Pubdate: Sat, 11 May 2013
Source: Miami Herald (FL)
Copyright: 2013 Miami Herald Media Co.
Contact:  http://www.miamiherald.com/
Details: http://www.mapinc.org/media/262
Author: Audra D.S. Burch

Drug Addiction

AS PILL MILLS FADE AWAY, HEROIN FILLS THE VOID

There Are Signs That Heroin Is Returning As a Cheap Alternative to 
Prescription Pills, the By-Product of Florida's Successful Crackdown 
on Pill Mills.

Kevin Foley stood before a judge in Broward County's drug court - 
fellow abusers sitting behind in him in the pews - talking about the 
fitful life of a recovering addict, the random drug tests, the 
counseling and what he hoped was his next, clean chapter.

Foley, 21, has been hooked on heroin for nearly two years. Before 
that, he was popping oxycodone and other prescription pills snapped 
up as Florida become a bustling marketplace of illegal pill mills. He 
turned to heroin after his drug of choice became too expensive. "I 
was chasing the next high," says Foley, who landed in drug court 
after a heroin possession arrest in December. "I wanted to try it all."

Heroin is inching back in Florida, the unintended consequence of the 
state's epic war on prescription pills. Now, with Florida officials 
successfully slowing the supplies, shutting down the pill mills that 
masqueraded as pain centers and arresting thousands of addicts and 
even doctors, heroin has become a popular substitute.

In January, a group of researchers from across the country met in New 
Mexico at the National Institute on Drug Abuse's Community 
Epidemiology Work Group conference and swapped frighteningly similar 
stories about the increased use of heroin. The Miami-Fort Lauderdale 
region was named one of the regions facing the heroin trend.

"The major drug headline of 2012 was the emergence of heroin both in 
urban centers and small cities and towns," said epidemiologist and 
drug expert Jim Hall of Nova Southeastern University's Center for 
Applied Research on Substance Abuse and Health Disparities, who 
attended the conference. "Young adults, 18 to 30, white, prescription 
opioid addicts are making the transition to heroin."

While the raw numbers remain small across Florida and police have 
seen little street activity, experts are already mounting a campaign 
to slow the trend, from public education about the risks of heroin 
and needle injection to law enforcement presentations and spreading 
the word about a Good Samaritan law designed to stop drug overdoses.

"This is a public health issue. In some ways, the scale of the 
prescription pill problem took us all by surprise," said Pat 
Castillo, vice president of the United Way of Broward County 
Commission on Substance Abuse. "We had been promoting the 
prescription drug monitoring system for nine years; the [pill] 
problem happened in the blink of an eye. We are very concerned with 
this issue of heroin."

 From July 2010 to June 2011, there were 45 heroin-related deaths 
statewide, according to the Florida Medical Examiners Commission. 
That number jumped to 77 heroin-related deaths from July 2011 to June 2012.

The Florida Department of Law Enforcement also reports a slight 
increase in heroin-related charges: In the first three months of 
2013, heroin-related charges totaled 948. In the same three-month 
period last year, that number was 772.

And in what may be the strongest marker, addiction treatment numbers 
are up in Florida. In 2012, Broward County - just a few years ago 
considered the center of the pill mill problem - addiction treatment 
centers saw an 87 percent spike in admissions among addicts using 
heroin as their drug of choice, jumping from 169 to 316, according to 
the Florida Department of Children and Families. In Miami-Dade, the 
admissions jumped from 227 to 308 in the first half of 2012.

"It's not on a wide scale - yet," said Hall who tracks drug trends 
and statistics for community organizations in Broward and Miami-Dade 
counties. "For these opioid addicts, it's about a euphoria but more 
importantly, the heroin keeps them from going into withdrawal, or as 
they would say, from getting sick. Any port will do in the storm of 
withdrawal."

Foley, of Coral Springs, began his drug odyssey with marijuana. He 
was 14, and before his next birthday, he had graduated to taking 
Xanax and Ecstasy. By the time he was 17, a junior in high school, he 
was approached by a dealer offering "blues"- oxycodone - at two for 
$20. Much of his habit was paid for with the money he earned at a 
part-time job.

"When I finally took a half of a 30 milligram pill, I threw up a 
couple minutes later. Then I started to feel warm all over, it was 
the best feeling I had ever had," he said. "I needed to get that 
feeling again. It escalated from popping pills to smoking to snorting 
to injecting."

Two years ago, Foley and a buddy met with a pill dealer who was 
touting a cheaper high: heroin. "It cost less, I didn't have the 
hassle of trying to find the pills and the high lasted longer. I 
started doing it every day."

He was arrested in December, charged with possession of heroin and 
drug paraphernalia and the case was referred to drug court.

