This is the third in a three-part series about the problem of heroin in North Carolina. (Parts one and two are below.)
Heroin in NC Part Three: Bible Study
North Carolina is not immune to the nation's growing heroin problem. The number of overdose deaths in the state has quadrupled in just a few years. More people are seeking treatment. In our final installment of the series, Jeff Tiberii reports on efforts to re-open a shuttered clinic in High Point.
Jennifer Harris has two kids, lives with her boyfriend and works as a waitress and bartender in High Point, N.C. She says she first smoked marijuana as a teenager, went through an abusive relationship and a bad divorce. She tried cocaine, got hooked on opiate painkillers and then like many others, moved to heroin when the prescription went dry.
"A heroin high and a pill high - I ain't going to lie - it's amazing, you have all the energy in the world, you feel like you're Superwoman," she says.
At one point Harris was spending $400 a day on the street. She describes the falls after that state of exhilaration as nasty.
"You're heart is racing, you're sweating, you are throwing up all at the same time. You need a toilet and a trash can. You can't move. I can't even explain it to you. I would really rather have my brains blown out than have to deal with that."
Harris says she has been clean for two years. The 31-year-old has improved in part because of methadone, a drug she takes every day. It's an FDA approved synthetic opioid designed to help ease withdrawal symptoms for addicts.
People are ashamed to come in and get help
Ron Rau is the Executive Director of Alcohol and Drug Services (ADS) in Guilford County. He's been battling the stigma attached to addiction for years. He says strategies like "just-say-no" or quitting cold turkey, rarely work long-term when it comes to opiates, including heroin.
"This compulsive need to satisfy the opioid receptors in the brain has to be healed. It's no longer a matter of about just saying no, because your brain has changed."
ADS had a methadone clinic in High Point, but due to considerable budget cuts it closed two years ago. It's now the largest city in the state without such a facility.
Making matters worse is a powerful batch of heroin that hit this area in April. Police say in less than six months there have been 102 heroin overdoses and 11 deaths. (In all of 2013 there were only 17 overdoses and one death.) Rau is seeking a quarter million dollars to again provide services.
"Certainly for $250,000 we could reestablish our methadone clinic here and the ancillary services that would go with that," he says.
Critics
There are critics of methadone. It's a high-risk treatment in which the programs are regulated very tightly. Too much methadone is fatal. Dr. Jim Finch is an addiction specialist in Durham. He has been working in the area of opiate addiction for 20 years.
"Methadone programs vary widely. Some programs are very conscientious and others are not so much," he says. "Some methadone programs have physicians who are prescribing the methadone that really know what they're doing and are knowledgeable. Some are not particularly experienced at all."
Finch notes some doctors are over-prescribing methadone and other pain pills. He recalls a conversation with one patient.
"I said 'Well, do you have enough methadone to last you until you can get into treatment?'
And he said 'No, and I hate to go back to my friend's grandmother to buy more.'
And I said, 'Your friend's grandmother? What's that about?'
And his wife chimed in and said, 'Yes there is a group of grandmothers in our town. They have a Bible study group, and everybody knows where Bible study meets that week because after Bible study they all stick around and you can drop by and buy their 'extra medicine.'
More people die from overdoses of prescription painkillers than die from heroin overdoses. However the heroin deaths are increasingly rapidly, while prescription painkiller deaths are decreasing slightly.
"Every person I admit to treatment almost invariably says, 'You know I know five or 10 people that need to be in treatment, so we know there is a lot of unmet need," says Finch.
Clinicians say even more control of narcotics is needed and increased public awareness will encourage others to seek help.
Heroin in NC Part Two: A Quick Fix
The number of people overdosing on heroin is rising in Guilford County, many parts of North Carolina and across much of the nation. Local officials say a particularly lethal batch of heroin is a main reason for the problem here. First responders, non-profit agencies and regular citizens are working to distribute and administer an emergency agent and saves lives.
Thirty-eight people died from heroin overdoses in North Carolina four years ago. That figure soared to 183 last year. Officials say the deaths represent only a small fraction of the total number of overdoses.
Richard Matthews is a field training officer with Guilford County EMS. On a recent day he was rooting around inside the back of an ambulance, opening compartments and unzipping gear.
"This is our main med bag right here ... Here's the NARCAN," he says.
NARCAN, generic name Naloxone, is an opioid antagonist - it reverses the effects of heroin and prescription pain killers. Think of it as similar to an EpiPen. First responders can use it in an attempt to bring someone who has overdosed back around, if they arrive in time.
Matthews describes what he does when he's called to respond to someone who's overdosed on heroin. He's got a saline flush, he'd tie a tourniquet, start an intravenous line. Then, he says, "I would start that NARCAN and just push it - in small increments."
The EMS crews here have carried NARCAN, or naloxone, for years. In response to the growing number of heroin deaths and overdoses in the state, however, this medicine is being used twice as frequently and with more success.
Access
Doctor Anthony Steele is with Alcohol and Drug Services (ADS) of Guilford County. He says it's important that the drug is widely available -- and not just to professionals.
"Make this medication readily available to individuals who may be in situations that may be in their home ... or whatever, to have this medication available to bring someone out of an overdose state," Steele says.
The General Assembly passed a bill last year making access to the drug easier. Since then, the North Carolina Harm Reduction Coalition has handed out more than 4,300 Naloxone kits to friends and family members of addicts.
Jim Albright is director of the county EMS. He says the kits are simple to administer and have very little risk, but that many people don't understand that the drug may take several minutes to work. In addition, he says, it may cause people to not feel well.
