Pain pill shortage leads to heroin resurgance

Foley, 21, has been hooked on heroin for nearly two years. Before that, he was popping oxycodone and other prescription pills snapped up as Florida become a bustling marketplace of illegal pill mills. He turned to heroin after his drug of choice became too expensive. “I was chasing the next high,” says Foley, who landed in drug court after a heroin possession arrest in December. “I wanted to try it all.”

Heroin is inching back in Florida, the unintended consequence of the state’s epic war on prescription pills. Now, with Florida officials successfully slowing the supplies, shutting down the pill mills that masqueraded as pain centers and arresting thousands of addicts and even doctors, heroin has become a popular substitute.

In January, a group of researchers from across the country met in New Mexico at the National Institute on Drug Abuse’s Community Epidemiology Work Group conference and swapped frighteningly similar stories about the increased use of heroin. The Miami-Fort Lauderdale region was named one of the regions facing the heroin trend.

“The major drug headline of 2012 was the emergence of heroin both in urban centers and small cities and towns,” said epidemiologist and drug expert Jim Hall of Nova Southeastern University’s Center for Applied Research on Substance Abuse and Health Disparities, who attended the conference. “Young adults, 18 to 30, white, prescription opioid addicts are making the transition to heroin.”

While the raw numbers remain small across Florida and police have seen little street activity, experts are already mounting a campaign to slow the trend, from public education about the risks of heroin and needle injection to law enforcement presentations and spreading the word about a Good Samaritan law designed to stop drug overdoses.

“This is a public health issue. In some ways, the scale of the prescription pill problem took us all by surprise,” said Pat Castillo, vice president of the United Way of Broward County Commission on Substance Abuse. “We had been promoting the prescription drug monitoring system for nine years; the (pill) problem happened in the blink of an eye. We are very concerned with this issue of heroin.”

From July 2010 to June 2011, there were 45 heroin-related deaths statewide, according to the Florida Medical Examiners Commission. That number jumped to 77 heroin-related deaths from July 2011 to June 2012.

The Florida Department of Law Enforcement also reports a slight increase in heroin-related charges: In the first three months of 2013, heroin-related charges totaled 948. In the same three-month period last year, that number was 772.

And in what may be the strongest marker, addiction treatment numbers are up in Florida. In 2012, Broward County — just a few years ago considered the center of the pill mill problem — addiction treatment centers saw an 87 percent spike in admissions among addicts using heroin as their drug of choice, jumping from 169 to 316, according to the Florida Department of Children and Families. In Miami-Dade, the admissions jumped from 227 to 308 in the first half of 2012.

“It’s not on a wide scale — yet,” said Hall who tracks drug trends and statistics for community organizations in Broward and Miami-Dade counties. “For these opioid addicts, it’s about a euphoria but more importantly, the heroin keeps them from going into withdrawal, or as they would say, from getting sick. Any port will do in the storm of withdrawal.”

Foley, of Coral Springs, began his drug odyssey with marijuana. He was 14, and before his next birthday, he had graduated to taking Xanax and Ecstasy. By the time he was 17, a junior in high school, he was approached by a dealer offering “blues” — oxycodone — at two for $20. Much of his habit was paid for with the money he earned at a part-time job.

“When I finally took a half of a 30 milligram pill, I threw up a couple minutes later. Then I started to feel warm all over, it was the best feeling I had ever had,” he said. “I needed to get that feeling again. It escalated from popping pills to smoking to snorting to injecting.”

Two years ago, Foley and a buddy met with a pill dealer who was touting a cheaper high: heroin. “It cost less, I didn’t have the hassle of trying to find the pills and the high lasted longer. I started doing it every day.”

He was arrested in December, charged with possession of heroin and drug paraphernalia and the case was referred to drug court.

Almost weekly, Broward assistant public defender Rudy Morel watches as his clients stand before Broward Circuit Judge Michele Towbin Singer, some with evidence still visible from their last heroin high — track marks, and, occasionally, blood oozing from puncture wounds.

“It used to be you rarely see heroin and now it’s on the docket every day or every other day,” says Morel who also holds a medical degree.

