Pubdate: Sun, 23 Sep 2012
Source: Star-News (Wilmington, NC)
Copyright: 2012 Wilmington Morning Star
Author: Brian Freskos


Amber Spivey tilts her head back and swigs the vial of methadone. 
"Oh," she moans, shaking her knees back and forth like engine 
pistons. Her face contorts in disgust. She chases the 
Kool-Aid-colored liquid with water. The taste, she says, is like a 
thousand pills dissolving on your tongue.

Methadone is helping Spivey, a 28-year-old freckled mother of three, 
reclaim her life after years of heroin addiction. She is among dozens 
who line up each morning at the New Hanover Metro Treatment Center, a 
white space of offices hidden off a highway heading downtown. Some 
wait inside to take their daily dose. Other patients pick up their 
"take-home" doses for the next days, weeks or month, a privilege 
earned by attending counseling and passing random drug tests.

The story of how Spivey wound up on methadone is the story of an 
emerging problem confronting America. Introduced to prescription pain 
relievers as a teenager, she shifted to heroin in her early 20s after 
somebody convinced her the high was twice as strong at half the cost 
of what came out of the pharmacy. Spivey's story exemplifies a 
relationship between legitimate pharmaceuticals and an illegal street 
drug, a connection that treatment centers see with alarming frequency.

The number of people seeking treatment for dependence on opium 
derivatives is surging statewide. The disturbing trend is being 
fueled by precipitous growth in prescription drug abuse, which 
doctors and law enforcement officials say has fast created a new 
category of heroin addict.

The waning availability of black market medications has prompted 
fears that a dearth of prescription drugs will lead to escalating 
heroin use as addicts once dependent on pain pills such as Oxycontin 
grasp for something to satisfy their cravings. A recent Substance 
Abuse and Mental Health Services Administration study found that 81 
percent of people who tried heroin for the first time between 2008 
and 2010 previously abused prescription drugs. The link between 
chemically similar opium derivatives has rekindled a long-running 
debate about the effectiveness of America's war on drugs, renewing 
questions about the lopsided focus on law enforcement versus the lack 
of funding for treatment.

Alfred Blumstein, a professor at Carnegie Mellon University's Heinz 
College who studies drug policy, said laws passed over recent decades 
have resulted in drug offenders being incarcerated longer, despite 
warnings that such practices lead to ballooning costs and are 
ineffective at curbing the problem.

"When you take a rapist off the streets, you remove his rapes from 
the street," Blumstein said in a telephone interview. "But when you 
take a drug dealer off the street, you find a basis for recruiting a 
replacement as long as the demand is there."

Law enforcement officials argue that efforts to dismantle trafficking 
organizations have not only kept supply from spiraling out of control 
but also checked the violence that regulates the black market.

Combating prescription drug abuse has become a priority for policy 
makers. In recent years, local, state and federal governments have 
launched programs to rid medicine cabinets of idling medications and 
educate physicians on detecting drug-seeking behavior, among other 
things. Despite such efforts, the federal government reports that 
prescription drugs cause more overdose deaths than heroin and cocaine combined.

But experts say strides have been made. Access to prescription drugs 
is harder now because of tighter laws, stronger bonds between police 
and pharmacies and doctors, and reformulations that make pills more 
difficult to snort and inject.

But those obstacles have produced an unintended byproduct. Addicts 
intent on getting high turn to whatever they can put their hands on. 
Spivey turned to heroin, a potent powder that took her down a path 
toward homelessness, debt, prostitution and prison.

Red Dogg

Born in Wilmington in 1984, her earliest memories are living in a 
drab Nesbitt Courts concrete apartment block, in the now defunct 
public housing project off Third Street. Her father and mother split 
soon after her birth. Spivey grew up with a sister, two stepbrothers, 
her father and stepmother, in a project notorious for drugs and violence.

Home life was far from ideal. Disabled by a nervous condition, her 
father received government assistance. He fought with her stepmother. 
When he landed in jail, the kids landed in foster care.

