Pubdate: Sun, 20 Apr 2014 Source: Macomb Daily, The (MI) Copyright: 2014 The Macomb Daily Contact: http://www.macombdaily.com/ Details: http://www.mapinc.org/media/2253 Author: Jameson Cook Bookmark: http://www.mapinc.org/heroin.htm (Heroin) Page: 6 MACOMB LEADS STATE IN OVERDOSE DEATHS First in a two-part series. So many heroin abusers hop onto the No. 560 SMART bus to Detroit to buy drugs it's been dubbed "the heroin express." "It's called the heroin express. There's not much we can do about it," said Roseville Police Chief James Berlin, whose city includes multiple popular Gratiot Avenue stops, after attempts to crack down on the practice. "Yeah, the 560," sheriff's Lt. David Daniels, head of his department's drug unit, repeated in a tone of familiarity. "We've had them on that bus from Macomb Township and Chesterfield Township." The 560's route mostly on Gratiot from Macomb County across Eight Mile to Detroit -- has steered hundreds of young people down the path to a premature death. Heroin and opiate prescription drug abuse has skyrocketed in the county in recent years, giving Macomb the dubious distinction of leading the state in fatal heroin overdoses over a three-year period. Heroin began seeping into the county about 10 years ago. Its prevalence has progressed to the point where addiction, arrests and overdoses from heroin and other opiates are overwhelming. "It's something that happening in every community," said Judge Linda Davis, president of the statewide organization, Fraser-based Families Against Narcotics (FAN), formed in 2007. "We've been screaming about it for the past seven years and nobody listened. Now kids are dropping like flies. They're not just addicted now, they're dying. We are getting so many calls from people wanting to get involved with us." "I'm very concerned," said Macomb County Executive Mark Hackel, the former sheriff. "It's devastating to the community," said Monique Stanton, CEO of CARE of Southeast Michigan. "It's disruptive to families, the school systems. It affects the spouse or the partner, siblings, friends, relatives. If the person is employed, it affects their job. It's affecting all aspects of the community." Sheriff Anthony Wickersham said at least 70 percent of inmates at the county jail did drugs or committed a crime to fund a drug habit. "The increase (in heroin) has been around for the past five years if not longer," Wickersham said. "That is a change from 10 years ago when powered cocaine and crack cocaine were our main focus." Overdoses for relatively cheap heroin exceed those for the more costly cocaine. "They are turning to heroin, which is relatively cheap. But it's also deadly," the sheriff said. "It has a devastating effect on our mental health hospitals and court system," said Davis, a judge at 41B District Court in Clinton Township, where she runs the drug court. Debby Winowiecki of Fraser, whose 20-something son is recovering from heroin addiction, said an addict can destroy a family and affect anyone who comes into contact with him or her. "Your addict will often steal from you first and then go out and steal from other people," said Winowiecki, a FAN member and wife of the group's executive director, David Winowiecki. "They lie, they cheat, they steal. "Unfortunately we have too many people who have lost loved ones. It's just heartbreaking." Hundreds die from overdose Death from heroin abuse has crushed hundreds of Macomb County families over the past 15 years. During the three-year period 2010-2012, the county led Michigan in fatal heroin overdoses, with 202, according to the state Department of Health, although the state's figure conflicts with the number provided by the county Medical Examiner's Office, which says 191 heroin overdoses took place over the same period. The second most overdoses occurred in Wayne County, with 179, and the third most occurred in Genesee County, with 84. There were 16 in Oakland County. Medical Examiner Daniel Spitz said officials are in the process of finalizing the 2013 overdose information. He said it appears the number will be consistent with prior recent years. Since 1999, 477 people have overdosed on heroin in Macomb County, with gradually increasing numbers for each three-year period. Wayne County had the most, 807, in the past 15 years, with more than 200 in each three year period 2003-2005 and 2006-2008. Renee Campion, the Fraser Public Safety Officer for schools and FAN treasurer, said FAN learned in late March that a handful of young people overdosed. "We found that five or six kids in the area that passed (away) from heroin overdoses," Campion said. "Every meeting we have some parent that stands up and says they lost their child to heroin. It's sad. You think you're tackling the problem but it's still out there and it's still a big problem." Macomb County Health Department Director Bill Ridella is concerned, too. "It's a significant public health problem and a challenge to our community," he said. "As a health department, we are continuing to seek strategies to reverse this trend." Pills-to-heroin progression Most heroin addicts progress from popping pills such as the opiates OxyContin and Vicodin, officials said. They