Pubdate: Sun, 27 Apr 2014
Source: Day, The (New London,CT)
Copyright: 2014 The Day Publishing Co.
Contact:  http://www.theday.com/
Details: http://www.mapinc.org/media/293
Authors: Greg Smith and Izaskun E. Larraneta
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)

Deadly Addiction an occasional series

HEROIN, A TRAGIC WRONG TURN

Painkiller Abusers Find a Cheap Option to Help Them Cope, Often With 
Lethal Consequences

Just 10 years ago, heroin made up a small fraction of the 
drug-related arrests in Norwich. These days, Detective Lt. Mark 
Rankowitz and fellow officers can recite any number of stories about 
the drug's ever-increasing impact.

There is the star high school athlete with national aspirations who 
injured her knee and became addicted to prescription painkillers 
before turning to the cheaper and more widely available alternative - heroin.

There was the man back in March who apparently drifted into 
unconsciousness before his car plowed into a parked box truck and a 
stair rail at St. Mary's Church on Central Avenue. Paramedics 
administered a dose of Narcan, a drug that reverses the effects of 
opiates like heroin. The man was asking for his keys moments later.

Department of Mental Health and Addiction Services Commissioner 
Patricia Rehmer said this spring that on average one Connecticut 
resident a day dies of a drug overdose, which also is the leading 
cause of death for males ages 18 to 25.

In many cases the drug is heroin. Its use has reached crisis levels 
in the region, across the state and nationwide, leading to a spike in 
the number of overdose deaths and an increased push by legislators 
for public education and resources for treatment and law enforcement. 
Police say the main focus is not on users but dealers peddling the 
sometimes deadly concoctions of heroin and other chemicals. Heroin is 
typically cut with other substances; in one case in Norwich, police 
said a dealer was adding powder from a pulverized a ceramic lion.

New London County had 34 heroin-related overdose deaths last year, up 
from 23 in 2012. The state Office of the Chief Medical Examiner 
reports a nearly 48 percent jump in heroin overdose deaths in both 
New London County and across the state.

Heroin was a contributing factor in 257 accidental overdose deaths in 
Connecticut last year, compared to 174 in 2012.

The deadly nature of the heroin currently being sold is linked to 
either additives or higher purity levels, which can fluctuate wildly 
from bag to bag. In Rhode Island and other states, heroin overdose 
deaths are being blamed on the addition of the potent painkiller 
fentanyl. Fentanyl was a contributing factor in only nine 
heroin-related deaths in Connecticut in 2013.

Many in the health care field attribute the increase in overdose 
deaths to a rapid rise in the use and abuse of painkillers such as 
Oxycontin, Percocet and Vicodin. Both physicians and police say 
people are getting hooked on painkillers following treatment for 
injuries or after pilfering pills from the family medicine cabinet.

Following an arrest of an apparently healthy young person on 
heroin-related charges, Detective Rankowitz said, "Our first question 
is 'How'd you get hurt?'"

William Savinelli, clinical director at the Stonington Institute, 
which runs both in-patient and out-patient substance abuse treatment 
programs in the region, said more than half of the 400 assessments he 
performed last year for those seeking treatment involved use of 
opiates. He said many started using heroin after getting hooked on 
prescription pain medication.

"Pills are expensive.... It costs $5 to $7 for a bag of heroin," he said.

The "gateway" prescription drugs are either opiates - a narcotic 
derived from the poppy plant - or opioids - a synthetic compound not 
found in nature. Heroin is a semi-synthetic compound, a derivative of 
morphine, which is made from chemicals found in the poppy.

The Centers for Disease Control and Prevention have classified 
prescription drug abuse as an epidemic, and a national drug survey 
showed that one-third of people aged 12 and older who used drugs for 
the first time began by using a prescription drug nonmedically.

The Drug Enforcement Administration's 2013 National Drug Threat 
Assessment reported that controlled prescription drugs continue to be 
the nation's fastest-growing drug problem. The DEA study shows that 
emergency department visits involving nonmedical use of prescription 
opiates/opioids increased 112 percent - from 84,671 in 2006 to 179,787 in 2010.

State Police Lt. Kenneth Cain, a commander in the statewide narcotics 
task force who is helping organize a law enforcement response to the 
problem, agrees that the availability of prescription painkillers 
over the past decade has led to the increase in heroin use.

"We almost get a sense that heroin is blowing up because people can't 
get prescription drugs like they used to," Cain said.

William A. Aniskovich, CEO of Stonington Behavioral Health, which 
operates Stonington Institute, said heroin kills the user much faster 
than other illicit substances.

"There are two ways to get off heroin - you get off heroin or you 
die," he said.

Detox center expands

Calling the rise in overdose deaths from heroin and other 
prescription painkillers an "urgent public health crisis," U.S. 
Attorney General Eric Holder made a nationwide appeal in March, 
saying the Justice Department would combat the epidemic through a mix 
of enforcement and treatment efforts. Between 2006 and 2010, heroin 
overdose deaths increased by 45 percent nationally.

The local impact of the crisis is palpable. People line up at 
shopping center methadone clinics in New London and Norwich for daily 
relief by substituting the legal opioid methadone for heroin. 
Methadone is a synthetic drug with many of the properties of morphine 
but without the associated high. It is used to reduce withdrawal 
symptoms in former heroin users.

Suboxone clinics, which provide an alternative to methadone for 
opioid withdrawal, treat an increasing number of patients in the 
privacy of a clinician's office. Many of those seeking treatment at 
suboxone clinics are hooked on painkillers.

