Montgomery County still deals with more than 850 overdoses annually.
Its bedroom communities nearest the notorious heroin hive of Kensington in Philadelphia have been dealt heavy blows by the deadly epidemic as far back as 2014.
Still, the slowing overdose death rate is significant.
By contrast, the coroner said surrounding counties are still seeing accelerating rates of fatal overdoses, some by as much as 50 percent. That was the staggering death rate increase Montgomery suffered in 2016.
Officials cautioned that it’s too early to say for sure overdose deaths are slowing here. But the optimism echoed in the press conference is that the county could be approaching a turning point.
If so, it would provide welcome evidence that Montgomery’s intensive focus, coordinated response and the considerable resources brought to bear in a multi-front war on the opioid epidemic are working.
Since the Abington Township Police Department sounded the alarm over opioid overdose deaths in the fall of 2014, Montgomery County, with a $409.5 million annual budget, has operated at virtually all levels with a single goal in mind – reducing the epidemic’s death toll.
County Commission Chairwoman Dr. Val Arkoosh described the all-out effort as having the full support of virtually every public official, first responder, human services social worker and law enforcement officer across the county.
Initially, the effort was led by former Commission Chair Josh Shapiro, now Pennsylvania’s attorney general. Arkoosh, a former anesthesiologist who once worked with drugs like fentanyl, has since doubled-down.
“It has taken an absolute all-hands-on-deck approach just to get a handle on this thing,” Arkoosh said during an interview following the county’s mid-October press conference.
“It's not one thing; it's 40 things that the county is doing,” she added. “I hope people would look at our numbers and see a ray of hope in the fight.”
Hope, yes. But despite the air of optimism at the press conference, there are no declarations of “mission accomplished.”
“This is not a victory lap but a chance to recognize the impact of the men and women across Montgomery County who work in law enforcement, EMS and human services to save the lives of those battling substance use disorder,” Arkoosh clarified.
Indeed, the epidemic remains at a critical stage, especially with Chinese-manufactured fentanyl accounting for an ever-growing number of overdose deaths, both here and across Pennsylvania.
The doctor in Arkoosh knows just how powerful and potentially deadly this substance can be, especially when manufactured on the unregulated international black market, then measured out by drug dealers who lack the professional skills of pharmacists.
“The likelihood of it being deadly is so much higher now with fentanyl,” she said.
Worst of all, the Chinese fentanyl, which is delivered mail order to the U.S., is not only many times stronger than heroin, it’s also cheaper and more profitable.
As a business venture, it’s hard to resist.
This is where Montgomery County’s district attorney, Kevin Steele, comes in.
Since being elected in 2015, he’s been marshaling the county’s considerable law enforcement resources – including his own team of nearly 40 detectives, as well as local police and federal authorities – to shut down major heroin and fentanyl distributors and prosecute drug dealers for delivering death to county residents.
Best of all, Steele has been scoring victories.
“People are thinking twice about coming to Montgomery County with their poison,” he said.
All of Pennsylvania’s district attorneys will tell you they are battling the opioid epidemic. Few, if any, are doing it on so many different fronts and with as abundant resources as Montgomery County’s DA.
Steele’s first lesson is victories don’t come cheap.
Steele enjoys resources other county DAs can only envy. He has a $16.5 million budget and a stable of 39 veteran detectives, each one hand-picked for their big-case experience and their many years of seasoning on other forces.
Steele immediately dispatches one of his county detectives to the scene of any overdose death across the county. From nearly the moment of a 911 call, Steele is building a potential prosecution for drug delivery resulting in death, a charge that carries a 40-year prison sentence.
His office has successfully prosecuted seven such cases so far this year, by far the highest success rate in Pennsylvania. Other district attorneys interviewed for this series could point to, at most, a couple of such successes.
Indeed, district attorneys in many other counties complain of the difficulty of bringing these prosecutions. They point out that overdose victims don’t die with a single drug in their systems, rather a toxic stew of many, making it hard to trace death to a single delivery.