often start with Vicodin because it initially is the easiest to get; doctors routinely prescribe it for pain. Randy O'Brien, who treats addicts as director of the Macomb County Office of Substance Abuse (MCOSA), described a common scenario: A youth or young adult gains access to pill swiped from his or her parents or grandparents' medicine cabinet, or is prescribed pain pills for a sports injury or a procedure such as wisdom-teeth removal. "They'll use that for a while go get their buzz," O'Brien said. "But that source will dry up and that start looking out the streets. ... They'll graduate to heroin. They start snorting it and before too long that start using needles for the better effect. It (injection) gives them an immediate high." Data supports the rise in opiate abuse. Admissions to county-sponsored treatment programs for heroin and other opiates has more than doubled in 10 years, climbing from 1,126 in 2004, to 2,045 in 2008 to 2,497 in 2013, according to MCOSA. Drug counselor Larry McCarrick of St. John Providence Health System's Eastwood Clinics substance abuse facilities, said the addiction problem is so out of control that treatment programs can't keep up. "The amount of opiate addiction is far outpacing our ability to treat it," he said. Macomb County, the state's third most-populous county, last year had the fourth most total substance-abuse admissions, 4,350, behind Wayne, Oakland and Genesee counties, according to the Bureau of Substance Abuse and Addiction Services within the Michigan Department of Community Health. For heroin addiction, Macomb had the second highest percentage of total admissions, 37.1 percent, behind Monroe County, at 44.6 percent. But Macomb's rate of opiate addiction admissions last year was among the bottom half of the state's 83 counties at 13.8 percent. McCarrick said minimal opiate use begets more opiate use. "They get used to it and have to do more as their tolerance builds up," he said. Once the dependency takes hold, the opiate addict will do anything to get more because the alternative is a painful withdrawal. "It's like the worst flu you've ever had in your life," he said. "It's just so painful and dramatic, they will do anything to avoid it, and have to do more." When the initial sources dries up, the addict must hit the streets. "Pills are available on the street," Campion said. "They're not cheap. They are expensive. But they get them. They get them from wherever. "The pills can go from $10 to $50, depending on the milligrams. They're just as addicting (as heroin). I call them, 'Heroin in a pill,' because that's what it is." Heroin provides a discounted high. A single "bindle" or hit, a fraction of a gram, can cost $5 to $15 while a single prescription pill has a street value triple that or more. Addicts often buy heroin bindles in bulk to get a greater discount. A gram roughly costs about $100 to $120, according to First Lt. Darwin Scott, commander of the County of Macomb Enforcement Team (COMET). Judge James Biernat Jr., one of two circuit Drug Court judges and former assistant prosecutor in the drug unit, said addicts climb a ladder of Vicodin (hydrocodone), Percocet (oxycodone/acetaminophen) and OxyContin (oxycodone), among others, to the top for "smack," "dope," "junk." "It's like a ladder, and the first step is Vicodin," he said. "Once you get addicted to the prescription drugs, it all leads down one road, to heroin. "Kids like to experiment with different things, but you can't experiment with these drugs. It's not like before when kids would go to a party and drink beer. These are dangerous drugs." Carrie Ryan, a Clinton Township-base substance abuse counselor, discovered the existence of "pharm parties" from young clients. Each person brings a pill to the fathering and drops it into a bowl; party-goers make their selections. Biernat said he has learned that drug dealers sometimes provide "free samples" of prescription drugs at parties to introduce youths to opiates. Most of the current participants in circuit Drug Court in Mount Clemens are addicted to heroin or other opiates. Thirty of the 44 participants (70 percent) are heroin addicts while five (12 percent) are addicted to other opiates, according to Chief of Specialty Courts Lisa Ellis. The remaining nine are addicted to cocaine, alcohol or marijuana, in descending order. That's a 10-percent increase from 2011 when 62 percent of participants were addicted to heroin and 10 percent were addicted to other opiates. Nationally, heroin use has nearly doubled from 2007 to 2012, according to the Substance Abuse and Mental Health Services Administration. Fatal heroin overdoses increased 45 percent from 2006 to 2010, according to the Drug Enforcement Administration. United States Attorney Barbara L. McQuade said recently the number of fatal overdoses nationally from prescription drugs in 2013 was more than six times the number of "other illegal drugs combined." In Macomb County, in three of the four years from 2009 to 2012, overdoses from other drugs, including other opiates, exceeded the heroin overdoses, according to the Medical Examiner's Office. Kid next door, soccer moms The drug's resurgence from its "junkie" status