CRIME & COURTS

Iowa's surging addiction: From pain pills to heroin

MacKenzie Elmer, and Charly Haley
DesMoines

Iowa’s crackdown on prescription painkillers is pushing more abusers to heroin, spurring a deadly new wave of addictions that experts say has reached epidemic proportions in the state.

Although heroin still lags far behind marijuana, methamphetamine and painkillers as Iowa’s drug of choice, its use is climbing quickly — with deadly results.

Fatal heroin overdoses have climbed from one or two per year in the early 2000s to 20 in 2013 and 19 last year.

Experts say the heroin epidemic, which is a growing problem nationwide, is largely spurred by people who first become addicted to prescribed opiate pain medication. Then, as the pills become more expensive and harder to obtain, people move on to heroin, which is cheaper and provides a more potent high.

A single pill of painkillers such as Percocet or OxyContin can cost from $10 to $80, while a bag of heroin sells on the street for about $10, according to the U.S. Drug Enforcement Administration.

“We are at a crossroads of Interstate 35 and Interstate 80. It’s coming at us from Chicago and Omaha and Texas,” said executive director Mike Polich of United Community Services in Des Moines. “There’s lots of product out there on the streets, and it's cheaper than trying to buy the pharmaceuticals."

And users accustomed to precisely manufactured pain pills can be more prone to deadly consequences with a street-made and highly addictive drug such as heroin, experts say.

Heroin is often smoked or snorted, which makes it less "scary" than the traditional method of injection, dependency experts say. Beating heroin addiction can take users many tries.

“Opiate addiction has the most miserable withdrawal,” said John Peters, clinical supervisor of Powell Chemical Dependency Center at Iowa Lutheran Hospital in Des Moines. “They can’t sleep. They can’t stand to get off of it.”

Addict, now 1 year sober, met her match with opioids

Heroin addiction has gained more national attention in recent months as presidential candidates campaigning in New Hampshire have been exposed to the depth of the problem there.

Heroin alone or in combination with other drugs caused 97 deaths in the state in 2014, according to the New Hampshire Union Leader. And that's in a state with only 1.3 million people, compared to Iowa's 3.1 million.

While not as severe, Iowa’s problem has grown so serious that earlier this month more than 100 law officers, prosecutors, public health experts, addiction-treatment providers and others gathered for a heroin and pain-pill summit at the University of Iowa.

Experts traded information about the spread of addiction and the tragic results, as families described losing loved ones to overdoses.

Kim Brown, a nurse from Davenport, told those gathered how she lost her 33-year-old son, Andy, who overdosed roughly four years ago.

“There is so much shame and stigma surrounding the substance use disorder and death by overdose, whether it be prescription drugs or heroin,” she said at the summit.

Responding to overdoses

The Iowa counties hardest hit by the heroin surge are Polk, Johnson, Linn, Black Hawk, Dubuque and Scott, said Pat Reinert, assistant U.S. attorney for Iowa's northern district office, based in Cedar Rapids.

Heroin and other opiates such as pain pills caused half of the 310 overdose calls that Cedar Rapids police responded to in 2014, Reinert said.

In Des Moines, firefighters have responded to 145 heroin overdoses through Nov. 11 of this year, said Tony Sposeto, with the department’s emergency medical services team. That’s up from 111 in 2014 and 106 in 2013 for the same period.

Des Moines firefighters carry the medication naloxone, commonly called Narcan, which reverses the high of opiates. The medication is administered by emergency personnel when someone has overdosed to the point of near death. Those who have witnessed Narcan say it can bring an overdose victim from the brink of death back to life within seconds.

But life-saving Narcan has been on and off the national shortage list of medications for the past three years, Sposeto said.

“We have to over-buy that stock because I can’t keep it in our vending machines fast enough,” Sposeto said. “We’re probably using triple what we usually use.”

What’s more, Narcan has nearly doubled in price. Before Aug. 1, one dose cost the fire department about $14; it now costs $34.35.

Sposeto warned that if the heroin problem continues to worsen, firefighters may have to ask the City Council for more funding.

“It’s definitely a life-saving drug, and one you can’t do without,” Sposeto said.

Unintended consequences

Heroin’s surge can be traced back in part to federal and state changes tightening restrictions on prescription pain pills.

On Oct. 6, 2014, the federal Drug Enforcement Administration made hydrocodone pills, a highly abused prescription opiate, Schedule II drugs. The Iowa Board of Pharmacy subsequently passed the same rule and recommended the state Legislature incorporate the change in state criminal code.

But the Legislature didn’t take up the issue.

