Wednesday, April 16, 2014
Victoria Morris of Portland first used heroin when she was 20. Eight years later, her addiction has cost her her husband, her children and her home.
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
She had already smoked crack and done other drugs, but it was a blood clot in her arm that set her heroin addiction in motion.
The hospital gave her Dilaudid. From there, she graduated to heroin because “it was cheaper than Dilaudid,” she said.
Heroin takes her pain away, she said, and staves off the nausea, diarrhea and other withdrawal symptoms. It’s also cheaper than other opiates.
“Oxy 30s are like 40 bucks,” she said, referring to the cost of a 30-milligram tablet of OxyContin. “You can go spend 40 bucks on dope and I can make it last three days.”
A drug kingpin couldn’t have planned it better: Flood the market with a cheap, socially acceptable, addictive drug. Once customers are hooked, reduce the supply, raise prices and offer a cheaper – and deadlier – alternative with a huge profit margin.
That’s what has happened in Maine and across the country as abuse of prescription painkillers has led to opiate addiction, driving some users to heroin as a less expensive alternative.
As Morris said, the commonly prescribed painkiller OxyContin costs $40 for a single pill – if it’s available. That same $40 can buy two, three or even five bags of heroin – enough for maybe three days, depending on its purity and the user’s tolerance.
“For most (addicts), they’re using both opiates and heroin and both give a similar effect,” said Ronni Katz, substance abuse program coordinator for Portland’s Division of Public Health. “If someone is jonesing, they go for either one, but they’ll go with what they can afford and heroin you can get a lot cheaper.”
Law enforcement and the health care industry are cracking down on prescription drug abuse, but are also seeing a corresponding surge in heroin use and deaths from overdoses.
The number of people dying in Maine from a heroin overdose quadrupled from seven to 28 between 2011 and 2012, and estimated numbers put 2013 on pace to surpass that, according to the state medical examiner’s office.
That comes as no surprise to people in the treatment community.
Kenny Miller is executive director of the Down East AIDS Network based in Ellsworth, an area hard hit by painkiller abuse, and now heroin.
“This is the end of the beginning,” he said, noting that today’s addicts are the consequence of years of easy access to prescription painkillers. And the heroin overdose numbers are likely to continue climbing for some time, he said.
Miller said a lot of work is being done to curb painkiller abuse, and those efforts are eventually expected to have a corresponding effect in bringing down heroin abuse. If fewer people abuse prescription painkillers in the first place, the logic goes, fewer will end up turning to heroin as an alternative.
HEROIN – PLENTIFUL AND CHEAP
Prescription painkillers had been almost free for many people through private insurance or publicly funded health insurance programs such as MaineCare. In some long-standing Maine industries like fishing, forestry or construction, missing work because of chronic pain means missing a paycheck. The time-release painkiller OxyContin seemed a blessing.
But by 2000, law enforcement and health care providers were seeing problems with abuse, diversion and addiction. People who couldn’t get a prescription for pain pills would buy – or steal – them from people who could.
People who wanted to use the drug to get high learned how to scrape off the time-release coating to get a quick surge of the narcotic. It was viewed even then as a gateway drug. People who would never think of experimenting with heroin saw OxyContin as less dangerous because of its therapeutic uses. Some began injecting it for a more powerful effect.
“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.”
HOW IT GETS HERE
The route heroin takes to get to Maine explains some of the variation in purity and why it’s so readily available.
Most of the heroin in Maine originates in South America, primarily Colombia, the largest producer in that region, according to the federal Drug Enforcement Administration. In 2006, Colombia grew enough opium poppies to produce 4.6 tons of heroin, the latest numbers available from the DEA.
While Middle Eastern and Asian countries like Afghanistan and Myanmar are also major producers of opium, most of their product goes to the European market. Heroin from Mexico targets the western U.S.
Kilos of heroin bound for the East Coast are smuggled through Mexico or the Caribbean to New York City, known as the capital of “Smack,” one of the street names for heroin.
There, the heroin is cut with another substance, like baking soda, to increase the volume. It’s then sometimes ground into single doses of 0.1 gram, or 1 gram or 10-gram “fingers.”
Earlier this month, just before actor Philip Seymour Hoffman died of an apparent heroin overdose in Manhattan, drug agents broke up a mill operation in the Bronx, seizing 33 pounds of the drug worth $8 million, as well as 18 coffee grinders used to process it and hundreds of thousands of individual glassine bags stamped with the logos “NFL,” “government shutdown,” “iPhone,” and “Olympics 2012,” all names for different batches of heroin, according to the DEA. The names are used by dealers to promote their brand and to suggest consistency in a product that is constantly adulterated: weakened to increase the volume, but strengthened with other drugs to give it potency.
The farther from New York the heroin travels, the more expensive and less pure it is, and the greater the profit.
That creates a financial incentive for dealers from New York, who often deal in OxyContin and cocaine, as well as heroin, to set up shop in Maine, where a $5 bag of heroin can still be diluted and sold for $10 or $15.
“Driving from New York or mailing it up to Maine or New England, they’re seeing a bigger profit motive because they can make more selling it in Maine,” Pettigrew said. “The only thing that matters to people who deal drugs is profit. They don’t care who suffers, what communities are destroyed.”
The economics that make Maine an attractive market also make it worthwhile for users to drive south to obtain the drug for less.
A gram of heroin might be $45 in Lowell and Lawrence, Mass., a 90-minute drive from Maine, and a single dose costs $5. An addict can pay for the trip and his own heroin needs by making the drive. Mainers have also been known to use buses and trains to reach cheaper supplies in Boston and New York.
While heroin has been a problem for years, police used to seize heroin prepackaged in small glassine bags, with a dealer stamp like “the Grim Reaper,” said Portland Assistant Police Chief Vern Malloch.
“Now what we’re seeing is higher volumes. It is in ‘fingers’ ready to be cut and distributed. That’s a lot of heroin,” Malloch said.
OxyContin is still in high demand, typically selling for $1 or more per milligram, said Cmdr. Scott Pelletier, head of the Maine Drug Enforcement Agency in southern Maine. An 80-mg pill would cost $90 to $100.
A similar amount of money spent on heroin will last longer, he said. And it’s easier to get.
“For a long time, everything was suboxone. It was easy to get,” Katz said, referring to an addiction treatment medicine that is sometimes abused. “Heroin has moved in and taken its place. Heroin has really flooded the market.”
Staff Video Reporter Susan Kimball contributed to this report.
David Hench can be contacted at 791-6327 or at: