As restaurant industry mourns and searches for answers, experts weigh in on the deadly effects of fentanyl

The North Fork community was rocked late last week with six overdose deaths, caused by what police believe to be cocaine laced with fentanyl. In the wake of these tragedies, many community members have been left with questions. What is fentanyl? Why would someone mix it with cocaine, and why was the combination so lethal? The Suffolk Times spoke to addiction experts for answers and to leaders in the hospitality industry for how they are moving ahead on education and prevention. 

Fentanyl is a “very potent opiate-type narcotic” with “similar effects to heroin,” according to Dr. Lloyd Simon, director of addiction services at Quannacut at Stony Brook Eastern Long Island Hospital.

“When it first came out, you may remember that people were overdosing because it is so much more potent than heroin and those were people with opiate disorders,” he said. “A lot of opiate-use disorder patients will actually seek it out. They like to get the more dramatic effect. So a lot of patients with opiate disorders have become tolerant of these more potent medications and higher dosing of opiates.” 

Cocaine on the other hand, he added, is a stimulant. And as tragically demonstrated just days ago, even small amounts can be life-threatening to those without an opiate tolerance. 

“If somebody is seeking the high that they get from cocaine, and is not used to taking opiates, then even what may be relatively small amounts of fentanyl mixed in, even if it was done inadvertently, as I’ve seen suggested in some newspaper articles, might be too much for them because they don’t have any tolerance to the opiate kind of drug,” Dr. Simon explained. 

This is not a new problem, nor is it unique to Long Island. Leigh Wedenoja, a senior policy analyst at the Rockefeller Institute of Government, said fatal fentanyl doses — a drug she described as a synthetic opioid originally developed to treat “extreme, debilitating, fatal pain” — started to increase rapidly between 2015 and 2017, leveling off in 2018 and 2020 in New York.

“It is extraordinarily powerful, so even the tiniest whiff of it can be lethal,” she added. On a national level, fentanyl deaths in 2020 jumped by approximately 20,000 over the previous year, according to preliminary data from the Centers for Disease Control and Prevention.

People keep talking about this being a bad batch of cocaine and a number of experts have already said, I’ve seen it quoted, there’s no such thing as a good batch of cocaine.

Dr. Lloyd Simon

Although heroin and prescription opioid overdoses have been declining, Dr. Wedenoja said a recent increase in overall overdoses have been driven partially by fentanyl and fentanyl mixed with cocaine and methamphetamine. In Suffolk and Nassau counties, before 2015 and 2016 respectively, the number of combination deaths were low enough that their individual statistics weren’t released.

“However, those numbers have started to skyrocket,” she said. They peaked in 2017 with 40 deaths in Nassau and 123 in Suffolk. And although national increases in general overdose deaths leveled off in 2018 and 2019, there was a nearly 30% spike in overdose deaths in 2020. 

“What aspects of the pandemic led to this spike is almost impossible to figure out. Is it the stress? Is it that people were at home? Is it the interruption of support services like medication assisted treatment, distribution of Narcan, of 12-step programs? It’s probably all of them,” she said. 

One common thread among those who died locally this week, friends and colleagues have said, is that they worked in the local hospitality industry or interacted socially with friends and family members who worked at area restaurants and bars.

It was a local eatery, Little Creek Oysters, that first sounded the alarm loudly as reports of the fatalities began to spread through word of mouth.

On Friday night, the restaurant turned to social media with a public service announcement before police or the media ever did.

“We are going to interrupt the fun for a second. And please listen up. Our community has just lost five people to drug overdoses, three today alone,” Little Creek owner Ian Wile posted on the company’s Instagram. “There is clearly something bad on our streets right now. Not preaching, this is about telling everyone we know and love to be extra cautious, call your friends and family and spread the word. This is a human disaster. Gratefully the Little Creek crew is all here and safe, but we are all just one removed from devastation. Also, please know that every kitchen and restaurant crew in Greenport is crying right now. Be kind. Tell [expletive] everyone.”

Swainson Brown at The Pridwin in August 2018. Credit: Annabelle Woodward

Within just an hour of that post, the sixth victim, Swainson Brown, died on Shelter Island.

For those in the hospitality industry on the North Fork, where the population has boomed since the start of the COVID-19 pandemic and staffing shortages have led to increased pressure, the deaths are a wake-up call.

Greenport Business Improvement District president Rich Vandenburgh of Greenport Harbor Brewing Co. said one immediate way local businesses are looking to address the issue of drug use within the industry is through education and prevention.

“This is horrible when something like this happens, especially when you’re somewhat uneducated on this topic,” he said. “You read about something like this happening elsewhere and think it’s never gonna happen here. You’re at a loss, so what do you do?”

Mr. Vandenburgh said he has already spoken with Tina Wolf, executive director of Community Action for Social Justice, about doing Narcan training at area bars and restaurants. The idea is that the organization could visit a different Greenport business each week in a structured series of training sessions sponsored by the BID. He said CASJ already visits Greenport weekly to work with Quannacut, the addiction treatment center at Stony Brook Eastern Long Island Hospital.

