Pubdate: Sat, 05 Apr 2014
Source: Bellingham Herald (WA)
Copyright: 2014 Bellingham Herald
Author: Amy Forliti, Dan Sewell And Nigel Duara
Note: Associated Press National Writer Sharon Cohen contributed to
this story. Forliti reported from Minnesota; Sewell from Ohio; Duara
from Oregon.
Note: Part 1 of a three-part series


[Bellingham Herald] EDITOR'S NOTE: The death of actor Philip Seymour
Hoffman underscored a troubling development: Heroin, long a scourge of
the back alleys of American life, has spread across the country. First
of a three-part series.

On a beautiful Sunday last October, Detective Dan Douglas stood in a
suburban Minnesota home and looked down at a lifeless 20-year-old  a
needle mark in his arm, a syringe in his pocket. It didn't take long
for Douglas to realize that the man, fresh out of treatment, was his
second heroin overdose that day.

"You just drive away and go, 'Well, here we go again,' " says the
veteran cop.

In Butler County, Ohio, heroin overdose calls are so common that the
longtime EMS coordinator likens the situation to "coming in and eating
breakfast  you just kind of expect it to occur." A local rehab
facility has a six-month wait. One school recently referred an
11-year-old boy who was shooting up intravenously.

Sheriff Richard Jones has seen crack, methamphetamine and pills plague
his southwestern Ohio community but says heroin is a bigger scourge.
Children have been forced into foster care because of addicted
parents; shoplifting rings have formed to raise money to buy fixes.

"There are so many residual effects," he says. "And we're all paying
for it."

Heroin is spreading its misery across America. And communities
everywhere are indeed paying.

The death of actor Philip Seymour Hoffman spotlighted the reality that
heroin is no longer limited to the back alleys of American life. Once
mainly a city phenomenon, the drug has spread  gripping postcard
villages in Vermont, middle-class enclaves outside Chicago, the sleek
urban core of Portland, Ore., and places in between and beyond.

It remains a small part of America's drug problem; cocaine, Ecstasy,
painkillers and tranquilizers are all used more, and the latest
federal overdose statistics show that in 2010 the vast majority of
drug overdose deaths involved pharmaceuticals, with heroin accounting
for less than 10 percent.

But heroin's escalation is troubling. Last month, U.S. Attorney
General Eric Holder called the 45 percent increase in heroin overdose
deaths between 2006 and 2010 an "urgent and growing public health crisis."

In 2007, there were an estimated 373,000 heroin users in the U.S. By
2012, the number was 669,000, with the greatest increases among those
18 to 25. First-time users nearly doubled in a six-year period ending
in 2012, from 90,000 to 156,000.

The surge is easily explained. Experts note that many users turned to
heroin after a crackdown on prescription drug "pill mills" made
painkillers such as OxyContin harder to find and more costly. Whereas
a gram of prescription opiates may go for $1,000 on the street, that
same gram of heroin will sell for $100, authorities say.

It's killing because it can be extremely pure or laced with other
powerful narcotics. That, coupled with a low tolerance once people
start using again after treatment, is catching addicts off guard.

In hard-hit places, police, doctors, parents and former users are
struggling to find solutions and save lives.

"I thought my suburban, middle-class family was immune to drugs such
as this," says Valerie Pap, who lost her son, Tanner, to heroin in
2012 in Anoka County, Minn., and speaks out to try and help others.
"I've come to realize that we are not immune. ... Heroin will welcome
anyone into its grasp."


The night before Valentine's Day, some 250 people filed into a Baptist
church in Spring Lake Park, Minn., a bedroom community north of
Minneapolis that brags of its "small-town charm and friendly folks."
There were moms and dads of addicts, as well as children whose parents
brought them in hopes of scaring them away from smack.

 From the stage, Dan Douglas gripped a microphone as a photograph
appeared overhead on a screen: A woman in the fetal position on a
bathroom floor. Then another: A woman "on the nod"  passed out with
drug paraphernalia and a shoe near her face.

Douglas didn't mince words. "You just don't win with heroin," he
declared. "You die or you go to jail."

It was the third such forum held over two weeks in Anoka County, which
encompasses 440 square miles of urban neighborhoods, rural homesteads
and suburban centers that are home to nearly 340,000 souls. Since
1999, 55 Anoka County residents have died from heroin-related causes.
Only one other Minnesota county reported more heroin-related deaths
58  and it has a population three-and-a-half times greater than Anoka's.

