The number of people who died from heroin overdoses in New London and Norwich doubled last year, a jolting statistic that local hospital and substance abuse treatment officials attribute to what appears to be a rise in heroin use.

At least 20 combined deaths recorded in the two cities in 2013, 10 in each city, were caused by heroin or, more often than not, heroin and a mix of other substances such as alcohol and cocaine, according to statistics provided by the state Office of the Chief Medical Examiner.

At least five people died of heroin overdoses in each city in 2012. Other overdose deaths may have been in part caused by heroin but are attributed to "multiple drug toxicity," without specific drugs listed in the medical examiner's report.

The increase in deaths corresponds with a spike in the number of heroin overdose victims being taken to local hospitals.

Dr. Oliver Mayorga, chairman of emergency medicine at Lawrence + Memorial Hospital in New London, said he noticed a pronounced jump in heroin overdoses in the fall. Hospital records show there were 14 heroin overdose patients at L+M in the months of December and January. There were a total of 17 in all of 2012.

"Those are the ones that made it to the hospital," he said. "That's pretty telling."

The year-by-year numbers from The William W. Backus Hospital in Norwich are also sobering. The hospital treated 77 heroin overdose patients in 2012 and 90 in 2013, according to numbers provided by the hospital.

Mayorga said if an overdose victim makes it to the hospital, his or her chances of survival are very good.

One important fact to know about the statistics, according to Chief Medical Examiner Dr. James R. Gill, is that some "drug intoxications" involve cases of people who overdose and are taken to a hospital where they are officially pronounced dead. The number of those cases varies each year. Since Norwich and New London are the locations of the two hospitals in the county, the increase in overdose deaths in these two cities reflects some overdoses that occur in surrounding towns but are attributed to New London or Norwich because that is where the pronunciation of death is made.

Trained in the Bronx, N.Y., Mayorga was surprised, he said, when he came to work in southeastern Connecticut and found the high amount of heroin use, which he had associated with bigger cities.

He said when paramedics are called for a report of an untimely death of a 22-year-old here, "it's almost always heroin."

Mayorga said heroin addicts, many of whom are high-functioning individuals who can hide their addiction, walk a fine line. That means when the strength of the heroin is higher than normal or there is an additive unknown to the user, the result can be disastrous, he said.

The treatment for an overdose is naloxone, commonly known by its trade name Narcan, which is an opioid reversal agent. Within 15 to 30 seconds after it is administered, the overdose victim loses their buzz, and many times is perturbed at the person who ruined their high. In 2012, legislation was passed in Connecticut that makes a prescription for Narcan, normally carried by paramedics, available to people who live with or know of someone with an opioid addiction. Health officials in Rhode Island are urging more police departments to carry Narcan in the wake of more than two dozen recent overdose deaths associated with the painkiller fentanyl, also an opioid.

State police warning

In December, Connecticut state police issued a warning about heroin laced with fentanyl, which they said may have been responsible for a rash of overdoses reported throughout the state, a high concentration of which have been in New London and Litchfield counties.

However, none of the deaths in New London in 2013 and just one death in Norwich were associated with the combined use of fentanyl and heroin, according to the medical examiner's report. That one case also involved cocaine.

Medical personnel know an overdose patient has taken an unusually high dose of heroin or another opioid when it takes "double or triple the dose (of Narcan) to wake them up," Mayorga said.

Unfortunately for the heroin user who may not know what additive is in the drug they are ingesting, "once it's in veins, it's in there," Mayorga said. "And God forbid you put something in stronger than you're used to. You'll literally fall asleep, stop breathing and you die."

Those are the ones who never get to the hospital and may have been alone when getting high.

Jack Malone, executive director of the Southeastern Council on Alcoholism and Drug Dependence Inc., said the increase in those seeking treatment has a lot to do with the soaring rates of addiction to opioids - mostly prescription painkillers such as Oxycontin and Vicodin. SCADD runs outpatient facilities in New London and Norwich, along with a 20-bed detox facility for heroin addicts in New London.

Someone who starts taking prescription drugs can quickly get addicted, Malone said. Once the prescription drugs run out or get too expensive, some will inevitably turn to heroin, which is readily available, cheaper and offers a similar high. While an Oxycontin pill may go for $40 on the street, a bag of heroin costs just $10. Although it is usually injected, Malone said some snort it.

"More people are coming in. It's a subtle but consistent change that crosses socioeconomic lines and now includes younger kids from affluent communities," Malone said.

Some heroin users will actually seek out the drug known to have caused on overdose in others, Malone said, in an attempt to obtain that elusive high they felt when they first starting using.

The state Department of Mental Health and Addiction Services, responsible for mental health and substance abuse treatment for the uninsured or underinsured, reports that heroin addiction ranks second behind alcohol as the reason people are seeking treatment.

There were 15,965 people who sought treatment from a DMHAS-funded facility for heroin addiction in 2012, a slight increase from the 15,736 in 2011. Numbers for 2013 were not yet available.

Drug overdose was the leading cause of injury death in the United States in 2010, causing more deaths than motor vehicle traffic crashes, according to the Centers for Disease Control. Of the 22,134 deaths relating to prescription drug overdose in 2010, 16,651, or 75 percent, involved opioid-based prescription painkillers.

Younger users

Those using heroin and other opioid painkillers are also getting younger, said Dr. J Craig Allen, the medical director at Rushford, which under the umbrella of Hartford Hospital operates mental health and addiction services at several locations in the state.

The Glastonbury location recently started offering a new medication-assisted treatment for opioid addiction known as buprenorphine or Suboxone treatment. The medication helps to prevent sickness from opioid withdrawal. Unlike methadone, Allen said buprenorphine can be obtained in the privacy of a clinician's office.

Allen called the prescription painkillers "a common pathway" to heroin, especially for adolescents who seek the high of the opioid but do not have the access or money for the prescription drugs.

Any treatment has to start with not using the drug, Allen said. And it's not pretty - the reason there are withdrawal drugs like methadone and Suboxone.

"People get very sick. Who wants to have diarrhea, nausea, vomiting, insomnia … ?" Allen said. "You've got to get through the withdrawal symptoms before you get into any kind of treatment."

He said many insurance companies don't pay for the treatment because it is not life-threatening. It's the reason, he said, that many relapse.

g.smith@theday.com