Pubdate: Mon, 03 Oct 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company
Author: Michael Wilson


The man entered the Red Robin restaurant inside the Staten Island Mall
two minutes after 6 p.m. on a Friday. He walked straight past the
booths and tables and entered the men's room.

A manager would find him there seven minutes later, lying on the floor
with a needle and foaming at the mouth.

His name was Jonathan Ayers, 27, and he was declared dead within the
hour that evening, Sept. 9, apparently of a heroin overdose.

Mr. Ayers's fatal overdose was the latest addition to a body count
without precedent. So far in 2016, there have been 71 deaths that
appear to be from heroin overdoses on the island, the Richmond County
district attorney's office said, already on pace to more than double
the record set two years ago. Nine people died of heroin overdoses in
a recent 10-day period, prosecutors said.

Mr. Ayers left behind an account of his addiction. After his death,
his mother, Ann Ayers, and brother, Christopher, found a journal he
had kept for the last couple of years that chronicled the lies he had
told them to conceal his continued dependence on drugs.

"I lie mostly I think because I am scared of being judged for the
truth," Mr. Ayers wrote in May 2015. "This journal is where I tell the
truth." Through the journal, his family would come to know the son and
brother they had lost, and see the thoughts of a heroin addict.

Staten Island has been home to a heroin epidemic for several years,
and it rivals the Bronx for the highest rate of deaths from heroin
overdoses in New York City. The drug arrived to meet demand for
opiates and fill the void left by law enforcement crackdowns on
prescription pills, which were widely abused there.

Heroin, much cheaper than pills, became the drug of choice for the
mostly white, middle-class neighborhoods on the island's south end. It
was brought in bulk from other boroughs and New Jersey, and easily
found on the island as an attractive diversion for bored and restless
young people - creating a crisis for law enforcement, treatment
programs and the parents of addicts, who have seen too many of their
children end up in jail or the morgue.

Since 2010, the number of arrests on the island in which heroin or
pills were found on the suspect has increased tenfold, to over 1,000
last year. Deaths attributed to heroin overdoses have also risen: In
2012 and 2013, the toll was 33 each year, and then jumped to 41 in

The deaths fall within a nationwide heroin epidemic that officials
have compared to the onslaught of H.I.V. in the 1980s and 1990s. An
estimated 125 people a day die from drug overdoses, 78 of them from
heroin and pills. The rise in deaths has left virtually no corner of
the country untouched, from New England to Appalachia to the Midwest
and Southwest.

On Staten Island, the numbers could be far worse. Emergency medical
workers and firefighters administered naloxone, an antidote to opioid
overdoses, 89 times from January through July. Police officers have
used it to save lives 35 times this year.

There have been new programs and initiatives and task forces and law
enforcement operations and arrests. There have been infusions of
funds. And yet nothing seems to be working.

"The drugs are too accessible and too acceptable," Michael McMahon,
the Staten Island district attorney, said in an interview last month.
"There seems to be a whole new population that thinks it's O.K. and
not taboo."

Mr. McMahon said too few resources were being directed to the

"If this many people were dying from Zika on Staten Island, we would
have an all-out emergency crisis response to it," he said. "Anywhere
else in the city of New York, if nine people died in 10 days from one
reason, it would be declared a citywide health emergency."

Mr. McMahon, shortly after taking office in January, announced the
creation of the Overdose Response Initiative, with officers responding
to every fatal overdose as if it were a homicide, gathering
information on the victims and combing their cellphones for leads on
the identity of the dealer of the drugs.

The investigations have given prosecutors and the police real-time
data on overdoses; in the past, they had to wait for lengthy
toxicology tests. The response has linked fatal overdoses to suspected
dealers in two recent drug takedowns that led to 18 arrests.

Assistant Chief Edward Delatorre, the borough commander of Staten
Island, said the police were initially led to believe that dealers had
taken their own measure to avoid scrutiny - selling weaker heroin.

"We got word back that they were cautioning the other dealers who
sold, 'Be careful what you sell on Staten Island,'" he said. "But here
we are again in September with a surge."

Mr. McMahon believes that the recent string of deaths resulted not
from a bad batch of heroin, but from the potency and ubiquity of the
drug and the recklessness with which addicts are using it.

"What does that tell you, the death in the mall?" said Luke Nasta, the
director of Camelot, an addiction treatment center on Staten Island.
"It's part of mainstream society. Bright, shiny glass and nice stuff.
The abundance of America, and using heroin and succumbing to an
overdose. It's a crosscut of society. It's here. There's no denying

A Chronicled Struggle

Mr. Ayers's overdose in the mall ended a struggle with addiction about
which he wrote candidly in his journal while hiding it from his
family. The journal and interviews with his family offer a glimpse of
a middle-class addict seeming to hold his life together even as it
spun downward.