In 2009, when Douglas began supervising a drug task force, authorities
were focused on stamping out meth labs. Heroin, with its dark and
dirty image, just wasn't a concern. Then investigators noticed a climb
in pharmacy robberies and started finding Percocet and OxyContin
during routine marijuana busts.

As prescription drug abuse rose, so, too, did federal and state
crackdowns aimed at shutting down pill mills and increasing tracking
of prescriptions and pharmacy-hopping pill seekers. Users turned to

"It hit us in the face in the form of dead bodies," says Douglas. "We
didn't know how bad it was until it was too late here in our community."

Douglas says authorities are doing what they can: educating doctors
about the dangers of overprescribing painkillers, holding events where
residents can dispose of prescription opiates, and aggressively trying
to get drugs off the street. But, he says, "law enforcement cannot do
this alone."

The idea for the forums came not from police but rather from Pap, a
third-grade teacher whose youngest son died of a heroin overdose.

Tanner was an athlete who graduated from high school with honors. In
the fall of 2012, he was pursuing a psychology degree at the
University of Minnesota, and dreamed of becoming a drug counselor. He
had not, to his mother's knowledge, ever used drugs, and certainly not

Then one day Tanner's roommates found the 21-year-old unconscious in
his bedroom.

Amid her grief, Pap realized something needed to be done to educate
others. She met with county officials, and the community forums began
soon after. At each, Pap shared her family's story.

"Our lives have been forever changed. Heroin took it all away," she
told the crowd in Spring Lake Park.

Douglas says most heroin-related deaths he has seen involve victims
who struggled with the drug for years. The detective usually tries to
shield his own boys, ages 7 and 11, from what he sees on the job. But
after meeting parents like Pap, Douglas shared his heroin presentation
with his oldest son  complete with the sobering pictures.

"Could I still be blindsided? Absolutely," he says. "But it's not
going to be for lack of information on my part. ... I don't want to
scare my kid. I don't want to scar my kid. But I sure as hell don't
want to bury him."


Brakes screech. The hospital door flies open. A panicked voice shouts:
"Help my friend!" Medical technicians race outside with a gurney. An
unconscious young man is lifted aboard, and the race is on to stop
another heroin user from dying.

It's known as a "drive-up, drop-off," and it's happened repeatedly at
Ohio's Fort Hamilton Hospital. The staff's quick response and a dose
of naloxone, an opiate-reversing drug, bring most patients back. But
not all. Some are put on ventilators. A few never revive.

"We've certainly had our share of deaths," says Dr. Marcus Romanello,
head of the ER. "At least five died that I am acutely aware of ...
because I personally cared for them."

Romanello joined the hospital about two years ago, just as the rise of
heroin was becoming noticeable in Hamilton, a blue-collar city of
60,000 people. Now it seems to be reaching into nearly every part of
daily life.

"If you stood next to somebody and just started a conversation about
heroin, you'd hear: 'Oh yeah, my nephew's on heroin. My next-door
neighbor's on heroin. My daughter's on heroin,"' says Candy Murray
Abbott, who helped her own 27-year-old son through withdrawal.

Abbott and childhood friend Tammie Norris, whose daughter was also a
heroin user, decided last year to bring attention to the problem in
their hometown, using Facebook to organize poster-waving
demonstrations by everyone from recovering addicts to parents and
grandparents of children who died of overdoses.

Norris could only shake her head at the surge in attention to heroin
after Hoffman's death. "Well, duh," she says, "it's been happening to
our kids every day  and nobody sees it."

A couple decades ago, the big problem in Hamilton was cocaine. That
shifted to prescription drug abuse, which morphed into heroin as
pharmaceuticals grew harder to come by. Now heroin-related deaths have
more than tripled in Butler County, where Hamilton is the county seat.
There were 55 deaths last year, and within one two-week period, the
city's emergency paramedic units responded to 18 heroin overdoses.
Once, they had five overdose runs in a single day.

Users run the gamut, says EMS veteran Jennifer Mason  from
streetwalkers to business executives. They die in cars, public parks,
restaurant bathrooms, a university building. Mason has found people
turning blue with needles still in their arms.

