Everyone has heard of the heroin epidemic sweeping across America. So much so that in an interview with Jacob Parker Carver of the Mental Health Association of Tompkins County, our conversation drifted away from the intended topic of mental health and into the heroin users in the Tompkins County Jail. Carver works in the jails as a leader of both the WRAP (Wellness Recovery Action Plan) and the Talk groups (which is quite literally just a group for talking).

Ithaca has also been the center of a recent controversial proposal surrounding heroin usage. When the Major Myrick revealed the plan last month he admits, even he thought it was a bit crazy. A public center where heroin addicts could legally shoot up under medical supervision, this is something that has never existed in America before. But that doesn’t mean it’s never existed at all. Injection sites have existed in places such as Switzerland and Vancouver for decades. And evidence shows that they have actually lead to reduced fatal overdoses, dropping as much as 35% in the Vancouver injection site community.

When discussing the epidemic within the jails Carver offers a thought that many wouldn’t even think to include, “There’s a mindset that someone who’s dealing with addition needs to be punished. Scared away from it, right? When in actuality someone who’s using heroin is not afraid of negative consequences. Someone who’s using heroin is already dealing with more negative consequences than they can handle. So adding more punishment onto that is not in any way an effective tool. Something that I’ve heard people is say is that they’re not supposed to like jail. Jail is supposed to be an uncomfortable place. Because we don’t want them to come back here. But scaring people out of going to jail, especially some dealing with addiction, they’re already dealing with more punishment just in their own internal world than you can put on them.”

Carver is quick to trace the drug abuse issues in Ithaca back to the treatment that the locals have available to them. “[W]e don’t have a lot of resources available for that. I mean we have CARS (Cayuga Addition Recovery Services), we have the Alcohol and Drug Council, we have staff programs. We have programs, we have agencies that are working for that but it doesn’t necessarily always work in the individual’s best interest. So there are some programs that you have to be sober before you can get access to. There are drug and alcohol counselors who are there to support you and talk you through your recovery and help you be sober, but you can’t show up there high. And that’s a stumbling block for a lot of people because if they could stay sober than they wouldn’t need the service, right?”

And this leads to another question, a matter of the financial burden. “And then there are some programs where you need to be well enough insured. You need to have Medicaid, you need to be able to pay for the help that you’re getting and that’s a huge stumbling block to a lot of people.” There have been a slew of articles associating an increase in crime with heroin addicts, so much so that a thieving addict has become a stereotype. But when they’re already scrambling for cash to support their addiction, how are they supposed to pay to attend a recovery center? It’s not like all addicts also have a stable job and a steady income, so that negates the easiest form of insurance. How are these people expected to get clean in a system that seems to be forcing them back towards their vices?

This brings Carver to his most compelling point of all. “If you think about it as opioids, of which heroin is one, they’re pain killers. So someone who is addicted to that, they’re dealing with pain. They’re taking that because they’re in pain and can’t handle the world without that painkiller.” This is an element of addition that isn’t often discussed. Self medication, in it’s purest form, has become an epidemic in our country and instead we’re treating it as a crime. These people are struggling to survive and they didn’t have the same chance to seek out antidepressants, therapists or counselors like many of us do. Heroin was the only option they saw: the only out. Because when you’re suffering that much all you really want is to stop the feeling, by whatever means necessary.

“So to be in that much pain and to then be so desperate to just try and get relief from it, and then to get arrested and have to go through that whole thing, and then to have to go through withdrawal in jail, is a nightmare,” Carver continues. “But right now, that’s like the best situation that we can offer because they’re at least kept away from that drug. It gives them an opportunity to get sober. And a lot of people end up, when they get released, just going back out into the streets looking for that drug again.”

And this brings us back to the financial difficulties so many addicts face. “Because even though they have had that time of sobriety, and maybe they are not quite so physically addicted by the time they get out, all the elements of their environment that lead them to use drugs as a coping mechanism are still there. They might still be homeless. They might still not know how to provide for their families. They might still not have jobs. They might still be dealing with X, Y, Z family situation that is making their lives miserable. And in many cases, in most cases, people are worse off by the time they get out of jail. You’re not making money, you can’t pay rent or do upkeep.”

The elements of their environment that caused them so much pain do not vanish during their detox. Even if the heroin is out of their system, the misery and strain of their life is just as real as it ever was. “Imagine you get arrested and you’re in jail for 8 months. Are you paying rent on that apartment for those 8 months? Probably not. So there are people who are panicked because what’s gonna happen to all their stuff? Sometimes landlords will just kick it out on the street. So there are people who get out of jail and maybe they’re sober, but they don’t have any money or a home or own anything. So for someone in that situation I don’t think it’s a hard stretch to imagine why they would start using again.”

Carver is able to shed a light on Ithaca’s opioid crisis. But the problem stretches far past upstate New York. According to a survey taken by The Center for Disease Control and Prevention and the National Center for Health Statistics, the world of heroin has changed dramatically in the past fifteen years. Looking back to 1999 there were only a handful of counties across the United States that saw more than twenty opioid related deaths per year. Looking at a map of 2014, there seem to be only a handful of counties that don’t see at least four overdoses per year. With a stark concentration of overdoses occurring in the mountain states and Appalachia, the map of our country today is covered in overdoses. In total drug overdoses killed 47,000 people in the U.S. in 2014.

The results for 2016 are yet to be seen but with such a recent spike it’s hard to believe numbers won’t grow. A deep rooted crisis on American soil, it’s time to take the taboos of addiction and medication out of this conversation and start looking at the facts. More people are dying from overdoses than car crashes. It’s time to examine your own community, and find out what you can do to help those in your own life who are in pain.