As a teenager, Spivey dabbled in drugs, smoking marijuana and 
occasionally using cocaine. But she steered clear of opiates. That 
is, until after college, when a friend gave her a narcotic Lorcet 
pill. Her friend got the pills from his dad and was trying to sell 
them. The euphoria was a feeling Spivey had never experienced.

After giving birth to her first son in 2004, she learned how to crush 
pills and snort them. But even then, opiates were more of a hobby than a habit.

Then things changed. It was 2005 or 2006, and Spivey was 22 years 
old. One day, she drove around Wilmington in her baby blue Cutlass. 
She drove with a friend looking for a dealer with prescription pain 
relievers. Hours passed. Many phone calls were made. But their 
efforts came up empty. Her friend insisted they forgo the pills and 
buy heroin instead. Spivey resisted. More time went by. Frustrated, 
Spivey eventually gave in. They called the "dope man." Spivey bought 
her first bag of heroin for $20, a white bag about the size of a 
sugar packet with the words, "Red Dogg," stamped on the front.

At home, Spivey's friend split the powder into two lines. They 
snorted it using a straw cut to about 2 inches. The high lasted all day.

She woke up the next morning wanting more.

An Expanding Market

In Wilmington, heroin is sold in small glassine bags. Each one 
contains about a tenth of a gram and usually comes stamped with a 
name as a way for dealers to differentiate their "brand." New users 
feel the effects from as little as half the bag; experienced addicts 
need more. At her peak, Spivey used 20 bags -- or two bundles -- a day.

Counternarcotic investigators say the heroin market in Wilmington has 
stayed stable since about 2009. For decades, the city suffered a 
booming trade, driven by steady demand and ready supply from local 
gangs with connections in New York and New Jersey. The problem was a 
focal point of anti-drug efforts, and over the years, heroin arrests 
skyrocketed from 12 in 2003 to about 145 in 2011, according to the 
Wilmington Police Department.

Despite a lack of growth, Wilmington's heroin market remains strong, 
experts say. A keen example of the city's thriving customer base came 
last year when authorities arrested Arthur Curtis King, a kingpin 
believed responsible for supplying 90 percent of the city's heroin. A 
year later, authorities began investigating a trafficking ring from 
New Jersey that moved to Wilmington intent on filling the vacuum. The 
operation didn't last long as police caught wind of their dealings 
and arrested them.

"New Jersey and their residents think they can come down here and 
wreak havoc on us. Well now, we're wreaking havoc on them," 
Wilmington Police Chief Ralph Evangelous said at the time.

"This bust shows us the huge demand of this very addictive, very 
life-altering drug."

Easy access to heroin has resulted in an influx of patients at drug 
local counseling clinics. The state has followed a similar trend. In 
2011, 2,081 people were admitted to treatment as a result of heroin 
addiction, the highest number since at least 1992, according to 
government figures.

Kenny House, vice president of clinic services at the 
Wilmington-based Coastal Horizons Center, a clinic off Shipyard 
Boulevard, said growing patient numbers are evidence of an expanding 
heroin market. When authorities arrest a major heroin distributor, 
supply temporarily dries up, forcing opiate addicts to revert to 
prescription relievers. But when heroin is available, addicts turn to 
it because it delivers a stronger buzz.

Dr. Westley Clark, director of the Center for Substance Abuse 
Treatment at the Washington, D.C.-based Substance Abuse and Mental 
Health Services Administration, said prescription drug addicts 
unwilling or unable to enter treatment and reluctant to quit are 
turning to alternative opiates. He is concerned that when the federal 
government releases its annual national assessment on drug abuse 
Monday, the results will show more people are using heroin.

Local law enforcement officials expect the same results.

Capt. David Ciamillo, the commander of New Hanover County's vice and 
narcotics unit, called curbing prescription drug abuse a 
"double-edged sword," saying the issue of users switching from pills 
to heroin "is already upon us."

