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Deadly addiction: Heroin use, a tragic wrong turn for prescription drug abusers, on the rise in region

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.


Deadly Addiction: Heroin


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