Heroin abuse shooting up in Southwest Washington

From the Longview Daily News, April 19 2009

Heroin addiction is shooting upward in Southwest Washington – and so are heroin overdoses. Emergency Department personnel at St. John Medical Center have seen “a definite steady and noticeable increase” in heroin cases, said spokesman Randy Querin.

Police reports show officers frequently coming in contact with heroin users in the past several months, including a prostitute who said she turned tricks to support her habit, a woman who said she used heroin to take the edge off her cravings for meth and a man twice found turning blue from heroin overdoses on different bathroom floors four days apart.

Wednesday, the Cowlitz-Wahkiakum Narcotics Task Force arrested 11 suspected heroin dealers in connection with an investigation that began in November. Agents seized nearly a kilo – about two pounds – of heroin during the investigation, said Sgt. Kevin Tate of the Task Force.

Drug culture changing

“There’s a fundamental difference in the illegal drug culture of Cowlitz County than two years ago,” Tate said. “Addicts are increasingly relying on opiates as their drug of choice, and frequently their drug of choice is heroin.”

Shawn Strock, 23, a former Cowlitz County resident living in Portland, is in recovery for heroin addiction and makes daily visits to a Vancouver methadone clinic.

He said he began using heroin when he was 20 (the average age for a first-time user, according to the U.S. Centers for Disease Control). His addiction to narcotic painkillers began at age 15 and included OxyContin, Roxicodone, Fentanyl and morphine.

He and other addicts told The Daily News they switched to heroin because of the high cost of pills.

“Pills are so expensive,” Strock said. “Oxy 80 (an 80mg OxyContin pill) is going for 70 bucks now, but you can get a balloon (about .3 gram) of heroin for $20. Oxy 80 lasts 4 hours, but a balloon of heroin, when you first start out, will last you all day.”

Economic downturn not related to drug choice

But don’t jump to the conclusion that the current economic downturn has anything to do with an addict’s drug choice, Tate said.

“This shift is what we have been preaching about for years now – it is not surprising, shocking or due to the economy,” he said.

In 2006, local and federal narcotics agents made a dramatic roundup of 26 people illegally selling prescription painkillers, which brought the public’s attention to pill abuse by children and teens.

Tate said the investigation also educated narcotics agents about introductory addictive behavior, and the task force’s latest heroin investigation is a natural continuation of the pill investigation.

“Many of the baby addicts are adolescent addicts now addicted not to pills, but to a general class of opiates,” Tate said. “What we’re seeing is that the ‘gateway process’ is accelerated. The window from never using to heroin addiction used to take quite a while, with many opportunities to get out. Now it’s concentrated, going from no drug problem to addicted in a short time span.”

Kids as young as 13 using heroin

Strock said he’s seen kids as young as 13 using heroin – and addicts as old as 75 or 80.

Querin said St. John Emergency Department staff have noticed an increase in heroin use from teens to middle age.

Tate said it distresses him personally to see some young people he knew as babies have become heroin addicts.

“We’re seeing 14, 15, 16-year-old kids addicted to opiates. When we see that 17-year-old high school junior or senior that suddenly OD’d, that’s impactful.”

Heroin withdrawal is like a severe case of the flu, Tate said. The stronger the addiction, the more severe the reaction.

Symptoms include cramping, diarrhea, chills and nausea, and can last as long as a week.

Addiction pushes users to crime

“When you know you’re going to get the worst flu ever, your fear level goes up, and you’ll do anything to avoid having that feeling,” Tate said. This includes stealing from loved ones to get money for more heroin, he said.

“There’s an increased focus on self,” he said. “Lying and deception become easier.”

Addiction makes it easy for heroin users to justify committing burglaries, thefts, robberies, prostitution and other things they’d never have considered before taking dope, he said.

Some heroin addicts point to tighter restrictions on prescription drugs after the 2006 raid as the reason they switched from pills.

“I’ve had a couple flat-out say, ‘I was pushed to heroin because I couldn’t get pills,’ ” Tate said. “I think that’s a bunch of crap. They’re using because they chose to use. Addiction or not, it’s still a choice.”

Former Task Force agent Paul Carlson, who worked on the pill investigation, said many of the major pill dealers were already using heroin before the arrests.

“I don’t think (the raid) made the problem worse,” Carlson said. “If you’re addicted to Oxy, for full-fledged addicts it’s not much different than heroin.”

