Pubdate: Thu, 31 Oct 2013
Source: New Times (San Luis Obispo, CA)
Copyright: 2013 New Times
Contact:  http://www.newtimesslo.com/
Details: http://www.mapinc.org/media/1277
Author: Matt Fountain

COMING BACK FROM THE DEAD: THE CENTRAL COAST FEELS THE EFFECTS OF A 
NEW CHEAP DRUG--HEROIN

Jake had been clean for just a couple of weeks, and he was struggling.

Facing a possible 15-year sentence in state prison on a joint 
suspension for burglary and possession of heroin, it was his "last 
shot." He'd spent weeks between sober living facilities and jail 
while waiting to be admitted to a treatment program at the San Luis 
Obispo County Drug and Alcohol Services.

Once he was enrolled in adult drug court, he bounced back and forth 
between sobriety and relapse while attempting to keep up with the 
strict regimen and almost impossible expectations of his treatment. 
He was required to attend group counseling in SLO three days a week, 
pass all drug tests, and maintain 32 hours of employment per week-as 
a felon with no driver's license.

He rekindled a friendship with a childhood friend, Kim (not her real 
name) who had gone through her own problems with drug addiction but 
had five months of sobriety under her belt. The friendship soon 
turned into something more as Kim selflessly worked to help Jake 
through his treatment.

"She worked two jobs but would give me every penny she had," Jake 
told New Times. "She would drive me to group, wait for me to get out, 
get me to work, buy me cigarettes. She taught me how to be happy 
again without artificial elation."

This went on for nearly a year, with Jake finally finding long-term 
success in treatment and holding down a full-time job. But, as even 
the most intense relationships often do, theirs began to fizzle out, 
around the time his girlfriend-who had always been more or less 
responsible in her drug use-began verbally toying with the idea of 
buying some weed. At first, Jake said he could be around it without 
any problems, but when she began to show up at home drunk, it all fell apart.

Though they stayed in touch, they saw less and less of each other in 
the months that passed. One day he ran into her in town. He said she 
looked great, but she asked if he could locate some of the potent 
opioid Dilaudid. He thought at the time that she wasn't likely to do 
it herself, but was rather looking to sell it to make a quick few 
bucks. He shook off the inquiry, and she left. Throughout the day, 
Jake continued to receive calls and text messages from her again 
asking about the drug.

The last text came in at 2 a.m. It was an apology.

He was at work the next day when he got a call from a friend 
informing him his ex-girlfriend was found dead from a lethal 
injection of Dilaudid.

"She was someone I walked through my first year of sobriety with side 
by side," Jake said. "I'm never going to get over it, but I've 
processed it enough to accept it and realize that I don't want to be 
the next person to die."

In just two years, Jake told New Times, seven of his friends have 
died in their struggles against opiate addiction.

Just 'like what they have in L.A.'

Jeff is a 24-year-old street kid originally from Simi Valley who, 
since arriving in San Luis Obispo in April, has pretty much spent his 
days hanging out in Mission Plaza, bumming cigarettes and quarters 
outside of convenience stores. At night, he finds a space to sleep 
either down by the creek or at a nearby park.

He told New Times on one sunny afternoon on Marsh Street in downtown 
SLO that heroin isn't just making the rounds in the resident or 
transient homeless populations. Everybody knows where to get it, he 
said-adding that a tenth of a gram, "enough to be good" for a few 
hours, goes for $15.

"Yeah, it's definitely around here. And I've heard a few people have 
died recently," Jeff said. "You can see people nodded out in the 
park, people ripping each other off."

He said that he left Los Angeles for the Central Coast last year when 
he got in trouble with the law and too many of his friends were 
dealing heroin and other hard drugs.

Though he said he doesn't fool around with the stuff himself, Jeff 
said he could easily take a reporter to a nearby location where 
someone could get his hands on "mud" for the sake of the story-in 
exchange for a pack of smokes. He sounded like he was telling the 
truth, but the offer was declined. The guy got some cigarettes anyway.