Still, prescribers must follow the state Board of Pharmacy rule, which allows doctors to give patients only one hydrocodone refill at a time. Previously, the pills had been designated Schedule III drugs, meaning patients could get an additional five refills in a six-month period.

Officers said they noticed a swift change after the new rules.

“Three years ago, I don’t think the general public understood how much prescription pill abuse was out there, how many people were addicted to prescription pills and how much crime there was related to that addiction, like thefts, robberies, prescription fraud to obtain pills, identity theft,” said Sgt. Brady Carney with Des Moines police.

Terry Witkowski, the Board of Pharmacy’s executive officer, wouldn’t go as far as to say that heroin use is rising because pain pills are harder to get.

But data from the state Office of Drug Control Policy show that substance abuse clinic admissions for heroin are at an all-time high — rising from six-tenths of a percent of all admissions in 2004 to 2 percent in fiscal year 2015, which ended June 30.

During that time, admissions for prescription drug use, including pain pills, dropped from 6.3 percent in fiscal 2014 to 5.3 percent this year.

Clinics are slammed

In fact, area clinics say they are seeing increasing demand.

United Community Services in Des Moines has 487 active patients in its methadone treatment program. Methadone is an opiate drug used to quell addicts’ appetite for heroin and ease withdrawals. Those receiving the medication are required to attend therapy and mental health courses.

Polich, the group's executive director, said the clinic has added capacity to keep up with demand for services.

Powell Chemical Dependency Center, which does not use methadone in its treatment programs, has operated with a growing waiting list as the demand for treatment for heroin addiction and other substance abuse grows, said Peters, the center's clinical supervisor.

It’s particularly a problem for heroin and opiate addicts, who often can’t stay off the drugs while waiting for treatment because of the excruciating withdrawal symptoms, he said.

Sometimes, by the time opiate addicts reach the top of the clinic’s wait list, they aren’t willing to go to treatment because their cravings are too strong, he said.

From injury to addiction

The problem is affecting all generations, all races and all socioeconomic backgrounds, Polich said. Many started with a legitimate injury that was overtreated with pain pills, which spawned an addiction.

Addicts start doctor shopping, or going to multiple doctors to get more pills, then move on to heroin when they can’t get what they need.

“They won’t get help until they’ve lost everything,” Polich said.

Of United Community Services’ 493 active opiate treatment patients, 47 percent are female. Just under a quarter are employed. Just over 90 percent are white; about 5 percent are black.

One of the scariest statistics for Elie Hays, a counselor at the clinic, is that 19 percent are 25 to 29 years old.

“A lot of them were prescribed this medication to start with — for the younger people, it was a sports injury. Now, I’m not saying they didn’t have addiction tendencies earlier, because some may have been using marijuana at a younger age,” Hays said. “But I don’t think they think of it as their fault to start with. They just want to get better.”

Kory Williams’ heroin addiction started with experimentation in high school. The 28-year-old from Altoona said he ran track in high school, went to state for the 4x100 relay and participated in the Drake Relays.

He started smoking marijuana, but it was when he started popping Vicodin and OxyContin that he got hooked.

“It’s like a warm blanket. It feels good,” said Williams, now a year sober.

Eventually, he graduated to injected drugs such as dilaudid, an opioid used to treat severe chronic pain. It was a strong rush, but it lasted only a few seconds, he said.

“It’s just amazing, and you get addicted to that feeling,” Williams said.

Chasing his craving, Williams discovered heroin, which was cheaper and stayed in his system longer.

He used off and on for years before he decided to get treatment. The bone-shattering pain of heroin withdrawals drove him to programs at MECCA and United Community Services.

“When you’re forced to get clean, you don’t stay clean. You have to do it for yourself,” Williams said.

All too many people are following paths similar to Williams’, said Reinert, the assistant U.S. attorney. They start with prescribed pain pills for an injury or steal the pills out of a friend’s medicine cabinet.

“They never started out as a heroin junkie,” Reinert said. “Nobody does.”

Where to get help

If you know someone struggling with heroin addiction, here are some local resources for help:

Signs of heroin addiction

According to the Mayo Clinic in Rochester, Minn., signs and symptoms of opiate or heroin use include:

  • Euphoria or feeling high.
  • Reduced sense of pain.
  • Drowsiness or sedation.
  • Slurred speech.
  • Problems with attention and memory.
  • Constricted pupils.
  • Lack of awareness or inattention to surrounding people and things.
  • Problems with coordination.
  • Depression.
  • Confusion.
  • Sweaty, clammy skin.
  • Constipation.
  • Runny nose or nose sores (if snorting drugs).
  • Needle marks (if injecting drugs).