Pubdate: Sun, 16 Mar 2014
Source: Star-News (Wilmington, NC)
Copyright: 2014 Wilmington Morning Star
Author: Adam Wagner
Bookmark: (Heroin)


In September 2012, the then-captain of the New Hanover County 
Sheriff's Office's Vice and Narcotics Unit predicted that efforts to 
curb prescription drug use could be a "double-edged sword" causing 
users to seek out heroin instead.

Now, 18 months later, that prognosis looks spot-on as the streets of 
Wilmington and highways of Brunswick County are awash with heroin, a 
drug Ben and Jon David, the district attorneys for New Hanover and 
Brunswick counties, respectively, both call "suicide on the installment plan."

Within the city limits, the Wilmington Police Department arrested 12 
people carrying heroin in 2003, a number that steadily ticked upward 
until it reached 214 in 2013.

In Brunswick County, sheriff's office records show more heroin was 
seized in 2013 than in the past 15 years combined. The value of 
heroin seized in New Hanover County in 2012, the last year for which 
records are available, was $2.16 million, nearly double the value of 
any other drug.

"The heroin problem in Brunswick County is the biggest we've seen in 
my tenure with the sheriff's office since 2000," said Lt. Steve 
Lanier, who oversees the Brunswick County Sheriff's Office's Vice and 
Narcotics Unit.

Unintended consequence?

Several officials and experts said the rise in heroin use could be 
the unintended consequence of efforts to curb use of prescription 
drugs such as hydrocodone and oxycodone. Among those efforts are a 
statewide reporting system designed to help identify abusers, 
doctors' monitoring of their patients with drug screens before 
prescribing and random pill counts during the course of treatment.

Lanier likened the rise in prescription drugs to a flood that has 
dried up because of law enforcement and medical efforts.

"Once the flood waters subside, the dam's put back in place, there's 
all this need for pills and now no pills or the pills are a lot 
harder to come by," Lanier said. "Then people start looking for other 
avenues, which leads right to the illicit use of heroin."

The shift from pain medication to heroin is nothing new. Users 
swapping use of prescription opioids for use of heroin was listed as 
a possible cause for an increase in overdose deaths nationally in the 
U.S. Drug Enforcement Administration's 2013 National Drug Threat 
Assessment Summary.

Among the reasons given for users transitioning between prescribed 
opioids and street-level drugs was the cost and the ease with which 
heroin could be bought while providing a similar high.

In Brunswick, a small baggy -- or bindle -- of heroin sells for as 
little as $6 and averages about $10, while one oxycodone pill is 
worth about $20, said Chris Thomas of the Brunswick County District 
Attorney's Office. Each bindle contains one-tenth of a gram of heroin 
- -- a typical dose for a new user.

"It's gotten so hard to get pills that people are turning to the 
easiest opiate to get," Thomas said.

That $10-a-bag asking price "is a kind of significant price that 
reminds me of when crack cocaine became very famous and very 
popular," said Dr. Paolo Mannelli, an addiction expert and associate 
professor of psychiatry and behavioral sciences at Duke University.

What use looks like

There is no "typical" heroin user.

"We've seen everything from teenagers to 80-year-olds. It doesn't see 
race, color, creed, it doesn't see a money amount, it doesn't see a 
poverty level. It doesn't see any of that," Lanier said.

In the Cape Fear region, powder heroin is the norm. Generally more 
potent than its cousin, black tar heroin, powder heroin originates 
from Afghanistan. Tar heroin is generally from Central America.

"What makes the powder heroin more dangerous than the tar heroin is 
it can be ingested so many different ways ... and apparently there's 
not a stigma attached to heroin for children, teenagers or young 
folks in college," Thomas said.

Among the ways powder heroin can be ingested are smoking, snorting, 
eating it and putting it in Visine bottles before dropping the 
dissolved drug into the eyes. In the 1990s, when heroin was last the 
dominant street drug, it fell out of favor for several reasons. A 
major factor was that it was usually only about 5 percent pure and 
had to be injected for a user to get high.

"But nobody wanted to use the IV because of HIV, so when they started 
using nasally it wasn't strong enough," Mannelli said.