Local detox facilities are a starting point for long-term treatment 
for many. A 20-bed detox facility on Coit Street in New London, run 
by Southeastern Council on Alcoholism and Drug Dependence Inc., is in 
the midst of a $900,000 renovation in part to accommodate medical 
staff for patients suffering the painful effects of withdrawal.

SCADD Executive Director Jack Malone said the facility serves mostly 
the indigent population, both alcoholics and heroin addicts, who have 
few other options and limited insurance coverage.

"We take care of the poorest and the sickest. People here are sicker 
than they've ever been," Malone said, adding that the sharing of 
heroin needles can lead to infections such as HIV and hepatitis B and C.

Savinelli, the Stonington Institute clinical director, said a heroin 
addict needs from three to six months of treatment to have a 
realistic chance at recovery. Numerous studies have shown that the 
relapse rate for heroin users is between 80 percent and 90 percent 
during the first year of recovery.

"From the moment they wake up, the addict is thinking about their 
next score and how they are going to get money for that score," 
Savinelli said. "Clients need to be rehabilitated at the core ... 
teach them new coping mechanisms and how to redirect their thoughts."

Problem spreads to suburbs

Long-term treatment works only for those who survive long enough to 
enter a program.

The number of overdose deaths reported in the cities of New London 
and Norwich more than doubled in 2013, from 10 in 2012 to 21 in 2013.

Both cities are home to hospitals, which means their numbers include 
people who have overdosed and are taken to the hospital and 
pronounced dead there. Medical staff at both Lawrence + Memorial 
Hospital in New London and The William W. Backus Hospital in Norwich 
have reported an increase in treatment of overdose patients during 
the past year - that is, patients found in time to receive treatment.

Oliver Mayorga, chief of emergency medicine at L+M, said of calls to 
paramedics reporting an untimely death of person in their 20s, "it's 
almost always heroin." It reflects the fact that younger people are 
experimenting with the drug, he said, saying addicts are no longer 
the stereotypical junkie, but instead come from all walks of life, 
including high-functioning professionals.

Aniskovich also disputes the notion that heroin use is an urban 
problem, noting that the vast number of clients seeking treatment at 
Stonington Institute have suburban ZIP codes.

Overdose patients, Mayorga said, have a chance at survival if 
paramedics can reach them in time to administer Narcan (naloxone 
hydrochloride), as an opioid reversal agent. It can be administered 
through a nasal spray or injected. Within seconds the user will lose 
the buzz. A person who is revived often will strike out at medical staff.

Massachusetts, New York and Rhode Island have passed legislation 
making Narcan more widely available to the general public and to 
emergency personnel and police. In Connecticut, Narcan is available 
by prescription to friends and family members of those with a heroin 
addiction, but is not administered by state and local police. In 
Connecticut, paramedics are the only emergency personnel allowed by 
law to administer the drug.

In the wake of Holder's announcement in March, Connecticut's U.S. 
Sens. Chris Murphy and Richard Blumenthal called for better 
coordination of government, health care providers and law enforcement 
so that resources are allocated "in the most effective way possible."

Blumenthal called heroin use and the spike in overdoses a 
"burgeoning, exploding crisis that requires immediate, substantial attention."

Murphy and Blumenthal have asked for an increase in the Obama 
administration's proposed $1.8 billion for treatment through the 
Substance Abuse and Mental Health Services Administration and for 
stable state funding to help crack down on major dealers from the 
state's larger cities.

A meeting last month organized by the statewide narcotics task force 
brought in law enforcement agencies from across the state.

Cain, the task force commander, said the meeting was a starting point.

"People are not sitting back on their hands," Cain said. "We're 
trying to do everything we can to combat this issue. It's definitely 
hitting the Northeast pretty hard."

One idea from the meeting is to have a central depository for 
information so police can spot trends that could lead to better 
investigation of the dealers that sell the drugs that lead to an 
overdose death.

Could 'be a lot worse'

A year ago, New London and Norwich police and various state and 
federal law enforcement officers arrested 100 suspected drug 
traffickers and their alleged conspirators in several towns. The 
sweep was the result of more than a year of investigation into a 
heroin and cocaine trafficking operations with ties to the Dominican 
Republic and Puerto Rico. Law enforcement officials said at the time 
that the groups were responsible for much of the drug supply on the 
street locally.

Police also see petty crimes associated with heroin use, such as 
burglaries, thefts from family members and the theft of scrap metal, 
which is then sold for cash at a local scrap yard.

Norwich Police Detective Jason Calouro, a member of the statewide 
narcotics task force, said arrests of addicts have become more 
commonplace because of what he sees as the increase in the number of 
addicts themselves dealing drugs.

People who Calouro said are using heroin and don't fit the 
description of a drug dealer are driving to Hartford and buying 
enough heroin to get themselves high and then paying for most of it 
by selling off a portion. He says someone can buy a bag for $4 or $5 
in Hartford and come back to Norwich and it for $10 a bag. By 
comparison, pills like Oxycontin can go for upwards of $80, or $1 per 
milligram.

"The goal of the narcotic unit is not to arrest people who are 
addicts. It's to arrest people distributing narcotics throughout the 
community," Calouro said.

"Yes, they're dealers, but they're dealing to support their own 
habit," Detective Rankowitz said. "They don't have extra money. They 
don't have nice things."

Police use the finger in the dike metaphor when talking about the 
overall problem associated with the drug trade. New dealers seem to 
sprout up to take the place of those arrested, and the court-imposed 
penalties, according to Rankowitz, always fall short of police 
expectations and lead to putting dealers back on the street within a 
few years of their arrest.

"Are we making a dent? I feel if we weren't here, it would be a lot 
worse," Calouro said.
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MAP posted-by: Jay Bergstrom