Pubdate: Sat, 22 Feb 2014
Source: Boston Globe (MA)
Copyright: 2014 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52
Author: Brian MacQuarrie
Bookmark: http://www.mapinc.org/find?132 (Heroin Overdose)

OPIATES TAKING HEAVY TOLL ON CAPE

Overdoses on Rise With Heroin's Spread

A rash of drug overdoses has plagued Cape Cod since the beginning of 
the year and sent local officials and outreach workers scrambling to 
respond to the surge in heroin and other opiate use.

Yarmouth has recorded 13 overdoses since Jan. 1, including two 
fatalities, police said. The Barnstable villages of Centerville, 
Osterville, and Marstons Mills have counted nine overdoses, including 
one death. And Falmouth has been hit with six overdoses, including 
two fatalities, authorities said.

"The ODs have become almost an epidemic problem down here," said 
Detective Sergeant Chuck Peterson, who has worked in narcotics for 20 
years with the Yarmouth police.

The alarming rise in overdoses does not appear to be unique to Cape 
Cod, as community after community in Massachusetts, Vermont, and 
other states has reported a spike in opiate abuse.

But Cape Cod is an example of a place afflicted by what many police 
and health officials are calling a crisis that is rapidly cutting 
across racial, income, and geographic lines.

'This isn't the drug user of the 1970s. It's your brother, your 
sister, it crosses all socioeconomic strata.'

It is a crisis in which drug users, many in their teens and 20s, are 
turning to heroin as a much cheaper alternative to once-popular 
prescription opiates such as OxyContin and Percocet, authorities said.

"It's not unique to any specific area of the state," said Hilary 
Jacobs, director of the Bureau of Substance Abuse Services for the 
state Department of Public Health. "It's coming from all over."

Fire Chief Michael Winn, who commands the station that serves 
Centerville, Osterville, and Marstons Mills, said the overdose 
problem has even reached the front door of the firehouse, where at 
least one victim, not breathing and slumped in the front seat, was 
driven by a friend on Jan. 30.

Firefighters attended to that victim, who survived. At the time, the 
ambulance was unavailable because it had been dispatched to an 
overdose in another part of town, Winn said.

"It's everywhere," the chief said. "The thing is, good people are 
getting sick and dying from it."

Pinpointing a reason for the recent spike is difficult, said 
authorities, but one possibility is that heroin has been mixed with 
fentanyl, a dangerously potent opiate generally used as a painkiller 
for end-of-life cancer patients.

Lab tests from Cape Cod overdoses have yet to detect fentanyl, 
officials said, but its presence in heroin bought on the streets has 
been linked to fatalities in Rhode Island, Pennsylvania, and other 
states. The sense among public safety officials and outreach workers 
is that fentanyl is on its way to Cape Cod, if not already there.

In Falmouth, Detective Captain Brian Reid said he suspects that 
fentanyl has arrived. "The evidence indicates that, absolutely," Reid said.

Max Sandusky, prevention and screening director for the AIDS Support 
Group of Cape Cod, echoed that belief.

"We've had reports of fentanyl from about a handful of users through 
our outreach; we don't know where it's coming from," said Sandusky, 
whose group is part of a pilot program to train the public in use of 
naloxone, an opioid widely known by the trademark name Narcan that 
can quickly reverse life-threatening effects of overdoses.

The AIDS Support Group, which also runs a needle-exchange program, 
provides training and distributes naloxone kits to a range of people, 
including family members and friends of addicts, emergency workers, 
and users. Since 2008, Sandusky said, about 100 people have reversed 
overdoses with Narcan they got from the organization. "That's 100 
lives saved," he said.

The need for naloxone might become greater very quickly because 
fentanyl can be more than 40 times more powerful than heroin, said 
Sandusky. For that reason, mixing it with heroin can be irresistible 
to a user seeking a more intense kick.

But that combination carries unpredictable and occasionally fatal 
risks, particularly because heroin on Cape Cod is generally sold in 
larger units now, often in half-grams or grams, which are 
exponentially bigger than the traditional bags of heroin that dealers 
offered as recently as several years ago, Peterson said.

As a result, the narcotics detective said, the user's "ability to 
regulate dosages is different; the potency is higher."

On Cape Cod, the frequency of overdoses this year compared with last 
year at this time is striking.

In Centerville, Osterville, and Marstons Mills, officials reported a 
total of two overdoses with no deaths in early 2013, compared with 
the nine overdoses, including one death this year. In Yarmouth, two 
nonfatal overdoses had been recorded by this date in 2013, although a 
cluster of them occurred shortly afterward. That compares with the 13 
overdoses, including two fatalities in 2014 in Yarmouth.

Falmouth police said they did not have data readily available for 
early 2013, but that overdoses have increased this year.

The spread of heroin on Cape Cod has sparked an increase in public 
discussion about the problem. Barnstable public safety officials and 
outreach organizations, including the AIDS Support Group, met 
Wednesday on the issue. "We, as fire chiefs, came together and said 
we have to do something as stewards of good health in our community," 
Winn said.

The first of a series of public awareness sessions is scheduled at 
Centerville fire headquarters in Barnstable on March 5. In Yarmouth, 
weekly meetings are held at the police station by Learn to Cope, an 
organization that reaches out to families of addicts.

Cape Cod is not alone in battling the rise in opiate use, but the 
area's relative isolation in the offseason might tempt some to abuse 
drugs as a way to relieve boredom, officials said. The Cape "goes 
from being a vacationland to being a pretty rural type area" in 
winter, said Joe Carleo, executive director of the AIDS Support 
Group. "People lose their jobs. It's pretty quiet. There are probably 
a variety of issues."

Carleo said that "we definitely have seen more kids using and using 
to a point where they're overdosing."

The ripple effects from overdoses often devastate families who feel 
powerless against the pull of an addictive drug on a son, daughter, 
or other family member, and the perceived stigma can prompt families 
to withdraw in shame. But in recent years, Sandusky and others said, 
the scourge has affected a much broader segment of society and led to 
a greater willingness to step from the shadows.

"Now what we're seeing is communities coming together to address the 
problem in a way that we have not seen," Sandusky said. "This isn't 
the drug user of the 1970s. It's your brother, your sister. It 
crosses all socioeconomic strata."

Winn, the fire chief in Barnstable, said that attacking the issue 
head-on should be part of the job description for a public safety 
department, even if firefighting is its main focus.

"We're in the business of saving lives, and I and my staff are 
passionate about that," Winn said. "If we're able to have a proactive 
approach - that is, a response before we respond - then we're doing 
the right thing."
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MAP posted-by: Jay Bergstrom