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Thursday, Sept. 25, 2008

Hooked on Heroin

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  Seven people died of heroin overdoses in Milwaukee County last year, and six in 2006.

  That may seem like a small number of drug deaths, especially when you consider that 47 people died from overdoses of cocaine in 2007 and 76 people overdosed on coke in 2006 just in Milwaukee County.

  But the handful of heroin fatalities represents a "significant increase in the use and abuse of heroin in just the last year or two," says David Spakowicz, a special agent in charge of the drug-focused REACT Initiative for the Wisconsin Department of Justice.

  Those few heroin deaths don't reveal the overall numbers of people using heroin in rural Wisconsin towns, affluent and blue-collar suburbs or Milwaukee's urban core. They don't indicate the numbers of "overdose incidents," in which people take too much but, thanks to the skills of experienced paramedics, survive. They don't shed light on the numbers of people who use heroin just to get through the day without getting sick. The deaths don't hint at the home and retail robberies committed so that users can pay for their next hit. And the number of deaths can't begin to describe the numbers of individuals and families lost in the abyss of opiate addiction.

Supply and Demand

  Heroin has always had a presence in southeastern Wisconsin, Spakowicz says, and there have always been some hard-core users in the area.

  But things changed in the 1990s, when Colombian cocaine traffickers saw the profits that Asian producers were making on heroin, primarily China White.

  So the Colombians began cultivating their own poppies and moving the resulting heroin to the United States, targeting East Coast cities such as New York, Boston and Baltimore.

  "The eastern United States just got hammered," Spakowicz says.

  That was the source of most of Milwaukee's heroin. Now, though, Chicago is supplying the "vast majority" of Wisconsin's users. That proximity makes distribution easier in southeastern Wisconsin. Instead of taking risky trips to New York or Florida to bring back large amounts of heroin, a couple of guys can make a quick run to Chicago, score a smaller amount of heroin, and bring it back to Milwaukee to deal it here. From Milwaukee, heroin has flowed to its suburbs, surrounding counties, the Fox Valley and into Dane County.

  "The supply is there, and the demand is there, too," says Lt. Keith Balash of the Milwaukee Police Department's vice squad.

The Networks

  Spakowicz's unit was responsible for investigating the suburban heroin ring that led to the July indictment of 27 people on federal charges of conspiracy to distribute heroin. Eighteen of those named were from Waukesha County. The drug trade in this instance led to five overdose deaths and six "non-death overdose incidents" in Waukesha County.

  Although there's sizable drug use in the outer suburbs, Spakowicz says that Milwaukee is still the hub of the regional drug trade. Typically, a few users will pool their money together, a few will drive into Milwaukee to pick up the heroin, and they'll take it back to their friends in the suburbs.

  Milwaukee doesn't have Chicago-style open-air drug markets, but heroin is available if you know where to look.

  "You see a variety of both street-level deals and medium-level suppliers," MPD's Balash says. "There's no one area it's confined to."

  One of the growing hazards of driving into the city, Spakowicz says, is the presence of stoned drivers on the road.

  "They'll pick up the heroin and go to a gas station or wayside, cook up that heroin with boiling liquid, draw it into their syringe and put it in their arm," Spakowicz says. "They don't care anymore."

Who's Getting Hooked?

  Although heroin in the suburbs-in sleepy communities such as Cedarburg, Pewaukee and New Berlin-has generated the most media buzz, experts say heroin has ensnared users across a broad demographic spectrum. But a few patterns have emerged.

  Spakowicz says the bulk of heroin users are between 18 and 26, young adults who have just enough freedom and disposable income to be able to afford drugs to party with. Young adults doing drugs certainly isn't a new phenomenon, but how they fall into a heroin addiction is.

  For generations, alcohol and marijuana were the so-called "gateway drugs" that could lead eventually to experimentation with or use of harder drugs such as acid, Ecstasy, coke and, the ultimate drug, heroin.

  That's changed. Now, marijuana can lead directly to heroin, although prescription opiates such as oxycodone (OxyContin) or hydrocodone (Vicodin) often pave the way.