And sometimes the deadly dose isn’t passed directly from dealer to victim, coming instead through an intermediary, such as a friend or relative. Finally, the cases almost always begin as a rescue scene, not a crime scene. And by the time the switch is made, crucial evidence can be lost.
This is why Steele assigns a detective from nearly the moment of the 911 call. Of course, there are many false starts and wasted trips. But the wins are worth it.
When Steele hits the bull’s eye, his message to street-level dealers is both clear and powerful:
“Deliver drugs here and kill one of our citizens, and we're going after you on a homicide charge,” he said in an interview.
Simultaneously, Steele, his bevvy of detectives and his deep bench of prosecutors have been going after big-time heroin and fentanyl distributors.
One of the most ingenious of these was within view from Steele’s office window overlooking Norristown. It all began with a truck battery – but not just any battery.
This particular auto battery, the remnants of which had been found in another case, had been carefully manufactured in Mexico to conceal up to three kilos of heroin, yet still was capable of operating a Ford F-150 pick-up truck.
Steele would not reveal all of the investigative steps in the case, but says his detectives eventually began looking deeply into the curious interstate travels of a certain Norristown towing company owner.
David Pacheco, 45, owner of D&J Towing, had been making repeated runs from Atlanta to New York City, via Montgomery County, in his pick-up.
Eventually, investigators determined Pacheco’s repeated travels were to pick up the heroin-embedded batteries in Atlanta, where the working battery would be installed in his truck. He’d then drive to the Bronx, have the battery hiding the heroin switched out with a regular battery, before heading back home to Norristown.
A Montgomery County jury recently convicted Pacheco of a heroin trafficking operation that moved 27 kilos of the deadly drug between Atlanta, the Bronx and Montgomery County. Sentencing in the case is pending.
“I wouldn't want to be in his shoes,” Steele quipped.
Another recent bust resulting from an investigation coordinated by Steele’s office seized a full kilo of fentanyl from county streets.
To illustrate the life-saving impact of this undercover buy, which took place in the parking lot of a Home Depot in Cheltenham, his office said the seized fentanyl could have produced 333,000 to 500,000 fatal doses.
In other words, enough to wipe out nearly half of the county’s population.
Finally, Steele last year empaneled a grand jury that spent 13 months hearing from 31 witnesses about all aspects of the heroin crisis here. Those findings are now guiding future efforts to fight the epidemic, including Steele’s unflinching focus on prosecuting as many drug delivery deaths as he can.
But building drug cases that deliver a message or make a dent in the epidemic takes painstaking work, along with lots of time and money.
“It's a matter of working up the ladder,” Steele described. “This is about impact. These are the kinds of cases you have to build if you are dedicated to stopping the flow of this into your community.”
It helps when your county is more populous than some U.S. states.
“This is a progression to get to the point we’re at now,” Steele said. “Drug dealers, most of them are not focused on county borders. But I think they are becoming focused on county borders, now. We are increasingly hearing this.”
That’s because Steele said he’s raising the cost of doing business in Montgomery County. The price is one’s freedom. These are the only terms opioid dealers and distributors seem to understand.
“They are business people,” Steele said. “This is about greed.”
Perhaps it’s fitting that within this sprawling county of suburbs and shopping centers, the opioid epidemic moves through Montgomery County along the arteries of commerce. The well-traveled roads that bring workers and shoppers in and out are the same ones that carry the drugs.
Overdoses can be tracked along these major routes, too. Especially those leading to Philadelphia’s notorious heroin hive of Kensington. The name of this struggling Philadelphia neighborhood is invoked repeatedly by Montgomery County officials like a curse.
They cite it as a main source of the heroin and fentanyl moving through Montgomery. Yet it’s many of the county’s own citizens who leave the relative safety of the suburbs and travel to Kensington to make their illegal purchases. Many times, these users are also dealers, bringing back some to sell and support their habits.
Others cannot wait to get home and get high. This is why the arteries of commuting and commerce are also the pathways of so many overdoses. They occur in shopping center parking lots, in park-and-ride lots and other convenient stops along these traffic-clogged roads.
