Pubdate: Wed, 28 Dec 2016
Source: Milwaukee Journal Sentinel (WI)
Copyright: 2017 Journal Sentinel Inc.
Author: Eric Litke


A police officer holds a bag of heroin confiscated as evidence on March 22
in Gloucester, Mass.(Photo: USA TODAY NETWORK)

Wisconsin's battle against heroin yielded more grim results in 2015.

The death toll rose for the ninth straight year, and the total of 281
deaths was triple the number killed by heroin in 2010. Meanwhile, the
number of total opioid deaths -- which includes heroin and prescription
opiates -- topped the number of Wisconsin traffic deaths for the third
straight year.

Officials did, however, see some reason for optimism since the increase in
heroin deaths was the smallest since 2010 and the opioid deaths actually
dropped for the first time since 2008.

"We are starting to see things, but it's really too soon to tell," said
Lisa Bullard-Cawthorne, the who runs the opioid harm prevention program
for the state Department of Health and Human Services. "This epidemic has
been growing over the last decade. We're not necessarily going to change
things quickly."

The state is several years into a multi-pronged effort to combat heroin
and opioid abuse. Departmental and legislative initiatives have included
advertising campaigns, prescription drug drop-offs, tighter prescribing
guidelines, increasing the availability of the overdose-halting drug
naloxone (commonly called Narcan) and increased focus on treatment
options, youth intervention and underlying mental health issues.

These responses grew in frequency and magnitude as the death tolls rose
steadily in recent years.

It's not unique to Wisconsin. Data released this month by the U.S. Centers
for Disease Control and Prevention show the number of heroin deaths rose
23 percent nationally in 2015, and opioid deaths rose 16 percent.

The Washington Post noted the heroin deaths passed a bleak milestone in
the process, surpassing the number of gun homicides for the first time.
Gun homicides outnumbered heroin deaths 5 to 1 in 2007.

And new county-level data in Wisconsin shows overdoses are far more
prevalent than the death tallies alone convey. In the past five years, 1
of every 1,000 state residents has been hospitalized for an overdose of
heroin or prescription opioid, according to DHS.

Heroin has claimed the headlines, but experts say fentanyl is the
fastest-growing threat.

The narcotic painkiller is similar to morphine but 50 to 100 times
stronger, making it a target for drug users in search of an enhanced high.
Versions in use on the street include diverted prescriptions as well as
synthetic fentanyl that is being illegally manufactured.

Nationwide, deaths from synthetic opioids other than methadone -- a
category dominated by fentanyl -- jumped 73 percent in 2015, according to
the CDC.

Wisconsin also can't track fentanyl deaths specifically, but the number of
synthetic opioid deaths rose from 90 in 2014 to 113 last year, according
to DHS. That is nearly double the number in 2012.

"On the street, people are hearing that you get a better high from
fentanyl because it's stronger, so people are using fentanyl instead of
heroin, or they're using heroin laced with fentanyl, or in some cases,
they don't even know." Bullard-Cawthorne said. "The fentanyl is scary
because it is so potent."

Milwaukee County already has doubled the number of deaths involving
fentanyl since last year. The Medical Examiner's Office reported 30
fentanyl-involved deaths in 2015, and 71 so far this year. Twenty-seven of
those 71 also involved heroin.

Bullard-Cawthorne said the state is working to better track fentanyl,
since lab tests currently can't tell if the drug leading to an overdose
was prescribed or synthetically manufactured.

Fentanyl is also just one of many opioids that drug users mix together. In
Outagamie County, for example, 13 of the 16 opioid overdose deaths last
year involved multiple drugs, the coroner reported.

Fentanyl deaths have spiked in recent years, officials say. The deaths
aren't tracked directly but comprise most of the synthetic opioids
category (Photo: Eric Litke, USA TODAY NETWORK-Wisconsin)

Recent sobriety is another common thread in overdoses.

Regular drug users build up a tolerance that leads them to increase the
dosage to get the same high. Those fresh off a stretch in jail or
treatment lose that tolerance but often return to the same level of drug

"It's one of the highest risks of an overdose, is someone who had a period
of sobriety and then they started using again," Bullard-Cawthorne said.