"When you take away the narcotic that their body is so desperately craving, they have a tendency to get quite ill," Albright says.
Increased Distribution
Last week the Harm Coalition and ADS announced increased distribution efforts in High Point. There is a growing need.
2013:
- 17 heroin overdoses
- 1 death
2014 (so far):
- 102 heroin overdoses
- 11 deaths
The Harm Coalition reports more than 150 civilian reversals (situations in which there was an overdose, the drug was administered, and the person survived.) The coalition suspects use of the drug is more prevalent, though, because overdoses are often under reported.
"What we've got to do as a community is to look for ways to get more awareness, so that people don't feel isolated, ostracized, stigmatized to the point that they suffer in silence," says Steele. "And then you have cases where they are overdosing because of the fear of being alone in this thing."
The Pitt County Sheriff's department carries the kits, which generally range from 10 to 30 dollars each. Additionally, Carrboro Police are planning to equip all officers with Naloxone kits by the end of this month.
'What we've got to do as a community is to look for ways to get more awareness, so that people don't feel isolated, ostracized, stigmatized to the point that they suffer in silence.'
"I think the only concern about access to Naloxone is to make sure it's combined with education and a move towards treatment," notes Dr. Jim Finch. Finch is an addiction specialist, with a practice in Durham.
He believes local organizations and first responders like EMS are providing users with information about risks and treatment -- and that might provide a silver lining, that word is getting out on the street about the issue.
Long Term vs. Short Term Fix
Even with increased awareness and availability of emergency medication, Naloxone is still simply just a short term fix.
The long-term treatment for many addicts includes methadone - an FDA-approved synthetic opioid. It's designed to help users avoid withdrawal symptoms and reduce their dependency on illegal drugs. But it too can be lethal.
High Point is the largest city in the state currently without a methadone clinic. It closed after budget cuts two years ago. Some say it needs to re-open.
Heroin in NC, Part 1: The Rise in Overdoses And Death
More and more people across the U.S. are dying from heroin. A recent government report says heroin overdose deaths in the nation doubled during a recent three-year period. The deadly upward trend is taking place in North Carolina as well. Jeff Tiberii reports that the number of overdoses in High Point, N.C. spiked dramatically this year.
Heroin is a dangerously addictive opioid. It gives users a euphoric high for less than the cost of a decent lunch. Too often, users become addicts and then they can't stop.
"I woke up with the needle in my arm - and I don't know how long I was gone. I just remember my baby knocking on the door crying," says Brandi Martinez, wiping away tears while describing a battle with addiction.
Heroin is also known as H, smack, or black tar. It has dozens of nicknames - and many chemical variations. A new one came to the region in April.
"Often times it has been mixed with an agent called Acetyl Fentanyl, which makes it at least five times more powerful than standard heroin," said Jim Albright, Emergency Services Director in Guilford County.
Acetyl Fentanyl is a designer drug that has no medicinal purpose in the U.S. Its potency is alarming. The High Point Police Department recorded 17 overdoses in the city last year - with one death. Through the first weekend in October this year, there have already been 102 overdoses. Eleven of those people have died. Per capita those numbers dwarf what has been reported in Charlotte, Raleigh and bigger cities across the state in recent years.
"We have gone and done a lot of research and looked at our calls to determine that these are heroin overdoses. I think this is what everyone else will be seeing if they unpack their numbers as well," explains Ken Shultz, the assistant police chief. He believes the count is more accurate this year.
High Point Is Not Alone
The Centers for Disease Control and Prevention just did some "unpacking of numbers" and found that heroin deaths in the US doubled between 2010 and 2012. The report also shows that though heroin deaths are on the rise, deaths from overdoses of opioid painkillers (including things like OxyContin) are decreasing. That national data stops there. But state statistics show the trend of heroin overdoses and deaths continuing to rise significantly through 2013.
Supply and Demand
"It can be as simple as what's the access to a particular grade of heroin in a particular community: Who's dealing it, how's it coming into that community," says Dr. Jim Finch, an addiction specialist with a practice in Durham. Finch adds that the problem can also be caused by international, geo-political choices such "as the U.S. choices in Afghanistan to not adequately suppress opium production."
Across a four-year period, heroin overdose deaths in North Carolina climbed from 38 to 183 - an increase of 450 percent.
Across a four-year period, heroin overdose deaths in North Carolina climbed from 38 to 183 - an increase of 450 percent.
"We're seeing people dying - or overdosing - in the bathrooms of restaurants; we're seeing people overdosing on park benches, we're seeing people overdosing in their homes," says Dr. Anthony Steele. Steele works for Alcohol and Drug Services (ADS), a clinic for addicts in Guilford County.
Steele notes this is an epidemic that is becoming more public and severe.
Firm data is not yet available for 2014. But hospital officials in Charlotte, Greensboro and Wilmington estimate the figures of heroin overdoses and heroin overdose deaths to rise again, by about double compared to last year. The High Point Police Department has made several rounds of arrests, though it admits that police work alone will not contain the problem. First responders and clinicians say it will take a group effort.
'I'm clean. And I will not, just will not go back the path I went.' - Brandi Martinez
Nobody Can Knock Me Down
Brandi Martinez says it has been two and a half years since she last used heroin.
"I feel like I'm on top of the world - like nobody can knock me down, like I'm strong, like I'm Superwoman," she says. "And I'm clean. And I will not, just will not go back the path I went."
Martinez says she has a steady job and is focused on her five kids.
"They can be proud of me again. I'm proud of myself. But it makes me feel like the best mom in the world, even though I'm not; we all make mistakes. They trust me now," she said.