Mark, a longtime resident homeless man who lives under a bridge in 
the downtown San Luis Obispo area, told New Times that his 
ex-girlfriend, who was also homeless and known to get high during the 
day by the creek near the Chinese Garden, recently died of an 
accidental heroin overdose.

"It's a terrible thing, man. I'll miss her," Mark said. "It's getting 
bad around here for sure."

To look to prosecution stats for reliable numbers of exactly how many 
heroin cases have gone through local courts would be tedious, mainly 
because the statute prohibiting possession of a controlled substance 
doesn't differentiate between the different substances out there.

But through information provided by different county agencies and 
city police departments across the county, a picture emerges that 
shows a growing problem. Anecdotally, while Grover Beach had as few 
as 11 heroin possession arrests so far in 2013 and seven in 2012, 
larger cities like Paso Robles saw 51 arrests for possession in 2013, 
up from 2012's 47 arrests, and more than double 2011's 24 arrests.

"It's not just a shift; there's been a monumental shift of the drug 
of choice," Atascadero Police Department Cmdr. Joe Allan told New 
Times, recounting that his department has made 35 arrests so far this 
year for heroin possession of varying amounts. In 2012, there were 
31. Not all of those arrests necessarily resulted in conviction.

According to the Drug Enforcement Agency spokesperson for the Central 
California region, Sarah Pullen, SLO County is experiencing a trend 
in line with what anti-narcotics agents are seeing across the country.

Until recently, pills containing the opioid oxycondone, such as the 
popular brand OxyContin-or Oxys-reigned as a top recreational choice 
for their ability to deliver a powerful morphine high when crushed 
and smoked, snorted, or injected. For a decade, the drug had been 
prescribed left and right for legitimate reasons and forgotten in 
medicine cabinets across the country.

Jim Heins, spokesman for Purdue Pharma L.P., the New York-based 
pharmaceutical manufacturer of OxyContin, told New Times that the 
company recognized its product's potential for abuse and has worked 
since 2001 to reformulate its popular brand of oxycondone to include 
a polymer that renders the pill plastic-like. Users can't open it, 
and it turns into a waxy lump if it's melted. He said the new drug 
went before the Federal Drug Administration as early as 2005, and 
five years later was approved on the condition the company would 
study how well the deterrent worked.

When the reformulated OxyContin hit the market in August 2010, 
reports of abuse did go down. But in the years since the new 
tamper-proof version completely replaced the old crushable tablets, 
public health officials nationwide started noting more admissions to 
detox and treatment programs-court-mandated and voluntary-for heroin 
addiction. But the numbers don't reflect any change in overall opiate 
abuse, including prescription drugs, suggesting heroin is becoming an 
alternative that's less hassle to procure and much cheaper, though 
not necessarily the primary drug of choice.

A New England Journal of Medicine quarterly survey of 2,566 patients 
in treatment for opioid addiction between July 2009 and March 2012 
reported that the selection of OxyContin as a primary drug of abuse 
decreased from 36 percent of respondents before the release of the 
abuse-deterrent formula to 13 percent. Though the demand for illicit 
Oxys remains-24 percent of the respondents found ways to crack the 
tamper-proof properties and continue to abuse the drug-66 percent 
reported switching to another opiate, with "heroin" as the most 
common selection.

"It's the whole squeezing-the-balloon effect," Purdue's Heins said. 
"One drug becomes less attractive, they'll go elsewhere. They'll turn 
to another."

 From a law enforcement perspective, this means a market for heroin 
has opened up, and wherever there's a market, there are dealers. Shop 
has been opened up on the Central Coast, same as anywhere else.

"Obviously, people are still looking for that fix. That's when we see 
the resurgence of black tar heroin," a Sheriff's Department detective 
assigned to the department's drug and gang task force told New Times 
on condition of anonymity because of his undercover work.

He said that most of the black tar heroin he's seeing on the street 
is likely from Afghanistan, but it mostly comes to California via 
Mexico. Inevitably, the refined drug is distributed on the street 
with help from regional street gangs.