Montgomery County even has a heat map of its overdose calls, showing the clusters of tragedy. There are hundreds and hundreds of points on this map.
Each one represents a life in the balance and a desperate 911 call placed to save it.
Montgomery County’s overdose-weary 911 operators take these frantic phone calls every day, often by the score.
They are the primal screams of people at the very worst moment of their very worst day. The impact of fielding a relentless tide of such terrible phone calls can be nothing short of devastating.
“I truly think it takes an emotional toll,” said David Paul Brown, deputy director of the county’s emergency operations center.
“It's chilling,” he said of the calls. “And they are dealing with this daily.”
Last year, Montgomery County 911 operators answered an estimated 850 overdose calls. So far in 2017, the pace has only increased. Yet the number of overdose deaths in the county has fallen slightly compared to last year.
The credit for this can be spread across the county to first responders armed with the opioid overdose antidote, Narcan. But Brown said the success begins with his 911 operators, all too often the forgotten first responder.
In Montgomery County, every operator is trained on specific, step-by-step call scripts for overdoses, including life-saving checklists and instructions on how to administer Narcan, if the drug is available at the scene.
“Our people are on the phone, but they are absolutely critical to what we're doing,” Brown said.
To help the operators answering what seems like a never-ending crush of overdose calls, the county’s ultra-modern emergency management center is equipped with a quiet room. In it, there are no phones or TVs – just couches and plush chairs where weary operators can take a timeout for meditation or a quick nap to regroup.
After a particularly emotional call, operators, who typically work 35 to a shift, can ask to be excused in order to take refuge in the quiet room.
Theirs is the day-in, day-out drudgery of saving lives, one phone call at a time. But by far the best encouragement is new statistics showing overdose death rates in the county may have stabilized, Brown said.
“I'm elated about that,” said the long-time paramedic. “I would like to believe that we are in the very early stages of making a difference.”
Due south in Abington, where the overdose crisis first flared, the epidemic remains complicated.
Adapt or die.
This is how Abington Township’s police chief managed to spend 45 years and counting in law enforcement, every last bit of it in this well-heeled, first-line bedroom community of Philadelphia.
For decades, this meant Chief John A. Livingood had to make sure trouble didn’t creep in from the big city to the south. The worry then was property crimes, mostly: Keeping burglars away from expensive suburban homes and tracking down shoplifters at the Willow Grove Mall.
Heroin changed everything.
Suddenly, it was Chief Livingood’s residents who were going south into one of Philadelphia’s toughest neighborhoods and haven for heroin.
“Kensington,” the chief muttered, as if the single word explained everything.
After buying heroin there, township residents would come back to Abington and shoot up.
Then, they started dying.
“We were used to seeing cocaine and other drugs,” Livingood said. “But not heroin.”
Yet, the stamp bags and used needles at fatal overdose scenes were unmistakable.
The dead were different this time, too. They were hard-working people, the Chief said. Young people. Athletes who might've suffered an injury.
“The stigma was this was always an inner-city issue,” Livingood said.
“There is just no type of person that wasn't affected,” Livingood added. “It was everybody.”
By September 2014, so many Abington Township residents were dying of opioid overdoses, Livingood’s predecessor went to then County Commission Chair Josh Shapiro and sounded the alarm.
The result is the coordinated, county-wide response that has been battling back ever since.
“It was an unusual amount of overdoses,” Livingood recalled.
The threat to the prosperous bedroom community he’d faithfully protected for decades wasn’t someone’s property or stolen goods from some store. It was a mortal threat now. One unlike any Livingood had seen before.
Worse, his own residents were literally lining up for the very substance that was killing them.
“We know the majority of the people here are obtaining their drugs in Philadelphia,” Livingood said.
Some never come back.
Kensington, a blighted eye-sore of a place between lower northeast and north Philadelphia, is close and accessible to the far fairer suburban surroundings just across the Montgomery County line. Historically, it was a border few here would cross.
The opioid epidemic changed everything. Uninviting Kensington has become home to an untold number of Montgomery County residents. They exist in Kensington’s scattered and squalid heroin encampments, which have been infamous here for years.