"Have mercy on me, O Lord, for I am weak," Mr. Ayers, a Catholic,
quoted from the Bible in one entry. "My bones are troubled."

Tall and stout at around 300 pounds, he was the classic gentle bear of
a man, his family said. He graduated from Wagner College in 2010 with
a degree in sociology but without solid plans, they said. Behind the
scenes, his troubles had already begun.

"I had only been drinking, but when I started college I started
smoking and eventually selling marijuana," Mr. Ayers wrote in 2015,
according to a transcript of the journal provided by his brother. "It
seemed harmless at first, but I guess it wasn't enough and I started
to experiment." This led him to pills.

"And as the saying goes, 'That was that,'" he wrote. "It went from a
weekend thing to a 3-day-a-week thing only at night and eventually to
an everyday thing."

He traveled to his brother Christopher's home in Virginia in January
2015 to get away from the island. He stayed a month, attending church
with his brother and sister-in-law, who were expecting a child, and
discussing his troubles with his brother's pastor. But he also took
mysterious drives to Baltimore, Christopher said last week. Asked why,
Christopher said, Mr. Ayers told him he was visiting friends.

When Mr. Ayers returned to New York in February, his brother noticed
$1,100 missing from his home, and he gave Mr. Ayers an ultimatum: Go
to rehab or you'll never see your niece.

Mr. Ayers had been to an outpatient center on Staten Island, but had
returned to pills, his family said. This time, he traveled to Florida
for a three-week program.

Mr. Ayers's experiences were similar to those of many addicts on
Staten Island. It is a widely held belief that one must leave the
island to get clean.

"We can't just do the same old stuff we've been doing," said Diane
Arneth, the president and chief executive of Community Health Action
of Staten Island, a treatment center. "This really is an incredible

She said treatment centers have discussed identifying "crisis points"
in an addict's downward spiral when they are open to the possibility
of treatment, such as after an arrest or a visit to the emergency
room, where they might meet with a counselor. "That's where people
shift," she said.

Staten Island police officers see these crisis points every day, and
they carry small containers of Narcan, a brand of naloxone, within
easy reach in their pockets. Squirting it up the nose of an
unconscious drug user blocks the absorption of opiates and stops an
overdose. One officer, Crystal Vale, has saved three people with
Narcan in the past year. "From being unable to respond, to being fully
awake and not wanting to go to the hospital," she said last week.

She said she was present when a man was revived with Narcan, and when
officers, paramedics and the man himself compared notes, they realized
it was the third time he had been brought back from the brink - the
Lazarus of Staten Island.

Another officer, Louise Sanfilippo, has logged 13 Narcan saves in a
year and a half. She uses the antidote so often that she hurries to
restock after a save, uncomfortable with an empty pocket.

"I never have none on me," she said.

The island lacks a 24-hour crisis center and relies on 9-to-5 offices
to treat walk-in drug addicts looking for help. "People don't need
help just during regular business hours," Ms. Arneth said.

'I'm So Sick'

Mr. Ayers stayed clean after Florida, but not for long.

"I should have never went to that damn party. Even deleting all the
numbers out of my phone didn't protect me from this," he wrote in
April 2015. "I felt so ashamed and I wasted the past 50 days of my
life and let everybody down who believed in me." He kept using: "I
can't even look at my mom in the eye right now. All I do is ruin her

A year passed. He got a job at a bar. But his mother would come home
from work at Wagner College and find him on the couch. "'I'm so sick,
I'm so sick,'" he told her, Ms. Ayers said. "He'd ask me for money for
Suboxone," a prescribed drug that curbs opiate cravings, "and I gave
it to him."

In August, he wrote his last journal entry: He needed to get his life
together "or I'm going to end up in jail or worse dead."

On Thursday, Sept. 8, he said he had been to the doctor and that his
prescription would be ready on Sept. 10.

On Sept. 9, his mother came home from work. He was on the couch. He
asked a question that almost every mother of a certain age has heard
before, practically a rite of passage.

Can I get a ride to the mall? He said he needed to meet a friend who
had some extra Suboxone and was waiting at the massage chairs outside
a Chase bank. "I don't know where that is," he told his mother.

She did. She drove him to the mall. He said he would be right

It is unclear exactly what Mr. Ayers did inside. But the massage
chairs were right where he was told they would be, along with, his
family assumes, what he came for. There he likely paused, figuring out
a next move that would be his last, his mother waiting in the car
outside, an escalator before him, the Red Robin below.
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