"Wherever there's a market for a drug, you can know gangs are going 
to get involved," the detective said. "I'm not seeing a real fondness 
of the refined heroin out there. Black tar just comes from the poppy 
plant, and it's pretty much pure."

"We know what gangs trade in. They trade in drugs, they trade in 
weapons, and they trade in fear," Atascadero's Cmdr. Allan said. "If 
the drug of choice is heroin, they're going to be in on it."

Despite the recent string of local arrests for possession and sales 
that have taken a significant quantity of heroin off the streets, the 
detective said there's not an official campaign against it, any more 
than there is against any other illicit drug. The department 
currently only has five detectives on the task force handling 
high-level narcotics investigations involving all drugs, he said.

Paso Robles Police Chief Robert Burton told New Times that opiate 
addiction is epidemic across the nation, not just Paso Robles. Those 
it impacts most are increasingly younger addicts and their families.

Three days after New Times interviewed Burton, his department's 
Special Enforcement Team served search warrants at a number of 
locations across the city, and a 21-year-old female resident was 
arrested on suspicion of possessing just less than a gram of heroin, 
a small amount indicative of personal use, which brings the 
department's total amount of seized heroin since the April creation 
of its Special Enforcement Team to roughly 90 grams.

"To think that 18- to 25-year-olds are using it can come as a real 
shocker," County Sheriff Ian Parkinson told New Times. "We're very 
concerned and putting a lot of effort into it."

Bringing back the dead

Just as New Times was wrapping up this story on Oct. 24, two deputy 
probation officers running compliance checks responded to a call of 
an intoxicated person in the bathroom of Downtown Brew in Paso 
Robles. They found him lying face down, not breathing, with a used 
syringe in his hand. They immediately began working to get him 
breathing before emergency medical services made it to the scene and 
injected him with a dose of Naloxone.

The officers-and those responsible for reporting the man 
quickly-saved his life. He later reportedly told the officers at Twin 
Cities Community Hospital that he had injected a dose of heroin into 
his neck before he went unconscious.

According to data from the city, emergency services has so far 
responded to 10 heroin-related overdoses in Paso Robles in 2013.

But help doesn't always make it in time. In May 2012, a 22-year-old 
man died of his dose in the parking lot of the Atascadero In-N-Out Burger.

Dr. Scott Bisheff is an emergency room technician at Sierra Vista 
Regional Medical Center in SLO and Twin Cities Community Hospital in 
Templeton. On a recent busy afternoon in the Sierra Vista E.R., 
Bisheff explained that despite the recent news, it's still rare to 
see a heroin overdose in the E.R. compared to those involving other 
prescription drugs and alcohol. He was only able to recall three 
life-threatening emergencies from heroin in his 11 years. Far more 
common are moderate-to-serious invasive skin infections due to 
frequent injection.

Bisheff explained that when an overdose determined to be 
heroin-related comes in, the patient is unconscious and not 
breathing. The morphine blocks receptors in the brain, he said, which 
causes the body to stop its automatic inhaling and exhaling. Doctors 
will immediately clear any obstructions in the airways and begin 
breathing for the victim with a hand-held respirator. A shot of 
Naloxone, commonly known as Narcan, works as an antidote to the 
effects the morphine has on the brain.

"Then they're up and running in just seconds," Bisheff said. 
"Unfortunately, it revives the pain receptors, too. They'll look at 
you in all this pain and say, 'What are you doing to meUKP' All you 
can do is say, 'Well buddy, you weren't breathing.'

"If they're alive when they get here, we can save them," he added.

Records provided by the SLO County Department of Public Health do 
reflect that there are more local deaths specifically from heroin 
overdoses these days, but prescription drug abuse continues to kill 
residents in far greater numbers. In 2003, for example, SLO County 
officials saw just one death from heroin toxicity. The numbers 
fluctuate between none and seven per year up to 2011, a year when 
four people died from heroin.

