer, she was an addict.

- Sue's daughter Shannon got such a long sentence because she was convicted under New Jersey's strict liability law that treats dealers like murderers.

- How can I be responsible for somebody's death when they chose to take the drug themselves?

They sought the drug out.

They bought the drug.

You know, I didn't force anybody to do anything.

- I wonder why the prosecutors in this case, why they thought it was necessary to prosecute this like she was some kind of a big-time drug dealer - To make an impact.

Because they, I guess weren't getting the real people, the real dealers.

So it's like, "Ooh, we got somebody.

Let's prosecute her."

No, you didn't get anybody.

You just wasted everybody's time.

And the dealers are still out there.

- [Simon] Shannon was a user herself who'd been struggling with addiction for years after a high school car accident left her hooked on prescription pain meds.

Soon enough she was using heroin.

She worked full-time for 13 years in human services for the New Jersey State Police, and was starting to think about getting clean when her dealer went to prison and left her in charge of his drug supply.

- I did owe him a decent amount of money.

And the agreement was that if I, you know what I mean, took care of that while he was in there, we would be even, so somebody asked for the drugs and I did give them to her.

- [Simon] Shannon says the woman who died texted her over 50 times saying she was sick and needed heroin.

- It was like 4:30 in the morning asking if I had his stuff, and you know, would I serve her?

And I told her I did.

I spent about 12 hours just bullshitting her, telling her, "Oh, you know, I'll come in a little bit.

I have to do this, I have to do that."

And then finally, around 5:30 PM, I did bring her the drugs and sell them to her, and that was it.

I went home and that was it.

- [Simon] Shannon didn't know the woman had overdosed until six months later, when police came to question her.

Six months after that, she was charged with murder under strict liability and given the 12 year sentence - During the questioning, I really just thought that, you know, I was gonna be, not that it's minor, but that I was gonna be in trouble for selling drugs and having possession of drugs.

And then to find out that it's that and somebody's death.

I mean, it was a huge shock, you know?

I remember I was sitting there, I was frozen.

I just didn't even know what to think or how to think.

It was like insane to me, honestly.

- I mean, 12 years is a long time.

What do you think would've been a more fair sentence?

- You know, I think it would be different if I knew that it was a lethal dose, if I purposely, you know, was trying to harm somebody.

But I don't know what a fair sentence would be for somebody who was using the same drugs and had no ill intentions.

I really don't know what a fair sentence would be.

- [Simon] At her trial, the judge in her case said he was giving her a harsh sentence as a deterrent to other dealers.

- He was using me as an example because of the fact that I was a functioning addict.

To just show that they're not playing, it doesn't matter, I don't think that's fair at all.

My knowledge is that's not how it was intended to be used.

That the law was originally for like cartel members, big-time drug dealer as a way to, you know, catch them, as a way to punish them.

Not somebody who is an addict using themselves.

- Even New Jersey law enforcement officials don't know whether strict liability is making an impact in reducing opioid overdose deaths.

After declining an interview for Attorney General Michael Simmons, the press office said that, quote, "The question isn't answerable.

It's not really possible to know what effect the strict liability law is having on the number of opioid deaths," end quote.

Shannon is appealing her case because she says other drugs were found where the woman overdosed, and there's no way to prove whether she died from the drugs Shannon gave her.

Do you think that the strict liability laws in New Jersey are actually discouraging people from dealing drugs?

- No, I really don't.

From anybody I talk to or anybody I know, that's not something that you think about when you're using drugs, or, you know, trying to get your money for drugs.

That's not something you think about.

I don't see how putting an addict away in jail is solving any of the issues.

- After speaking with Shannon MacGuigan, you can't help but think about the fact that she's gonna spend the next 10 years of her life here.

And the drug dealer who actually sourced the fentanyl that killed the victim in this case is still walking free.

And you know, I have to ask myself, is this how the lawmakers really intended this strict liability law to be used?

- You know, people want justice.

They want retribution.

They want their laws to be recognized.

And I understand that.

If you provide drugs to somebody and that person dies as a result, you are guilty of manslaughter in the first degree, murder in the second degree.

And the crime, a homicide crime is defined in that way.

I think you will run into results that many people would consider unjust or unfair.

You know, friends doing drugs together, one provides the drugs to another, someone who doesn't know that the drugs that they provided, that the other person had used previously, you know, contained fentanyl, which really the backers may not even had intended to begin with.

- [Simon] Harm reduction practitioner Sam Rivera believes drug users who deal to support their habit need treatment, not prison.

I asked him whether his organization, OnPoint, actually hurt people by making it easier for them to use, and whether it would be better to push them into treatment.

- 100% of our people have been to treatment and detox multiple times.

So, if I just responded to that, "Send them to treatment or detox," and I go, "I did," then what?

- MM-hmm.

- The reality, it ends up being a blame game.

So now it's them.

