No quick fix
Opioid addiction struck Kim*, a 25-year-old Jewish woman from Pittsburgh’s East End, while she was still attending a private middle school in Shadyside. (*Some names in this story have been changed for reasons of privacy.)
Kim’s mother, Julie, realizes now that there were signs of the addiction that still plagues her daughter but did not recognize those signs at the time: belligerence, falling grades, poor concentration.
“I was shocked,” Julie said. “I had no clue. I had no idea she had access to drugs of any kind. She didn’t run around at all. She was home at night and on weekends, not running around with a gang.”
Drugs simply were not on Julie’s radar.
“I thought my daughter was not at risk for that thing,” she said. “Neither her dad nor I had substance abuse issues.”
The heroin and opioid epidemic in Allegheny County is real, and its reach does not discriminate either geographically or demographically. While Jewish families are reluctant to talk about being affected by the crisis, many community members are suffering.
In the last two years, Rabbi Alex Greenbaum, spiritual leader of Beth El Congregation of the South Hills, has counseled four families that are affected by heroin addiction.
That number is high for a suburban congregation that serves only about 400 families, said Greenbaum, but he believes the actual number of families affected by heroin at Beth El is even higher.
“It takes many years before you approach a rabbi about a problem like this,” he explained. “I’ve counseled four families, but there are probably another four that are dealing with it and not talking about it. And there are probably another eight that don’t even know they are dealing with it.
“One of the biggest problems in the Jewish community is that we don’t talk about it,” Greenbaum said.
Addiction to heroin, and other opioids, continues to take its toll on residents of Western Pennsylvania with 246 opioid-related deaths in Allegheny County last year. Of those, 209 involved heroin.
“The Jewish community is more or less in the same boat as everyone else,” said Rabbi Moishe Mayir Vogel, executive director of the Aleph Institute, a not-for-profit organization offering services to imprisoned Jewish men and women and their families. “When the wind blows, it blows everywhere.”
Drugs have been a problem in the Jewish community for decades, Vogel said, and with the increase in heroin use, he has been called to the Allegheny County Coroner’s office “way too many times” to provide Halachic advice regarding the remains of Jewish overdose victims. In 2015, Vogel had to make three such visits.
“That number is very high for a small Jewish community of 35,000,” he said.
Julie discovered her daughter’s drug abuse when Kim was 15; cocaine was detected in Kim’s blood work during a checkup at the doctor’s office. Though Kim used cocaine, opioids became her “drug of choice,” Julie said.
“Pills, fentanyl patches, all of it is on the streets,” Julie said. “Dilaudid is a little harder to get. She also has done heroin.”
Kim’s opioid addiction began when a doctor prescribed pain medication to help with a medical issue.
“They were all prescribed,” Julie said. “Opiates, Dilaudid, Fentanyl, Klonopin and Xanax, which is a benzo.”
Kim became dependent on the pain medications, and when her prescriptions were exhausted, she had no trouble finding alternative ways to get her hands on the drugs.
“It was available in her school, from people online,” Julie said. “We lived in a nice neighborhood. She went to a private school. But she had no problem finding it.”
The genesis of Kim’s opioid addiction is typical, said Dr. Neil Capretto, the medical director of Gateway Rehab, a drug and alcohol treatment center founded in Pittsburgh in 1972 by Dr. Abraham Twerski.
The current opioid epidemic, with its wide geographic breadth, stems from what Capretto labeled “the perfect storm” of the mid-1990s.
“Opioid addiction and heroin have been around for decades,” he said. “It never went away. But it was usually limited to the inner city, people of color in poverty areas. It went down some in the 1980s, but in the 1960s and 1970s, people died of opioids.”
In the early to mid-1990s, the cocaine cartels surmised that the way to increase heroin sales would be to make it stronger, Capretto said, so that it would no longer need to be injected by needles; instead, the new heroin could be smoked or snorted. The market for users was thus expanded to people who were afraid of needles.
“As that was happening, in the mid- to late 1990s, there was also a dramatic rise of prescription medicine,” Capretto explained. “The medical profession had come under criticism that we needed to prescribe more pain medication, that we needed to treat pain.”
A campaign waged by the drug companies encouraged doctors to be more liberal in prescribing painkillers.
“We were given the wrong information,” said Capretto. “We were told that Oxytocin was a magic pill and that it was nonaddicting. The message to doctors was that these drugs were safe.”
Prescriptions for painkillers increased 600 percent from the mid-1990s to the mid-2000s nationwide, Capretto said, and the rise was even more pronounced in Western Pennsylvania because of the higher percentage of older adults and blue collar workers with medical issues.
“People were getting addicted to these drugs by the thousands,” he said. “It became like an underground community. The drugs became available on the street. They became known as good party drugs.”
