In the popular imagination, heroin lives in dark, damp Seattle alleys or dingy Edinburgh flats, the preferred vice of morose musicians or jaded junkies. But increasingly, experts say, the dangerous drug is coursing through the veins of well-adjusted, middle class youth, right here in sunny Central Oregon.
“The people who are becoming addicted to heroin is a different group than one would normally expect,” says Rick Treleaven, Executive Director of Bend-based BestCare Treatment Services. “The people we’re seeing from heroin are really from more functional families, who have an education and should be going to college. But they’ve gone down this path.”
And, that sentiment is backed up by numbers: In the past five years, the Deschutes County District Attorney’s Office has seen a more than seven-fold increase in the number of heroin charges—jumping from 22 in 2009 to 171 in 2014. Alone, that five-year increase is dramatic, but even more telling is that the problem only seems to be intensifying: In the single year from 2013 to 2014, the number of charges by the DA relating to heroin possession nearly doubled.
And, these numbers likely represent only the tip of the iceberg for total usage, points out Assistant DA Steve Gunnels.
“Police often discover heroin only when the user has overdosed and paramedics are called to try to revive them,” Gunnels explains. While it’s not uncommon for drug users to engage in petty crime to help fund their habit, heroin users, as a group, are less prone to violent and erratic behavior than, say, methamphetamine users. Moreover, if a heroin user dies, he or she obviously won’t be charged with possession and, if they don’t OD, they aren’t likely to cross paths with police.
Yet, although the full scope of heroin use in Deschutes County remains unknown, across the board—from law enforcement to the District Attorney’s Office to treatment providers—experts are troubled by what they agree is a dramatic increase in use in just the past few years.
Portrait of an addict
They say the typical heroin user is between 16 and 30, but Rimrock Trails Adolescent Treatment Services, one of the four primary treatment centers in the region, is seeing even younger addicts.
And while it’s tempting to assume that those ensnared by heroin are young people on society’s margins, without adult support or supervision, wrestling with the demons of early childhood trauma, Treleaven says that notion doesn’t match the people he’s seeing in BestCare’s treatment programs.
“Their family problems are no more traumatizing than most people’s family problems. They’re not the people coming out of foster homes, they’re not the people who have been beaten and abused. I think they’re starting out wanting to have a good time,” Treleaven says. “I’m 55, 30 years older than many of these folks. It has struck me that they are long removed from the heroin epidemics that we saw in ’60s, ’70s and early ’80s in this country. So they walk into a heroin addiction without really being cognizant of how devastating a drug it can be.”
And it’s not just overdoses that potentially await addicts, he points out. Other health issues are highly correlated with intravenous drug use, including hepatitis and HIV.
“Hepatitis C is rampant now. If people survive you’re just going to have a lot of people with liver transplants or dying of liver disease,” Treleaven says. “We have yet to see in the folks we’re seeing a real uptick in HIV—it’s there, we have people who have it. If people are sharing needles and getting hepatitis C, HIV goes along with that, just a lower amount.”
Deschutes County has a needle exchange program, but Treleaven says it needs to be stronger and better funded. Currently, IV drug users can exchange used needles and other supplies for clean ones in Bend and Redmond. According to County Health Educator Susan McCreedy, these services are currently available on a drop-in basis, but the Bend site hopes to move to 11 am to 3 pm on Tuesdays starting in March, to provide more in-depth support.
“Unfortunately, the general public views it as helping addicts, and so politicians respond to that and don’t fund that,” Treleaven explains.
He also points to the need for another form of assistance aimed at reducing the harm caused by heroin—naloxone (Narcan). Treleaven says efforts are beginning to make the medication more widely available in Portland, where heroin is more embedded in the cultural fabric, but local efforts have yet to take hold.
The roots of the problem, he explains, are much more far-reaching than those of other street drugs, often originating in the rampant prescription of pain pills, many which share the same opiate base as heroin.
“Central Oregon is still far too reliant on giving out opiate pain killers for chronic pain,” Treleaven says. “I think opiate pain killers are wonderful for acute pain and many are problematic for chronic pain. As a community we have begun to talk about widely providing alternatives to prescriptions as tools to manage chronic pain.”
