Pubdate: Sun, 12 Aug 2012
Source: Knoxville News-Sentinel (TN)
Copyright: 2012 The Knoxville News-Sentinel Co.
Author: Lee Bowman


Heroin has become the deadly crest of a wave of addictive drug use in 
communities around the country.

With addicts desperate for a cheaper high than prescription drugs or 
seeking a more powerful fix, experts are seeing heroin addiction 
treatment admissions, overdoses and fatalities rising in nearly every 
region, including areas where the drug has seldom been seen before.

In Ohio, state officials say drug overdoses from heroin increased 25 
percent between 2008 and 2009, and are continuing to rise.

In Cowlitz County, Wash., an unusually pure shipment of heroin killed 
seven people in just five days during April.

In St. Louis city and county, officials report heroin killed 310 
people in the past two years alone.

Data from death certificates compiled by the federal Centers for 
Disease Control and Prevention for 2009, the most recent year 
available, showed heroin killed nearly 3,500 Americans, almost double 
the number that perished a decade ago.

Scripps Howard News Service analyzed those statistics and found 
heroin is a multi-generational threat, but becoming proportionately 
more deadly among those under 30.

Addiction experts and law enforcement officials say young people may 
be at particular risk as they move from the relatively certain 
effects of prescription painkillers to a street drug notorious for 
ebbs and spikes in potency.

A third of the 3,358 deaths recorded in 2009 occurred among people 
under the age of 30, including 93 deaths among teens. The bulk of the 
deaths, 2,178, clustered among people in their 30s, 40s and 50s.

In 2001 heroin killed 1,901 people. Twenty-two percent were under 30, 
including 45 teens.

Experts say there is no typical heroin user. They come from rich and 
poor neighborhoods, all levels of education, and can be young, 
middle-aged or old.

"The death certificates don't tell us how long a person had been 
using heroin, but given the patterns of opioid use we're seeing among 
people in their 40s and 50s, it's not that surprising that the heroin 
overdoses are spanning the generations too," said Dr. Wilson Compton, 
director for Epidemiology, Services and Prevention at the National 
Institute of Drug Abuse.

Federal risk surveys from 2011 show 2.9 percent of high school 
students have ever tried heroin, and that more than 350,000 Americans 
of all ages are addicted to the drug. A national surveillance network 
of hospital emergency rooms estimates that of nearly a million visits 
for illicit drug abuse in 2009, more than 219,000 were due to heroin.

Law enforcement and addiction experts say the current surge in heroin 
deaths reflects both the increased availability of the illicit drug 
in many U.S. communities and a large population of Americans willing 
to use it because it is cheaper and often more available than 
prescription opiates, such as OxyContin, that millions have become 
dependent upon.

In fact, addiction experts from Washington University in St. Louis 
said in mid-July that reformulation of OxyContin in 2010, aimed at 
making it harder to crush and dissolve in water for a quick high, 
seems to have prompted many users to switch to heroin.

The researchers' analysis of data from more than 2,500 patients 
entering 150 treatment centers in 39 states showed that OxyContin use 
had plunged by more than half since the formula change.

In interviews with about 150 addicts who had stopped using Oxy, when 
each was asked what drug they were using now, "most said something 
like, 'because of the decreased availability of OxyContin, I switched 
to heroin,'" said Theodore Cicero, a professor of psychiatry 
specializing in brain reactions to drugs who led the research. His 
team reported the early findings in a July 12 letter published in The 
New England Journal of Medicine.

But heroin is a devil's bargain for addicts.

Although a dose that is smoked, snorted or injected may cost $10 
compared to the street cost of $50 and up for OxyContin and similar 
drugs, it's effects are uncertain, more or less powerful at the whim 
of how dealers "cut" their product with various fillers.

"From a medical perspective, heroin is identical to opioid addiction. 
It follows the same process in the brain," Compton said. "The great 
uncertainty is the differences in purity, and what may have been 
added to it. You never know what you're going to get, even if you're 
taking the same amount you did the last time."

In southern Ohio, "the pain pill addiction is still strong and the 
stories that we hear are that users start off with the Vicodin, the 
Oxycodone, the OxyContin. Their tolerance gets higher. It costs more 
money, and then they turn to heroin as a cheaper alternative," said 
Steve Gifford, program director at the Northland Rehab Center in Milford.

The results can be deadly. In Longview, Wash., a small batch of "hot 
heroin" - unusually pure - snuffed out seven lives during one 
five-day span in April by bringing on almost instant respiratory 
failure in the users.

In San Diego County, Calif., 721 people under the age of 25 were 
admitted to treatment centers for heroin addiction last year, three 
times the number admitted just five years before.

"We have got a heroin epidemic, but it's hidden," said Nancy Knott, a 
counselor with the Scripps Treatment Program in La Jolla, Calif.

St. Louis has been one of the hardest hit areas, with the city and 
county recording 116 heroin deaths in 2010, and 194 last year, even 
as the Drug Enforcement Administration and 32 other law enforcement 
agencies arrested dozens of dealers in the region. Local prosecutors 
have charged many of them with drug-induced homicide.

Although it follows much the same distribution channels as marijuana, 
heroin has become more available in some areas, experts say.

The Justice Department's National Drug Intelligence Center noted last 
year that heroin is "readily available throughout the U.S." The 
threat assessment also spotlighted the growing involvement of Mexican 
drug gangs in expanding the distribution of heroin the heartland America.

Once largely considered an urban street drug favored by older teens 
and young adults "heroin is really cutting across different 
demographics, it's really reaching into just about every part of the 
country, although it's more of a problem in a few areas," said Rusty 
Payne, a spokesman for the DEA headquarters in Washington.

East of the Mississippi, most of the heroin is from Colombia and 
comes in white powder form, Payne said. In the western half of the 
country, "it's mostly Mexican black tar, very nasty stuff, usually 
not as pure," the agent added.The spread of heroin heralds not only 
more overdoses, but more people hooked on the drug, which is 
notoriously difficult to shake.

"It feels really good. That's why nobody ever stops once they start," 
said Conner Rehbein, a 21-year-old addict working to recover in a 
Baltimore treatment center.

Opiate dependence "is very, very difficult to break," said Jon 
Morgenstern, director of Treatment Research at the National Center on 
Addiction and Substance Abuse at Columbia University and director of 
addiction treatment at Columbia Medical Center in New York. "The 
treatment is very complicated and problematic. There are several 
medications that can help block the effects, but all have their own 
problems and side effects."

As the deadly progression from prescription pain medicines to heroin 
becomes better understood, "One of the things we really have to 
address is getting more focus on early intervention, on physicians 
and the medical system spotting these problems with prescriptions 
before people really get hooked and desperate enough to turn to 
heroin," Morgenstern said.
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