"Unfortunately, when you're using heroin, you're at the top of the heap," Spakowicz says. "There is no higher drug. That old progression [of drug use] used to take a number of years. Now, young people are taking that leap into heroin sooner."

  Spakowicz says these users make a big mistake in thinking that they can use heroin recreationally-often, they'll end up snorting it first at a party, then trying it again the following weekend, then using it twice on weekends and so on until using heroin is necessary to get through the day. Snorting it at first also seems less dangerous than shooting it into a vein with a needle. But that's a mistake, too.

"The biggest misconception is that snorting will not get you addicted," Spakowicz says. "It will."

  He warns that weekend partying inevitably leads to a hard-core physical addiction, complete with needles and a self-perpetuating cycle of use and dependency.

  "Once you become addicted to heroin, you need it to avoid getting sick, withdrawals that are just physically devastating to the body," Spakowicz says. "Once people get addicted to heroin, that's their goal-to keep the sick off."

  Wilfred Humes, a clinical supervisor and counselor at the Quality Addiction Management facility in Milwaukee, says that heroin withdrawal is physically punishing.

  "The things that you go through, the throwing up and the pain-it's like having the flu, but with a lot of pain," Humes says.

When the Prescription Runs Out

  In addition to the recreational users-turned-addicts are those who first became addicted to the prescription opiate painkillers oxycodone or hydrocodone, sometimes with legitimate prescriptions, sometimes not. Spakowicz says that some of these users work in the trades and were prescribed painkillers after being hurt on the job. Once their prescription runs out, though, they still want their opiate, whether it's Vicodin or heroin. They find that heroin is cheaper on the street than OxyContin.

  "Within the last year there's been a significant increase in the cost of oxycodone [on the street]," Spakowicz says. "A lot of young people can't afford it, so they switch to heroin."

  But those who are used to the predictable high they got from a regulated prescription medication aren't prepared for the unpredictability of heroin.

  "We have recovered heroin in the area of 85% pure on the street," Spakowicz says. "A lot of times, people think they're shooting up one or two bags of 30% purity and it's more than they're used to. It's the unknown."

  Humes says that he's seeing more clients who are addicted to prescription opiates than heroin. In fact, more people now die from opiate overdoses than cocaine overdoses in Milwaukee County.

  "The only difference between oxycodone and heroin is that oxycodone is more pure, you know what you're getting," Humes says. "Heroin is the same thing, but you also get the street stuff that they cut it with that makes you die quicker. It's still opiates."

The Consequences

  A fatal overdose is, of course, the ultimate consequence of a heroin addiction.

  But more common are the "overdose incidents," the technical term for nonfatal overdoses.

  Spakowicz says that local paramedics have become experts at reviving those who took too much heroin, often with the use of Narcan, which overrides the effects of heroin.

  A brush with death would seem to be a wake-up call for users. But Spakowicz says that many who have overdosed go right back to the drug-sometimes even within hours of being treated with Narcan. That's extremely dangerous, because the user's bloodstream still contains the toxic level of heroin, even if they feel that they're fine.

  Spakowicz says that those who survive overdoses aren't always charged with using heroin, nor are they ordered to go into rehab. But he said that those options wouldn't necessarily lead to the users getting over their addiction anyway.

  "If they got into the criminal justice system and had court-ordered treatment, it would be a great way to get them into rehabilitation," Spakowicz says. "But that's easier said than done. The bottom line is that the person has to want to stop using heroin."

  Humes says heroin addicts need a two- to three-year treatment program that incorporates methadone to transition the individual off of heroin, and then holistic therapy to help that individual make different life choices.

  "You can go somewhere and be detoxed, but that's not going to change the people and the places [in your life] and the things you like about heroin and why you did it all of those years," Humes says. "That's where the therapeutic part comes in. Detox is just the first step of long-term recovery. It's a process."

  He says that friends and family members have to get involved in the users' life.

  "Don't get angry at them," Humes says. "Help them seek treatment and become involved too. People get better when their support system is there and they believe that they can get better. The family is the best support unit we have."

  What's your take?

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