STATEN ISLAND — Christopher Perrotto was taking oxycodone with friends in a parked car in the South Shore on April 10, 2011 when he overdosed and died. He was just 22 years old.
His friends bailed and left him alone in the parking lot, but somebody eventually found Perrotto and called the police. His uncle worked nearby and went to identify his body while his mother — who thought Perrotto had gone to a detox center the night before — got an oil change.
When she got back to her Arden Heights home, detectives were already inside. She saw her father sobbing as she walked in and knew her son was dead.
"I just dropped and started screaming," said his mother, Ann Marie Perrotto.
Staten Island — which some have dubbed "Heroin Island" — has been in crisis over opioid addiction for nearly a decade. As elected officials and law enforcement fight to turn the tide, the number of fatal overdoses continue to climb to record highs, tearing families and communities apart.
Currently, more people die in the city from overdoses than homicides.
"We are doing everything seemingly possible, but we're still deep into the throes of this epidemic," said Borough President James Oddo. "There are moments that are extremely disheartening."
At least 107 people died from overdoses in the borough last year, the highest number on record and a 35 percent increase from 2015, according to Oddo and the Department of Health. Officials expect the number to climb as high as 119 when the final data gets released later this year.
An Addiction Begins With a Doctor's Visit
Most people don't start off using opiates recreationally, but get hooked when they're prescribed pain pills after an injury and are never able to stop taking them, said District Attorney Michael McMahon.
"The full medicine cabinets of Staten Island added fuel to this terrible fire," said McMahon. "The drug companies pushing those opioid-based pills out on the market bear a lot of responsibility."
For some users, all it takes is one pill for them to get hooked, according to a recent opioid study by the Centers for Disease Control and Prevention (CDC).
Patients in the study who were prescribed a single day of opioids — such as OxyContin, Percocet or Vicodin — had a 6 percent chance of using a year later, while people prescribed enough pills for eight days or more saw a 13.5 percent chance of continuing to use them a year later. Nearly 30 percent of the patients given a month-long painkiller prescription are still hooked, the study found.
That was the case for Perrotto, a straight-A student in grammar school who was a talented baseball player and loved to watch movies with his mother and sister.
Perrotto got into a small fender-bender when he was 19 and sustained minor injuries to his back. He could've simply taken Tylenol for the pain but his doctor prescribed him Percocet, a mix of oxycodone and acetaminophen, instead.
"I thought it was just something antibiotic or something to help his muscles relax," his mom said. "I didn't know anything about these painkillers that were on the street until I started seeing his changes."
Perrotto started with just one pill a day, but quickly increased to five, then 10, then 15. He topped out at 25.
He stopped taking care of his hygiene, started to skip sleep, fought with his mother and sister and either locked himself in his room for days or never came home.
His mother realized he was addicted to pills and tried to send him to several treatment programs, but he would either keep using or break a small rule and get kicked out.
She had him admitted to psych wards and arrested when he stole her car. She begged the judge to keep him in jail so he could get off drugs.
About two weeks before his death, she kicked him out of her home after he sold his Xbox to buy drugs, hoping he would hit rock bottom and kick the habit for good.
"I kicked him out and he died," she said. "I live with that guilt every day of my life. Why didn't I just stand by his side?"
Kevin Parker was addicted to pills and overdoses. He was in a coma for months but had to have his leg amputated when he regained consciousness. (DNAinfo/Ben Fractenberg)
Four out of five of Staten Island's fatal overdose victims started down the road to addiction when they got prescribed pills after an injury, McMahon said.
Eventually their daily needs exceeded the capacity from just one script, so they started visiting different physicians in a bid to get more — a practice referred to as "doctor shopping."
But after New York's I-Stop law was passed in 2012 to crack down on patients stockpiling drugs from different doctors — as well as keep better records of which doctors prescribed the pills — patients who had become addicted to the medication suddenly found themselves without a ready supply.
Drug dealers seized the opportunity — flooding the streets with a cheaper and more easily accessible opioid: heroin.
Instead of spending $90 for three oxycodone pills needed to get them through the day, users could spend $5 for a bag of heroin, experts said.
"The marketers of heroin knew that, so they made the drug widely available and cheap," said Luke Nasta, executive director of Camelot Counseling and a former heroin addict himself.
Why Staten Island Falls in the Crosshairs
The rate of fatal overdoses on Staten Island has steadily increased since record keeping started in 2000, with some dips, but shot up in 2016, according to the Department of Health.
Kevin Moran, a funeral director for the John Vincent Scalia Home for Funerals, holds a list of death certificates of people who died of overdoses he handled the funeral for in the past four months. (DNAinfo/Ben Fractenberg)
McMahon partly blamed the borough residents' success at landing well-insured jobs — with plenty of access to medical care and medication coverage — as an unexpected source of the problem.