Almost weekly, Broward assistant public defender Rudy Morel watches 
as his clients stand before Broward Circuit Judge Michele Towbin 
Singer, some with evidence still visible from their last heroin high 
- - track marks, and, occasionally, blood oozing from puncture wounds.

"It used to be you rarely see heroin and now it's on the docket every 
day or every other day," says Morel who also holds a medical degree.

Although he says the caseload has remained about level in the past 
year, he has seen a shift to heroin use in that time, with "many of 
those on heroin who were first on prescription pills."

Singer, who presides over the county drug court, says the defendants 
coming before her frequently offer similar stories about their paths 
to heroin. They started with an injury, began taking prescription 
pills, then abused prescription pills - sniffing, snorting, then 
eventually injecting.

"Once they are at the point of injecting, it doesn't take much to 
cross over to heroin," she said.

One of the concerns, she added, is that like prescription pills, 
heroin is a particularly difficult drug to kick and generally 
requires long-term residential treatment. There are only a few 
options in South Florida.

The actual drugs on the streets are also changing. The traditional 
poor-grade black tar or brown powder heroin from Mexico is now joined 
by a potent white heroin also out of that region, Hall said. Other 
white heroin available in South Florida comes from South America, he 
added. And while some users still snort or smoke it, others are 
turning to injecting the drug.

At the height of the prescription pill abuse epidemic about three 
years ago, seven people a day were dying of prescription drug 
overdoses in Florida. Addicts were lining up outside of pain clinics 
waiting to get prescriptions, some homegrown and others drug tourists 
who had traveled to Florida from as far as Kentucky and West 
Virginia, Tennessee and Ohio looking for what they called "hillbilly 
heroin." At one point, Broward was ground zero, home to more than 150 
storefront pain clinics where doctors liberally doled out 
prescriptions of highly addictive medicines with little or no medical 
cause. Almost overnight, Florida earned the dubious distinction as 
the painkiller capital of America.

Faced with a public health crisis, lawmakers attacked the problem 
with rigorous anti-pill mill legislation that drastically limited who 
could dispense narcotics and broadened penalties for pill mill 
operators. They also established a statewide prescription drug 
monitoring system that kept pill poppers from doctor shopping.

By the summer of 2011, Gov. Rick Scott was at a news conference in 
Miami touting the dwindling supply of pills coursing through Florida, 
more than 1,000 arrests and millions in cash confiscated. The 
eventual void in the streets - without much focus on treatment and 
recovery - led those addicted to look elsewhere for their high. Enter 
heroin, a drug that cost, on average, as little as a tenth or a 
quarter of the price of some prescription pills. The price for 30 
milligrams of oxycodone jumped from about $10 to roughly $30 last 
year, according to recovery experts.

"The state of Florida took dramatic action to reduce the supply of 
diverted prescription medications in addressing the epidemic, but 
until we provide adequate treatment resources for individuals to end 
their addition, the drug may change but the problem won't stop," Hall said.

Couple the low pricing with a hard-to-shake opioid addiction and 
heroin was primed for a comeback.

"The supply went away. The demand did not," said FDLE special agent 
supervisor David Gross. "For the heroin trafficker, the circumstances 
made business quite lucrative."

At the Novus Medical Detox Center, the number of patients coming in 
for heroin addiction has increased over the past two years, jumping 
from less than 1 percent of the total client population in 2011 to 3 
percent in 2012 to 7 percent in the first quarter in 2013.

"We had an individual recently receiving treatment who had been using 
prescription pain medication for a condition he had. He abused it. 
Then his doctor cut him off but he was addicted. He was at his local 
fitness center and a trainer introduced him to a heroin dealer," said 
Kent Runyon, executive director of Novus in New Port Richey. "He 
transferred the addiction."

But officials are fighting back.

In February, Broward's substance abuse commission and the 
Sanford-Brown Institute, a for-profit college in Fort Lauderdale, 
hosted a workshop to share the news about heroin. And the 
commission's board of governors, which include Morel and Hall, has 
met twice this year and formed a task force to put together an 
anti-heroin community campaign. Castillo said the task force is 
studying efforts in North Carolina and New Mexico, the latter a state 
particularly hard-hit by young, suburban heroin users. The group is 
also working to spread the word about the risks of heroin, including 
dirty needles that can spread disease. It is also publicizing a law 
aimed at encouraging fellow drug users to call authorities when they 
witness an overdose.

The 911 Good Samaritan Act, which went into effect in Florida last 
year, protects callers from prosecution for possession or ingesting 
low-level controlled substances under some circumstances.

"It's imperative that we remain committed to fighting the overall 
drug problem in our state," said Florida Attorney General Pam Bondi. 
"While prescription drug-related deaths are down for the first time 
in nearly a decade, we will remain vigilant in protecting Floridians 
from drug abuse as the drug of choice changes."
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MAP posted-by: Jay Bergstrom