Text by David Owens, Hartford Courant; video by Crystal Hall, FOX CT
Accidental heroin deaths in Connecticut last year were up 48 percent from 2012, mirroring a trend across New England and the nation that the U.S. Attorney General Eric Holder on Monday called an “urgent public health crisis.”
In Connecticut, 257 people died from heroin-related overdoses in 2013, up from 174 in 2012, according to data released by Chief Medical Examiner James R. Gill. In Hartford County, heroin overdose deaths increased 55 percent over the same period, to 82 in 2013 from 53 in 2012.
Heroin-related deaths and accidental overdoses have been on the rise throughout the Northeast. Authorities in Pennsylvania, Rhode Island, Massachusetts, Maine and Vermont have all reported significant increases in overdose deaths.
Vermont Gov. Peter Shumlin devoted most of his state of the state address in January to Vermont’s heroin problem, which he called an “immediate health crisis.” Fatal overdoses there nearly doubled from 2012 to 2013.
Heroin deaths nearly doubled from 2012 to 2013 in Hartford as well, and last month city police took the unusual step of warning addicts about an especially nasty batch of heroin contaminated with the synthetic opiate fentanyl. Heroin overdoses killed 31 people in Hartford in 2013, compared to 16 the previous year.
Accidental deaths from all drugs — including heroin, cocaine, morphine, codeine and mixes of drugs — increased 38 percent in Connecticut to 490 in 2013 from 355 in 2012, according to the data.
The steep death toll has continued into 2014, police said, although some overdose data are not available.
East Windsor has had four confirmed fatal heroin overdoses since Nov. 1, police said, and heroin is suspected in the deaths of three other people there as well. Fourteen-year-old East Windsor High School student Megan Koscinski died on Feb. 16.
“I would say 2014 is certainly going to be consistent with the rise in 2013,” Hartford Deputy Police Chief Brian Foley said. Hartford narcotics detectives are “attacking it head-on,” Foley said. “It is getting the majority of our narcotics attention right now. We’re working with outside municipalities as necessary.”
The especially dangerous heroin-fentanyl mix has attracted much attention, but the larger problem is the dramatic increase in the number of people using heroin, said Dr. Danyal Ibrahim, chief of toxicology at St. Francis Hospital and Medical Center in Hartford.
Efforts to curtail abuse of prescription opiates such as oxycodone have pushed addicts to heroin, he said.
Abuse of prescription opiates such as OxyContin began to emerge in the 1990s and exploded into a serious problem in the early 2000s. To curb abuse, the drug manufacturers reformulated OxyContin to make it more difficult to abuse, and the government aggressively prosecuted doctors who improperly prescribed the drugs. The reformulation made it more difficult for addicts to crush the drug into a powder they could then snort or inject.
Some addicts found ways to overcome the new formula. Others moved onto more readily available and less expensive heroin, Ibrahim said.
“If I am an addict on Vicodin or Percocet now experiencing withdrawal, an alternative is heroin because it works on the same receptors [in the brain],” Ibrahim said.
Theodore J. Cicero, a professor of neuropharmacology in psychiatry at Washington University in St. Louis, and a team of researchers noted the migration of prescription drug abusers to heroin in 2012 as a result of the reformulation of prescription narcotics.
They were so alarmed at what they found that they alerted the medical community in a letter to the New England Journal of Medicine. “It’s a very new development [in] the last two to three years,” Cicero said of the dramatic increase in heroin use by people who were abusing prescription drugs. “We’re beginning to see all across the country an increase in overdose deaths.”
Heroin use, which used to be confined mostly to cities and minority communities, has moved forcefully into the suburbs and rural areas. And the driver, Cicero said his research shows, is prescription drug abusers no longer able to get their hands on oxycodone who have moved on to heroin. “That’s a very ominous development.”
“Dealers have transitioned from shady people in the inner city to teenagers you go to school with, you work with,” he said. There’s also been a troubling change in attitude about heroin, he said.
“The whole social stigma with heroin has dissipated over time,” Cicero said. “We see kids skipping right over prescription opiates and jumping right into heroin.”
