February 23

Heroin use climbs in Maine as cheaper alternative to prescription drugs

Today’s addicts are a consequence of years of access to prescription painkillers, an expert explains.

By David Hench dhench@pressherald.com
Staff Writer

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Cmdr. Scott Pelletier, head of the Maine Drug Enforcement Agency in southern Maine, points out heroin packets that were seized in the state.

Gabe Souza/Staff Photographer

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“A majority of the people we see started by injecting prescription drugs,” said Miller, of the Down East AIDS Network.

State health officials worked with the pharmaceutical industry to curb drug diversion. Tamper-proof prescription pads made it harder to forge prescriptions. A statewide prescription monitoring program implemented in 2002 has made it harder for patients to “doctor shop” to try to obtain the same prescription from multiple doctors.

Miller said one area where the state and doctors need to improve is in referring those people who are attempting to obtain multiple prescriptions or who show other signs of abuse, to treatment.

The state also has worked to educate doctors and change coverage policies so that while opioids may still be appropriately prescribed for acute pain, other treatments for chronic pain, like osteopathic manipulation and cognitive behavioral therapy, are encouraged.

In 2013, about 50,000 people enrolled in MaineCare obtained prescriptions for painkillers, 10,000 fewer than the year before, said Dr. Kevin Flanigan, medical director for MaineCare. The state also has worked to educate doctors about responsible prescribing, which might include periodic urine samples or pill counts to make sure a patient is using pills as prescribed.

Purdue Pharma, manufacturer of OxyContin, also changed the composition of the pills to make it harder to bypass the time-release coating.

OxyContin now is harder to find, harder to use and more expensive to buy. And heroin is as plentiful and cheap as it has ever been.

A 2012 survey by researchers at Washington University in St. Louis and Nova Southeastern University in Florida found that once tamper-resistant OxyContin hit the market, the number of opiate users listing OxyContin as their primary drug dropped from 35.6 percent to 12.8 percent in less than two years. The most common alternative was heroin, according to the study, which was described in the New England Journal of Medicine.

“When people first start using heroin, they’re not seeing themselves as junkies, not seeing themselves as injectable drug users,” said Anthony Pettigrew, spokesman for the Drug Enforcement Administration’s New England region. “They’re snorting it when they first start. Overall, the heroin on the street now is purer than it was 10 or 15 years ago as a rule. Before, people would have to inject it to get the high.”

Prescription opiates still accounted for the vast majority – 101 – of Maine’s 163 overdose deaths in 2012, but the number of deaths from heroin overdoses is rising.

“It’s still a small sample size, but we’ve seen them escalate rapidly and alarmingly,” said Katz.

The dark irony is that an overdose from heroin can often draw more addicts to that batch.

“Other people who are addicted to heroin will seek the area where people overdosed because they’ll believe the people who OD’d didn’t know what they were doing when they used it,” said Pettigrew.

And the profile of the modern addict has changed.

“You have a lot of new users and that’s what’s been so scary about this, younger, newer users,” Katz said. “They start snorting, then they want a better high and they start shooting up. That’s what I hear from a lot of my treatment people, over the last few years they’re seeing a lot of younger and younger users. ... There are a lot of middle- and upper-class people.”

Some users are also turning to crime to get the money to satisfy their habit, committing robbery or prostituting themselves. Almost all pharmacy robberies target oxycodone and other opiates.

“Logic isn’t always front and center when people are in their act of addiction,” says Guy Cousins, director of the Maine Office of Substance Abuse and Mental Health. “The unfortunate part of addiction is oftentimes people’s values often go out the door. It isn’t always a cash business. People will do many things to get the drugs.”

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