It's a narrative that proved all too real for one Winnebago County mother.

The woman, who requested anonymity over concerns for her son's safety,
said her then-19-year-old son came home in August 2014 after a three-month
stint in treatment for heroin addiction. The treatment seemed to go well,
but it stuck for only a few weeks.

"He got sucked right back in with a guy he met at drug court who started
to use heroin again. Then (my son) started using heroin again," the woman
said. "The second overdose happened in our driveway, and I was the one who
found him, and I had to call the ambulance. At the time he wasn't

The son survived, and the drug charge that resulted has kept him behind
bars ever since.

The same story plays out across the state, with deadly results.

In Fond du Lac County, four of the 16 drug deaths last year involved
someone who had recently been released from jail, said Medical Examiner
Doug Kelley.

In Kenosha County, the connection between jail release and overdoses
spurred the creation of a drug death review panel in 2014. The group meets
every other month to go through overdose deaths in detail and identify
trends more quickly. It includes the health department, law enforcement,
medical examiner, medical professionals and community agencies.

"A lot of people, if they were being released from jails or detention
centers, it seemed like they were turning up dead soon after that," said
Debbie Rueber, health educator with Kenosha County.

A similar review system is launching in Milwaukee County as well.

Heroin and opioid overdoses have risen in recent years. Data from the
Wisconsin Department of Health and Human Services (Photo: Eric Litke, USA

New data on drug-related hospitalizations shows how much higher the death
toll could be without the increasing availability of naloxone, an
anti-overdose drug used by emergency responders and drug addicts alike.

Wisconsin ambulance crews administered between 3,500 and 4,000 doses of
naloxone each year from 2012 to 2015, according to the DHS. The drug
immediately ends an overdose by forcing opioid receptors in the brain to
release whatever drug molecules are attached.

Last year in Wisconsin, 1,485 people were hospitalized due to an opioid
overdose. Like the opioid death tally, that number has leveled off since
2011, averaging about 1,400 annually.

Heroin-related hospitalizations are growing -- up from 175 in 2011 to 359
last year -- but still account for only about a quarter of all opioid
overdoses, the DHS data shows.

That data, released publicly for the first time, also shows a regional
divide between heroin users and prescription opioid abusers.

Hospitalizations due to opioids were more common in rural areas, with the
five highest per-capita rates coming from Menominee, Milwaukee, Marquette,
Vilas and Sauk counties when examining all opioids.

Heroin hospitalizations were concentrated in urban counties. Kenosha,
Milwaukee, Dane, Rock and Waukesha had the highest per-capita rates.

Heroin hit especially hard last year in Sheboygan, Manitowoc and Dodge
counties, all of which more than doubled their five-year average for
heroin deaths.

But in recent years, the Milwaukee area has consistently fared the worst,
even when accounting for its large population.

Kenosha County had the most heroin deaths per capita from 2010-15 at 5.1
per 10,000 residents, followed by Milwaukee and Racine counties. Eau
Claire, Outagamie and Sheboygan counties had the lowest per-capita rates
among the counties with at least 100,000 residents.

And things are getting worse in the state's largest city.

Milwaukee County posted one-third of the heroin deaths in Wisconsin from
2010-15 despite housing only one-sixth of the population, and that ratio
appears set to rise this year.

The Milwaukee County Medical Examiner's Office has confirmed 116 overdose
deaths involving heroin in 2016, already above its 2015 total of 110. The
office is still awaiting toxicology reports to detail the drugs involved
in 53 other deaths.

The deaths included a spurt of 20 suspected heroin deaths in a two-week
span in July and August, a streak the medical examiner's office called

An increase in heroin deaths also appears likely statewide in 2016, based
on a survey of coroners and medical examiners conducted by USA TODAY
NETWORK-Wisconsin. Fifty-two counties provided data on the first six
months of 2016, reporting 142 heroin deaths. Those counties had 254 deaths
in all of 2015.
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