Pubdate: Mon, 16 Jun 2014
Source: Cincinnati Enquirer (OH)
Copyright: 2014 The Cincinnati Enquirer
Contact: http://drugsense.org/url/aeNtfDqb
Website: http://www.cincinnati.com/
Details: http://www.mapinc.org/media/86
Authors: James Pilcher and Lisa Bernard-Kuhn

ACROSS THE US, AN EXPLOSION OF ADDICTION

Over the last 18 months, The Enquirer has used a team of reporters to
cover the heroin problem locally. We joined with Gannett papers in
Arizona, Delaware and Vermont for this series on heroin nationally.

First of five parts.

When it comes to fighting a sharp and frightening influx of heroin,
the Cincinnati area is not alone.

In Burlington, Vermont, the police chief sees soccer moms hooked on
heroin.

In Knoxville, Tennessee, addicts desperate for help are waiting six
months to get into treatment facilities.

In Ohio, a Republican governor who had long called for the repeal of
Obamacare sidestepped the General Assembly to enroll his state in a
Medicaid expansion under the Affordable Care Act because the state
badly needed the included federal help to treat an overwhelming surge
of heroin addicts.

The United States is in the grips of one of the worst heroin epidemics
in its history, due in part to a flood of cheap doses of the drug,
which can be had for as little as $4 apiece, ordered on dark corners
of the Web and delivered to front doors in the suburbs. In some
regions, such as the Great Lakes states, heroin is deemed "highly
available" by local police in more than three times the number of
communities as it was just seven years ago.

The resurgence of the deadly drug has sparked a flurry of action from
governors' mansions and statehouses across New England and the Midwest
to small-town police stations from Northern Kentucky to Wisconsin.
Even Capitol Hill and the White House are weighing in on what's become
a full-blown health crisis that cuts across geographic, social, racial
and economic boundaries.

"It's really on the top of everyone's radar from a public health
perspective," said Thomas MacLellan, director of homeland security and
public safety for the National Governors Association.

Government studies estimate the number of heroin users is around
330,000 and growing, up about 75 percent from five years ago and up
almost three times compared with the decade low of 119,000 in 2003.
It's a level of regular usage not seen since heroin's peak in the
mid-1970s, when government studies estimated 550,000 regular users.
Although heroin represents a small fraction of the nearly 24 million
Americans who misuse drugs overall, heroin use is growing faster than
all others.

"We've got soccer moms on heroin. =C2=85 You walk down any street in any
town in Vermont right now and chances are there is at least one house
where someone is dealing with this," said police Chief Michael
Schirling of Burlington, Vermont. He said heroin trafficking cases
there increased fivefold in two years. "This is a completely
underground, behind-closed-doors phenomenon."

No way out : Heroin addicts trapped in deadly maze

All told, heroin and related opioid pain pills have killed more than
125,000 in the U.S. in the past 10 years.

One very early victim of the developing crisis was Casey Wethington of
Northern Kentucky, who died in 2002 of a heroin overdose at age 23.

"Within six months of learning about Casey's heroin addiction, we were
burying him," said his mother, Charlotte Wethington, of Morning View
in southeast Kenton County.

"We have a tremendous amount of needless deaths -- tens of thousands,"
said Wethington, now an anti-drug activist pushing for increased
awareness among local and state officials across the country. "These
statistics are real people. And those who knew them, their lives will
never be the same again."

Heroin hot spots: Great Lakes, New England, Mid-Atlantic

Governors and other state officials nationally are scrambling to
control the epidemic, which a wide range of government statistics
indicate is worst in the Great Lakes, New England and Mid-Atlantic
regions along with New York and New Jersey.

In the Great Lakes, for instance, the Drug Enforcement
Administration's National Drug Threat Assessment reported that 9
percent of law enforcement agencies deemed heroin highly available in
2007. By 2013, 40 percent of police agencies reported heroin as highly
available. In New England, the percentage of police agencies seeing
heroin as highly available rose from 40 percent to 55 percent over
that same time. In New York and New Jersey, high availability jumped
from 30 to 45 percent.

