Pubdate: Mon, 10 Jun 2013
Source: Milwaukee Journal Sentinel (WI)
Copyright: 2013 Journal Sentinel Inc.
Contact: http://www.jsonline.com/general/30627794.html
Website: http://www.jsonline.com/
Details: http://www.mapinc.org/media/265
Author: Ashley Luthern

HEROIN OVERDOSE DEATHS SURPASS COCAINE FATALITIES IN MILWAUKEE COUNTY

Young woman's final, fatal overdose shows difficulty in overcoming
addiction

It's been almost a month since Lisa Marmolejo buried her little
sister.

Olivia Marmolejo, 21, died May 17 of an apparent drug overdose.
Although investigators are still waiting for toxicology results, Lisa
said she's certain heroin played a role in Olivia's death.

Lisa first noticed her sister was becoming distant last summer. The
track marks on her arm were an ominous warning. In August, Olivia
overdosed on heroin.

That time, and after a second overdose in October, Olivia recovered.
Last month, she didn't.

Lisa said she can't help but wonder "what if." What if her sister had
been arrested after the October overdose? What if she could have been
forced into treatment? What if there was something else to be done?

"It's debilitating to everybody who loved her and thought 'What could
I have done?'" Lisa said.

The Marmolejo family faced an impossible situation, one shared by a
growing number of families in and around Milwaukee as heroin use
skyrockets. Neither loved ones nor police can force an addict to get
help, though the criminal justice system is seen as a last resort.

Although judges can order drug users into treatment depending on the
criminal charges against them, even the best treatment won't help if a
drug user doesn't want to stop.

Heroin, a highly addictive opiate, is often lethal. Increasing purity
levels, combined with a high risk of overdose after treatment or
incarceration, can have fatal consequences.

In a decade, the percentage of overdose deaths attributed solely to
heroin has jumped from 9% in 2002 to 24% in 2012 in Milwaukee County.
In those same years, heroin was present in 14.7% and 32% of fatal
overdoses from mixed drug cocktails.

Last year was the first time heroin overdose deaths surpassed cocaine
deaths in the county. Of 159 overdose deaths, 34 were caused by
cocaine and 38 were caused solely by heroin.

Not just Milwaukee

It's not happening just in Milwaukee County. Waukesha recorded 13
fatal heroin overdoses last year, compared with five in 2011 and two
in 2010. Racine and Washington counties had five heroin overdose
deaths in 2012. Ozaukee County had one heroin overdose death in 2012
and 2011, and already this year, heroin is suspected in two deaths.

Although prescription drug overdoses are more common, pills are also
part of the problem because addiction to prescriptions often leads to
heroin use.

Experts say the heroin numbers would have been higher without the use
of narcan, a heroin antidote that has saved many. But it's not fail-safe.

It saved Olivia in October.

Five shots of narcan were used to revive her Oct. 31.

Lisa is the one who found her sister unconscious that day. She knocked
on Olivia's apartment door about 6:30 p.m. and let herself in when she
didn't hear anything.

A Milwaukee police report describes the pieces of tinfoil, needles, a
bent spoon and more than 80 prescription pills found in Olivia's room.
Eleven more pills were found in her jacket pocket.

In an interview at the hospital, Olivia told an officer that she
"caved in" when she saw her recently deceased mother in a dream.

Lisa said she asked Milwaukee police to arrest her sister. She felt
out of options. Her sister's August overdose led to one week in rehab.
Other pleas to get her into treatment weren't working.

"She was a stubborn, stubborn girl," Lisa said. "She thought, 'I can
handle it. I can stop doing it.'"

Police can't detain someone simply for drug addiction or force them
into drug treatment, but they can make arrests for drug possession or
other related charges.

After Olivia was released from the hospital in October, a Milwaukee
officer tried to help by using an emergency detention to send Olivia
to the Milwaukee County Mental Health Complex, but doctors at the
overcrowded mental hospital quickly realized Olivia was suffering from
addiction, not mental illness.

Lisa said her sister was released the same day.

More and more people like Olivia are dying as heroin prices fall, the
drug's purity rises and longtime stereotypes about heroin users fade.

Before someone starts snorting heroin, the person is usually abusing
legally obtained prescription drugs, according to Milwaukee Police
Capt. Anthony Smith. Between 70% and 80% of heroin users cite
prescription drug abuse as a precursor, he said.

Tightened regulations have made it more difficult for prescription
drug abusers to keep up their habit with legitimate prescriptions, and
pills illegally sold on the street can cost between $50 and $100 each.

"They realize they can get the same high from heroin for $10 to $20 a
hit," Smith said.

Heroin is cut, or "stepped on," with other chemicals. Batches of
heroin differ depending on the purity of the heroin and the cutting
agents. The average dose of heroin contains about one-twentieth of a
gram of heroin, said Smith, who leads the department's drug unit.

But users can never be sure what they are going to
get.

"If the old heroin of the '70s came back, that heroin was maybe 3% to
5% purity. It was injected. It had the stigma of being a back-alley,
inner-city drug. But now with high-purity heroin, you can snort it,"
said David Spakowicz, director of eastern region field operations for
the Wisconsin Department of Justice.

Heroin is highly addictive because of its interaction with the
brain.

It latches onto receptors that influence involuntary heart rate and
breathing. Normally, the body can take care of itself, but if those
receptors are blocked by heroin, then breathing slows and fluid builds
in the lungs, which can cause death, Spakowicz said.

