Editor’s Note: This is the second part of an ongoing series which will take a deeper look at heroin in the Eastern Panhandle.
MARTINSBURG, W.Va. — After 40 years in the medical field, Berkeley Medical Center Director of Emergency Services John Wilty is still surprised by the number of heroin overdose cases being seen locally – and how many patients don’t seem to understand the toll associated with this kind of drug abuse.
While there’s somewhat of a “regionalism” to drug use, Wilty has no doubt that heroin seems to be the local drug of choice.
“When I was in Alexandria, Virginia, it was crack cocaine. And when I was in Cumberland, Maryland, it was more about people huffing inhalants – like paint thinner and even some bath salts, things that were real cheap – to get high. But it’s heroin here, and I see more heroin overdoses here than the other emergency rooms I’ve worked in the last 10 years,” Wilty said.
A registered nurse who’s spent about half of his career in critical care, Wilty, who has been in this area for three years, is also surprised by how frequently some heroin addicts frequent the hospital’s emergency room.
“I have seen the same person more than once in the ER on the same day for overdosing on heroin. It’s hard to believe, but that really does happen,” he said, shaking his head at the memories.
Heroin is synthesized directly from the morphine in opium poppy seeds. It mimics the action of naturally occurring endorphins on the brain by producing euphoria and is the most addictive of all the opiates, according to medical professionals.
A State Police sergeant who works with the Eastern Panhandle Drug and Violent Crime Task Force said he’s witnessed the same kind of local transition.
“I’ve been doing this for 20 years and when I first got started doing drug work early in my career it was crack cocaine around here. I remember seeing some slides from Washington, D.C. and the heroin epidemic they were having. I also remember thinking ‘I hope we never have to deal with that here,'” he said, speaking at a synthetic drug forum held this fall at Jefferson High School.
“It was about 2000 when we first started seeing heroin get popular, and when I left here two years ago it was all about heroin. Nearly every day there is a heroin overdose somewhere in the area,” he said.
THE PAIN BEHIND THE PAIN
Another task force supervisor agreed, saying, “I would say that in the last five to eight years, heroin has taken over this county.”
Not surprisingly, most people don’t grow up hoping to became an addict – but life experiences can sometimes point them in the wrong direction, he said.
“There’s usually some type of factor, or some type of change in life that makes people go toward heroin – whether it’s an accident, the loss of a family member or a job, depression or divorce. Overall, there’s usually been some type of tough time responsible for this – your average person doesn’t seek out heroin,” he said.
Police often see a connection between heroin addiction and pharmaceutical drugs, typically when a person seeks medical treatment for an injury and is prescribed some type of medicine to help, he said.
“They either get addicted to that medication, or their quality of life is controlled by that medication which means they can’t function without it. But when that is no longer available – say the doctor cuts you off or the insurance runs out and it is too expensive to pay for out of pocket – one alternative is to get it on the streets, which usually leads to getting involved with more stuff,” he said.
“And if you want something stronger, or maybe cheaper, that’s where heroin comes into the picture.”
HEROIN’S PHYSICAL TOLL
While heroin is typically sold as a white or brownish powder, most local users prefer “cooking” or melting it down into a liquid that can be injected into a vein by using a hypodermic needle, according to a task force supervisor .
“That’s because it’s the best way to get high fast, injection causes the quickest response,” he said, adding that the powdered form can also be snorted or smoked.
Jefferson County Health Department health officer Dr. David Didden said since it is a fast-acting opiate, this also means heroin enters the brain quickly – producing an almost immediate “rush” or surge of euphoria that’s craved by individuals who become addicted to it.
The user will get a dry mouth and his or her skin will flush. The user’s pupils will be constricted. He will feel heavy and dopy and may fade in and out of wakefulness. This drowsy state is known as being “on the nod” and addicts may nod off suddenly. Breathing will be slowed, which is how an overdose kills.
Over time, however, heroin users tend to become tolerant to the drug and need more to achieve the desired high – a cyclical pattern that often ends in physical addiction.
Didden, who also volunteers as a physician educator with the Maryland correctional system, has heard horror stories from medium-security inmates at the Roxbury Correctional Institute in Hagerstown about how heroin destroys bodies, minds and families.