Those addicted to opioids build up a tolerance to the drugs, and after nine or 10 months, they require more drugs to achieve the same effect. The pills, he said, are very expensive.
“For many people, they could no longer afford their pills,” said Capretto. “But the new heroin was out. They could spend $200 a day on pills, or for $40 a day they could do heroin. Its purity went up, and its price went down. And no needles were necessary. Ninety-five percent of heroin addicts started with prescription drugs in Pittsburgh. The pills drove the heroin.”
Many communities have been unprepared to deal with this addiction, he said.
“It’s out in the suburbs,” Capretto said. “Now it’s everywhere. It’s in every community and every walk of life. Ph.D.s, M.D.s, there are people over the age of 50 who are starting heroin for the first time.”
“Heroin,” Capretto said, “is easy to find.” Someone looking for the drug can enter a new community and within 15 to 30 minutes have the drug in hand.
Shira, a local Jewish college student, saw heroin for the first time at a friend’s house in Greenfield.
“I was at a get-together,” Shira said. “I didn’t know what it was till after [the party]. Someone told me afterward.
“It’s more common than you think. Not everyone in college here is doing it, but the people who use it would surprise you. A lot of people try it for fun. People are curious and college is like that one chance where you want to try things before your real life starts, like getting married and having kids.”
At various parties, Shira has seen “cocaine, pounds and pounds of weed, ecstasy, pills such as Percocet, Oxy and Vicodin, shrooms, chocolate-covered shrooms, Molly in pill form, MDMA, acid in strips and heroin in powder form — it was darkish, tannish color,” she said.
These drugs are mostly used at house parties, where five or six people are hanging out, she said, and getting heroin is “very easy.”
“I know one person who knows a lot of these junkie people and would hook you up. I feel like it’s harder to get weed. Cops are more vicious about weed. If you have pills in your bag they won’t know. You should see how easy it is to get heroin or Molly or something. Pills, everyone has extra ones around their house nowadays. Doctors will give you pain meds for anything.”
Scoring pills often requires no more effort than going to a friend or family member’s house, she said, especially if an “older parent or grandparent” lives there.
Alternatively, the drugs are usually just a phone call away.
“You call up your mutual friend or someone you know who uses, and say ‘I need’ or ‘I need for a friend,’” Shira said. “That person will ask, ‘What’s your price limit? How much are you looking for? OK, let me get back to you.’ Usually, within a couple of hours, they get back to you and say, ‘I can meet you tomorrow.’ Usually, it’s like in a grocery store parking lot, somewhere with a lot of people.”
Jimmy, a Jewish man in his 20s, no longer lives in Pittsburgh, but that is where his drug habit began.
“In Pittsburgh, I used to take pills — Oxys, Vicodins, Percocet, Klonopin, more for anti-anxiety — drink a little alcohol, smoke weed, get a little crazy.”
The drugs were very accessible.
“You just meet people at parties and get their number,” Jimmy said. “That’s how we would do it. It was usually five, 10 bucks a pill.”
Other times, Jimmy got pills from friends who recently had surgery, “people who had their wisdom teeth taken out and didn’t need the pills,” he said.
Jimmy said that following high school his drug use increased, and he became worried about his burgeoning dependence.
“The drugs were numbing pain,” he said.
Jimmy sought help from a psychologist and a drug therapist and now feels as if he has control over his drug use. He has not, however, committed to stopping it entirely. While it has been about six months since Jimmy has taken Vicodin, he has not ruled out taking it again, he said.
“The reason I still use is not to cover anything up. It’s like I drink a beer here and there. I don’t think I’ll get addicted to it.”
Jimmy confirmed that addiction exists in the Jewish community, despite people’s reluctance to talk about it.
“A lot of people will keep it a secret,” he said. “They’re ashamed of it. Drug abuse, drug use, using pills, it’s a lot more common than people think it is, [and] it’s people you wouldn’t expect to be using. It’s not just kids. You really don’t know. It could be the mom, the dad, the uncle. It’s a lot more widespread than people realize.”
You can’t compete with heroin
Beth El’s Greenbaum, who is working to bring an addiction support group to a local synagogue, knows from speaking with heroin users that addiction can come on “so strong and so hard and so fast, even trying it once can change your life.”
“I was speaking to a heroin addict who said that once they tried heroin, everything else in their life was gray,” Greenbaum said. “Nothing is as good as heroin. This is the kind of thing where one mistake can ruin your life.”
Rita Lowenthal knows how true that is. Now living in California, Lowenthal grew up in Pittsburgh and attended Taylor Allderdice High School, as did her son, Josh. Josh died of a heroin overdose at age 38, 25 years after he began using. Lowenthal recounts Josh’s struggle with heroin, his imprisonments in San Quentin and the toll it took on their family in her 2007 book “One Way Ticket: Our Son’s Addiction to Heroin.”
