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Growing Addiction: Rampant addiction to painkillers throughout Appalachia has attracted a cheaper, more addictive alternative

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Photo courtesy of Hancock-Brooke-Weirton Drug and Violent Crime Task Force Photo courtesy of Hancock-Brooke-Weirton Drug and Violent Crime Task Force

If ever there was an equal opportunity addiction, it’s heroin.

Young or old, rich or poor. Black, white, Indian, Hispanic, Asian ... none of it matters: Heroin does not discriminate. It crosses all socio-economic strata to ruin lives, relationships and communities alike.

Whether it’s used with other substances such as alcohol, laced with an even more potent opiate like fentanyl or taken in its purest form, heroin can be — and too often is — deadly.

“Nobody wakes up in the morning and says, ‘I’m going to be addicted to drugs, I’m going to lose everything, I’m going to hurt my family and my loved ones,’” said Matt Boggs, project director at The Healing Place of Huntington, a residential treatment center for men. “Unfortunately, we’re in the middle of an epidemic. It’s a disease, addiction, and this area is plagued by it.”

Epidemic, indeed.

  • West Virginia led the nation in heroin deaths per 100,000 population in 2012 with 67, nearly double the 34 reported in the state in 2010.
  • Men between the ages of 25 and 40 are most at risk. Of the 218 people who died of heroin overdoses from 2008-2012, all but 52 were men.
  • Since 2004, there have been 296 overdose deaths involving heroin in the Mountain State. All but 50 were men.

While that’s a relatively small percentage of the more than 4,500 men and women who died of all drug overdoses in that same time span, authorities say heroin is particularly alarming because of the stranglehold it has on those who have used it: Full-blown addiction can be just one use away.

“You have cute, young cheerleaders doing heroin who never in a million years thought they’d stick a needle in their arm,” Booth Goodwin, U.S. Attorney for the Southern District of West Virginia, said. “They do it because they need it to not be sick, they need it just to function. I’ve had people who are addicted tell me if you don’t get opiates you’re as sick as you’ve ever been in your life.

“They say to imagine the worst case of flu you could ever have and multiply it times 10.”

Opiates, and heroin in particular, have a powerful, euphoric effect on the brain, William Ihlenfeld II, U.S. Attorney for the Northern District of West Virginia, points out.

“They provide more pleasure to the brain than just about anything else you derive pleasure from, whether it’s food or anything else,” he said. “The brain never forgets the effect heroin had on it, therefore it’s very difficult to recover from heroin addiction.

“That doesn’t mean you can’t, just that it’s very challenging. I’m told laboratory animals will cross electric shocks to get to opiate drugs — they won’t do it for anything else, but their brain remembers the effects of that drug.”

Crisis mode

No one sets out to be a heroin addict.

It just happens — for some, the very first time they use it.

“You might make it through the first time and not feel the addiction or draw, but the second time you use it it’s got its hands on you,” Hancock County Sheriff Ralph Fletcher said. “And by the third time, it’s a monster that grabs you and holds onto you.”

It’s the sense of euphoria that hooks you, but it’s the tolerance for heroin and the dependence on it the repeated use of it breeds that turns lives upside down. Simply put, the more you use heroin, the more heroin you’ll need to satisfy the brain’s craving for it. And the more you use it the more dependent you will become, and the harder it’s going to be to break the addiction.

“I talked to one lady in the past, she was a lawyer and her husband was a lawyer,” recalls Charleston Police Department Lt. Chad Napier, commander of the Metropolitan Drug Enforcement Network Team. “She said they’d spent $200,000 on rehab for their son — he was a very good athlete, he could have played college ball and maybe even gone pro.

“If they spent $200,000 on treatment and it hadn’t worked, there’s not a lot I can do.”

The numbers are frightening.

  • Three years ago the National Institute on Drug Abuse said as many as 4.2 million Americans had used heroin at least once.
  • The U.S. Department of Health & Human Services Substance Abuse & Mental Health Services Administration estimates more than a half-million Americans used heroin in 2012.

