Pubdate: Sun, 06 Apr 2014
Source: News & Observer (Raleigh, NC)
Copyright: 2014 The News and Observer Publishing Company
Author: Thomasi Mcdonald


DURHAM -- Long before the overdose death of actor Phillip Seymour
Hoffman thrust heroin back into the headlines this winter, the return
of the potent narcotic was already known to police and public health
officials in North Carolina. Heroin, which emerged in popular culture
in the 1940s as an exotic product associated with jazz musicians and
later became known as the dead-end drug of junkies in movies and
songs, had never gone away. A few dozen people died of heroin
overdoses in North Carolina each year since 2000, according to the
state Department of Health and Human Services.

But in 2012, heroin deaths nearly doubled statewide, to 148, while
overall deaths from all narcotics and hallucinogenic drugs ticked up
only slightly. WakeMed hospitals throughout Wake County admitted 50
people for heroin overdoses in 2013, more than twice the annual
average of the previous five years, said spokeswoman Kristin Kelly.

At the same time, police say the amount of heroin they've found in
drug arrests has soared.

In Durham, police seized about 4 pounds of heroin last year, more than
five times as much as in 2010, said spokeswoman Kammie Michael. In
Raleigh, heroin seizures went from less than a pound in 2010 to nearly
24 pounds last year, said spokesman Jim Sughrue.

The surge in heroin use comes after what the Centers for Disease
Control and Prevention called a nationwide epidemic of overdose deaths
involving opioid pain relievers, including OxyContin, methadone and
hydrocodone. In 2008, overdose deaths from opioid prescription drugs
accounted for more than heroin and cocaine combined, the CDC reported
in 2011.

Public health officials say the resulting crackdown on pills has
driven up the price and helped fuel the switch to heroin.

"Some of these prescription medicines sell for $40 a pill," says
Robert Childs, executive director of the N.C. Harm Reduction
Coalition, a statewide public health and drug policy reform
organization based in Durham. "That's on the extreme end. Most cost
less. But if you can get a bag of heroin for $5 to $20 instead of
paying up to $25 or $80, it's really a simple choice to users."

And the new generation of heroin users may not be familiar with the
dangers, resulting in more overdoses and deaths from a drug that can
be injected but also snorted or smoked.

Tessie Swope Castillo, who works as an advocacy coordinator with the
state's Harm Reduction Coalition, said the agency has "seen an
anecdotal increase in the popularity of heroin, especially among
young, white people and people of affluence."

"People who might never have started using heroin because of stigma
against it or fear of needles, for example, started on OxyContin and
became addicted," Castillo said. "And when their Oxy supply was cut
off or became too expensive, they got desperate and turned to heroin."

Crackdown on opiates

The state legislature passed a bill last year that beefed up the
state's prescription drug reporting system that aims to crack down on
opiate-based prescription drug abuse. The bill, signed into law by
Gov. Pat McCrory, was strongly supported by the N.C. Child Fatality
Task Force after it found more and more young people abusing drugs
such as oxycodone, OxyContin and Percocet.

The bill revised an earlier law that established a statewide reporting
system to improve North Carolina's ability to identify people who
abuse and misuse prescription drugs. The law was also enacted to help
medical providers identify patients who may be abusing prescription

The revised law now requires a shorter reporting period and increases
the penalties for violations.

Scott Proescholdbell, who heads the injury epidemiology and
surveillance unit with the N.C. Department of Health and Human
Services, says the new law may prompt some pill users to switch to
heroin but does not think it's a "one to one" corollary.

"There are probably some instances," he said. "But the other big
driver is economic. A 30 milligram pill of oxycodone sells for $20. A
bag of heroin costs $10."

Castillo agreed. She said the intent behind the law was to help alert
medical providers about patients who may be "doctor shopping."

"I don't know whether [the law] has actually reduced prescription drug
abuse, but that certainly was its intent," she said. "These types of
laws have become very popular recently and most states have them, but
the jury is still out about whether they actually reduce prescription
drug abuse or merely divert abuse to other drugs."

Childs explained that many of the young users who are now dying of
heroin overdoses grew up in a "pill culture" and would pop pills that
they had taken from family members or from a friend. He and other
experts wonder if former narcotic pill users are turning to heroin,
with disastrous results.

"We hadn't seen such a spike in heroin deaths," he said. "For people
who have been using a long time, there was no change in the overdose
rates. It's the new users who don't know what they're doing. They
can't figure out how strong the heroin is. Sometimes, if they are
worried about police involvement, they will rush to use the drug and
not have a good overdose prevention plan. A bad plan is using by
yourself, with no one there to call 911."

Law helps with overdoses

The governor signed another bill into law last year that's meant to
reduce drug overdoses by giving limited immunity to someone who seeks
medical help for a person experiencing an overdose. The so-called good
Samaritan law grants someone immunity from criminal prosecution for
possessing less than one gram of heroin or cocaine if they were
seeking assistance for a drug-related overdose.

The law also allows users, their friends and family to use the drug
Naloxone to revive people who may be dying of drug overdoses. Last
week, the Food and Drug Administration approved a device that
automatically injects the proper dose of Naloxone.

The government has not published statistics for drug overdose deaths
in 2013, but Proescholdbell says that since McCrory signed the bill
into law in June, nearly 50 people who would have died from drug
overdoses were revived.

Catherine Harper of Charlotte, a former heroin user, works as an
outreach worker for the Harm Reduction Coalition distributing Naloxone
to people in her social circle who are addicted to heroin and their
friends and families. In three months, Harper says, Naloxone has
revived seven people she knows who would have died of heroin
overdoses. They range in age from 17 to their mid-30s.

"It's so amazing," said Harper, 27. "I have met with the parents who
have lost their children to overdoses. It's good to know there are
parents who don't have to go through that."

Another challenge facing law enforcement and public health officials
is the seemingly endless supply of people willing to sell illicit
drugs -- people such as Steve "Mannie" Manning of Durham. Now 30,
Manning was 12 when he first started selling crack cocaine, a path
that led him to heroin trafficking charges in 2012.

Manning was in jail in Durham awaiting trial when he met Castillo of
the Harm Reduction Coalition. Castillo spoke to him about the
debilitating effects the drug he was selling had on individual users
and the community. Castillo offered him the chance to do outreach work
in some of the same neighborhoods where he used to peddle dope. He
jumped at the chance.

"So I knew the harm it was doing to people versus me just out here
making a dollar," he said.

Now at least three days a week, Manning straps on a backpack filled
with condoms and hands them and other safe-sex materials out to
residents in Durham neighborhoods that may have little or no access to
resources to help diminish the direct or indirect effects of heroin

The CDC reports that injecting drugs was responsible for approximately
10 percent of new HIV cases between 2008 and 2011.

"The Harm Reduction Coalition is about taking a dangerous activity and
making it less dangerous," Castillo said. "Obviously unsafe sex is a
dangerous activity."

The federal trafficking charges against Manning were eventually
dismissed, although he was convicted in state court of felony
possession of cocaine and sentenced to probation.

Manning's outreach efforts include Wabash Street in the McDougald
Terrace public housing complex in southeast Durham, where residents
know him.

"I been doing this for over a year, since 2012," he said. "They call
me 'the Health Department Man.' "

Castillo said she asked quite a few of the people locked up on drug
charges to do similar outreach in their communities.

"Mannie was the only one who called," she said. 
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