Difficult to stop using

If someone stops using heroin, those receptors are all
raw.

"You are not going to die from heroin withdrawal, but you wish you
were dead because it is so devastating to the body," he said. "Their
whole body is screaming. They constantly flip and flop and they
describe it as the worst case of flu they've ever had."

It generally takes about one month for the withdrawal symptoms to
subside. Overdoses frequently occur after an individual has been in
treatment or jail and his or her tolerance has lowered.

Once a person is hooked on snorting heroin and tolerance to the drug
builds, shooting up is next.

"When you inject heroin intravenously, it provides a stronger high and
lasts longer," Smith said.

The danger is a "hot shot," one in which the purity is more than the
person's tolerance.

"Your body just can't take it," Smith said.

Most heroin is produced in the Middle East and Southeast Asia, and
usually travels through Mexico before arriving in the U.S.

In Wisconsin, heroin tends to end up in Milwaukee, Madison and the Fox
River Valley, where suppliers distribute to lower-level dealers.

"Now it's getting out of the major metro areas, what we call
outstate," Spakowicz said.

Decades ago, heroin was associated with inner-city, male users. Now,
it's everywhere, including suburbs, and used by everyone, regardless
of age, sex, race and socioeconomic status.

Recent surge in cases

Lt. Rod Galbraith was assigned to the drug investigation unit of the
Ozaukee County sheriff's office from 1992 to 1998. In that time, he
investigated one heroin case.

"It was a New York or L.A. problem, maybe Chicago. We never thought we
would experience it here," he said.

That changed in 2005, a watershed year when a 17-year-old Cedarburg
girl died from a heroin overdose. Ben Stibbe of Grafton was convicted
of supplying the heroin that killed her and three Grafton adults.

Fifteen overdoses, most caused by prescription drugs, occurred in the
county from 2002 through 2009. Seven more have been recorded since
then.

Police officers often are dispatched to overdose calls, along with
emergency medical personnel.

Although certain investigative techniques in drug overdoses are common
across Wisconsin, there is no set standard for how police should
respond to a nonfatal overdose, Spakowicz said.

In Ozaukee County, if an emergency call appears to be drug-related,
investigators are instructed to look for evidence to help secure a
search warrant and request a blood draw from the person, said Capt.
Jeff Taylor of the Ozaukee County sheriff's office.

An overdose can be accidental, intentional or an attempted suicide,
but regardless the department now pursues all overdose cases and turns
information over to the district attorney. That's a change from past
practice.

"If a responding officer went to a scene and thought it was more of a
mental issue, they would more than likely overlook the potential
criminal component. That was changed years ago," Taylor said.

The Milwaukee Police Department does not have a standard operating
procedure specific to overdose investigations, said Sgt. Mark
Stanmeyer, police spokesman.

In Olivia's October case, it appeared as if all the heroin she
possessed was consumed and she gave limited statements about her drug
use, denying she had even used heroin, Stanmeyer said.

The investigating officer did not believe there was enough information
or evidence for an arrest for possession of heroin, Stanmeyer said.
Possession of heroin, no matter the amount, is a felony.

The officer realized Olivia needed immediate medical treatment and
recognized that she also needed psychiatric assistance, so the officer
placed the emergency detention hold despite Olivia's denial that she
was attempting to hurt herself, Stanmeyer said.

"An officer's primary concern is always for the well-being of the
person in distress. Decisions to refer the investigation to the
district attorney's office are evaluated based on a totality of the
circumstances," Stanmeyer said.

A records request for Olivia's fatal overdose report was denied
because the investigation is ongoing.

Lisa wanted her sister arrested in October, and Milwaukee police would
have been within their rights to do so because of the pills and
paraphernalia in her possession. Lisa knows an arrest might not have
prevented Olivia's death, but at least she would have had some hope of
treatment through the court system.

When heroin users do get treatment, it's often because the criminal
justice system intervened, Spakowicz said.

"The first reason people are in treatment is because they got arrested
and thought it would look good to the judge," he said.

"The second reason is because their friends or family got them there.
The third reason is that they're sick of it. Unfortunately until No. 3
becomes No. 1, I think we're in a world of hurt. They don't want
treatment, the withdrawals are terrible and they just love the drug,"
he continued.

After Olivia's week of rehab in August, her sister tried to persuade
her to get more treatment.

"Olivia was such a good person. So much potential - lost. It just felt
like an uphill battle that she was never going to win," Lisa said.

Helping mom

The sisters were separated in age by more than 20 years but were still
close. Last June, Olivia moved in with their mother, who suffered from
fibromyalgia and had recently undergone back surgery.

"She was off of work and living with our mom, essentially helping her
around. She probably then had too much time on her hands," Lisa said.

Their mother, Laura Marmolejo, died Oct. 8. She was laid to rest at
Wisconsin Memorial Park in Brookfield, where her daughter joined her
on May 23.

Lisa said she wonders what the odds are of someone beating a heroin
addiction. The National Institute on Drug Abuse estimates that about
23% of people who use heroin become dependent on it. Experts agree the
best chance of ending addiction comes from those who enter treatment
willingly.

"Kids don't understand what they're doing," Lisa said. "The second
they stick that needle in their arm, they get themselves into a very
difficult situation that they may never get out of except when they're
dead."
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