Pubdate: Mon, 24 Aug 2015
Source: Washington Post (DC)
Copyright: 2015 The Washington Post Company
Author: Lenny Bernstein


Washington, Pa.- The first call came at 7:33 p.m. last Sunday: Two 
people had overdosed on heroin in a home just a few hundred yards 
from the station where firefighters were awaiting their nightly round 
of drug emergencies.

Six minutes later, there was another. A 50-year-old man had been 
found in his bedroom, blue from lack of oxygen, empty bags of heroin 
by his body.

At 8:11, a third call. Then another, and another, and another and another.

By 8:42 - 69 minutes after the first report - a county of slightly 
more than 200,000 people had recorded eight overdoses, all believed 
to be caused by heroin. There would be a total of 16 overdoses in 24 
hours and 25 over two days. Three people died. Many of the others 
were saved by a recent decision to equip every first responder with 
the fast-acting antidote naloxone.

The toll wasn't from a supply of heroin that had been poisoned on its 
journey from South America to southwestern Pennsylvania. Nor was 
there an isolated party where careless junkies miscalculated the 
amount of heroin they could han-dle. Last week was simply an extreme 
example of what communities in parts of the country are enduring as 
the heroin epidemic rages on.

"It's absolutely insane. This is nuts," said District Attorney Eugene 
A. Vittone, a former paramedic who is trying to hold back the tide of 
drugs washing across Washington County, a Rust Belt community 30 
miles south of Pittsburgh. On any day, Vittone said, the county 
averages five to eight overdoses, almost all from heroin. More are 
recorded each day in towns just over the county line.

"There's been a progressive increase in overdoses the last two years, 
and it just went out of control," added Rick Gluth, supervising 
detective on Vittone's drug task force. "I've been a police officer 
for 27 years and worked narcotics for the last 15, and this is the 
worst. I'd be glad to have the crack epidemic back."

The United States averages 110 overdose deaths from legal and illegal 
drugs every day. The heroin death toll has quadrupled in the decade 
that ended in 2013, according to the Centers for Disease Control and 
Prevention. By all accounts, it has only grown worse since. In 
Washington County, there have been more than 50 fatal overdoses this year.

The national drug-death total, larger than that from auto accidents, 
is disproportionately concentrated in the Rust Belt, the Great Lakes 
region and the Northeast.

"There is a growing sense of community outrage that we can't accept 
this like we are accepting it," said David J. Hickton, U.S. attorney 
for western Pennsylvania and co-chair of the National Heroin Task 
Force established by the Justice Department in April. "We just can't 
go on like this."

In this working-class community near the Monongahela River, where 
drilling for gas deposits has begun to stoke an economic revival, 
there is little sign that anything will change soon.

"I'm destroyed. I'm totally destroyed," Valerie Mack said Thursday 
onthe front porch of thehome she shared with her brother and several 
other people on a modest block here.

Her brother, Sammy Mack, the second overdose victim in the Sunday 
night skein, was found dead in his bedroom, curled in a fetal 
position. Near his body were "stamp bags" of heroin - small paper 
packets that most closely resemble chewing gum wrappers. They bore 
the supplier's brand, "MADE IN COLOMBIA."

The label is one of two flooding the area, Gluth said. The other is 
stamped "BLACK JACK." Authorities are still investigating but believe 
both types of heroin are laced with fentanyl, a powerful synthetic 
opiate that increases the drug's potency and may have contributed to 
the rash of overdoses.

Sammy Mack had long had problems with alcohol and was not unknown to 
law enforcement authorities. But as so many others have, his sister 
said, he turned to heroin after treatment with narcotic painkillers 
prescribed for an injury he suffered a few months ago. Mack's divorce 
was recently finalized, she said. His four children are living with 
his ex-wife not far away.

As he began to use heroin, Mack's habits and personality changed, she 
said. He became withdrawn, spending more time in his room. That 
Sunday, she was fixing him a chef's salad and became suspicious when 
he didn't respond to her calls. She tried to push open his bedroom 
door but couldn't. Aneighbor finally forced his way in.

Mack's prized possession, a Harley-Davidson motorcycle, still sits in 
the home's back yard. He had promised it to his 14-year-old son upon 
his high school graduation. "I'll just have to follow through," 
Valerie Mack said.

With so much awry in Sammy Mack's life, his sister said, "Maybe the 
Lord intervened and decided just to take him."

Jessica Neal, 26, another of last week's overdoses, is still alive 
after a close call. She was found unconscious in a bathroom at a 
local Walgreen's on Monday, her 2-yearold strapped in a stroller in 
the stall with her. She was revived with naloxone.

Her father, Sonny, who has a different last name that he requested 
not be used to protect his privacy, said he threatened to have her 
committed to the psychiatric unit of the local hospital that same day 
after Neal spoke of committing suicide. Instead, she agreed to sign 
herself in. She was released Friday and headed to jail. The child is 
in her father's care, he said.

"She doesn't need jail," Sonny said outside the home where the two 
lived with Sonny's wife, who suffers from amyotrophic lateral 
sclerosis (ALS), until last week. "She wasn't out stealing or doing 
crimes. What she needs is help. She needs to be in rehab. And after 
rehab, she needs to be in a halfway house."

Nationally, there are only a small fraction of the inpatient drug 
rehab beds needed for addicts, but Hickton, in an increasingly common 
stance for prosecutors, has agreed that users need help more than 
they deserve incarceration. Even as he has stepped up prosecution of 
dealers, he is taking a multifaceted approach to the current problem.

"If they're using and trafficking, I prosecute them," he said. "If 
they're just using, they need help."

Hickton promises to bring homicide charges against any seller he can 
link to a death. Butthat is easier said than done. There are no 
open-air drug markets in this epidemic like the ones that captured 
public's attention during drug outbreaks of past decades. Muchof the 
commerce is conducted on cellphones and by word of mouth.

With many more middle-class people addicted via prescription opioids 
this time around, heroin is bought and sold in bars, nightclubs, 
homes and more unlikely places, said Neil Capretto, an addiction 
psychiatrist and medical director of Gateway Rehabilitation Center, 
which has 20 locations in the Pittsburgh area.

Gluth said he has undercover detectives all over the streets making 
buys, painstakingly working their way up the chain in search of bigger dealers.

He believes the latest load of heroin came from New Jersey, but 
Washington County's location makes it particularly vulnerable to drug 
traffic. Not far from the Ohio and West Virginia borders, it sits at 
the intersection of Interstates 70 and 79, east-west and north-south 
conduits for drugs and everything else. Vittone said the county 
receives drugs from New York, Newark, Washington, Chicago, Detroit 
and elsewhere.

"We're kind of like ground zero," he said.

On the streets here, prescription drugs are selling for about $1 per 
milligram, or $20 for a single dose. Heroin is much cheaper, at about 
$8 a stamp bag, Gluth said. It is also much more potent than the 
heroin of previous eras, Capretto said. Users often start with a 
single bag, but as their resistance grows, they need increasing amounts.

All of which signals more overdoses and deaths, at least until 
authorities can find ways to stem the demand and the supply.

"If we had a serial killer killing one-tenth as many [people], we'd 
have the National Guard here," Capretto said. "We'd have CNN here every night."
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MAP posted-by: Jay Bergstrom