Heroin is highly addictive. Quitting is a torturous endeavor. Spivey 
endured withdrawal for the first time after a month of using. She sat 
on the toilet at her grandmother's house, having diarrhea while 
simultaneously vomiting into the bathtub. "Am I going to die?" she 
later asked a doctor at the hospital. "No," he replied. "But you're 
going to wish that you were dead."

Like Heaven

As painful as it was, withdrawal didn't stop Spivey. Right before 
turning 23, her addiction worsened when she learned how to use intravenously.

Spivey remembers her first shot. It happened in her bedroom. Her 
neighbor sat on the edge of her bed. She watched as he mixed the 
powder with water in a spoon and sucked the liquid into a syringe.

She felt nervous.

She'd snorted heroin before, but the needle was supposed to deliver a 
faster, stronger high, unlike anything she'd experienced. With the 
syringe ready, Spivey sat on the floor and stretched her arm over her 
neighbor's leg. She recalls how he tied her off with a belt fastened 
tightly around her bicep. She watched veins rise up under her skin. 
They zigzagged like swelling blue rivers.

He inserted the needle, then loosened the belt. Spivey stood up. A 
few seconds passed. Nothing. She wondered when it was going to hit 
her. Then, suddenly, the feeling rushed over her. The lights dimmed. 
Her heartbeat, her breathing, slowed. Her body felt weightless. It's 
a feeling Spivey likened to heaven.

 From there, her habit quickly escalated. Her life soon revolved 
around scraping together enough money to buy another bag. She landed 
in hospitals and detox centers and prison for six months as she 
stole, schemed and tricked her way to another fix.

Addiction quickly upended her life. Her landlords evicted her. She 
slept on wooden benches at Greenfield Lake Park. In her car. On the 
street. She bathed in fast food restaurant bathrooms and wore the 
same clothes for weeks. Her parents took custody of her children.

"It was really bad," she said recently. "And I haven't really been 
back on my feet since then."

Finding Help

After five years as an addict, Spivey finally realized she'd had 
enough. She joined a methadone program on Jan. 5. She says she has 
been clean ever since.

But methadone treatment brings its own struggles. Spivey must make 
the 8-mile trek to the clinic every morning, except on Sunday, when 
she uses her take-home dose, a benefit she earned by passing drug 
tests and staying involved in counseling.

She realizes treatment is a long-term commitment. Patients stay on 
methadone for years -- even a decade or more -- before weaning off.

A synthetic form of opium, methadone is central to a therapy used 
around the country. When taken in prescribed doses, it provides a 
therapeutic level of opium to prevent withdrawal.

But the treatment is also controversial. Critics argue that methadone 
merely replaces one opiate with another. And it is not uncommon for 
law enforcement to find people selling take-home doses on the street.

"Years of methadone treatment can build up dependence, but it tends 
to be easier to go off of methadone," said Linda Dykstra, a professor 
at the University of North Carolina at Chapel Hill who studies opioid 
analgesics. "And hopefully during that period, you're coming into a 
clinic every few days so you're getting all of the social and 
behavioral therapy along with it."

Despite drawbacks, methadone treatment has grown increasingly 
prevalent in recent years. According to the Drug Enforcement 
Administration, the number of methadone prescriptions doubled from 
2.2 million in 2003 to 4.4 million in 2010.

Spivey credits methadone with keeping her sober. Ten months off the 
needle, treatment has given her an opportunity to learn about 
herself. It's like she used heroin one day and woke up from a coma 
many years later. She had no idea about simple things, like how she 
enjoys arts and crafts, and how her favorite restaurant is Chili's.

"Heroin is the devil. It took the life out of me," she said. "I 
didn't know who I was or what I was like."

She is continuing to cope with the ramifications. Felony convictions 
prevent her from securing a job. And debt keeps her from re-enrolling 
in college. Perhaps most hurtful, Spivey doesn't get to see her children much.

"I'm going to be dealing with the consequences of this for years," 
she said. "But any way you look at it, my worst day being clean is 
hundreds of times better than my best day being high.
- ---
MAP posted-by: Jay Bergstrom