The borough has a large percentage of residents who work for the city and others who get good health insurance from their job. It makes it easier for doctors to prescribe them painkillers and for them to afford the pills, McMahon explained.
The last Census data showed that 22.3 percent of all Staten Islanders were employed by the government, compared to no more than 16 percent in other boroughs, according to the Staten Island Advance.
Compounding the problem, studies have found rates of addiction increase significantly for people who have undergone significant trauma — with some finding 29 percent of Manhattan residents increasing substance use after 9/11, according to Time.
Of the 2,977 people killed in the World Trade Center attacks, 275 lived on Staten Island. The borough was also hit the hardest in the city by Hurricane Sandy — with 24 people dying and hundreds more losing their homes.
McMahon said neighborhoods decimated by Sandy also have the highest number of fatal overdoses in the borough.
From 2012 to 2013, ZIP codes in the borough damaged by Sandy were in the top five for overdose deaths in the city, according to the Health Department.
The Toll on Families
Rosemarie Iacono's oldest brother, Anthony Iacono, was given his first pain pill prescription after he hurt his back.
He had landed a decent paying job as a longshoreman right out of high school but hurt his back while working a few years in. Doctors gave him a choice, either take pills or get surgery.
Since he couldn't afford the time off work he chose pills, and got hooked. He fatally overdosed at the age of 29 in 2012.
A year later, his brother, Raymond Iacono, had his 20th overdose and died at 26, leaving three other brothers fighting addiction and their sister the only sober one in the family.
"In two years I lost the most important people in my life," said Rosemary Iacono, 26. "They never even got to live."
Brian Hunt, who lost his son Adam Hunt, 23, in 2014 to an overdose, speaking at a Scared Straight forum at Wagner College. (DNAinfo/Ben Fractenberg)
Family members are put in an impossible situation — made worse by the fact that an opioid addict often shows no symptoms of drug abuse until they're far along in their addiction.
"A person would look completely OK, it's not until it gets more advanced that you might notice something," said Dr. Stephen Gilman, an addiction psychiatrist in Manhattan and a medical director of an outpatient facility. "It can often be hidden for a longer period of time than other dependence problems."
Ann Marie Perrotto, who started Christopher's Reason recovery center after her son died, said addicts can be high in front of people without them even realizing it.
She was tipped off to her son's addiction only because of his mood changes and he stopped spending time with his family. Before he started on the pills, he would love to watch movies with his mom and sister or go to large family gatherings.
As a result, by the time many family members realize they have an addict in their home, they're often so deep into the addiction that it makes recovery very difficult.
"You have to get treatment as soon as possible," said Gilman. "The physiological dependency of an opiate can escalate rapidly the longer they're on it."
Rosemarie Iacono said she started to notice her brothers' addiction when they stopped going to work and her cash went missing.
"My brothers would steal my money, all of my jewelry," she said. "Anything that was valuable had been taken from me."
This is often the first sign for many families that their loved one is an addict, said Joanne McKernan, who runs a support group for family members of addicts at the YMCA.
"People have to put locks on their bedroom doors," said McKernan. "They're living with their pocketbooks underneath their pillows. It's not an easy way to live."
Others commit small felonies to feed their habit, leading to an increase in crimes like car break-ins around the borough, McMahon said. Some move to selling the drugs themselves so they can continue their use.
"If they don't steal, they deal," said Alicia Reddy, a registered nurse dubbed the "Addiction Angel" who runs support groups and helps addicts get treatment. "Unless they have a job, which how many addicts can be an addict and hold their job? Eventually they lose their job."
Alicia Reddy, a registered nurse dubbed the "Addiction Angel," runs support groups, Scared Straight forums and helps addicts seek treatment. (DNAinfo/Ben Fractenberg)
Perrotto also moved to selling pills when he needed money, something that wracked him with guilt.
"He told me one day that God was punishing him because he sold to other people," his mother said. "No matter what I tried he always told me that it was a demon in the back of his head that would pull me."
Road to Recovery
While some evidence shows that rehab has a low success rate for addicts, particularly short-term programs, that hasn't stopped a host of short-term, profit-driven facilities around the nation from seizing on the opioid epidemic to take advantage of desperate families searching for a cure for their loved ones, Nasta said.
These 28-day centers are funded by insurance companies and can charge up to $1,000 a day for treatment. They aggressively target Staten Islanders by buying them plane tickets, sending cars to transport them to the airport and a host of other amenities to lure patients to their facility.
"Something should be done to stop them from even existing," said Nasta. "They're not based on any science that says in 28 days you can rehabilitate a heroin addict. It's based on an insurance benefit."
While users can withdraw from the drug in that time, it isn't long enough to address the root cause of the addiction or make permanent changes to their lifestyle, Nasta said.