“It’s a public health crisis,” Ihlenfeld said. “And we have to attack it on a number of different fronts, but it’s not the only drug we’re concerned with. Heroin is certainly at the top of the list, but it’s followed closely by prescription pills.

“Statistics show that over the past five or 10 years or so, more people in West Virginia died of drug overdoses from prescription drugs. But we’re starting to see it change; more people are dying of heroin overdoses. I don’t know if it’s overtaken it, but heroin is going straight up the charts as far as the number of deaths it’s causing.”

A heroin on-ramp

Part of the reason for that is cost: Heroin is cheap and, thanks to the drug cartels, widely available.

Goodwin said that has a lot to do with efforts to curb the prescription drug abuse rampant in Appalachia.

“The road to heroin leads right through prescription drugs,” Goodwin said. “They’re both part of the same opiate family. Once people can’t get pills in the quantity they need they’ll often resort to a higher potency, lower cost alternative — heroin.”

Goodwin says prescription drug abuse, rampant in the Mountain State in recent years, is an on-ramp to heroin addiction.

“It’s difficult to call it a silver lining because it’s in no way a good circumstance,” he said. “But seeing this movement to heroin means we’re having a significant effect on the supply of illegal prescription drugs.”

Ihlenfeld said it’s not happening by chance, either.

“Heroin is showing up in places where we’re not used to seeing it,” Ihlenfeld said. “Most of the heroin we see in North America comes from Mexico. There are reports that one cartel, the Sinaloa Cartel, controls half of the heroin market in the U.S. They used to focus on growing marijuana and bringing it to the U.S. and selling it, but now, with 20 states plus the District of Columbia having legitimized marijuana in some form or fashion, there’s not as much profit in marijuana so they’ve switched over.

“Why are we seeing so much of it here? The cartels are shrewd. They know there’s going to be demand for heroin in the same areas where there’s been prescription pill abuse problems — Appalachia being one of the worst areas for prescription drug abuse.”

A 2013 study put West Virginia at the top of the list for drug overdose deaths on a per capita basis, with Kentucky and Tennessee not far behind.

“We’re a target for the cartels, a profit center,” Ihlenfeld said. “It goes up to Chicago and then comes into the Ohio Valley. Why? Because there’s a demand for it; they’re making money.”

But using heroin is like playing roulette — users can’t be sure what they’re getting when they hand over their money.

“There’s no quality control,” said Huntington Police Capt. Rocky Johnson. “Somebody may be addicted to pills and they know they’re getting a specific pill, a specific milligram dosage. When you switch over to heroin, you don’t know what you’re getting.”

It could be laced with a dangerous substance in its own right, like fentanyl, a narcotic commonly prescribed to people with chronic pain or end-stage cancer. Much more powerful than morphine, dealers use fentanyl to cut heroin. The problem for addicts is that when they buy it, they don’t know how much fentanyl is going to be mixed in. At least 80 overdose deaths across the country have been blamed on fentanyl-laced heroin, including 22 in Western Pennsylvania and 37 in Maryland. Or it could be pure, equally deadly when a person accustomed to heroin that’s been cut with something as innocuous as, say, sugar or starch doesn’t realize the potency of what they bought. Instead of giving them a high, it kills them.

In the right circumstances, even alcohol mixed with an opiate can be fatal.

An addict who guesses wrong is a dead addict.

“I had a call once where when I got there, the guy still had the needle in his arm and a Twinkie in his mouth,” Weirton Police Detective Brian Beatty said. “It happened that fast.”

The problem you get with overdoses “is that when people die, it’s because no one was there to call 9-1-1,” he said.

In Charleston, Napier said he has seen several surprises.

“One time, one place can lead you down that road,” Napier said. “I’ve talked to a family where the dad’s a firefighter, the mother was a paramedic and their 25-year-old son died of an overdose of Opana (an opiate) and alcohol.

“Most times people don’t overdose on one drug, per se. It’s multiple drug toxicity, they’re mixing drugs — maybe they’re taking a depressant and drinking alcohol on top of it. It’s deadly.”

No safe haven

There’s no corner of the state immune to heroin and the problems it brings to people, families and communities, but border communities are hardest hit.