The City of Philadelphia finally broke up the biggest encampment at the Gurney Street train gulch, but those hooked on heroin here just kept moving.
Next, it was the McPherson Square library lawn, where overdoses happened daily and the librarians would run out with Narcan. Swept from there, the next heroin haven became the abandoned Ascension of Our Lord parish.
These days, camps of heroin users are scattered across Kensington, especially along the Conrail train tracks, Philly.com recently reported.
The opioid crisis crosses the border into this suburb of 56,000 people, as well.
Waves of highly coordinated retail crime connected to the opioid epidemic wash ashore at Abington’s many shopping centers. This is no five-finger discount. These teams of savvy thieves target only high-dollar, easy-to-sell items, such as arm-loads of designer dresses at Macy’s and Bloomingdales. They stuff coats full of Crest White Strips, razors, over-the-counter medicine and baby formula at pharmacies, Chief Livingood said.
The purloined products are resold on the black market, with the proceeds going to fund heroin habits, he added.
“We haven't had a whole lot of luck finding where they are selling it,” Livingood said. “But there are a tremendous amount of business people in our area suffering from this.”
In trying to solve other vexing aspects of the opioid epidemic, the Chief is finding the law sometimes doesn’t apply at all.
Inhabitants subsist in tents made of soggy bed sheets and dirty towels. By all appearances, it is a life of utter agony in between the numbness of a heroin high.
Abington Township Commissioner Lori Schreiber knows some of her own citizens are now unofficial residents of Kensington. They went down and didn’t come back. But Abington isn’t writing them off.
Various community outreach groups regularly prepare care packages to be distributed on the bleak streets of this blighted city neighborhood, given over to the opioid epidemic. Other groups provide medical services, places to bathe and opportunities for enrolling in addiction treatment.
The hope is to keep these street addicts alive until they are ready for help, Schreiber explained.
But every year there are more suburban volunteers to assemble the care packages, perhaps because more and more residents know someone lost to addiction on Kensington’s inhospitable streets.
“I think it touches the lives of so many people,” Schreiber said. “Everybody has an awareness that they haven't had before.”
Narcan is not enough.
Yes, the opioid antidote acts instantly to reverse the effects of overdose. Yes, it saves scores of lives.
But it can’t save souls. Not ones still hopelessly lost to heroin.
Chief Livingood sees it all too often. His 90-plus officers are all armed with Narcan, as are cops throughout Montgomery County. Often, they are first to arrive on the scene of an overdose, administering that initial hit of Narcan to the victim.
In many cases, the effect is instantaneous.
The victim comes back like someone breaking the water’s surface after swimming up from the depths
But from the moment of this life-restoring inhalation, the victim comes crashing down from their high.
The Narcan has terminated their blissful opioid trip with prejudice.
The simultaneous combination of resurrection and coming down can be violent. Some revived victims urinate or defecate in their pants. Others awake angry and aggressive, already craving their next hit of heroin.
There is but one thought on their minds – the next score. The last thing many of these revived overdose victims want to hear is talk of rehab or treatment. A good number don’t want to go to the hospital and refuse the ambulance ride.
It’s as if the Narcan is too effective. The antidote is so good at bringing overdose victims back, it allows them to get up and go right back to using the substance that nearly killed them.
Spectator in his own life
Steven Harris has been there and back.
The Montgomery County resident has overdosed and been brought back seven times. This includes twice in one day and a half-dozen times in a single month.
It started with surgery for shoulder pain, then spiraled into full-blown heroin and fentanyl addiction – a story chilling because it’s so common.
The first time Harris overdosed and nearly died, it came as a shock. He mistakenly believed it wouldn’t happen because he was snorting the drugs, not injecting them. Afterward, he thought this near death experience would be his catalyst to quit.
He was wrong.
Hospitals will talk about “warm hand-offs.”
It’s the practice of dispatching a social worker to counsel a hospitalized overdose patient about his or her treatment options. But this system only works if the overdose patient goes to a hospital. Many don’t.
