Pubdate: Sun, 24 Apr 2016
Source: Richmond Times-Dispatch (VA)
Copyright: 2016 Media General Communications Holdings, LLC.
Authors: John Ramsey and K. Burnell Evans


Toll Tied to 40% Spike in Heroin Overdoses

Michael Carter felt a brief flash of relief before searing grief consumed him.

His son's life had ended, but so, too, had the nights spent wondering 
when police would show up at his Hanover County home to tell him 
Graham had fatally overdosed.

A year later, Carter is left with the pain, and a question: How many 
more sons and daughters will die as state and federal officials 
pledge progress on stemming the tide of epidemic heroin and 
prescription pill abuse?

There's no end in sight. Fueled by a 40 percent spike in heroin 
overdoses, the Virginia death toll from opiates continued to rise in 
2015, according to newly released state data. The drugs now kill more 
people in Virginia than car crashes or guns. And, with every death, 
family members like Carter and his wife, Alison, grapple with grief, 
guilt and a million "what-ifs."

"I can't help but wonder whether it hurt him or helped him to have us 
to fall back on," she said.

Every false start along their son's winding road to recovery brought 
fresh heartache - and every relapse, paralyzing anxiety.

"The worry ate away at us, but I always felt that Graham could make 
it," he said.

Graham Carter had a chance. He graduated from Patrick Henry High 
School in 2004 and attended Reynolds Community College, Hampden- 
Sydney College and Randolph- Macon College. One professor told 
Graham's parents that he was among the best students in class - when 
he decided to show up.

He had the support of his family and three stints of rehab under his 
belt. He was even mentoring others who wanted to stay clean.

The 28- year-old with a quick wit and bright grin that would tighten 
into a smirk when he had been using drugs died alone in a house full 
of his friends on Carter Street in Richmond. They found his body in 
the bathroom a year ago last week. He recently had completed a long- 
term recovery program at The Healing Place in South Richmond.

"I can't help wondering whether they took time, you know, to clean up 
after they found him," his mother said. "How long was he in there? 
Would it have made a difference? I guess it doesn't matter now."

Last April, he was one of nine people who had died in Richmond of a 
heroin overdose during the first few months of 2015. Thus far in 
2016, there have been 18. The number of nonlethal overdoses 
yearover-year has risen 350 percent, from 22 to 99, according to 
Richmond police data.

The local trend mirrors newly released statewide figures that show 
opiaterelated overdoses continued to climb through the end of last 
year. Those numbers mark the first full year of statistics compiled 
since Gov. Terry McAuliffe in September 2014 created a new task force 
charged with taking "immediate steps to address a growing and 
dangerous epidemic of prescription opioid and heroin abuse in the 

Other state leaders, from Attorney General Mark R. Herring to local 
commonwealth's attorneys and police, have been trying to change the 
way addiction is treated, with a focus on treatment over arrest.

But the latest figures show no signs of any reversal to the leading 
cause of accidental death across the state and the country.

"It's definitely is an epidemic, and the ripple effects grow out, 
out, out," Alison Carter said.

Prescription painkiller deaths remained flat last year, but heroin 
deaths - which have tripled since 2011- have continued to rise. More 
heroin overdoses were recorded in 2014- 15 than in 2010 through 2013 combined.

That spike has been fueled in large part by new regulations that 
slowed the growth of painkiller prescriptions and unintentionally 
opened a larger market for heroin. People addicted to pills began 
using the illegal substance because it affects the same receptors in the brain.

"We control those prescriptions so we're able to kind of squeeze out 
what the excess is and try to ensure the prescriptions are getting to 
the right people. But with illicit drugs, you can't really do that," 
said Rosie Hobron, a forensic epidemiologist with the state Office of 
the Chief Medical Examiner who tabulates and studies statewide overdose data.

"What do you do with heroin when it's not something like prescription 
opiates that you can monitor who is taking the prescription, who is 
writing the prescription? I don't know if there's a good answer."

The numbers, Hobron said, represent a best-case scenario. Between 100 
and 200 other possible overdoses from last year are still being 
investigated, meaning the official death toll is likely to rise. 
Hobron said the 882 deaths currently attributed to heroin and 
prescription painkillers is likely to surpass 1,000 once all the 
additional death cases become final.

"Certainly the numbers are deeply troubling, and it is really 
important to underscore that every one of these, behind every one of 
these deaths, that's a life and a family that is tragically 
impacted," said Herring, who has spent the past couple of years 
raising awareness about Virginia's opiate epidemic.

