Although the large-scale prescription pill ring allegedly operated by Riverhead physician assistant Michael Troyan was not the biggest the county has seen in recent years, it underscores a troubling fact: In the ongoing opioid crisis, Suffolk is disproportionately affected.
In 2011, for example, the national rate of deaths due to poisoning from opioid analgesics was 5.4 people per 100,000, according to a December 2014 report from the Centers for Disease Control and Prevention. That year, the rate in Suffolk County was roughly 11 people per 100,000 — more than double the national average.
Between 2002 and 2012, the number of arrests in Suffolk County for driving while intoxicated on a prescribed substance increased 413 percent, and in 2011 alone, such cases accounted for almost half of all DWI charges, according to a 2012 report from the Suffolk County District Attorney’s office. That report was filed as a response to the 2011 Patchogue pharmacy robbery-murder that left four people dead.
Mr. Troyan, who prosecutors say distributed more than 60,000 pills over a period of four years, is not an isolated case, either. In the 2012 report, DA Thomas Spota noted the county had almost twice the state average in cash prescriptions for oxycodone, which themselves are not illegal but are a red flag that the pills are being abused or resold.
Just three months ago, Patchogue nurse practitioner Ingrid Gordon-Patterson was sentenced to 9 to 19 years in prison for prescribing more than 400,000 oxycodone tablets in exchange for cash over a one-year period from June 2011 to June 2012.
That report called for a variety of changes, including felony charges for doctors who overprescribe.
Since then, “dramatic increases in arrests and overdose deaths related to painkillers were noted,” said Robert Clifford, spokesman for the DA’s office, in an email.
In August 2013, New York State enacted a law, sometimes referred to as I-STOP, that requires medical experts to use a digital system when writing prescriptions for controlled substances. That system prevents patients from procuring multiple scripts from multiple doctors and then reselling the pills.
“We have seen more responsible prescribing patterns thanks to the legislation, but apparently there are doctors still finding loopholes in the system,” said Steve Chassman, executive director of the Long Island Council on Alcohol and Drug Dependence.
Use — and abuse — of prescription pain medications exploded in the past 20 years thanks to a confluence of new pharmaceutical manufacturing, lobbying by large pharmaceutical companies and changes to medical practices. Doctors began treating pain as a condition instead of a symptom and prescriptions were more readily available for complaints as general as back pain, the county wrote in its 2012 report.
And some practitioners, such as Mr. Troyan, fueled the fire by allegedly exchanging prescriptions for cash.
“Here is [someone] who was, despite professional ethics, lured in by money and greed and unethical behavior, which isn’t uncommon,” Mr. Chassman said. “You’d assume people go into such an arduous, academic path with a desire to help patients, but like every field, there are a few bad apples.”
On the flip side, Mr. Chassman said, “The world has sped up exponentially,” so people try to self-medicate to grapple with the various “stressors the modern age has presented them with.”
“We all are being inundated by stimulation and pressure and anxiety and fear,” he said. “These very powerful narcotics were created for physical pain. But you know what else they numb? Emotional pain.”
Now, the CDC considers opioid addiction an “epidemic.”
In 2014, fatal prescription drug overdoses caused 204 deaths on Long Island, with 137 further deaths caused by heroin overdoses, according to statistics provided by LICADD. Those numbers are down slightly from last year’s, and Mr. Chassman attributed that change to increased access to Narcan, a drug that helps reverse the effects of overdose — in other words, he said, abuse itself is not decreasing. Since 2011, the number of people seeking help from LICADD for addiction to any substance has more than doubled.
The recent surge in heroin abuse goes hand-in-hand with painkiller abuse, too. Mr. Chassman explained many people start abusing pills, assuming they are safer because a medical professional prescribed them.
“For the most part, people don’t wake up and say, ‘I’m going to do heroin.’ They start with gateway drugs,” he said. “Prescription meds have definitely served as the fast-track to dependence.”
But once the “spigot is turned off” and pills become harder to acquire, perhaps because of cost or accessibility or both, people who suffer from addiction — people who are truly ill and are fighting the agony of withdrawal — often turn to heroin.
According to an analysis done by Yale University professors of data between 2004 and 2010, one in 15 people who abuse prescription pain medication will try heroin within 10 years.
“They just want that euphoria,” Mr. Chassman said.