DURHAM — Long before the overdose death of actor Phillip Seymour Hoffman thrust heroin back into the headlines this winter, the return of the potent narcotic was already known to police and public health officials in North Carolina.
Heroin, which emerged in popular culture in the 1940s as an exotic product associated with jazz musicians and later became known as the dead-end drug of junkies in movies and songs, had never gone away. A few dozen people died of heroin overdoses in North Carolina each year since 2000, according to the state Department of Health and Human Services.
But in 2012, heroin deaths nearly doubled statewide, to 148, while overall deaths from all narcotics and hallucinogenic drugs ticked up only slightly. WakeMed hospitals throughout Wake County admitted 50 people for heroin overdoses in 2013, more than twice the annual average of the previous five years, said spokeswoman Kristin Kelly.
At the same time, police say the amount of heroin they’ve found in drug arrests has soared.
In Durham, police seized about 4 pounds of heroin last year, more than five times as much as in 2010, said spokeswoman Kammie Michael. In Raleigh, heroin seizures went from less than a pound in 2010 to nearly 24 pounds last year, said spokesman Jim Sughrue.
The surge in heroin use comes after what the Centers for Disease Control and Prevention called a nationwide epidemic of overdose deaths involving opioid pain relievers, including OxyContin, methadone and hydrocodone. In 2008, overdose deaths from opioid prescription drugs accounted for more than heroin and cocaine combined, the CDC reported in 2011.
Public health officials say the resulting crackdown on pills has driven up the price and helped fuel the switch to heroin.
“Some of these prescription medicines sell for $40 a pill,” says Robert Childs, executive director of the N.C. Harm Reduction Coalition, a statewide public health and drug policy reform organization based in Durham. “That’s on the extreme end. Most cost less. But if you can get a bag of heroin for $5 to $20 instead of paying up to $25 or $80, it’s really a simple choice to users.”
And the new generation of heroin users may not be familiar with the dangers, resulting in more overdoses and deaths from a drug that can be injected but also snorted or smoked.
Tessie Swope Castillo, who works as an advocacy coordinator with the state’s Harm Reduction Coalition, said the agency has “seen an anecdotal increase in the popularity of heroin, especially among young, white people and people of affluence.”
“People who might never have started using heroin because of stigma against it or fear of needles, for example, started on OxyContin and became addicted,” Castillo said. “And when their Oxy supply was cut off or became too expensive, they got desperate and turned to heroin.”
Crackdown on opiates
The state legislature passed a bill last year that beefed up the state’s prescription drug reporting system that aims to crack down on opiate-based prescription drug abuse. The bill, signed into law by Gov. Pat McCrory, was strongly supported by the N.C. Child Fatality Task Force after it found more and more young people abusing drugs such as oxycodone, OxyContin and Percocet.
The bill revised an earlier law that established a statewide reporting system to improve North Carolina’s ability to identify people who abuse and misuse prescription drugs. The law was also enacted to help medical providers identify patients who may be abusing prescription drugs.
The revised law now requires a shorter reporting period and increases the penalties for violations.
Scott Proescholdbell, who heads the injury epidemiology and surveillance unit with the N.C. Department of Health and Human Services, says the new law may prompt some pill users to switch to heroin but does not think it’s a “one to one” corollary.
“There are probably some instances,” he said. “But the other big driver is economic. A 30 milligram pill of oxycodone sells for $20. A bag of heroin costs $10.”
Castillo agreed. She said the intent behind the law was to help alert medical providers about patients who may be “doctor shopping.”
“I don’t know whether [the law] has actually reduced prescription drug abuse, but that certainly was its intent,” she said. “These types of laws have become very popular recently and most states have them, but the jury is still out about whether they actually reduce prescription drug abuse or merely divert abuse to other drugs.”
Childs explained that many of the young users who are now dying of heroin overdoses grew up in a “pill culture” and would pop pills that they had taken from family members or from a friend. He and other experts wonder if former narcotic pill users are turning to heroin, with disastrous results.
“We hadn’t seen such a spike in heroin deaths,” he said. “For people who have been using a long time, there was no change in the overdose rates. It’s the new users who don’t know what they’re doing. They can’t figure out how strong the heroin is. Sometimes, if they are worried about police involvement, they will rush to use the drug and not have a good overdose prevention plan. A bad plan is using by yourself, with no one there to call 911.”
Law helps with overdoses
The governor signed another bill into law last year that’s meant to reduce drug overdoses by giving limited immunity to someone who seeks medical help for a person experiencing an overdose. The so-called good Samaritan law grants someone immunity from criminal prosecution for possessing less than one gram of heroin or cocaine if they were seeking assistance for a drug-related overdose.
The law also allows users, their friends and family to use the drug Naloxone to revive people who may be dying of drug overdoses. Last week, the Food and Drug Administration approved a device that automatically injects the proper dose of Naloxone.
The government has not published statistics for drug overdose deaths in 2013, but Proescholdbell says that since McCrory signed the bill into law in June, nearly 50 people who would have died from drug overdoses were revived.
Catherine Harper of Charlotte, a former heroin user, works as an outreach worker for the Harm Reduction Coalition distributing Naloxone to people in her social circle who are addicted to heroin and their friends and families. In three months, Harper says, Naloxone has revived seven people she knows who would have died of heroin overdoses. They range in age from 17 to their mid-30s.
“It’s so amazing,” said Harper, 27. “I have met with the parents who have lost their children to overdoses. It’s good to know there are parents who don’t have to go through that.”
Another challenge facing law enforcement and public health officials is the seemingly endless supply of people willing to sell illicit drugs – people such as Steve “Mannie” Manning of Durham. Now 30, Manning was 12 when he first started selling crack cocaine, a path that led him to heroin trafficking charges in 2012.
Manning was in jail in Durham awaiting trial when he met Castillo of the Harm Reduction Coalition. Castillo spoke to him about the debilitating effects the drug he was selling had on individual users and the community. Castillo offered him the chance to do outreach work in some of the same neighborhoods where he used to peddle dope. He jumped at the chance.
“So I knew the harm it was doing to people versus me just out here making a dollar,” he said.
Now at least three days a week, Manning straps on a backpack filled with condoms and hands them and other safe-sex materials out to residents in Durham neighborhoods that may have little or no access to resources to help diminish the direct or indirect effects of heroin abuse.
The CDC reports that injecting drugs was responsible for approximately 10 percent of new HIV cases between 2008 and 2011.
“The Harm Reduction Coalition is about taking a dangerous activity and making it less dangerous,” Castillo said. “Obviously unsafe sex is a dangerous activity.”
The federal trafficking charges against Manning were eventually dismissed, although he was convicted in state court of felony possession of cocaine and sentenced to probation.
Manning’s outreach efforts include Wabash Street in the McDougald Terrace public housing complex in southeast Durham, where residents know him.
“I been doing this for over a year, since 2012,” he said. “They call me ‘the Health Department Man.’ ”
Castillo said she asked quite a few of the people locked up on drug charges to do similar outreach in their communities.
“Mannie was the only one who called,” she said.