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heroine-lead

A drug is killing people in Ann Arbor. It’s in Saline, Chelsea, Dexter, Ypsilanti and Milan, too.

 
You can buy it on any high school or college campus in the county. You can buy it in broad daylight in front of the bus station on Huron Street in downtown Ann Arbor.

When police and ambulances are called to the scene of an overdose, they’re more likely rushing into the back bedroom of a nice, middle-class house on a tree-lined street than into a dope house on the other side of the tracks.

It’s not a fancy, new designer drug or LSD making a comeback – though those are here, too. It’s just heroin. Heroin. Been around for decades. What’s the big deal?

Through the first 11 months of 2013, 22 people died of heroin overdoses in Washtenaw County. Eleven died in all of 2012, and 10 in 2011.

In the first week of December, on the very day that the medical examiner provided that latest death count for this article, two more people died of suspected heroin overdoses within a 24-hour period.

The 18 men and four women who died (in the official count so far) ranged in age from 19 to 45. Their average age was 33.

Heroin had its original heyday in the 1960s and ’70s, but then melded into the drug scene undercurrent as new drugs of choice – cocaine, crack, meth, Ecstasy – took their turns in the headlines. So why is heroin making a comeback? Local public health and law enforcement officials say that’s a complicated question, but the uptick is related to an increase in prescription pain medication abuse, which national studies show is this country’s fastest growing drug problem.

What starts as a legal prescription for OxyContin pain pills after a surgery, for example, becomes an addiction. When the legal pills run out and doctors won’t prescribe more, it sometimes leads down the road to other opiates like heroin.

Heroin often has a better high and it’s cheaper and easier to obtain on the street. Equally alarming is a trend toward family members, including children in middle school and high school, discovering leftover pain pills in the family medicine cabinet. Experimentation leads to addiction, which can lead to heroin, which can lead to death.

Compounding the problem, say health officials, is that heroin these days is much stronger, perhaps 90 percent pure, compared to 30 years ago when it was more often only 10 or 20 percent pure. That means it can now be snorted and smoked without the intimidation and problems that go with needle injections. More potency and intake options lead to more frequent overdoses, particularly for younger and inexperienced users, or those who relapse after being clean for several months in prison or a treatment program.

The police reports for the recent heroin overdoses are remarkable and depressing for their similarity. It’s usually late at night or maybe just before dawn. Either a police officer or a Huron Valley Ambulance paramedic is the first to arrive and usually finds the victim in one of two places – slumped over in the bathroom or lying on the floor of a bedroom. Sometimes a brother or father or friend is yelling to awaken the victim or starting some form of CPR. The cop or the paramedic takes over as family members watch. The victim is blue or purple and either barely breathing or not breathing. Chest compressions and CPR are started. The rescuers ask questions of the family or bystanders; if it’s obvious it’s a heroin overdose, paramedics may administer Narcan, the brand name of a drug called naloxone, which rather amazingly can quickly bring an overdose victim back to consciousness.

Regardless of whether the user is revived, police then gather up the evidence – syringes, spoons with burn marks, lighters, needles, cotton balls and assorted other drug paraphernalia. They dutifully write up the report in the next day or so. Sometimes drug charges are filed within a few weeks if the victim has survived.

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Trying to keep up with the local heroin trade – never mind the other drugs in the community – is a challenge for the ever-fluctuating budget of the Livingston and Washtenaw Narcotics Enforcement Team. It operates with grants, forfeitures of assets collected during drug busts and funding and/or personnel from the state police, Washtenaw County Sheriff’s Office, Ann Arbor, Ypsilanti, Brighton and numerous other townships and towns in the two counties.

Detective Lt. Dale Smith of the Michigan State Police, who leads LAWNET, describes prescription pain meds and heroin as being “everywhere.” He guarantees that even in any of the small towns around the area he could find heroin “right now.” During a recent stakeout, he witnessed heroin being sold “hand to hand” near the bus depot in downtown Ann Arbor.

At a recent drug bust in Ypsilanti, LAWNET collected about 500 heroin “bindles” – small, folded paper packets containing the drug.

Smith says heroin dealers go to Detroit, Flint, Lansing, Toledo and Jackson to pick up the drug, which has come into this country from Mexico, Afghanistan and South America.

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Heroin sells for as low as $5 or $10 a bindle, maybe $25 at the top end. That’s cheaper than the prescription pain pills in the medicine cabinet at home or pain pills sold on the street.

Smith says society has become lax about drug use. “The whole perception that, ‘It’s OK that I do heroin as a recreational drug,’ is crazy. … The denial is huge, just incredible.” The common refrain he hears is, “I’m not an addict, I’m a user.”