Lowenthal painfully describes Josh’s descent. She recounts him telling her: “Cool it Mom. You can’t compete with heroin.”
“[Readers of the book] have told me that line — ‘you can’t compete with heroin’ — has been the most helpful thing for them,” said Lowenthal by phone.
Josh Lowenthal died in 1995. Until recently, a bench bearing his name sat outside the Squirrel Hill Post Office on the corner of Murray and Darlington avenues.
Although people are reluctant to talk about it, losing a Jewish loved one to heroin is more common than most would suspect.
Mendel Marcus, 27, has lost several Jewish friends to heroin and other drugs.
“There was a case here,” Marcus said. “A friend of mine OD’d.”
Marcus’ friend died in the bathroom of a Squirrel Hill coffee shop, and Marcus remains in contact with his late friend’s father.
“I’m friends with his dad,” Marcus said. “I saw the decline [from what he] had been through, the whole thing, the devastation, the heartbreak it had. He’s a broken, horribly sad man.”
Marcus said that the Jewish community treats heroin like “a non-issue” despite is ubiquity.
“It’s available here. I’m sure I could find it,” he said. “If push came to shove, a couple of days, a phone call or two. At the same time I’ve watched lives get ruined, divorces. It’s definitely something that happens in this community.
“There is a certain level of shame,” Marcus continued. “I’m always extra supportive. And I understand you want to keep it hushed up. It just creates a whole stigma. The only thing I could compare it to would be sexual abuse — you’re shunned for being the abused often more than being the abuser.”
While Marcus considers himself “a social guy” and at parties has seen kits, straps, needles and pills, he has been able to avoid their use.
“Because I’ve seen the destructive force, I’ve avoided the temptation or peer pressure behind it,” he said.
But he also said that there is no rhyme or reason for who becomes an addict.
“The people I saw in my life get hooked varied,” he said. “Some were the last you’d expect.”
Like one Jewish friend, who Marcus described as good-looking, charismatic and popular, but became addicted to methamphetamine (or “meth”). Marcus’ friend then joined a drug ring, undertook illegal activities to feed his meth addiction and is now in jail.
Besides death or jail, the effects can be devastating.
“I knew someone that was so high on heroin,” Shira said, “they don’t remember the birth of their child, and they don’t remember their sibling’s wedding.
“His wife told on him because he was stealing money from his parents,” Shira continued, adding that his wife eventually left him.
“He didn’t care. He didn’t want to fight for anything. He really doesn’t look good. This happened in an Orthodox Jewish community, and no one was aware of it. If they would have seen or realized from a younger age, maybe it could have been prevented. It didn’t just happen in one day.”
The road to recovery
“Someone told me addicts get well when parents hit rock bottom,” said Julie, whose daughter Kim has been sober now for five months.
Still, the call of drugs remains out there. Just last month, Kim’s dealer texted her while she was in the hospital recovering.
“I had her phone,” Julie said. “I texted him back and said, ‘I know who you are, know where you live. If you ever contact her again I’ll turn you in.’ He said, ‘I’ll never contact her again,’ but of course he did. The fear factor only lasts so long.
“But it was like whack-a-mole,” Julie continued. “If he wasn’t there, someone else would be.”
Julie is an advocate of drug and alcohol treatment programs.
“There is a lot of wisdom in the recovery community,” she said. “They are not afraid to take a strong stance.”
Kim is now in a halfway house.
“I told her you will never be alone if you stay in that community,” Julie said. “You don’t find that in the mental health community.”
In a typical week, about 300 people come to the Aleph Institute on Beacon Street to participate in 12-step programs for substance abuse, according to Vogel. And there are many more Jews who choose to seek help in non-Jewish programs, he said, to avoid being identified in the community.
“We have drug meetings every morning of the week,” he said, adding that those affected range from youngsters to older adults.
Those who are recovering from opioid abuse are “usually broken individuals,” Vogel said, and it is imperative to provide them with supportive services. A mentor can make a big difference in the life of an addict trying to transition back into society.
Mike Pasternak is a local licensed clinical social worker that ran a program from 2001 to 2009 called Transitions for boys from Orthodox homes who were dealing with addiction issues.
“Kids can get better with the right treatment,” he said, and entering a rehab facility is a good start.
The key, he said, is maintaining ongoing support from their families and from the community.
“There is no quick fix,” he said. “It’s long-term.”
One persistent problem in the Jewish community, said Pasternak, is denial that the problem exists.
“No one is immune to this,” Vogel said. “There is not a community in this country that is immune to drugs and alcohol. We need to wake up and realize it’s a plague affecting everyone. These individuals can become a blessing to the community rather than, God forbid, a terror to the community.”
For help, go to gatewayrehab.org, or alephne.org.
Toby Tabachnick can be reached at email@example.com; Adam Reinherz can be reached at firstname.lastname@example.org.