“It’s the most highly used drug we have going on right now,” said Hancock-Brooke-Weirton Drug and Violent Crime Task Force Officer Mike Baker. “Even the ones who go to recovery, nine out of 10 will use again.

“They’ll tell you they want to feel that way, they don’t want to feel sick inside.”

Napier said as recently as five or six years ago, “we hardly ever saw heroin in Charleston. It was there, but you had to go look for it. Now, eight out of 10 people who come into our office come in because of heroin. That’s what they can buy, and they’re abusing it.”

He said middle- and upper-class kids start by taking pills.

“They have money and they think of it as partying; it’s not a big deal to them,” he said. “Then it gets out of control.

“So many people have thrown their lives away because of it.”

With pills harder to come by and so much more expensive to buy, addicts turn to heroin. They’ll do anything they have to for money to support their habit — stealing from family, friends and neighbors, dealing themselves, transporting drugs for dealers and even prostitution.

Police throughout the state blame heroin addiction for a drastic increase in property crimes.

“It’s all about how they’re going to get their next fix,” Fletcher, Hancock County Sheriff, said. “And they don’t care how they do it. That makes them much more frightening than a professional thief who’s looking to rob someone and not get caught.

“For today’s drug addict thieves, the idea they might get caught doesn’t even enter their mind, they’ll break into homes while the owners are still there.”

They’ll steal from family and friends as quickly as strangers, he added.

“I put my family through so much turmoil, so many sleepless nights, not knowing if I’d be alive or dead in the morning,” said Boggs, the project director at The Healing Place, who has been clean for two years. “When I showed up here I’d lost everything. I was 30 years old and didn’t have anything to show for it.

“Everything I’d ever aspired to be I’d lost. Pretty much everything I had I’d given away in the name of addiction. I’m not proud of that at all. My mothers always told me, ‘You’ll understand when you have kids — if your child is hurting, if your child is going through something, you want to fix it. You want to put a Band-Aid on it, pick them up off the ground and do something for them.’”

Boggs explained that no help will stick until an addict is ready on his own to accept it.

“The best thing my family ever did was tell me they were done watching me kill myself,” he said. “I could call but they didn’t want me around my nieces and nephews. All it was going to do was harm them.

“I lied to them, I manipulated them, I stole from them ... I used their love for me against them.”

Napier recalls a retired police officer who asked him to lock up his daughter.

“He tells me his daughter, a beautiful girl in her 20s, started out using pills,” Napier said. “Then she started selling and ‘mule-ing’ pills back-and-forth for the Detroit drug dealers.

“His only request to us was to lock his daughter up. He knew the alternative for her was death. Police officers don’t make that much money; he couldn’t afford to send her to rehab. He said he’d rather visit her in prison than go to her grave.”

Napier said family members pay a high price for addiction: Babies are being born with it in their systems. Kids are growing up watching their mothers and fathers get high. Parents see their children destroying themselves, or find them dead.

Bad as it is, Napier said the overdose problem would be even worse if ambulance crews didn’t have drugs like Narcan, otherwise known as Naloxone, to reverse the deadly effects of opiods. He said medics in the Charleston area use Narcan to reverse three to six opiate overdoses on any given day.

“As fast as they overdose it brings them back,” Beatty, the Weirton detective, said. “I’ve seen guys lying in the street dead. (Medics) push the Narcan and they’ll sit up, they won’t even go to the hospital.”

Fletcher said the addiction may be an individual problem, but its effects impact entire families.

“Nobody’s safe from the pain an addict in the family causes. Nobody,” he said. “I’ve had parents who recognized their child had a problem, wipe themselves out financially, sending them to rehab over and over. It gets to the point where they say maybe the safest place for them is in jail, at least then they’ll know they’ll be alive tomorrow.

“I can’t tell you how many people have told me that, that at least when they’re in jail they know they’re safe and being fed properly. They can sit back and cross their fingers and hope that when they get out, they’ll have a head-start on being sober. Many times, that’s the only chance the offender/addict has to get clean, when they’ve reached rock bottom.”