Even then, the timing must align to regular Monday-through-Friday business hours, when such overdose outreach staffers work. Many overdoses do not coincide with business hours.
Convinced there had to be another way to reach overdose victims, Chief Livingood consulted The Hub, a collection of local representatives from healthcare organizations, behavioral health, social work and faith-based organizations.
Chief Livingood calls on the Hub for what he describes as creative solutions for when the law just doesn’t have any answers or real power.
The Hub is a place where police problems meet community solutions
At one time, such cases simply slipped through the cracks.
Now Livingood was adding opioid overdose survivors to the Hub’s agenda.
Instead, Harris went out and purchased more of same drug from the same dealer later that very day.
“I couldn’t believe I was doing it,” Harris said. “I felt like a spectator in my own life. I didn’t have control.”
No, Narcan is not enough. Chief Livingood is convinced of this now.
Far too many addicts like Harris are falling into what is perhaps the biggest loophole in the battle against the opioid epidemic. That is the gaping hole in the system that allows just-revived overdose victims to get up and simply walk away after Narcan saves their lives.
Chief Livingood took this nagging problem to a group of community organizations and stakeholders he calls “The Hub.”
Together, they have come up with a solution that just might save addicts’ souls, as well as their lives.
When he brings a case before The Hub, Chief Livingood first discusses it without disclosing the subject’s name nor any identifying information. He simply outlines the issues involved, then polls Hub members to see if any of their organizations are capable of assisting.
If one is, Livingood provides the subject’s contact information so the interested organization can then reach out and offer assistance or services. All Hub members must sign confidentiality and non-disclosure agreements, barring them from sharing details about the cases.
These days, thanks to the Hub, many of the overdose victims revived by Abington police aren’t just left with a business card containing their treatment options. Overdose survivors are receiving personal phone calls or knocks at their doors with offers of immediate assistance.
It’s the warm hand-off done better because it’s offered at the victim’s convenience, not in the immediate aftermath of a Narcan revival or according to hospital business hours.
“It's a social services model, not a police model,” Livingood said of the Hub.
“We bring our problems and see if they can help us,” he said. “We don't have a solution. But we're trying to get to the people that can't help themselves.”
These days, opioid overdose survivors are at the top of the list.
“It's just one more attempt to lead the horse to water, when it comes to the overdose victims,” Livingood added. “You got to keep trying. It just makes so much sense. I think it's a model that's going to be copied in other places.”
This is how a 45-year law enforcement veteran adapts when residents’ lives are at stake.
“You try everything,” he said.
Steven Harris knows the only reason he’s alive today is because Montgomery County – his community – didn’t give up on him.
Not the 911 operators who took every one of the desperate calls when he overdosed seven times. Not the EMS or the police who administered the Narcan that brought him back. Not the treatment specialists who ultimately connected him with the medically-assisted treatment option of daily methadone maintenance.
“I’m so grateful to be alive and to feel alive,” said Harris, 48, who’s been clean seven months. “I’m not ashamed because I’m a survivor. The compulsion is over.”
This is why Harris came to the county press conference, where the announcement that 111 people have died instead of last year’s 116 is considered good news during these still-grim days.
“I just want to say ‘thank you’ to you all today,” Harris told the gathering of top county officials who’ve made saving lives their No. 1 priority.
“Not that any of you know me, but you loved me when I couldn’t love myself,” Harris said. “It’s just a tragedy to see young people lost every single day. But there is still hope for the hopeless. I was hopeless -- and helpless. But it’s not a lost cause. It is a worthwhile cause.”
Of that, Harris is living proof.
In a resource-rich county that has thrown nearly everything it can at the opioid crisis, one recovering addict’s stirring words underscore the return on this investment better than the practiced rhetoric of 50 politicians.
The moving math is nothing less than lives saved and addicted souls redeemed.
“You can’t go to treatment if you are not alive,” Commission Chairwoman Arkoosh pointed out. “The effort here has been enormous, integrated and comprehensive. But it works. And we’re seeing results. That’s the message.”