In Saline, police Detective Don Lupi and his colleagues wish they didn’t know the pattern of heroin abuse so well. For reasons no one can explain, Saline has been beset with more than its share of heroin overdoses and deaths in the past several years. Police there were recently called to the scene of the city’s third fatal heroin overdose of 2013. There were 11 other non-fatal overdoses as of early December. Two of the three people who died in Saline in 2013 had previous overdoses requiring emergency response. A 25-year-old man who died in August had overdosed twice before, only 11 days apart in late January and early February.

Countywide, there seems to be spurts of overdoses or deaths, all within a few days. Sometimes it appears a bad batch of heroin has entered the county, officials say, and sometimes it seems to be a coincidence of inexperienced users injecting too much. One such spurt took place in June 2013; within eight days there was a death and overdoses in Saline, a death in Ypsilanti and several overdoses in the Ann Arbor area.

After that experience, Saline Police decided in early December to be proactive when a 21-year-old man died and another overdosed on the same day. The police called several people they knew had overdosed previously.

“This time, we wanted to do what we could to get the word out that there may be a bad batch of heroin in the area,” Lupi said. “We’re not sure if it’s a bad batch of heroin, a tolerance issue, or something else altogether. We just attempted to take a proactive approach.”

Alice Penrose, medical director of the county health department, is encouraged by upcoming regulations that will limit refills of one class of strong painkillers and require written prescriptions rather than call-ins. “If you’ve got somebody with a broken arm, you don’t necessarily need to give them 30 hydrocodone,” Penrose said. “Maybe 15 will do.”

And the health department wants doctors to make better use of the state’s MAPS system, which tracks patients’ prescription patterns in an attempt to identify those who might be “doctor shopping” to obtain more pain meds.

Dr. John Hopper, an addiction medicine specialist at St. Joseph Mercy Hospital, says about 5 to 9 percent of the population is genetically predisposed to the disease of opiate addiction – roughly the same percentage as for alcoholism. Because the prescription of pain medications has become so widespread, the medical community is introducing a higher percentage of the population to opiates. “So by exposing all these people to the drug,” he said, “we’ve unmasked a bunch of people who were at risk for addiction or misuse.”

The new formula, he said, should be “less pills for less time with more thought about who gets them, and more monitoring of people who are on them long-term.”

Educating the public about treatment needs and options, and coordinating funding for that treatment, is a main focus for Marci Scalera, director of the Substance Abuse Coordinating Agency with the Washtenaw Community Health Organization. “Addiction is everywhere,” Scalera said. “People just don’t want to acknowledge that no matter where you look in society, that there is substance abuse. (They still think) that it’s a choice, that it’s a moral issue. They’re still thinking it’s that skid row person. They’re not acknowledging that it’s a problem everywhere.”

Penrose, medical director of the county health department, puts it this way: “With influenza, we can recommend vaccination. With pertussis, we can talk about isolation of cases, and prophylactic antibiotics. With heroin, it’s hard to know where to start. How do you prevent an addiction? This is a national problem, not just a local one.”

Glynis Anderson is chief executive officer of Home of New Vision which, along with Dawn Farm is one of county’s two core providers of publicly funded treatment for substance abuse. “We need to destigmatize addiction in general,” she said. “That’s one of the biggest issues. It’s really about education. … Funding groups sometimes resist giving money to substance abuse treatment because they say substance use disorder and addiction is not a health issue.” But health and social issues tend to be interrelated. Anderson quotes the oft-used line of a local homeless shelter manager: “We don’t have a homeless problem, we have a substance abuse problem.”

 

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About half those treated at Dawn Farm are there for opiate addictions, said Jim Balmer, the organization’s president, and the addicts are getting younger. “We see kids in their teens into their 20s who have full-blown habits, who often by the time they hit us, they have multiple prior treatments. They’ve been in a couple of hospitals (for treatment) until they burn through their insurance. … It’s huge. It all starts in a medicine cabinet, make no mistake.”

Balmer, who has worked at Dawn Farm since 1983, is a walking encyclopedia of addiction treatment history, successes, failures and options. Dawn Farm has put together a variety of different treatment programs but the the one that works best, Balmer says, is a 90-day stay, high monitoring of the addict’s progress and an extensive support system of other recovering addicts. A variety of studies agree that’s the “gold standard” for success, Balmer said.

On the wall behind Balmer’s desk is a framed quote from George Vaillant, a Harvard addiction specialist: “If you want to treat an illness that has no easy cure, first of all, treat them with hope.”

“That’s what’s transformative for people,” Balmer said, “seeing somebody like themselves on the other side who says, ‘You won’t have to feel this bad anymore.’’’