Sojourner Recovery Services, an addiction treatment organization in
Hamilton, has a six-month waiting list for beds for male addicts.

Romanello's hospital saw 200 heroin overdose cases last year, and
countless related problems: abscesses from using unsterile needles,
heart-damaging endocarditis and potentially fatal sepsis infections.

Overdose patients usually bounce back quickly after given naloxone,
known by the brand name Narcan. It works by blocking the brain
receptors that opiates latch onto and helping the body "remember" to
take in air.

At least 17 states and the District of Columbia allow Narcan to be
distributed to the public, and bills are pending in some states to
increase access to it. Attorney General Holder has called for more
first responders to carry it. Last month, Ohio's Republican governor
signed into law a measure allowing a user's friends or relatives to
administer Narcan, on condition that they call 911.

Romanello says his patients are usually relieved and grateful by the
time they leave his hospital. "They say, 'Thank you for saving my
life,' and walk out the door. But then, the withdrawal symptoms start
to kick in."

"You would think that stopping breathing is hitting rock bottom," adds
Mason. "They don't have that fear of dying. You've blocked the heroin,
and they have to have it. They go back out to get more. You haven't
fixed their addiction."


Before 9 o'clock every weekday morning, the secret to one of the most
successful drug rehabilitation clinics in Portland, Ore., waits behind
a locked door. Meet David Fitzgerald, leader of the mentor program at
Central City Concern, which claims a 60 percent success rate for
treating heroin addiction.

The lock, Fitzgerald says, is a necessity because his addicts will
take every opportunity offered, including early access to the "mentor

Inside, the walls are covered in photos, including a collage from last
year's group picnic. Recovering addicts smile and hold plates of food.
Seven months later, Fitzgerald looks over the faces. Are they all
still sober? Are they all still alive?

"Most of them," he says. "Not all."

Heroin cut a gash through the Pacific Northwest in the 1990s. Then
prescription pills took over until prices rose. Now the percentage of
those in treatment for heroin in Oregon is back up to levels not seen
since the '90s  nearly 8,000 people last year  and the addicts are
getting younger.

Central City's clients reflect that. In 2008, 25 percent of them were
younger than 35. Last year that went to 40 percent.

"A lot of them aren't ready at a younger age," Fitzgerald says. "The
drug scene, it's fast ... it's different. It's harder than it was."

Fitzgerald, 63, speaks with a laconic prison patois, a reflection of
20-plus years incarcerated, all the while addicted to various drugs.
The worst was heroin. In 1997 he got sober, and in 1999 he joined
Central City Concern, then a burgeoning outfit.

Fitzgerald saw that the usual path for treating addiction wasn't
working. Addicts were processed through detox for seven or eight days,
then handed a list of tasks that included finding work, meeting with a
probation officer, and locating the drop site for their daily food

"Like they're going to do any of that," Fitzgerald scoffs. "First
thing they do is see somebody they know, get that fix."

Central City Concern instead accompanies clients to housing
appointments, keeps their daylight hours filled with to-dos and
requires they spend idle hours at the facility, where they also sleep.

It's a bare-bones staff operating on a razor-thin budget, and the crop
of younger addicts presents a new problem: finding appropriately aged
mentors to match them with. But Fitzgerald has hope in 26-year-old
Felecia Padgett, who remembers clearly the first time she fired heroin
into her veins.

"I heard one time somebody say it's like kissing God," says Padgett.
"It is. It's like getting to touch heaven."

Padgett's six-year tumble involved, in order: heroin smoked, heroin
shot intravenously, homelessness, one overdose, two close calls, a
suicide attempt, arrest, jail, arrest, jail, arrest, jail and,
finally, a one-shot, last-chance stop at Central City.

Before sobriety, she found herself selling to people younger than
herself, suburban kids rolling up in their parents' cars.

Fitzgerald doesn't yet have money to pay her, and Padgett herself is
still in recovery. But she, and others like her, may play a crucial
role in confronting the problem as the face of Portland's heroin
addiction gets younger.

Fitzgerald knows that many of the clients he sees at 25 may be back in
rehab at 35, but he tries to remain optimistic that some of what they
learn at Central City will, ultimately, make a difference.

"That's about all you can do," he says, "hope some of it

Associated Press National Writer Sharon Cohen contributed to this
story. Forliti reported from Minnesota; Sewell from Ohio; Duara from
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