Now, two decades later, the heroin has jumped in purity to at least 
10 percent, often reaching 20 percent to 25 percent, Mannelli added, 
and the increased potency of the drug could be one of the primary 
causes of a jump in overdose deaths.

Local law enforcement agencies do not check for purity, instead 
sending samples of seized substances to the N.C. State Bureau of 
Investigation's State Crime Lab to determine simply whether it tests 
positive for heroin.

The lab also tests to see what the heroin has been "cut" or mixed 
with. Among common "cuts" in Brunswick and New Hanover counties are 
mannitol, lactose, caffeine and benzocaine, said Noelle Talley, an 
SBI spokeswoman.

Finding heroin in Brunswick and New Hanover counties is particularly 
easy at the moment, said both officials and addicts.

Thomas said Brunswick County investigators have interviewed people 
who have purchased 250 bindles of heroin at the street level without 
even knowing the name of their suppliers.

Often, these bindles are stamped with cartoonish logos or brands so 
that addicts know what product they want.

Dealers using those logos often put out uncut, more potent heroin for 
a couple weeks to draw addicts in, Thomas said. Then they'll cut it 
with different substances, leading the users to switch "brands" after 
a little while.

Why is it in Wilmington?

During January's Wilmington City Council meeting, Wilmington Police 
Chief Ralph Evangelous said crime throughout the city was down, but 
"obviously we've got issues with the drug trade, the heroin trade out 
there that's driving some of this violent crime."

Evangelous presented a map showing overlap in 2013 between drug 
busts, violence and public housing communities -- targeted in the 
past year by special enforcement efforts.

While much of the violence does take place in public housing, Ben 
David said, it is often fueled by users from the wealthier parts of 
the region buying drugs there.

"We have great wealth pushed up against great poverty in this 
community, and heroin is keeping the dichotomous structure alive," he 
said. "... What's going on behind the wall or gate of a beautiful 
community in a million-dollar beach home has everything to do with 
what's going on in an open-air drug transaction in public housing."

Wilmington's status as the terminus point for Interstate 40 also 
makes it a logical distribution point for drugs, David said.

Often, Wilmington's heroin -- which also makes its way to Brunswick 
County -- is distributed by Bloods gangs and some Crips who are 
active in New York and New Jersey.

Tom Old, an assistant district attorney in the New Hanover County 
District Attorney's Office, said groups of three and four gang 
members have been coming to Wilmington during the past five years and 
serving as de facto sales representatives for the drugs.

"I wouldn't say they are totally integrated into the Wilmington 
street gangs, but they have their foot in the door because they were 
gang members, and that then begins the distribution of the midlevel 
people and the street-level people who are local gang members," Old said.

Lanier, the Brunswick County vice and narcotics officer, crafted this 
scenario: A would-be dealer travels to New York or New Jersey where 
heroin typically sells for $2 or $3 and buys 1,000 bindles, or dosage 
units. Then, including gas and hotel, that person spends another $400 
or so on the trip, so he's made a $3,400 investment.

After returning to North Carolina, though, the dealer can sell that 
heroin for $10 to $20 a bindle, meaning a minimum profit of $6,600.

"Unfortunately for people that are addicted to heroin, there's always 
going to be a supply where there's a demand. There's always going to 
be somebody that wants to step up and make that easy money, or that 
quick money," Lanier said.

Law enforcement role

While law enforcement agencies in the Cape Fear region saw the 
possibility for a boom in heroin when the strict prescription pill 
laws went into effect, it was hard to predict how severe it would spike.

Technology can also make the battle against drugs more difficult, as 
dealers no longer have to sell from a static location.

"Everybody has a cellphone, so rather than dealing with people on the 
street, you'll call your dealer and it'll be, 'Meet me at this 
parking lot or that parking lot,' and that'll be throughout the 
city," said Capt. Jeff Allsbrook, who oversees WPD's Vice and Narcotics Unit.

To battle the drug trade, law enforcement has to turn to some 
tried-and-true methods such as confidential informants, tips from 
community members or talking to addicts themselves.