Although he says the caseload has remained about level in the past year, he has seen a shift to heroin use in that time, with “many of those on heroin who were first on prescription pills.”

Singer, who presides over the county drug court, says the defendants coming before her frequently offer similar stories about their paths to heroin. They started with an injury, began taking prescription pills, then abused prescription pills — sniffing, snorting, then eventually injecting.

“Once they are at the point of injecting, it doesn’t take much to cross over to heroin,” she said.

One of the concerns, she added, is that like prescription pills, heroin is a particularly difficult drug to kick and generally requires long-term residential treatment. There are only a few options in South Florida.

The actual drugs on the streets are also changing. The traditional poor-grade black tar or brown powder heroin from Mexico is now joined by a potent white heroin also out of that region, Hall said. Other white heroin available in South Florida comes from South America, he added. And while some users still snort or smoke it, others are turning to injecting the drug.

At the height of the prescription pill abuse epidemic about three years ago, seven people a day were dying of prescription drug overdoses in Florida. Addicts were lining up outside of pain clinics waiting to get prescriptions, some homegrown and others drug tourists who had traveled to Florida from as far as Kentucky and West Virginia, Tennessee and Ohio looking for what they called “hillbilly heroin.” At one point, Broward was ground zero, home to more than 150 storefront pain clinics where doctors liberally doled out prescriptions of highly addictive medicines with little or no medical cause. Almost overnight, Florida earned the dubious distinction as the painkiller capital of America.

Faced with a public health crisis, lawmakers attacked the problem with rigorous anti-pill mill legislation that drastically limited who could dispense narcotics and broadened penalties for pill mill operators. They also established a statewide prescription drug monitoring system that kept pill poppers from doctor shopping.

By the summer of 2011, Gov. Rick Scott was at a news conference in Miami touting the dwindling supply of pills coursing through Florida, more than 1,000 arrests and millions in cash confiscated. The eventual void in the streets — without much focus on treatment and recovery — led those addicted to look elsewhere for their high. Enter heroin, a drug that cost, on average, as little as a tenth or a quarter of the price of some prescription pills. The price for 30 milligrams of oxycodone jumped from about $10 to roughly $30 last year, according to recovery experts.

“The state of Florida took dramatic action to reduce the supply of diverted prescription medications in addressing the epidemic, but until we provide adequate treatment resources for individuals to end their addition, the drug may change but the problem won’t stop,” Hall said.

Couple the low pricing with a hard-to-shake opioid addiction and heroin was primed for a comeback.

“The supply went away. The demand did not,” said FDLE special agent supervisor David Gross. “For the heroin trafficker, the circumstances made business quite lucrative.”

At the Novus Medical Detox Center, the number of patients coming in for heroin addiction has increased over the past two years, jumping from less than 1 percent of the total client population in 2011 to 3 percent in 2012 to 7 percent in the first quarter in 2013.

“We had an individual recently receiving treatment who had been using prescription pain medication for a condition he had. He abused it. Then his doctor cut him off but he was addicted. He was at his local fitness center and a trainer introduced him to a heroin dealer,” said Kent Runyon, executive director of Novus in New Port Richey. “He transferred the addiction.”

But officials are fighting back.

In February, Broward’s substance abuse commission and the Sanford-Brown Institute, a for-profit college in Fort Lauderdale, hosted a workshop to share the news about heroin. And the commission’s board of governors, which include Morel and Hall, has met twice this year and formed a task force to put together an anti-heroin community campaign. Castillo said the task force is studying efforts in North Carolina and New Mexico, the latter a state particularly hard-hit by young, suburban heroin users. The group is also working to spread the word about the risks of heroin, including dirty needles that can spread disease. It is also publicizing a law aimed at encouraging fellow drug users to call authorities when they witness an overdose.

The 911 Good Samaritan Act, which went into effect in Florida last year, protects callers from prosecution for possession or ingesting low-level controlled substances under some circumstances.

“It’s imperative that we remain committed to fighting the overall drug problem in our state,” said Florida Attorney General Pam Bondi. “While prescription drug-related deaths are down for the first time in nearly a decade, we will remain vigilant in protecting Floridians from drug abuse as the drug of choice changes.”

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Information from: The Miami Herald, http://www.herald.com