They're bad people.

Treatment is great, detox is great.

They're the bad people.

No, they're managing some deep stuff.

Really deep stuff that most of us don't wanna talk about.

We don't wanna hear about it.

We don't wanna address.

- [Announcer] Red hammer.

Red hammer.

- Why do you come here?

Why won't you just use at home?

- I mean, me personally, I don't have a home.

Not only do I feel comfortable here, like I got close with everybody here, it's like family.

I don't just say hi to them, I give them hugs.

- [Simon] Steven Santiago is another regular at OnPoint.

How long have you been using?

- Heroin, I've been using, I think five years.

Because first I had scoliosis, they will gimme the Percocets, then the oxys, then the oxy 15s.

And during that time I started with the heroin.

- Steve's spiral into heroin injection is characteristic of the modern opioid epidemic, in which the mass over-prescription of opiates for legitimate medical conditions has led millions of people to addiction and illicit use of hard drugs.

Have you ever thought about, you know, trying to quit again?

- Oh yeah, all the time.

Like I actually have been lowering myself.

- Yeah.

- I was strictly shooting up about 15, 20 times a day.

- Wow.

- And I OD'd 17 times, off-record.

- Holy cow.

- And I only know that 'cause my mom told me, she woke me up.

- Okay, let me get my jacket and we good.

You got the copies?

- [Simon] Back at Samaritan Daytop Village in the Bronx, Alebert Aponte is getting ready to distribute much-needed supplies to the drug users and homeless here.

- [Elevator] Going down.

- Okay, here we go.

- Ramon Cruz, the man Alebert helped get into detox, hasn't been seen in the area for a few weeks.

Alebert hopes that means he just doesn't wanna be around people using drugs so he can stick with his recovery.

Because just as likely he may have died of an overdose.

When we get to the square by the subway, Alebert asks around to see if any of the regulars have heard from Ramon.

- I'm looking for a month already.

Yeah, he went to detox, rehab.

- Oh he did?

- Yeah, yeah, yeah.

He was doing good.

- Where?

- We haven't found him.

So that's a good sign, you know?

- Yeah, yeah.

- Yeah, he says same thing as me, you know, it's a good sign that he's not around, you know?

- [Simon] Yeah.

- Like I say, hopefully he is in a residential program and he can't communicate.

Ramon!

Oh, oh, oh.

[Alebert chuckles] Good to see you.

I'm glad you're alive, bro.

- [Simon] But Ramon's not in recovery.

He's back here and using again.

It's a bittersweet moment for Alebert.

20 days?

- 20 days, yeah.

- And you weren't using for 20 days.

- Yes.

- How did that feel?

- It feels fine.

The fact that you being out in the street and still being an addict, I usually, know what I'm saying, it's more psychological.

- So when you're buying, what are you asking for?

- I'm not sure how.

- But they're giving you fentanyl.

- They still giving me crap.

- So we just ran into Ramon Cruz, and we found out that he did go into recovery and he spent 20 days there.

But when they found out he had another medical condition to do with his liver, he was discharged to a hospital.

And after he got discharged from the hospital, he ended up back on the streets.

So he didn't kick the habit permanently, but at least he's still with us, and that's something.

I just think it's a shame that because of your liver condition, you couldn't stay in there.

- Like that's a disgrace.

They treat alcoholism, okay.

And operations.

It's best to always go to main.

- [Simon] How long were you in the hospital?

- Like about a week.

- [Simon] And then back on the street here?

- And then back on the street.

- You shoulda came back and told me, man.

We would've got you some place.

- For sure.

- All right, Ramon, take care of yourself.

- You're a good man, Ramon.

- All right.

[sirens blaring] - Yeah, a lot of times, you know, they look for a place to rest, and then come back out here all over again, you know?

They say, "Okay, now I got my weight up a little, now I could go out there and hang out for another six months, you know, before going again."

But eventually, you know, he'll get the message, and he'll get tired of the lifestyle that he's living.

He's smart.

- Does it make you frustrated when you see people like Ramon struggling to get into recovery permanently?

- I wouldn't say frustrated, you know, because right now you're in recovery when you say you're in recovery.

To him, that could be his recovery, you know?

And I'm not one to judge.

Part of what I do is not to judge people Whenever he's ready, you know, to take it to another level, I'm there for him, you know?

- [Simon] No one's path to recovery is the same.

And some people may not go through with it at all before it's too late.

But Alebert says there's always hope because he was himself in and out of recovery 20 times before he managed to stop using drugs two decades ago.

Ramon Cruz's struggle is just one part of the crisis New Yorkers are facing, in which there are no easy answers in the fight against fentanyl.

[suspenseful music] [suspenseful music continues] [suspenseful music continues] [suspenseful music continues] - [Narrator] Funding for New York Public Media's response to the "Overdose Epidemic" is provided in part by the New York State Education Department.