among users in the 1960s and 1970s has cut across all demographics and age groups, officials said. Officials say many heroin-addicted youths were considered good students who were involved in sports and other extracurricular activities. "The average kid we see is an honor student, an athlete, the kid that lives next door," Davis said. "Kids who you would never think would become a heroin addict." Dr. Kevin Brody, one of several emergency room doctors at Henry Ford Macomb Hospital in Clinton Township, said he sees several overdose patients each month. "They're getting younger and younger, in their late teens and early 20s," he said. Biernat recalled his first heroin case as an assistant prosecutor around 2004. The defendants were high school athletes and cheerleaders. "When I thought of heroin addicts, I thought of Keith Richards," Biernat said. "I didn't think of cheerleaders and football players." Biernat said studies show that a continued heroin addiction leads to two outcomes prison or death. Among five addicts who related their experiences, all started drinking alcohol in high school and some also smoked marijuana. They progressed to opiate prescription pills, and four of the five progressed to heroin. Andrew Fortunato of Fraser, was an athlete and well-spoken high schooler who became an alcoholic and advanced to opiate prescription addiction following a prescription for an injury suffered in a bicycle accident. But he stopped short of heroin. He has become a speaker for FAN, ran a "recovery house" for a year and is a mental health technician at a hospital. "(Opiate addiction) is usually a very gradual process," Fortunato said. "Nobody wakes up and says, 'I think I want to become a heroin addict today.' It's a slow and steady slide to the gateway of hell." Matt, who didn't use his last name, said he started drinking alcohol in high school because, in his mind, "It made me bigger, stronger and more outgoing." He was an avid hockey player but injured his knee his junior year for which he was prescribed Vicodin. He lost his passion for hockey. "Opiates was my first love," he said. By his senior year, he began using heroin. Now in his mid-20s, he has spent years in and out of rehabilitation centers but believes he has turned the corner. "As soon as I lose my sobriety, I lose who I am," he said. Another addict, "Chad" started doing prescription drugs a dozen years ago due to a "broken heart" when he lived in Warren. The 29-year-old drug of choice at different times alternated between heroin and methamphetamine; that required him to "commit crimes" to fund a $100 per day habit. He overdosed several times. "I learned to shoot heroin while I was in treatment," Chad said. "I was in and out of jail in my 20s." Chad is now in recovery, participating in the circuit Drug Court. Officials also are seeing more middle-aged and senior-citizen heroin addicts who, like their youth counterparts, graduate from drugs such as Vicodin and OxyContin, typically prescribed for pain. "We've arrested people in their 50's, 46-47-year-olds," said Warren Deputy Police Commissioner Louis Galasso said. "It's a whole new heroin world out there." "This is totally difference from when you think about the junkie from days of old," Ryan said. "There's a whole new dynamic. There's no boundaries. There's soccer moms, car-pool moms, executives." The three largest age groups for overdoses deaths in Michigan from 2010 to 2012 were 30-34, with 115; and 25-29, with 111; and 20-24, with 99, according to MDCH. The next largest age groups were 45-49, with 90 deaths and 50-54, with 84 deaths. Many overdoses occur when the user resumes using following a relatively long abstinence during a stay in a rehabilitation facility or prison or jail, said Dr. Tony Bonfiglio, medical director of the county Medical Control Authority and chief of the emergency room at St. John Macomb Hospital in Warren. He said users believe they can still handle the same amount of heroin or other opiate that they were taking before their time of absentia. "But their body isn't used to it," he said. Once snorted or inhaled, the drug doesn't confine itself to the lungs or blood system. Heroin and other opiates often attach to the brain. "Too much (opiate) will make your brain forget to do things like breathe," Bonfiglio said. Brody of Henry Ford said he is shocked that users are so careless in using "dirty needles." The addict not only can contract HIV or Hepatitis B and C, but is at risk for bacterial infections. The infection can be at the site of the injection and can become very serious if it reaches the heart muscle or heart valve, he said. An infected valve will spread the infection to other organs. Lt. Daniels, commander of the Sheriff's Selective Enforcement Team, said stronger versions of heroin contribute to overdoses. Drug dealers try to improve their product's quality by increasing its purity, mixing it with a lower percentage of the "cutting agent," such as baking soda or powdered milk. "The dealers want users to buy products, and they if they provide more potency and a better high, the users will come back," he said. When drug dealers several years ago mixed heroin with another