"They can tell us who's got the strongest bags or whose bags aren't 
really good," Lanier said. "Some of them can tell you if a bag came 
from New York, New Jersey, Atlanta from the type of dope it is and 
the high they get."

Still, even with informants, battling the drug trade can prove 
frustrating for law enforcement. Lanier compared arresting a dealer 
to dipping your finger in a bucket of water and then pulling your 
finger out to see if it had left a hole.

In other words, arresting a dealer may create a temporary void, but 
there is enough demand -- and enough heroin to fill that demand -- 
that the gap is filled almost instantaneously.

"It's a sheer numbers game," Lanier said. "When you look at the 
thousands of people using, selling or somehow involved with heroin 
and there's a small group of us that are trying to combat that, we 
have to go at it as hard as we can and as fast as we can, but we're 
not gonna be able to get everybody."

Narcotics detectives do have some tricks, though. Thomas, the 
assistant district attorney in Brunswick County, told of going on a 
ride-along once with a narcotics detective and being told the person 
they were trailing had cigarette filters in his car.

When he asked why that mattered, Thomas was told that addicts will 
suck the heroin through the cigarette filter with a syringe and then, 
when they're having a bad day or can't find their dealer, they'll 
gather the filters, heat them up and get enough residue to tide them over.

Officers can make an arrest "just by asking somebody for their 
driver's license and having the street knowledge to know what those 
little pieces of cigarette filters signify," Thomas said.

What's next?

Even though the Cape Fear region is struggling with heroin, use of 
the drug might not yet have peaked, as addicts continue to find their 
access to painkillers limited.

"My sense is that we will see a kind of incredible increase of 
users," Mannelli said. "It will be a big, big rise of users and, of 
course, the competition isn't about using either heroin or pain 
medication. They're using both."

Battling heroin use in the near future will require an investment in 
treatment, education and some elements of enforcement, agree both 
officials and families who have been touched by the drug.

Heroin users are taking their first hits at a younger age, according 
to the 2013 National Drug Threat Assessment. In 2011, the average age 
of first use among heroin users was 22.1 years old and in 2010 it was 
21.4 years old, whereas it was 25.5 in 2009.

The drop among the average age of the users is a consequence, 
Mannelli said, of the $10-a-bindle price.

"Being available for cheaper means young people can use it freely," 
the Duke professor said.

The 2012 National Survey on Drug Use and Health from the U.S. 
Department of Health and Human Services found that psychotherapeutic 
drugs such as prescription opioids are the second most common drug 
among people ages 12 to 17, with 2.8 percent of young people 
describing themselves as users.

While that number has seen a slight decline, falling from a high of 
about 4 percent in 2003, officials still expressed concern.

"That's terrifying," Ben David said. "You start projecting those 
numbers out, I can tell you what's gonna be huge for them in college 
in 10 years: It'll be heroin."

A rise in North Carolina's population -- from 8.05 million people in 
2000 to an estimated 9.85 million in 2013, according to the U.S. 
Census Bureau -- has also caused officials to wonder whether the 
state might need more prisons.

The other area where investment seems necessary is treatment, as the 
number of people seeking help for heroin addiction rises.

In 2000, for instance, heroin was a factor in 131 admissions to 
treatment in the Wilmington Metropolitan Area, according to data from 
the Substance Abuse and Mental Health Data Archive. That number had 
risen to 299 people by 2010, the last year for which data was available.

"What we need to do right now is take a look at the next 20 years and 
say, 'Where are we really as a state on this issue?' Maybe it is time 
to do some infrastructure investment, definitely on drug treatment, 
maybe in prisons, too," Ben David said.

Keith Thompson's daughter, Blaire, died of a cocaine overdose in a 
Market Street motel on Dec. 23, 2004. She had overdosed on heroin 
earlier in the day before her companions gave her a lethal dose of 
cocaine in an attempt to wake her up.

Fighting heroin, Thompson said, requires a three-pronged approach 
based on strict enforcement of the state's drug laws, educating both 
parents and kids and allowing addicts to have accessible and affordable care.

"It takes all three of those happening simultaneously to put a dent 
in it," he said. "If you take any of them out of the picture, it's 
just not gonna happen."
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MAP posted-by: Jay Bergstrom