Compare that to deaths from abuse of oxycondone, methadone, or 
fentanyl. In 2011, records show that 30 people died in SLO County 
from overdoses of prescription or illicit opioid abuse, not including 
heroin. But the record isn't the most reliable, County Health 
epidemiologist Anne McDow said, because many deaths are listed only 
as "multiple prescription drug accident" or "accidental OD of drugs, 
injected self."

McDow's office didn't yet have data for 2012 or 2013, but Sheriff's 
Detective Jeff Nichols did. As one of three coroner's investigators 
for the SLO County Sheriff-Coroners Office, Nichols' job is to 
determine what substance led to death in the event of an overdose. 
According to Nichols, he saw five heroin-related fatalities come into 
the autopsy room in 2012. So far in 2013, there have been eight.

Nichols has performed more than 1,000 autopsies over the last six 
years, and he says from his experience that while the number of 
heroin-related deaths in SLO County is up, one reason past numbers 
are lower may be the result of how difficult the drug is to trace in 
the body if an autopsy isn't performed right away. In the autopsy 
room of the Coroner's Office's new facility on Aerovista Drive in San 
Luis Obispo, Nichols explained to New Times that heroin is 
metabolized into morphine in the body and, because "track marks" 
alone don't point exclusively to heroin, it's critical to perform an 
autopsy investigation quickly.

He said in order to do so, coroner's investigators will test the 
vitreous humor. That's the clear, gel-like fluid that fills the space 
between the lens and retina of the eyeball.

"If we get a case where we suspect heroin is involved, we'll have 
investigators test the vitreous. It costs more money, but it's 
essential to the case," Nichols said. "And it can be a pretty painful 
thing, but we have to get the answers to the families."

Nichols also added that while heroin is rightly getting focus as an 
alarming trend, prescription drug abuse in its many forms is still 
far more dangerous, and it results in anywhere from 20 to 40 deaths 
each year in SLO County.

Kicking

Even after waking up in an emergency room following a nearly fatal 
overdose, Jake had no interest in kicking his full-blown heroin habit.

His road to the gurney wasn't traveled overnight. Jake grew up in a 
stable living situation with a caring foster family in Paso Robles. 
His behavioral problems surfaced earlier and louder than did any from 
his foster brothers and sisters, and he moved to Los Angeles when he 
was 18 to study music production. While there, he began getting into 
the local hip-hop scene, making good connections in the industry. 
Though he was no stranger to the typical pot and booze, Jake's taste 
quickly progressed to cocaine-and increasingly Oxys. Being a guy who 
knew people, he also began selling to make money and fund his habit. 
Whatever he didn't move, he would crush up and snort or inject.

By the time of the reformulation, Jake's opiate addiction had 
progressed to a point where he was using and selling heroin every day 
to keep in drugs. Now living in Atascadero, he said he and his 
then-girlfriend lived this lifestyle while caring for their newborn 
son. They burned through money and bridges to the point where they 
increasingly had to hustle to maintain their lifestyle.

When the heroin ran low, Jake said that his friends and he would find 
a way to get their fix, sometimes even finding and manipulating 
fentanyl packets-the kind you apply to an area of the body when 
you're in pain or preparing for surgery. They'd crush up or melt down 
the opioid inside and chew or inject it. Fentanyl is especially 
dangerous due to its standard measurement in micrograms as opposed to 
the standard milligram, making it much easier to overdose on.

"A junkie will hear that their friend just OD'd, and the first thing 
they think, 'Where did he get his shit from? 'Cuz I want some too,'" 
Jake said. "That's how sick the disease is."

Jake and his girlfriend were arrested during service of a search 
warrant by county narcotics officers in 2009. He would later learn 
that detectives were surveilling his apartment for weeks. He was 
charged with possession and cruelty to a child.

Following a stint in jail, Jake skipped out from sober living and 
ended up on a meth and heroin binge with two friends in a trailer in 
Paso Robles. Facing the a six-month jail sentence, he suffered a 
suicidal breakdown. Jake said he robbed a local residence and sold 
some goods for two grams of heroin, which he slammed after cooking 
both with just enough water to successfully inject the dose.