"You can withdraw from it and stabilize over a six-month period physically, but psychologically your brain has been rewired," said Nasta. "You're a different person and you have this psychological dependency that no matter where you go you bring it with you."
Cravings can be so intense while trying to get sober that many experts advocate utilizing medically assisted treatments, like buprenorphine, that can help manage withdrawals to give users a better chance of staying clean.
While the city has worked to increase access to buprenorphine, there has been pushback from some who don't want to prescribe the drug locally.
"Staten Island physicians do not want to dispense buprenorphine," said Oddo, who co-chaired the mayor's Heroin and Prescription Opioid Public Awareness Task Force. "I believe they have some preconceived notions of who this clientele would be."
Another tool to help decrease the number of fatal overdoses has been outfitting emergency workers across the city with naloxone — a nasal spray that essentially reverses the effect of an OD.
Last month, Mayor Bill de Blasio announced a $38 million-a-year program to combat addiction rates. The initiative will increase naloxone access, boost treatment programs, increase the availability of buprenorphine and more in a hope to reduce overdose deaths by 35 percent over the next five years.
Last year, 74 people were saved with the drug by police around the borough and 48 have been saved so far this year, according to McMahon's office.
However, while naloxone saves a person's life in the moment of an overdose, it will not stop them from future use or overdose.
"It's just an emergency antidote for an overdose, it's not an ongoing treatment," said Gilman.
Nasta, who got clean after he was arrested, believes long-term programs like his are the most effective ways to kick the habit.
Patients live at his centers for months, or even years, on end. They meet with therapists, have group sessions, get assigned a job at the site and take classes to get their G.E.D. so they have job prospects when they get out.
"We harness the influence and power of the residents to help and heal each other," said Nasta. "We guide them. We also provide them traditional individual counseling and group counseling, work with their families."
Ann Marie Perrotto also hosts group and individual counseling sessions at Christopher's Reason and tries to give addicts an abundance of love and support while they go through recovery.
Her Charleston site has an open-door policy and she encourages people to spend their time there while not in meetings, playing pool or watching TV, to develop a life that isn't controlled by drugs.
"The easy part is coming off the drugs, the hard part is staying off," she said. "When they're coming off the drugs, they're lost. If you're not there for them and you don't have a good support system, they're going to go back."
Even if they have every intention to stay clean afterward, relapse is common.
"They can have a very strong craving for a substance, even if they're been off of it for a long period of time," said Gilman.
"That will draw them back to using even if at some level they don't want to use."
In addition, people who may have had a temporary break from the drug as part of a rehab program can end up overdosing — sometimes fatally — if they relapse, because they use the same amount of heroin as they did before they got sober despite their tolerance being lower, said Nasta.
The Rise of Fentanyl Turns an Opioid Epidemic Deadly
Fentanyl is 50 more times potent than heroin and entirely synthetic, whereas heroin is partially derived from poppy plants. Dealers started to mix fentanyl into their supply recently to drive down costs and increase potency, officials said.
A comparison of the lethal dose of heroin compared to fentanyl, which is being mixed in with batches of heroin to cut down on costs for dealers. (New Hampshire State Police Forensic Lab>
Officers are warned to not even handle it with their bare hands because one touch could be fatal and there's no way to tell when heroin has been cut with fentanyl by just looking at the drug.
"People don't realize that it's pure fentanyl or fentanyl laced heroin when they buy it," said McMahon. "They're literally poisoning people to death."
While some users end up with fentanyl-laced drugs by accident, others actively seek it out — hunting for dealers after learning that they were behind the batch that caused an overdose, experts say.
"They hear the news, Staten Island isn’t small," said Reddy. "It doesn’t scare them, which is the most frightening."
The rise of fentanyl also makes relapses far more deadly than before because it takes a much smaller amount to overdose on than straight heroin.
"Now that one bag is so much more potent than it used to be," said NYPD Assistant Chief Edward Delatorre, borough commander for Staten Island. "It's very common for us to see people coming out of rehab and overdosing because their bodies can not handle the higher potency of the drug."
Officials all pointed to the introduction of fentanyl as a major reason for the sharp increase in overdose deaths in 2016 and have started to crack down to get it off the streets.
In February, police arrested five dealers — including a paraprofessional who sold at the middle school she worked at — who sold fentanyl around Rossville, Richmond Town, Tottenville, Great Kills and Rosebank. Last month, more than 30 people were busted for smuggling fentanyl from Asia into Brooklyn.
"In a sea of drug dealers, we're looking to focus on and isolate the ones that are causing overdoses," said Delatorre.
Rep. Dan Donovan, who represents Staten Island and parts of Brooklyn, re-introduced legislation in Congress last month to make the penalties stricter for dealers who sell fentanyl.
Some argue that measures like this could do more harm than good because it would make users so afraid of arrests that they won't call for aid if a friend's overdosing.
"In the majority of drug-induced homicide cases, there was an opportunity to save the overdose victim, but they chose not to act because they were afraid of prosecution," said Melissa Moore, deputy state director for the New York chapter of the Drug Policy Alliance, a nonprofit that pushes for decriminalization of drug use in favor of treatment and harm reduction measures.
"There's no data that shows there's a real deterrence effect. There's a replacement effect within the market instead of dealing with the problem systematically."
Moore argued that increased access to medically assisted treatments, needle exchanges and supervised injection facilities where users are also offered treatment — like Insite in Vancouver — are a better way to help curb addiction rates instead of criminalization.
Those harm reduction plans have not been suggested for Staten Island yet, but Oddo worried they could do significant damage if brought here.
"If you want to have needle exchange, if you want to have clean shooting spaces, I'm not going to judge you," said Oddo.
"To heavy handedly force feed some of these harm reduction to Staten Island will be counterproductive, will take us back and will empower people who I think are ignorant on this issue to assail all of these efforts."
Aside from cracking down on dealers, officials have started several other programs to drive the numbers down and may be seeing some small relief in the borough.
There have been 20 suspected overdose deaths so far in 2017, a 33.3 percent decrease from the same time period last year, according to statistics from McMahon's office, which were current as of Tuesday.
The numbers only reflect overdoses reported to the NYPD, not people who check into hospitals, so McMahon expects the actual number of overdoses could be up to 30 percent higher.
However, there has been a 50 percent jump so far this year citywide compared to the same period a year ago, said Dermot Shea, Deputy Chief of Crime Control Strategies for the NYPD at a recent law enforcement conference about the epidemic.
Since he took office, McMahon has launched a dedicated drug court to handle cases in the borough and an Overdose Response Initiative to treat every OD like a crime scene to try and trace the source. The program has lead to five takedowns so far.
The District Attorney also partnered with several other groups — including the Legal Aid Society — to launch the HOPE program this year that will dismiss charges for low level drug offenders who seek treatment, the first of its kind in the city.
"At the moment of arrest we're trying to divert them to treatment," said McMahon. "The quicker we get them into treatment and recovery, the better chance we have at saving their lives because one more use of the drugs that are out on the streets today could kill them."
Since the program launched in January, 119 people have been offered it and 64 were found to "meaningfully engage" in treatment and got their charges dropped. Only 13 refused the program.
The majority of the people identified for the program have been males between 19 to 30 years old, according to the DA's office.
Addiction rates have also been rising in women around the borough, so Camelot has started to build a new residential facility in Port Richmond for them, which has faced pushback from the local community, said Nasta.
The NYPD has started several initiatives to help stop children from ever picking up pills in the first place and partnered with Oddo to bring a "Too Good for Drugs" program to every fifth-grade classroom in the borough. They started a pilot program this year to expand it to seventh- and eighth-graders as well.
"It's only reaching a fraction of the audience that we need," said Oddo. "You have to get this message to students of all ages."
The curriculum differs from the old D.A.R.E. program because it goes more in-depth and has officers who work in the local precinct teach the class so they can make connections at an early age, Delatorre said.
"This deals in a much deeper way with issues like decision-making, peer pressure and bullying," said Delatorre, who used to be a sergeant in the D.A.R.E. program.
They also quietly started an initiative, Operation Youth First, that made it protocol for officers who find intoxicated children to talk to their parents and put them in touch with service providers.
"Often when we speak to the people who are addicted we find that they started very young," said Delatorre. "Often with softer drugs and often right in front of their parents."
They have had nine children engage in the program so far, he said.
The NYPD has also started to keep real-time data to map overdose deaths, especially ones linked to fentanyl, to identify patterns and respond to trouble locations, an expansion of the city's RxStat program.
"We laid a solid base in New York City to now catapult us forward," said Shea.
But as lawmakers figure out how best to deal with this problem, family members still have to live with the aftermath of it daily.
Concerned parents watch a "Scared Straight" forum at Wagner College. (DNAinfo/Ben Fractenberg)
Ann Marie Perrotto dedicated her life to helping others like her son since his death, but it hasn't made it any easier nearly six years after she buried him.
"I wake up every day and I know that I can never touch him, never kiss him or watch a movie with him," she said. "They say it gets easier, but it gets harder everyday because I miss him more."
Reddy, who hosts "Scared Straight" forums around the borough to keep kids from picking up drugs in the first place, said the experience of being a parent of a drug-addicted child is heart-rending.
"As a mother of two children, if somebody told me my son had to be afflicted with a disease and I had to choose between cancer and addiction, I don't think I would ever pick addiction."