Christopher Maschino was struggling with addiction when he ran afoul of the law, resulting in 23 felony convictions on charges including breaking and entering, larceny and more.

He was never charged with a drug crime, but Maschino said his addiction had everything to do with his case.

Now in his fifth year in recovery, he works as a certified drug and alcohol counselor, helping others who suffer from the same disease that he said is culturally stigmatized today.

That's due in no small part to his memories of how employees that he encountered at his area syringe exchange program showed him compassion and avoided judgement when he was still using.

"The staff and the people who choose to do harm reduction work treat people who feel immense shame with love, and that goes farther than I could ever put into words," he said.

Maschino shared a window into his past during a recent online forum, "The 4th Wave of the Opioid Epidemic: Polysubstance Use," hosted by the Berkshire District Attorney's Office and the Berkshire Opioid Addition Prevention Collaborative. He was among a group of panelists to discuss topics such as trends in drug use and techniques for reducing its negative consequences.

"Addiction is still viewed as a moral issue, rather than an illness," he said. "It's pretty clear that what we do doesn't work. It's pretty clear that shaming and criminalizing just perpetuates the issue."

Before the COVID-19 pandemic began, some 6 percent of the county's population was addicted to opioids, according to District Attorney Andrea Harrington, and local law enforcement agencies have indicated that they are seeing increases in drug overdoses stemming from the crisis.

Harrington recounted a recent presentation she attended, during which officials from the Drug Enforcement Administration and the Federal Bureau of Investigations advised that communities prepare for an increase in the prevalence of stimulants like methamphetamine and cocaine — alongside opioids — which they described as the fourth wave. Key to that effort, she said, is addressing the demand for illegal drugs.

"We can expect to see more fentanyl; we should expect to see more stimulants," she said, "and they're telling local municipalities that we need to be ready for this."

Dr. Daniel Ciccarone, a physician and professor at the University of California, San Francisco, said overdose deaths involving methamphetamine are creeping up too.

"The reason why this is important is it's a historic change," he said. "You don't think of methamphetamine as being an East Coast drug. We think of it certainly as a West Coast drug."

Ciccarone said a few factors might be driving the increase, the first being what he said was an increase in supply of imported as well as domestically produced methamphetamine. Potency, he said, in some cases has also reached "almost pharmaceutical quality" of up to 97 percent.

He presented unpublished data from his own research that looked at 200,000 individual drug samples seized in Ohio over a 10-year period, which found that 7.5 percent of cocaine samples and 2.5 percent of meth samples were contaminated with heroin or fentanyl.

Without certain information, such as the potency of the opioid contaminant, he could not conclude whether any of the samples could have led a user to overdose. He suspects some people unknowingly ingested contaminated narcotics, though he noted the practice of intentionally mixing a stimulant with an opioid is on the upswing again.

A big-picture approach is needed to respond to the epidemic of addiction, he said. In addition to offering treatment and harm-reduction services, communities should focus on "fixing the cracks in society" that drugs too often fill, and preventing adverse childhood events that make kids more vulnerable to drug use as they grow up.

In the immediate, Ciccarone said, the best thing to do is keep a level head.

"First thing, we don't panic," he said. "Moral panic and layering on stigma and shame does not help; it is in fact our biggest enemy to reduce the public health consequences of drug use."

Samantha Kendall manages the syringe access program at North Adams Tapestry, which has capacity to distribute 10,000 syringes each month. When someone comes into Tapestry, Kendall said, staff handle more than a quick exchange; they talk to the person about drug use and how to manage associated risks.

"If we don't keep individuals alive, they'll never have that chance of treatment that they may potentially want down the road," she said.

Sarah DeJesus, supervisor of Healthy Steps, a harm-reduction program run through Berkshire Health Systems, said some barriers to health care have been toppled, making it easier, for example, to obtain a test and treatment for hepatitis C, which was seen in high rates in Berkshire County, particularly among intravenous drug users.

But other roadblocks to recovery stand, she said, and can become apparent as soon as someone decides to go to a detox facility.

"More often than not, there's not an open bed for them," DeJesus said, "and if we don't catch people in that moment, we lose them until the next time — if and when they may be ready to take that step again."

Two narratives that endeavor to explain the phenomenon of opioid and drugs emerged, said Dubois Thomas, neighborhood revitalization director of Central Berkshire Habitat for Humanity. One holds that void is left behind when a large employer, such as General Electric in the case of Pittsfield, leaves and changes local economy all but overnight.

Another finds the roots of addiction in "the general decay of our social fabric," Thomas said, which breeds isolation and from which drug use emerges as "a symptom of our disconnectedness."

Like how water finds a level plane, drugs will be consumed, he said. Responding is about determining what's most problematic, then mitigating that harm.

Harrington said her office seeks not to criminalize addiction, and focuses instead on working to get people into treatment. But when a crime is committed and the harm borne by others, charges may follow.

"In my office, we absolutely seek not to criminalize substance use disorder and we're really working on ways to get people into treatment programs," she said. "However, when people cross the line and are committing crimes that we feel endanger the community, like breaking into homes holding up stores, and trafficking, we do prosecute those kinds of cases."

Amanda Burke can be reached at aburke@berkshireeagle.com, on Twitter @amandaburkec and 413-496-6296.