“Many of these guys were involved in the heroin trade in Baltimore, either as addicts or distributors. And their main message was to stay the ‘bleep’ away from it,” he said.
But Didden, who has a family practice in Harpers Ferry, has also seen this scenario unfold for himself as a medical professional.
Heroin doesn’t respect age, community boundaries, income levels or professionals, he said.
“If it’s your kid, it’s worse. You cannot imagine being in the emergency room and not knowing if they are going to be able to get oxygen. You cannot imagine seeing them in respiratory distress and having to get intubated,” he said.
“So as bad as you think it is, it’s worse,” Didden said.
Since heroin is often injected intravenously, it has also been linked to transmission of human immunodeficiency virus (HIV), hepatitis (especially Hepatitis C), sexually-transmitted infections and other blood-borne diseases, mostly through the sharing of contaminated drug paraphernalia, medical experts say.
NUMBERS DON’T LIE
Officials now fear that ongoing efforts to crack down on so-called “pill mills” and doctors who over-prescribed prescription drugs may play a role in the nation’s rising heroin abuse rates, especially since it can be cheaper and easier to obtain in some communities, according to the National Institute on Drug Abuse.
NIDA figures show that the number of “past-year heroin users” in the United States nearly doubled between 2005 and 2012, from 380,000 to 670,000.
In addition to possibly dying from an overdose, heroin addicts are also at risk because the drug is not regulated and is sometimes “cut” with other dangerous substances, including fentanyl -a potent prescription opioid that is also abused by itself, the NIDA states.
Data from the state Health Statistics Center shows that the number of people dying from heroin overdoses was 22 in 2007, but had increased to 67 deaths in 2012 -roughly tripling in those five years.
And just between 2011 and 2012, heroin overdose deaths in West Virginia increased from 41 to 67 – a 63 percent jump, according to state data.
Berkeley County had the state’s highest overdose death rate with 36 people having died from heroin overdoses during that same five year period.
Things are now comparatively worse locally, because since April there have already been 23 heron-related deaths in Berkeley and Jefferson counties, based on current task force numbers.
IN THE FIELD, ANSWERING OVERDOSE CALLS
Berkeley County Emergency Ambulance Authority officials say the overall volume of overdose calls hasn’t changed much in the last year, but they are ready whenever this kind of medical attention is needed.
EMS Director Robyn Fowler said this type of call made up about 3.5 percent of the agency’s approximately 7,700 calls in 2013 and about 3.1 percent this year, through November.
However, specific types of overdoses – such as heroin -are not singled out, she said.
In comparison, calls for shortness of breath account for about 9.6 percent of the total call volume, while chest pain calls are about 8 percent, Fowler said.
“So even though overdose calls are on the lower end of the volume we do, that’s not to say we don’t see them, because we do and we see them in various forms. But whether we’ll be able to treat them in the field depends what an individual overdoses on,” she said.
“If we walk in and someone is unconscious, maybe not breathing, we have certain things we look for to determine if it’s an opioid or heroin overdose – and we can give the drug Narcan to those people,” she said.
The drug, which helps reverse the effects of opiates, can either be given by a shot or an atomizer, which can be used to mist inside the patient’s nose, Fowler said, adding that many addicts’ veins have collapsed due to shooting heroin and can’t be used to administer medicine.
Since heroin depresses the body’s respiratory drive – it relaxes and almost forgets to breathe -Narcan “kicks the heroin off the outside of the cell, doesn’t allow it to attach,” according to Fowler.
Narcan works quickly, she said, adding, “Patients go from lying there and not breathing, to being up and about talking to you – although most of the time they either don’t remember what happened or just don’t want to tell us.”
Beginning in January, EMTs will join paramedics in being able to administer Narcan, Fowler said.
There’s also a growing movement nationwide for this drug to be available to the public. That would be especially helpful to parents or friends of heroin addicts, she said.
But its effect doesn’t last long, typically less than an hour, so it is possible an individual will relapse depending on how much heroin was taken and how long ago, said agency executive director Brian Costello.
“So when the Narcan wears off, the heroin in their system is going to kick back into action if it was a strong enough dose. But many people don’t seem to know that or understand they do need to be monitored for a couple hours, to see that the heroin has been metabolized enough not to be a problem,” he said.