Although injecting heroin still carries a stigma, dealers introduce prescription drug addicts and others to heroin by telling them they can snort it or smoke it. Heroin is so addictive, though, that it’s only a matter of time until users inject it.
The life of a heroin addict is already dangerous, especially for one who abuses heroin intravenously. Infections and diseases from sharing needles are a constant threat, Cicero said.
Prescription medications are predictable when they are abused. Users know the dose and what they are taking. Street drugs could be anything. Dealers add substances to heroin all along the supply chain so that he or she can increase profits.
“You can take a tablet, you can see a number on it, you can know it’s oxycodone at a certain dose,” Cicero said. With heroin, “you’re buying a powder. The purity is uncertain. Addicts know that it’s not pure, but they don’t know exactly what the composition is. They make a guess at what the purity might be, inject, snort it … and they end up dying.”
And that’s before heroin is mixed with fentanyl, which dramatically increases the chances of death in a heroin user.
Sometimes what is presented as heroin is pure fentanyl, said Lt. Ken Cain, head of the state police Statewide Narcotics Task Force. Other substances used to cut heroin include Benadryl, methadone, benzodiazepines and even veterinary drugs.
“Most drugs are not pure,” said Dr. Kelly Johnson-Arbor, a toxicologist at Hartford Hospital. “What do you expect when you use heroin? Almost all of the heroin supply in the U.S. is contaminated. It’s no surprise that we’re seeing contaminants.” The fentanyl, she said, “is a particularly bad one that causes more problems.”
Cain said he suspects success in treating heroin addicts has also led to intoxication deaths. Addicts get into treatment, get clean and go to live in sober houses, he said.
“When those people relapse, they are more susceptible to overdosing and dying because their bodies are not used to the heroin,” Cain said. “You get clean people who used to use 10 bags of heroin. They relapse. They get the same 10 bags and they put it into their body again.” Their body can’t handle it and they overdose.
Hospitals treat every heroin case differently because doctors can’t know what the addict injected, Ibrahim said.
People who have accidentally overdosed are typically treated immediately with naloxone hydrochloride, which is also known as Narcan. The drug can dramatically reverse the results of an accidental overdose, and health officials are pushing for it to be widely available.
On Monday, Holder encouraged law enforcement agencies and first-responders to carry the drug.
Narcan is mostly useless to an addict unless there is someone nearby who can administer it.
“Narcan can be prescribed to people who live in close proximity to those who use opioids,” said Mary Kate Mason, a spokeswoman for the state Department of Mental Health and Addiction Services. “You can’t give it to yourself. You have to have friends or relatives available.”
Paramedics can administer Narcan in Connecticut, and advocates are working to get Narcan into the hands of other first-responders, including police, firefighters, emergency medical technicians and others who would be in a position to aid someone who has accidentally overdosed.
“Connecticut is behind,” said Shawn Lang, who has been working with an overdose prevention group the past year to get Narcan into the hands of those can use it to save lives.
“We would love Connecticut to model basically all our surrounding states so all first-responders — police officers, EMTs, firefighters — have Narcan available and can administer it,” she said. “They’re often the ones who arrive at the scene first. Those minutes are critical.”
Police acknowledge that arresting drug dealers and seizing drugs will never solve the problem. Addicts need to have access to treatment and follow-up support to keep them from relapsing.
Cicero said his research, which includes surveys of and interviews with addicts, indicates there is a significant mental health component for many who become addicts.
“It’s really very striking how psychiatrically problematic these individuals are,” Cicero said. Addicts very often suffer from depression, anxiety and phobias.
“We find people are taking them to escape from life,” Cicero said. “They want to blunt their emotional issues, feel better about themselves. We need to attack those fundamental problems.”
The approach has been to treat substance abuse as an entity in itself, Cicero said. “What we’re suggesting is it’s a symptom of a larger problem. “You see how poorly people think of themselves and how much better they feel on drugs. There’s something fundamental going on that we need to be addressing. From my perspective, that’s the demand issue.”
“When confronting the problem of substance abuse, it makes sense to focus attention on the most dangerous types of drugs,” attorney general Holder said. “And right now, few substances are more lethal than prescription opiates and heroin.”