At least 18 state legislatures addressed new heroin bills this year,
according to the National Conference of State Legislatures. Subjects
range from allowing easier access to drugs that counteract heroin and
other opiate overdoses for first responders and even the public, as
well as leniency for low-level heroin offenders who agree to
treatment. Some states also are debating legislation that would
toughen sentences for major drug crimes and trafficking involving heroin.

Vermont Gov. Peter Shumlin in January went so far as to devote nearly
his entire State of the State address to what he called the "rising
tide of drug addiction and drug-related crime spreading across Vermont."

"In every corner of our state, heroin and opiate drug addiction
threatens us," Shumlin said. "It threatens the safety that has always
blessed our state. It is a crisis bubbling just beneath the surface
that may be invisible to many, but is already highly visible to law
enforcement, medical personnel, social service and addiction treatment
providers, and too many Vermont families."

In Massachusetts, after deaths from heroin and opioid drugs spiked
more than 90 percent since 2002, Gov. Deval Patrick declared a public
health emergency in March. "Sometimes it takes a crisis with big
numbers to get the public's attention," said Public Health
Commissioner Cheryl Bartlett.

Under Patrick's emergency declaration, the state invested $10 million
to create a court diversion system for nonviolent drug offenders,
getting them treatment, and spent another $20 million into the overall
drug treatment system.

"Heroin is such a harsh drug that no one figures that it will be a
part of their lives either through themselves or someone they know
until it's too late," Bartlett said.

In Butler County, home of U.S. House Speaker John Boehner, the number
of children being removed from their parents' custody doubled between
2010 and 2012, with heroin accounting for more than half of cases in
2012. Across Ohio, heroin addictions, demand for treatment and
overdose deaths all prompted Gov. John Kasich, a stalwart Republican,
to opt to go along with Obamacare measures despite the political
consequences.

Across the Ohio River in Kentucky, heroin abuse is "spreading like a
cancer," Senate Minority Leader Mitch McConnell, R-Ky., told a Senate
narcotics group in May. "We are losing close to 100 fellow Kentuckians
a month to drug-related deaths. This is more lives lost than to fatal
car crashes."

Overall drug abuse deaths now exceed car fatalities nationwide,
according to the Centers for Disease Control and Prevention and the
National Institute on Drug Abuse, the federal agency that studies drug
abuse and policy.

In Knoxville, 73 people died from drug overdoses last year, more than
from homicides and traffic accidents combined. Opiates of some sort
were involved in at least 36 of those deaths. "Heroin got here later
than other places, but it is here now full-blast," Knoxville Police
Chief David Rausch said.

Treatment facilities are overwhelmed, with wait times of six months or
longer. "We have 40 beds available, and we're increasingly having to
turn people away," said Ginger Marshall, the volunteer alcohol and
drug treatment coordinator for the local Lost Sheep Ministry.

"This is just overwhelming everyone. It doesn't help that most
insurance only pays for 30 or 60 days of treatment, when it can take
that long just to get the drugs out of your system."

The opioid connection: Drugmakers pushed pain pills

The government, law enforcement and medical experts now concur the
heroin surge can be traced to the rise of prescription painkillers
such as OxyContin, Vicodin and Percocet. The drugs are heroin's
chemical siblings -- containing compounds derived from or similar to
opium.

"Heroin is just a symptom of the prescription drug problem," said
Joseph Rannazzisi, deputy assistant administrator of the Drug
Enforcement Administration, during a U.S. Senate hearing in May.

Driven by drugmakers' promotion of physicians' wider use of
painkilling drugs -- advocacy later called into question by federal
regulatory action and in state and federal courts -- doctors wrote
millions of prescriptions for opioids over the past 15 years. From
1999 to 2010, sales of opioid painkillers increased about 300 percent,
according to the Centers for Disease Control and Prevention. The drugs
are now prescribed to 12 million Americans a year.

Drug companies "told us addiction is extremely rare. They told us
opioids worked well for chronic pain," said Andrew Kolodny of New
York, president of the national Physicians for Responsible Opioid
Prescribing. "They told us that it wouldn't be hard to get patients
off of opioids. That was all totally not true."