"It does take time for all of those policies to begin to take effect 
and get the number down. We are making progress in a number of areas. 
. We need to do more."

Herring and others agree that the complexities of heroin and 
painkiller addiction make the problem difficult to solve and require 
commitment from communities alongside nearly every level of 
government. The conversations about addiction have changed as people 
become more aware that it's an illness instead of a moral failure, he said.

And some policies have helped reduce the number of people taking 
painkillers long-term, but there has been little progress on 
providing help for people who are already addicted.

The state included $ 11 million in its budget for next year aimed at 
reducing or eliminating the months-long waiting list that addicts 
face when they turn to the state for addiction treatment.

But that money primarily will go toward medication- assisted 
treatment, or programs that use replacement drugs such as methadone 
and buprenorphine, which some addiction specialists criticize as 
trading one addictive drug for another.

Private recovery outfits including The Healing Place and the McShin 
Foundation in Henrico County, which avoid medication- assisted 
treatment and waiting lists for their patients, often find themselves 
scrambling for enough money to keep operating. The Healing Place, for 
example, lost $ 75,000 from United Way last year when funding went 
instead toward helping the homeless.

The new state funding will be available only to people who qualify 
for Medicaid.

"A lot of the people who have addiction now don't qualify for 
Medicaid. ... I suspect a lot of people who need the treatment are 
going to be in that area that won't get it, so it's not a perfect 
solution," Secretary of Health and Human Resources William A. Hazel 
Jr. said Friday. "When we are fundamentally under-resourced in mental 
health and substance abuse, you can get into a situation where it all 
helps, but it's not enough.

"We don't have a lone ranger with a silver bullet to ride in and solve this."

The text from his mother read, "Call me. I have bad news."

Graham Carter's younger brother Zack knew what must have happened 
when he awoke to it and dozens of missed calls after a night out at a 
friend's bachelor's party in Las Vegas.

"In a way, I had been waiting for that call, and knowing it was going 
to come made it even more unreal," he said. "You put so much power on 
that moment, and then, when it happens, it feels like a dream."

The first time he thought his older brother might have a drug 
problem, they were talking about Graham's marijuana use. It was the 
summer after Graham graduated from high school.

"He said, ' When I'm ready to stop, I'll go see a hypnotist,'" Zack 
Carter recalled. "It sounded bizarre that he needed some outside 
force to intervene."

In hindsight, he said, Graham exhibited compulsive behaviors early 
on. He couldn't resist junk food and would play video games seemingly 

Strange, but nothing like what came after. The lying, the stealing - 
the moments when Zack had to choose between breaking his parents' 
hearts with the truth or lying about Graham's drug use to keep the 
peace- all weighed on him.

Gone was the good-natured, whip-smart boy of his youth. Zack found 
himself keeping a slight distance from the man his brother had 
become, the best version of which Zack last saw the fall before Graham's death.

He seemed relaxed then, at peace even, during a family celebration of 
their mother's birthday, Zack recalled. But the worry persisted.

"I found myself mourning well before he died," Zack Carter said. "It 
happens gradually; he wasn't who he had been anymore, and part of me 
had already dealt with losing that first brother."

More than 4,700 people have died of heroin and painkiller overdoses 
in Virginia since 2007. And for every death, there are those left behind.

"This is very much a family disease," Alison Carter said. "Sometimes, 
you help the most when you help the least, but it's hard to know how 
and when to let go."

She will spend the rest of her days thinking and then trying to 
forget about the ins and outs of Graham's struggle, which in many 
ways became the fight of her life.

"I would have died for him," she said. "I can't help but wonder if, 
in some way, the pain we're feeling now is a trade-off for him not 
having to feel pain anymore."

What could they have done differently? Better?

Service providers and experts are at odds over how best to help - 
with medications to ease withdrawal symptoms, or not?

In outpatient settings, or inpatient?

If inpatient, who will pay?

The cost of admittance for intensive services can be high, and higher 
still when insurers decline to cover a problem that has long been 
seen as a moral failing.

All that is changing, but not soon enough, Alison Carter said.

"You don't have to be a heroin junkie to be a heroin user," she said. 
"This disease is an equal-opportunity problem with devastating 
consequences for everyone it touches."

Last Monday marked the first anniversary of Graham's death. Alison 
Carter sought solace in the mundane; a day that flowed into the next 
like any other.

But she did send a message to the number that had been his.

"I texted him and told him how much I miss him and that it hasn't 
gotten any easier," she said. "I guess one day it will."
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