If you want to see the impact of the opioid addiction crisis, look at Vaida Hogeboom, 7, and her sister Kaileeanna, 18 months, of Mohawk.

They’re growing up with teddy bears made out of their father’s shirts, but not with their dad, Joshua. He died in February at age 34 of a heroin overdose after 8½ months in recovery, said his father Kent. Kent Hogeboom and his wife, Deborah, won custody of their grandchildren a little over a year ago because of their son’s alcoholism and addiction, he said.

They have made a choice to speak out about their family tragedy. “We just want people to know these kids are the ones who suffer,” Deborah said. “This little 7-year-old goes to bed crying just about every night. Every night. And she had a softball game last night and she came home from the softball game and she said, 'I don’t want to play. I don’t want to play. It’s what my daddy loved and I don’t want to do it. It makes me think of my daddy.'”

Kent said he wants to spread awareness among other families. “We made a decision early on, that (one way) we could deal with our own grieving was to try to do anything we could (to) help. And part of that, to us, is talking about it.

“If we can get communities talking about it, if we can get middle-class parents, who think it’s an inner-city problem, to talk about it ….”

A lot of people are talking about opioids and addiction these days. Many families like the Hogebooms have been touched by the pain of addiction and, all too often, death. What started as a wave of both accidental addiction through prescription painkillers and deliberate abuse of purloined pills has become an epidemic of heroin.

Many addicts switched from painkillers as new regulations made that medicine harder and more expensive to come by. But given the ready supply of heroin in the area, some drug users chose to try heroin instead of other illicit drugs, those in the substance abuse treatment field say.

And now the advent of fentanyl — a prescription drug widely manufactured illicitly — has made addiction even more dangerous. Fentanyl, sometimes laced with heroin and sometimes sold on its own, is 50 times more powerful than heroin. Some users seek it out for the powerful high and others think they’ve just bought heroin.

“It’s very scary, looking at it both ways,” said Roberto Gonzalez, Safety First Syringe Exchange Program coordinator for the Mohawk Valley for ACR Health. “We have had reports of people saying, ‘I didn’t know it was fentanyl until I overdosed. I didn’t know it was fentanyl until my sister died.’ … And in other cases, it’s, 'We're looking for that fentanyl. We want that fentanyl.’ So it’s scary looking at it from both ways.”

But all the talk about opioids has led to a lot of action, too. State Sen. Joseph Griffo, R-Rome, served on the state Senate heroin and opioid task force that formed in 2014 and traveled around the state, listening to professionals, people in recovery and families who lost loved ones.

“I think it all helped not only raise awareness and acknowledge the seriousness of this challenge and this problem, but also that we couldn’t just sit idly by, that we all had to work together geographically across party lines in different branches of government to really put a coordinated plan and strategy together to really make a difference,” he said.

The problem has sparked a tremendous amount of cooperation between government at all levels, law enforcement, treatment providers, the health care system and community agencies as they work together on a multi-faceted approach that focuses on prevention, education, support for addicts and their families, treatment and recovery.

Progress is being made through cooperation, said Ashlee Thompson, program director of the Community Recovery Center at Rome Memorial Hospital. “Just like any addiction, things don’t happen overnight and it’s definitely a process. … We’re no longer working in silos and we’re trying to work together to make sure that everyone’s needs are met,” she said."

Harm reduction

One of the biggest changes in recent years has been the spread of so-called harm reduction techniques. “Harm reduction is kind of the bridge,” said Julia LaVere, assistant director of prevention/syringe exchange services for ACR Health. “Prevention, just saying no, misses some people and they just use drugs anyway. And recovery is great and the ultimate goal.”

But some people just aren’t ready for recovery or they find recovery a bumpy process with dangerous setbacks, she said. Harm reduction keeps people with opioid abuse disorder alive until they’re ready for treatment through things like training and distribution programs for naloxone, the medication that can reverse opioid overdoses, and syringe exchanges to prevent hepatitis C and HIV infections through the use of shared needles.

More than 400 community agencies now offer naloxone training to the community and 160,000 first responders have been trained since 2006, according to the New York State Department of Health. To make that happen, the state changed regulations, allowing more people to administer naloxone, and it provides free naloxone kits to anyone who goes through naloxone training.

A syringe exchange program in Utica, run by ACR Health, offers clean needles, antiseptic and other supplies — as well as education and links to support services and treatment — to anyone who uses injectible drugs, including heroin, insulin and hormones.

This is all good news for the families of those with substance abuse disorder who want help with two things: getting their own lives back on track and helping their loved one get help, said Ambi Daniel, family support navigator with the Center for Family Life and Recovery. “The biggest hurdle is usually that their loved one isn’t ready to accept help that is offered and they are at danger of overdose and death. Families are desperately trying to keep their loved one alive,” she said.

But naloxone is facing new challenges as fentanyl becomes more common. “We’re seeing a lot of users who are coming in and needing naloxone for reversal, people who sometimes need multiple doses of naloxone because of the severity of what they’re using. So we’re seeing more patients and more severity of what they used,” said Dr. Ross Sullivan, assistant professor of emergency medicine and director of medical toxicology at Upstate Medical University.

And sometimes, it doesn’t work.

Making treatment easier

When the opioid epidemic first hit the area, patients with opioid abuse disorder and their families often reported a big problem — barrier after barrier standing between the patient and successful treatment.

Sometimes the barrier was insurance denial for the right kind of treatment. Sometimes it was a lack of options for kinds of treatments close to home. Sometimes it was waiting lists for treatment. And sometimes it was just getting lost in the system.

The state and federal governments, treatment providers, community agencies and others have been working to knock down those barriers ever since.

For example, treatment providers have added walk-in hours for evaluations. The state has gone after insurance companies for requiring patients to fail in outpatient treatment before paying for inpatient care. The federal government has eased restrictions on how many patients on Suboxone, an opioid used to wean patients off other opioid drugs, one doctor can see, making it easier for patients to find a doctor.

Local agencies have hired, with state money, a family support navigator and peer educators to provide support, information and a link to services. They’ve also started family support groups.

“We have changed our programming to meet the needs of patients,” said Admira Spahic, director of program operations at the Beacon Center, which has locations in Utica, Rome and Herkimer. “We continuosly work on faster access to treatment. We have walk-ins, assessment appointments within 24 to 48 hours, insurance navigator on site, etc. All of this is an attempt to help save a life. We know with heroin use, there is a high chance of overdose and we want to prevent that.”

And The Beacon Center opened the county’s first clinic to offer methadone, another opioid used in addiction treatment, in Rome in November.

“All these little things are coming together,” said Nicole Siriano, outpatient services director for CNY Milestones in Utica. “Obviously, there’s more work that needs to be done, but all in all, where we were a few years ago, we’ve come very far from two years ago. And that’s because the state has listened to us. They’ve listened to families. They’ve listened to our clients.”