"Suddenly, I come back to consciousness and I've got tubes in me and 
I'm on the gurney being slid into the ambulance," he said. "The EMT 
is slapping me to stay awake, but I'm trying to fall asleep because I 
want to die, you know? When we get to the hospital, the last EMT 
tells me I have a guardian angel out there."

But once the doctors left him to himself at Twin Cities-keep in mind 
he was on felony probation and on the run-he ripped out the IV and 
fled, bleeding, out of the hospital.

His run was short lived. Police investigators soon picked him up in 
connection with the recent burglary.

Despite strong opposition from prosecutors, SLO Superior Court Judge 
Michael Duffy suspended a 15-year sentence for Jake's myriad criminal 
offenses pending his last-chance effort to complete a rigorous adult 
drug court treatment program.

Clark Guest is program supervisor for the Drug and Alcohol Services 
division of the San Luis Obispo County Department of Behavioral 
Health. When drug offenders like Jake get arrested and inevitably end 
up in a court-mandated drug program, they spend a lot of time in 
group therapy with Guest and members of his staff.

Guest told New Times that of his 1,131 clients treated in the 2010-11 
calendar, 6.7 percent were admitted for heroin addiction, far below 
all alcohol, meth, and marijuana admissions. Meth accounted for 29.3 
percent. Prescription opiates, however, accounted for 13.9 percent of 
admissions.

Drug and Alcohol Services data indicates that heroin use almost 
doubled in the county between 2007 and 2010, but county numbers are 
still lower than the state average.

"I think it underscores that people have weaknesses-all walks of 
life, all careers. People with the best upbringing get hammered with 
addiction," Guest said. "And they all seem to start at the same place."

When they end up requiring detox before treatment, Drug and Alcohol 
Services offers in- and out-patient detoxification programs, which 
have recently undergone a number of improvements. Also, the age 
requirement dropped to 16. And according to the newly released 2013 
county report for addressing detoxification needs, the county 
proposed creating a detoxification team consisting of a nurse 
practitioner, a psychiatrist technician to administer medications and 
provide monitoring, and a case manager to provide transportation and 
to solicit placements into housing. The county expects the team to 
treat some 150 people in its first year of operation. Ninety percent 
will be offered case management services afterward.

It can take anywhere from 90 days to six months for the brain to 
begin functioning normally again so recovery can begin. Failure to 
successfully detox can be tragic.

"No addict who passes away thinks it's their time, and I hear from 
some of my clients who are dealing with some horrible loss," Guest 
said. "Especially in that situation, unless they're coming into 
treatment, getting social support, it's just going to be a perpetual cycle."

By his own admission and from other accounts, Jake has been 
completely clean and sober-with the exception of immenso carmelo 
espressos-for nearly two years. He continues to work full time, 
maintain his drug court requirements, and has even founded a SLO 
County-based hip-hop record label, which has signed five artists.

When New Times referenced Jake's story to Guest, the counselor 
indicated with a proud nod he knew exactly who we were talking about, 
though he wasn't able to confirm Jake's name.

"He's the real deal," Guest said.

"I lost everything-my son, my family, everything. But I've got it all 
back and others can too," Jake said. "Two years ago, I would have 
said that only something like one of my best friends dying could get 
me to get high. But in the three weeks after [Kim's] death, I had 
people from drug court around me at any time to support me-and that's 
because I kept going to treatment."

[sidebar]

BREATHE

During an overdose, heroin will block receptors in the brain 
responsible for causing a person's body to keep breathing when they 
are unconscious. A hand-held respirator is used to force a patient to 
breathe long enough for Narcan to be administered.

REVIVER

Naloxone-commonly known as Narcan-is administered to victims of 
heroin overdose to counteract the drug's effect on the brain. The 
patient will come to within seconds, said one emergency technician.
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