Heroin continues to be scourge of state, nation

CDC has declare sharp increase in heroin use a ‘public health crisis’

By Dave Altimari
Hartford Courant

HARTFORD, Conn. (AP) — Heroin deaths continued to spike across Connecticut in 2015, fueled largely by an increase in the number of people overdosing on a mix of heroin and the synthetic drug fentanyl.

Deaths from that combination have increased more than sevenfold in less than two years, records obtained by The Courant reveal. Fentanyl, a synthetic opiate similar to but more powerful than morphine, is often mixed with heroin to increase its potency.

Through the first nine months of 2015, 65 state residents died after overdosing on the lethal cocktail, according to data released by the state medical examiner’s office. Last year, 37 died from overdosing on the two drugs; in 2013, only nine died from the combination.

In 2013, Connecticut saw 257 deaths in which heroin was involved, compared with 325 in 2014. The projected total for 2015 is 381.

That spike comes amid increased attention to the heroin scourge from Connecticut’s medical, law enforcement and political communities. The new statistics also support the notion that heroin use increasingly spans all social and economic demographics.

“There are people in every community who are dealing with these issues,” said Jim O’Dea, vice president of operations for Hartford HealthCare’s Behavioral Health Network, at one of a number of recent public forums on the drug.

Experts say a common path to heroin use starts with prescription drugs, especially if a patient has been prescribed the drugs for an extended period of time.

“Your doctor says they are not going to prescribe anymore and there are pills all over the street. . The pill is $10 and a bag of heroin is $5,” said Patricia Rehmer, a senior vice president at Hartford HealthCare.
Patients often are driven to heroin by strong withdrawals from prescription drugs.

“If somebody has been on pain medication for an extended time, there needs to be a medical detox. If not, they are going to go somewhere else, and if they get cornered or frustrated enough, heroin is very available in New England,” said Rehmer the former commissioner of the state Department of Mental Health and Addiction Services.

Earlier this year, the federal Centers for Disease Control and Prevention declared the sharp national increase in heroin use a “public health crisis” and called for a comprehensive response, including tighter control of narcotic painkillers that are often associated with heroin abuse, and greater access to naloxone, the drug marketed as Narcan, a prescription medicine that reverses an opioid overdose.

On the political front, New England’s congressional members established a task force to address the growing use of heroin.

The task force last week wrote to U.S. Health and Human Services Secretary Sylvia Burwell, urging the administration take steps that include funding research for alternative pain-management techniques.

State law enforcement received a boost last year through legislation that extended the protection from civil liability and criminal prosecution to the person administering Narcan. With that protection in place, police departments increasingly are administering Narcan. The law has applied to physicians, surgeons, physicians’ assistants, APRNs, dentists and podiatrists since 2012.

Dr. James Gill, the chief state medical examiner, said the rate of deaths involving heroin and fentanyl is alarming.

“People addicted to drugs have no guarantees about the dose, quality, or composition of drugs that are bought on the street,” said Gill.

The rise in deaths by heroin/fentanyl overdoses is by no means only a Connecticut problem — every New England state has seen big increases in the number of deaths.

In Vermont, deaths involving the two drugs went from zero in 2010 to 17 in 2014, records show. In New Hampshire, legislators recently established a 26-member task force to come up with a plan to crack down on fentanyl deaths. The task force must produce a final report by Jan. 6.

“We are seeing similar scenarios all over New England,” Drug Enforcement Administration spokesman Timothy Desmond said.

Fentanyl is 30-50 times more potent than heroin and 50-100 times more potent than morphine, one of the drugs it is supposed to be replacing as a legitimate painkiller. Most of the illegal fentanyl that ends up in the streets in New England is manufactured in Mexico, Desmond said.

It has become the drug of choice to mix with heroin to form a powerful opiate.

“The chance of overdosing and dying increase considerably when you mix heroin and fentanyl,” Desmond said. “The problem is people also may not know the drugs have been mixed.”

The DEA issues a nationwide alert in March of 2015 warning about the deadly combination of the two drugs. It has not stopped the flow of deaths in Connecticut, Gill said.

While deaths involving cocaine have stayed about the same — there were 147 deaths involving cocaine in 2013 and 111 so far in 2015 — heroin deaths continue to increase, just not at the same rates as deaths involving fentanyl.

Statistics from the medical examiner’s office show that the problem is not confined to just cities.

An analysis of the data provided by the medical examiner reveals that people from 58 communities have died from overdoses involving heroin and fentanyl in the last three years. While cities such as New Britain and Waterbury have seen the most deaths with eight each, the analysis of the data shows that people also are overdosing in smaller towns, such as Andover, Lisbon, Redding and Sharon.

More have died in Brookfield, which has had three heroin/fentanyl related deaths since 2013, and Enfield, which has had four, than in New London or New Haven, which had two each.

“These drugs are not limited to any specific geographic area. It’s not a city thing or a suburban thing,” Desmond said. “It is an epidemic.”

Age also doesn’t seem to be factor.

More people in their 30’s have died from a fentanyl overdose, 31, than any other age group in the past three years. Three teenagers have died from using the drug, as have four people over 60.

Desmond said the death totals also may not be complete because, until recently, some labs did not test for the presence of fentanyl. Hospitals don’t screen routinely for fentanyl when a patient is brought in who has overdosed.

That is now changing across the country, and particularly in New England, where medical examiners from all six states test for it.

In New Britain, police are attacking the problem by increasing the number of officers investigating drug crimes, according to Chief James Wardwell.

“Heroin is a powerful drug but fentanyl is even more powerful, and combined they are deadly,” Wardwell said. “There is such a sad loss of life from all across the spectrum.”

The department has officers on federal and state drug task forces and in 2014 started a Street Crimes Unit to work with an already existing drug unit. Despite increased law enforcement efforts, Wardwell acknowledged that the heroin problem is not slowing down and it’s possible that an even more lethal drug to mix with heroin will emerge eventually.

“I’m seeing the epitome of desperation; that’s the best way to characterize it,” Windsor Locks police Officer Jeff Lampson said.

Lampson retired last year from the Manchester Police Department, where he was a lieutenant and supervisor of the detective bureau. He said most of the heroin addicts he’s seen have no support system to help them emerge from hellish lives.

“The people that I’m seeing, their family lives are fractured, and maybe that’s what contributes to their addiction as well. There’s no love,” he said. “They’re trying to claw their way out of it, they have the best of intentions to get out of it, but the drug is so powerful and so overwhelming that they just can’t do it.”

Lampson responded to a medical call recently involving a man who said he was a veteran of the war in Afghanistan and had been wounded in action. He was dependent on heroin because he could no longer get prescription drugs for pain, had no insurance and could see nowhere to turn for help, Lampson said.

Addicts often resort to theft, stealing from family, breaking into cars to scoop up loose change, Lampson said. After a while, they’re not chasing another high; they just want to avoid the ordeal of withdrawal, he said.
“It has this power that I don’t think anyone can comprehend,” Lampson said. “It takes control over every ounce of your being. It’s all you think about.”