He said the raid had a positive effect on the community because it scared customers on the fringe of the drug world, many of whom were teens, into quitting.

“I think there was a huge impact on the pill population, the ones that weren’t dealing,” he said. “They saw the wide roundup and that freaked them out.”

Steady climb in heroin overdoses

At St. John Medical Center, Emergency Department workers code overdose patients either “poisoning/heroin” or “unspecified opioid type dependence,” but the opioid is most likely heroin, said PeaceHealth spokesman Randy Querin. He said there’s been a steady climb in opioid/heroin cases at St. John since 2007, from 128 in the first half of 2007 to 259 in the last half of 2008 (see table).

Overdoses are “more common than you realize, but most people don’t die,” said Carlson, who said he responded to a lot of overdose calls when he was a Longview patrol officer. “If it wasn’t for Narcan we’d have a ton of deaths.”

Narcan (naloxone) is an antidote that neutralizes the effects of opiates in a minute or less, depending on how much heroin the person has taken.

Mike Turner, a paramedic/firefighter with Cowlitz 2 Fire & Rescue since 1986, said paramedics don’t keep track of overdose numbers, but he injected Narcan in about 15 overdose patients in the last year.

“I wish there was a way we could videotape these people before we intervene,” he said. “They’re essentially dead. They’re not breathing. There’s barely a heart rate. Then they wake up, and they’re mad and deny using drugs. Sometimes there’s a needle still in their arm, but they’re always in denial. They think we’re stupid. We’re not the cops. We don’t need to be lied to. We just saved their lives, for crying out loud.”

As for fatal overdoses, Coroner Tim Davidson said his office documented 21 drug deaths in 2008. One was definitely heroin and the rest were fatal mixtures of drugs, he said.

He’s awaiting toxicology results on suspected drug overdose deaths from this year.

Sgt. Tate of the Task Force offered these theories for the increase in heroin overdoses, fatal and nonfatal:

The user is new to the drug and doesn’t know how much to take.

The user is changing the method of taking the drug from smoking to injecting, but is not changing the amount taken.

The source of the user’s drug supply fluctuates, and therefore so does the purity level, but the user can’t tell the purity by looking. Higher purity means the drug has not been diluted as much with other substances and is therefore more potent.

The user mixes heroin with other drugs without realizing how they interact chemically. The user also might inadvertently double-dose by taking a time-release opiate such as OxyContin and later taking heroin, not realizing the other opiate is still in the system.

How to tell if someone is a heroin addict

Heroin addicts don’t stand out like meth addicts do, but here are a few clues suggested by police and heroin users:

Immediately after taking heroin, a user goes “on the nod” – lethargic, incredibly sleepy, unable to function.

For the majority of the high, the user is very upbeat and seems normal.

Because the high wears off in four to six hours, look for recurring “flu” (withdrawal) that seems to disappear quickly (because the user takes another fix). The average heroin user is in withdrawal about half the time.

* Abrupt mood swings.
* Pinpoint-sized pupils.
* Stealing and other crimes.

Several heroin addicts in recovery told The Daily News they’d like to see a methadone clinic in Cowlitz County similar to the two clinics in Vancouver. All said those clinics serve a large number of Cowlitz County patients.

Methadone is a synthetic narcotic designed to help wean addicts off heroin. Taken orally once a day, methadone suppresses narcotic withdrawal. It’s only available in clinics. Its critics point out that methadone is also addictive.

A newer drug, Suboxone, also treats opiate dependence and is considered to have a lower potential for abuse than methadone, according to the U.S. Food and Drug Administration. One of its ingredients is naloxone, also used in Narcan. Suboxone requires a doctor’s prescription.

Tate said enforcement, education/prevention and treatment all are equally important. He’d like to see longer sentences given to dealers. Ninety-seven percent of people arrested by the task force are found guilty or plead guilty, he said.

“I think treatment is fantastic, but if we put them back in our community they’re going to stay in our community and they’re going to do what they know how to do: Deal drugs.”

He said law enforcement and community leaders have talked for years about the necessity for a balanced approach to drug treatment and interdiction.

“Show me a program that works,” he said. “We (law enforcement) saw people dying. We have tools to stop people from dying – and make an opening for treatment programs to do their part. I would love to see every one of those heroin addicts in treatment and clean.”

EXTRA – The straight dope on heroin, Longview Daily News