In fact, hundreds of thousands of people got hooked on the
painkillers. With the reformulation of prescription opioids to make
them harder to abuse and government crackdowns aimed at curbing legal
and illegal prescription of the drugs, those addicted to pills turned
to heroin.

Mexican drug dealers met the new demand with cheap heroin and made it
so that customers didn't have to risk their safety or reputation by
being seen going to street corners to get it. Mexican heroin, which
dominates the American market, sells for $4 to $10 a dose compared
with $40 to $80 for an 80 milligram opiate pain pill. Perhaps as
important, the new powder heroin can be snorted instead of injected,
removing a psychological barrier for some users.

"People are going to go where the drugs are, and right now, the
cheapest and easiest way to keep that addiction going is through
heroin," DEA spokesman Rusty Payne said. His agency first noted the
painkillers-to-heroin "cycle of addiction" in 2009.

In Vermont's Rutland County, population 63,000, doctors in 2011
prescribed more than 1 million individual doses of oxycodone, the
primary ingredient in OxyContin and other opioids. That's according to
Jim Baker, chief of police in the city of Rutland, who said the
numbers came from local pharmacists.

"Now we have people openly admitting a heroin habit of 20 bags a day,
and I haven't talked to a single person who did not get started by
using the pills," Baker said. "I've been blown away by the depth of
the addiction problem. I've been doing this a long time, and I've
never seen anything like this."

Nora Volkow, director of the National Institute on Drug Abuse, the
federal agency that studies drug abuse and policy, says surveys show
about 80 percent of recent heroin addicts switched from opioid pain
pills. Those same surveys show about 3 percent of the nation's 2
million opioid pill addicts turned to heroin since 2007, a percentage
that she predicts will grow.

The nexus with pain treatment makes heroin "a very sensitive issue"
for policymakers "because we can't just do away with opioid
medication," Volkow said.

Feds say they were surprised, but others warned early

U.S. Attorney General Eric Holder acknowledged the epidemic "snuck up
on us" at a national law enforcement summit on heroin in April. But he
also pledged renewed attention to "an urgent public health crisis."

Holder cited a rise in investigations and heroin seizures by the DEA
over the past three years and the Justice Department's commitment to
specialty drug courts that let addicts get treatment "and return to
their communities before incarceration."

Last year, the DEA seized more than 2,100 kilos, or about 2.3 tons, of
heroin at the Mexican border. That's more than triple the amount
seized in 2008. DEA officials say they weren't targeting heroin;
there's just more crossing the border.

At the summit, Holder acknowledged more needs to be done. "Addressing
this ... will require a combination of rigorous enforcement and robust
treatment."

At the same time, the explosion of heroin users, addicts and overdose
deaths has some critics asking why it took so long and whether a
faster response by public officials -- at all levels -- could have
slowed or prevented heroin's resurgence. Much of the criticism is
aimed at the Food and Drug Administration's handling of the approval
of the original opioid pain pills for wide use.

"This did not sneak up on us," said Kolodny, who is also chief medical
officer for Phoenix House, a New York-based drug treatment nonprofit
organization. "The opioid epidemic began in the late 1990s, and very
early on we saw people who were addicted to opioids move over to
heroin. Had the FDA been doing its job, I don't think we would have an
epidemic today."

Wethington, the anti-drug activist, said the fervor with which
government officials are acting is encouraging, but it is much
delayed. "I was trying to sound the warning bell, and nobody was
listening," said Wethington, who now works as an addiction and
recovery counselor.

Unable to find local help from doctors, law enforcement or treatment
centers, before and after her son's overdose, Wethington pushed for
changes to Kentucky law to allow families to petition courts to
intervene and order addiction and rehab services for drug addicts --
even if they had no criminal record.

"I never understood the concept of letting an addict crash and burn
before you intervene," she said. "This is a public health crisis.
Addiction is a chronic disease."

Kentucky adopted the Matthew Casey Wethington Act for Substance Abuse
Intervention in 2004 -- modeled after an existing Florida law. Ohio
adopted a variation of Casey's law in 2012. Advocates in at least 11
other states, including Indiana, Arizona, New York and Florida, are
working to do the same.

"I get calls from people all over the country who ask me how can I get
Casey's law in my state. It's bittersweet because we couldn't save our
own son."
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