Mr. Vandenburgh and other restaurant owners interviewed this week said conversations around substance abuse — an industry issue that extends far beyond just the North Fork — can be difficult for management to have with staff.

Still, Mr. Vandenburgh said, a time when hospitality workers are simultaneously mourning and searching for answers is when effective change can happen. And he hopes area businesses are as eager to educate themselves as time progresses.

“We have a real strong community of hospitality, food and beverage workers who innately run to the aid of each other when in serious need,” he said. “We all shoulder up and help each other. These are difficult conversations to have. It can be controversial. We all need to make sure that we are as prepared and know that we could make a difference if called upon to [do so].”

Noah Schwartz, chef/owner of Noah’s in Greenport, said while no one on his staff was among those who died this week, it hit “close to home” and left his workers feeling “devastated.”

For them, a lot of the conversation this week was about consoling each other.

At nearby Lucharitos, owner Marc LaMaina made the decision to close Monday at peak season to give staff a chance to mourn the friends they lost and to take a mental break.

Everyone agrees the North Fork’s hospitality workers might just be at a breaking point, as they work harder than ever to meet the demands of customers and management.

“I can totally understand how at the pace at which we’re expecting our staff and working families to create the experience that everyone has come to expect from our industry here that someone might turn to [drugs] because they have a need for release or are seeking that false energy that kind of keeps you going,” Mr. Vandenburgh said. 

Mr. Schwartz said the incidents have forced him to realize maybe there’s a bigger problem out there than he ever quite realized. He admits the past two years have been as challenging as ever.

“There is some pent-up anger and anxiety everyone is feeling as they’re busy keeping businesses going,” the chef said.

A bag of 4-fluoro isobutyryl fentanyl which was seized in a drug raid is displayed at the Drug Enforcement Administration (DEA) Special Testing and Research Laboratory in Sterling, Va. (Credit: AP Photo/Cliff Owen

Although it’s not unusual for people to mix different drugs, the tragedy on the North Fork last week “where so many people got enough … we presume fentanyl mixed in with cocaine to cause this many overdoses and this many deaths is way out of the ordinary,” Dr. Simon said. 

He pointed out that drug dealers don’t typically want to kill their customers. It’s possible that someone tried to purposely introduce small amounts of the drug into cocaine, to get people hooked on more than one substance — “maybe that’s the bizarre rationale of a drug dealer,” Dr. Simon said.

Dr. Jarid Pachter, medical director at substance abuse treatment facility Quannacut Outpatient Services, echoed a similar sentiment. 

“The theory with [fentanyl and cocaine combinations] is that it will then get people hooked on opiates and now you’ll be buying more products,” he said. He added that although he’s read about the cocaine and fentanyl epidemics elsewhere in the country, this is the first time he’s personally encountered cocaine-related overdoses on the North Fork. 

Dr. Simon and Dr. Wedenoja emphasized, however, that fentanyl mixtures are not always intentional. 

“When people who produce or sell drugs sell both fentanyl and other drugs such as cocaine, even if it’s not intended to get the fentanyl into the cocaine, fentanyl can end up in cocaine. This is also happening a lot with methamphetamines,” Dr. Wedenoja said.

But on the North Fork, right now there’s no way to truly know what happened last week. “That’s all speculation,” Dr. Simon said. “Ultimately, if they make an arrest, they might find out more about how this tragedy occurred.” 

More Narcan training

CASJ will return to the North Fork to conduct Narcan training at Mattituck-Laurel Library at 5 p.m. Tuesday, Aug. 24. Call 631-298-4134 for more information. 

The best way to prevent a repeat of said tragedy, he added, is to avoid drug use altogether.

“People keep talking about this being a bad batch of cocaine and a number of experts have already said, I’ve seen it quoted, there’s no such thing as a good batch of cocaine,” he said. “Clearly every time you put your life in the hands of a dealer who’s selling illicit drugs, you are taking a risk every single time. People can die just from cocaine also.” 

He emphasized that addiction is a disease — “these are not bad people, these are people with bad diseases.” Community interventions need to focus on preventing people from starting drugs in the first place and help current users accept treatment and begin recovery.

The current efforts to get Narcan into the community is a good start, he said.

“I’ve always said if it were up to me, there would be free Narcan vending machines at every entrance of this hospital,” he said, referring to Stony Brook Eastern Long Island Hospital. “The more people have Narcan out in the community, the better, because you never know where you’re going to be when somebody can take an overdose, either accidentally or even on purpose.” 

Dr. Pachter emphasized that physicians also need to speak to their patients about drug use.

“You’re not going to talk people out of substance use, but you can certainly alert people of the dangers and just like people getting vaccinated, a doctor’s conversation goes a long way with helping decrease the risk for people,” he said.