Counselors point out that doctors aren’t necessarily prescribing painkillers to teens, but that youth find access to the painkillers from their parents’ or friends’ medicine cabinets. According to 2013 survey results released by The Partnership at Drugfree.org and MetLife Foundation, one in four teens reported misusing or abusing a prescription medication—a 33 percent increase over five years. And more than a quarter of those surveyed said they believe it’s safer to get high off prescription drugs than street drugs.
“Until you have alternatives to chronic pain, then the chronic pain world will continue to feed a recreational market and out of that you’ll get heroin markets,” declares Treleaven.
A dangerous game
“Heroin and nicotine have a similar rate of addiction,” Treleaven says, explaining that a monthly user has a 95 percent chance of becoming addicted. By comparison, only about 10 percent of monthly drinkers become alcoholics. “Not many people are able to use heroin for very long without becoming dependent on it. It becomes a very difficult drug for people to quit.”
Because heroin withdrawal comes with such unpleasant side effects, Treleaven says it’s one of the few drugs he doesn’t recommend quitting cold turkey. Those coming off the powerful drug may experience extreme sweating, vomiting, diarrhea, extreme muscle and bone pain, crying, and other uncomfortable effects. When more heroin seems to be the only “cure,” addicts face sometimes insurmountable temptation to use.
For young users, this come-down may be harder to avoid, since conventional detox programs are not readily available to teens and children.
“There is no medically managed treatment available for opiate-dependent youth,” says Erica Fuller-Hewitt of Rimrock, a two-decade-old treatment center in the region exclusively for teens. “We are in the process of exploring the feasibility of developing a medically managed treatment regimen—often referred to as detox—for opiate-addicted youth in our residential program.”
But sadly, some users never get the chance to try detoxing. Compounding the drug’s inherent pull, Treleaven says, is the fact that many users are naïve to dynamics of dependency, often with deadly consequences.
“The danger for heroin, of course, is if you go to jail or treatment and get clean off it for a month or more, your tolerance will go down. You have people who relapse and they’ll use the amount they were using before and that can kill them,” Treleaven says. “We’re seeing some heroin overdose deaths and far more near deaths,” he laments.
A national crisis
The trends emerging in Central Oregon are not unique. Heroin is making a comeback across the country, mostly concentrated in larger cities, but also devastating small towns.
Nationally, the estimated number of annual heroin overdose deaths—about 6,000 in 2012—has now far surpassed the peak of 3,500 annually in the 1970s, when Vietnam War vets were returning to the United States with a nagging stowaway.
Places that never saw heroin five years ago are now struggling to deal with the presence of an incisive intruder. In its January issue, GQ magazine profiled a heroin dealer in Laramie, Wyoming (population 31,814), exploring how a business-minded young man with an opiate addiction born out of a legitimately prescribed use of painkillers helped blindside the small city. And last March, U.S. Attorney General Eric Holder called the increasing number of deaths to heroin and prescription painkillers an “urgent public health crisis.”
“Between 2006 and 2010, heroin overdose deaths increased by 45 percent,” Holder said in a video released by his office. “Scientific studies, federal, state and local investigations, addiction treatment providers, and victims reveal that the cycle of heroin abuse commonly begins with prescription opiate abuse. The transition to—and increase in—heroin abuse is a sad but not unpredictable symptom of the significant increase in prescription drug abuse we’ve seen over the past decade.”
Because the drug trade is, at its core, a business, experts say drug dealers and producers are picking up on shifts in supply and demand—that is, the reduction in meth ingredients and the increase in opiate addicts.
Lt. Paul Kansky, with the Central Oregon Drug Enforcement team, says that efforts to curb the production of methamphetamine by restricting the sale of Sudafed locally and intercepting the trafficking of the ingredient internationally has put a pinch on the meth trade.
“Meth is still our primary issue drug,” Kansky admits. However, he says, “Drug dealers are a business…if they can get access to heroin, they push heroin.”