The problem with detoxing behind bars, Ihlenfeld said, is that it’s not as easy as it sounds.

“Detoxing in prison is not very fun; it’s probably the worst way to detox, but it happens every day,” he said. “They’re safe, they’re not using and they have a chance to be clean. But the public needs to understand how powerful addiction is — it’s not as simple as saying, ‘lock this person up and when they come out they’ll be fine, they’ll be off drugs and able to go out and be law-abiding citizens.’

“There’s more to it — even if they’ve been in jail for six months or a year or even longer, their brain still remembers that high and still wants to have it again. If we don’t have treatment available for them, there’s a good chance they’re going to relapse when they get out.”

Starting young

West Virginia’s schools have become the battleground for the war on drugs.

Ihlenfeld, Goodwin and the law enforcement community spend much of their time going to schools to talk to young people about drugs in general, heroin in particular, and how the course of their lives can change with just one bad decision.

The idea, of course, is to keep school-aged children from going down the same road that’s taken generations of West Virginians to addiction.

“I’m not naive,” Napier said. “We may go to a school and speak to 600 or 700 kids. If just one listens, it’s worth our time.

“I know some of them are going to go down that road anyway, but if one can be saved it’s worth it.”

Goodwin sees it as a battle for the future.

“I saw a study in Kentucky that said the first illicit use of drugs, prescription drugs in particular, happens as early as age 11,” he said. “I have a 10-year-old and a 12-year-old at home and it scares the bejesus out of me; not to mention the direct economic costs associated with addiction — it costs upwards of $35,000 a year to incarcerate someone in a federal prison, and rehabilitation is equally expensive, if not more.

“Then there’s the other costs, the loss of potential — these are promising, often very bright young people who, either through a bad decision or an unfortunate circumstance like a sports injury, start down that spiral of abuse.”

He said he’s encouraged by the sheer number of people who cleaned out their medicine cabinets for the statewide Prescription Drug Take-Back event: More than 6,100 pounds of unused, unwanted and expired medications were turned in across the state, he said.

“I’d thought because of the growth in the number of law enforcement agencies having drop boxes available every day would lead to a decline in the amount of drugs we would see being taken back at the Take-Back events,” he said. “But it’s gone up every time.

“I attribute that to the fact that people want to be engaged, they recognize that we have a real problem in our state and they want to do something about it. It’s an easy, but a very effective means of doing something.”

Ihlenfeld said West Virginia needs more treatment options, and those options need to be affordable.

“There’s always someone who comes up to me and tells me about a daughter, a son, a niece or nephew, someone who’s an addict and there’s no place for them to send them,” he said. “They ask me for an answer and I don’t have one. There are so few options in West Virginia, unless you’re wealthy.

“Most people don’t have the money to send (a loved one) to an out-of-town treatment facility and if they do, they may only have enough money to do it for 30 days. If the addict relapses, they don’t have the money to send them back. Most of the people who are successful in stopping their addiction have gone back to rehab multiple times.”

Boggs said that’s the insidious side of addiction: people are convinced it won’t happen to them.

“I just got a call last night from a good friend of mine, his girlfriend had OD’d and was in the hospital,” he said. “And in September last year, we had a ‘Race for Recovery’ the same day there were three funerals for men who had died from drug overdoses. Addiction is non-discriminatory.”

Often, treatment facilities have waiting lists. The Healing Place, for instance, has beds for 61 men in recovery plus eight in transition. Problem is, they have a waiting list of at least 40, “and that’s just the ones who call every day to see if we have room.”

“Right now we’re in the middle of the crisis,” Boggs said. “Face it, we’re behind. I think the community, the state as a whole, is playing catch up. We need more long-term treatment beds — I’ve been to so many facilities that are short-term, 28 days or even 60 days. That’s fantastic and they are needed, but I didn’t get addicted to drugs overnight and it takes a long time for somebody to overcome an addiction.

“Addiction is a disease — if you have cancer and somebody tells you to go do chemotherapy, do this or that and it will increase your chances of getting better, even though it may take a long time you’ll do it. It’s similar to addiction — treatment has to be long, and recovery services need to be long as well.”