prescription drug, fentanyl, disaster resulted. Dozens of users in Detroit overdosed. "You never know what you're going to get," Daniels said. Where are they getting it? Heroin's heightened popularity followed about 25 years of near dormancy, said O'Brien, of MCOSA. After an increase in the 1960s and 1970s, it remained in Macomb County but waned in popularity in the 1980s and 1990s as cocaine and crack cocaine took over. Ecstasy was popular for a stretch in the 1990s and early 2000s, when heroin began its resurgence. "The heroin and opiate trade has really taken over," O'Brien said. Scott, of COMET, the countywide drug unit, said heroin has increased its attraction by improving its status as a "dirty drug" years ago to a flexible drug today. It can be smoked, snorted or injected. "Black tar" heroin hasn't been seen a lot in the Detroit area, officials said. "There's so many different ways to use it, it's cheaper, and the high is pretty long lasting," Scott said. "Heroin reinvented itself and in around 2005, 2006, 2007 started to capture a new audience," Galasso said. Scott said most Macomb heroin addicts purchase the drug in Detroit. But some heroin is sold here in "mostly street level buys," he said. He said COMET, which consists of state police and local police officers, have been to crack down on Macomb's low-level dealers. In 2011, COMET made 53 heroin arrests of 233 total arrests and confiscated 337 grams of heroin. The next year, the law enforcement team made 187 heroin arrests of 424 total and seized 147 grams of heroin. In 2013, there were 110 heroin arrests of 299 total and confiscated 385 grams of heroin. The largest seizures were 206 grams of heroin in Warren, 31 grams in another Warren case, 11 grams in Chesterfield Township, and 35 grams in Detroit from a Macomb County probe, Scott said. Ryan, the therapist, said she learned from her clients that "Detroit is a huge hub, but they can get it here." Clients have mentioned buying heroin in Mount Clemens, Warren, Eastpointe and Chesterfield Township, she said. Despite the 560 bus route's multiple stops in Roseville, Chief Berlin said heroin hasn't been a huge problem in his city. Still, he said, his department has surveilled the bus and made arrests. "We do watch the buses and attempt to interdict when we can," Berlin said. The 560 provides addicts a cheap ride to and from their seller on Detroit's east side, without risking a traffic stop by police, although they risk personal safety going into crime-ridden areas. "I've known people that have gotten robbed and beat up," said Christina Szymanski, a recovering heroin addict who rode the 560 bus many times. "There's so many different houses" where to buy and use heroin, she said. "They'll meet you on the corner. They see a white person down there and they'll come up to you." Addicts typically ingest heroin in Detroit moments after their purchase, often in an abandoned home. They often carry more hits back to Macomb County to "last them through the night or to the next day," a police officer said. Still, many heroin users drive or ride to Detroit in a personal vehicle. In Warren, the number of heroin arrests resulting from traffic stops increased 69 percent, 209 to 354, from 2012 to 2013, according to Galasso. "A lot of them (heroin dealers) open up shop just across Eight Mile because some addicts don't want to go too deep into Detroit," he said. "Our officers certainly have been proactive in identifying people who are higher risk. If you're driving a half-mile out of Detroit at 2 a.m. and your license plate shows you're from Armada, you're putting a target on your back. "It's pretty easy to spot (on a person). The pupils are like pins. That's a sign of opiates." Warren undercover officers also made a substantial more number of heroin arrests, from 51 in 2012 to 78 in 2013. "These typically are street sales," Galasso said. Daniels of SET, which investigates drug cases in the communities served by the sheriff's office, said his investigators have only located users and perhaps small-time dealers here. Metro-Detroit's heroin supply comes mostly from Mexico, which is providing less cocaine and more heroin as opiate-addiction takes hold in the United States, according to Rich Isaacson, special agent for the Detroit office of the DEA. "The majority of illegal drugs consumed in Southeast Michigan is controlled by the Mexican drug cartels, and they do control the majority of heroin trafficking here," Isaacson said. "These are poly-drug organizations. Drug trafficking is always evolving." Heroin use is widespread, he said. "I have no doubt that there is not a community in this area that has not been affected by the opiate-abuse problem," he Isaacson said. "A lot of people have the outdated belief that heroin is used only in the inner-city. That is outdated thinking. The overdose deaths of teens and young adults have occurred in every community." Tributes to 15 people who have died as the result of drug overdose can be found on "memoriam" at the FAN website, familiesagainstnarcotics.org. Coming Monday: College dropout who stole from her grandmother on the road to recovery from decade-long addiction. - --- MAP posted-by: Jay Bergstrom