Fifth heroin-related death recorded in five weeks in Jefferson County
Trendy' in wealthier areas as deaths surge
Five times in five weeks, there has been a heroin-involved death in Jefferson County.
It is an unprecedented number for such a short period in metro Birmingham - the kind of number that doctors and cops used to count in a year.
In 2007, for instance, the county had seven heroin deaths. Last year that figure almost doubled, to 13.
This year, 16 people have died, or are suspected to have died, from the drug in Jefferson County, some with needles still protruding from their veins and tourniquets wrapping their arms.
It is a deadly game.
"Every time they shoot up, it's like playing Russian roulette," said Dr. Diamond Vrocher, assistant professor of emergency medicine at UAB. "The margin of error is very small. If you shoot up and there's nobody around, you might not wake up."
And those shooting up aren't just the stereotypical junkies from decades past.
"It has bled over into the suburban, white, wealthier areas, which is something we've never had here," said federal Agent Greg Borland, who heads the Drug Enforcement Administration office in Birmingham. "It's trendy, and it's a very significant problem that's growing daily."
It's a growing trend nationwide. In New York City, heroin abuse killed 650 people last year. On an average weekend in New York, five heroin fatalities are reported, but during the last weekend in June, that number rose to 24, according to Time magazine. That's an increase of almost 500 percent.
Authorities blame the rising death rate on an increase in availability, the level of purity of the drug, the constant effort by users of all descriptions to recreate yesterday's high and their naivete in doing so.
"We used to never see this stuff. It was rare," said Andy Robinson, a pathology professor and director for forensic toxicology at UAB. "I don't think it's bad heroin. I think it's inexperience."
Statewide, outside Jefferson County, toxicologists found evidence of heroin in four deaths in 2008, and eight so far this year.
"Does that mean the rate of heroin use doubled?" said Dr. Jack Kalin, toxicology discipline chief for the Alabama Department of Forensic Sciences. "The numbers say yes, but it's an increase of four (deaths)." His department performs death investigations for the 66 Alabama counties outside Jefferson County.
Heroin quickly metabolizes into morphine. If someone injects heroin at 8 a.m., as soon as 8:10 a.m. it can show up in drug screens as morphine. Because of that, authorities say many of those morphine deaths could have involved heroin. Anecdotally, they suspect the numbers are high since morphine is not a popular recreational street drug.
In 2008, there were 77 deaths in which morphine was present in toxicology tests. In those cases, about half were suspected overdoses; the rest were gunshots, hangings, car accidents and so forth. Only four of those were positively heroin, Kalin said.
So far this year, the number of deaths showing morphine has risen to 102.
It's important to note, Kalin said, that in none of the cases was heroin or morphine the only substance that showed up in testing. Most tests revealed a "poly-pharmacy" of drugs in a user's system, ranging from cocaine to antidepressants to ethanol.
"The combinations are what I find incredible," Kalin said.
`A huge increase':
In addition to the confirmed heroin-involved deaths in Jefferson County, authorities have seen a sharp increase in morphine deaths as well, Robinson said. There were 19 overdoses involving morphine in 2007, nearly doubling to 35 so far this year.
The prevalence is not just reflected in deaths. Doctors say they have seen an influx of overdoses showing up in the emergency room.
"Several of us that work in the ER have been talking about it," UAB's Vrocher said. "We're seeing a huge increase."
Vrocher has been in UAB's ER six years. In the first five, he took care of fewer than a half-dozen heroin overdoses, he said. "In the past month, every shift I work, there is someone there for heroin-related problems, whether it's overdose or withdrawal."
Paramedics carry with them medications that can reverse the heroin toxicity, he said, and if it is caught fast enough, the patients can be saved.
The majority of patients Vrocher has seen are young and white. "It seems like there's been a number of late teens and college students," he said. "My guess is the suppliers are targeting the teenagers."
Vrocher said people need to be aware there's a fine line between the euphoric dose and the deadly dose.
"They are novel users and they don't know what effect the dose is going to have on them," he said.
Seeking higher highs:
In the current drug culture, there has been widespread use of methamphetamine, Dilaudid and OxyContin by drug users who now are becoming desensitized to those drugs and are turning to the more powerful heroin, veteran drug investigators say.
Experts say the crossover is great and contributing to heroin abuse.
"There definitely is a resurgence of opiate addiction, especially painkillers, and heroin is part of that as well," said Robby Keeble, a Birmingham-based recovery specialist. "I haven't really differentiated because they interchange so rapidly and readily. When they can't find one, they use the other."
And that's becoming easier with heroin's growing availability.
Heroin costs the user about $50 for a 10th of a gram, compared with $50 for a gram of cocaine, drug deputies said. The drug dealer can buy a kilogram of cocaine for $22,000 to $25,000, while a kilogram of pure heroin goes for about $100,000.
"But once they break it down, the profit is so much higher on the heroin," said Jefferson County sheriff's narcotics Sgt. J.M. Davis.
An average, a heroin injection is about a 10th of a gram. Regular users can spend up to $500 a day on their habit.
Investigators say rising Mexican heroin production and purity may be contributing to the increase in heroin use in some areas. Methamphetamine from Mexico has decreased because of the tight restrictions put on sales of its key ingredients, such as ephedrine.
"They're losing profits on meth, so they've stepped up the flow of heroin into the U.S.," Davis said.
And the purity can be nothing short of lethal.
Purity as a lure:
That, authorities say, is key. Heroin is plentiful and cheap at the point of origin; it's just not worth the dealer's time and trouble to cut the purity.
From the 1960s to 1980s, heroin was only about 10 percent to 25 percent pure, drug investigators said. Now it's running more than 40 percent pure and, in some cases, between 87 percent and 92 percent pure.
"You don't get a certificate of analysis" with street purchases, Kalin said.
Dealers dole out the purer heroin in an effort to lure customers away from other dealers who are cutting it with powdered milk, laxatives, strychnine or other substances.
"They want everybody to come to them," Davis said. "A lot of these people we deal with are bragging about putting people in the hospital. ..."
The increase in purity also opens up the market to people who can snort it or smoke it, for those who aren't yet ready to inject it.
"But every time you use it, you have to use a little more to get the same effect, so most of the people snorting it will end up injecting it," Davis said.
Dealers are targeting the 16-24 age group, deputies say.
"These kids are falling victim to it hard," Davis said. "A lot of their parents have money and these kids are spending it."
County investigators worked a case in which two young women blew through $100,000 in inheritance money in six months on heroin.
DEA's Borland said the stories investigators see and hear are heartbreaking.
"One of the things that makes this drug so insidious is that parents and communities are prone to deny it as a problem," he said. "It is so foreign to what people in wealthy communities are used to, they can't even acknowledge the possibility. Somehow they think it's more shameful than any other drug."
As the problem continues to grow, especially in areas where heroin has not been prevalent before, Borland pleads with parents to tune in to their kids and their kids' friends.
"As parents, we tend to map out our children's futures and we don't include drug abuse on that map," he said. "The drug-abuse indicators are there across the board, and you have to be willing to see them."
Sunday, September 27, 2009
News staff writer