Heroin surge continuing

November 1, 2016

 

Once only the province of cheap, seedy hotels, today's junkies are shooting up in living rooms, public bathrooms, in affluent shopping malls and nice restaurants. Users are young and old, and everyone in between. They're overdosing on heroin, on pain pills and opioids, on synthetic drugs better left in operating rooms or with veterinarians. Often, users don't even know what their doses are laced with, and that their hits are tens, or hundreds of times, stronger than heroin alone. As a result, drug users across the country are overdosing at a skyrocketing rate.

Law enforcement officers, treatment centers and medical examiners across the country are scrambling to respond to the surge of heroin and opioid addiction, as well as the drug’s increased and toxic potency. Meanwhile, people of all ages continue to overdose to the point of death, or near death – and Oakland County is no exception.

Heroin is an equal opportunity destroyer, Oakland County Sheriff Michael Bouchard pointed out. “No one out there reading should presume ‘I live in a certain community and it won’t happen here.’ It happens to the most economically challenged areas and the most prosperous. It happens to all races, and all creeds.”

Although heroin use is nothing new, synthetic opioids are appearing in toxicology tests at potency levels rarely, if ever, seen before. 

Fentanyl, a short-acting synthetic opioid that is approved by the U.S. Food and Drug Administration (FDA) and is 80 times as potent as morphine, is ordinarily used in hospitals for anesthesia, or by physicians to treat chronic pain. But illicit fentanyl is being produced in clandestine laboratories and mixed with or substituted for heroin and sold to addicts who don't know any differently. It is packaged in pills disguised as other less potent opioids, and cut with other drugs, such as cocaine. When taken other than as prescribed, fentanyl can suppress breathing up to the point of death. 

According to the Drug Enforcement Administration (DEA), at least 12 different analogs of fentanyl – substances with a similar chemical structure to fentanyl – have been identified in the U.S. drug traffic industry. Similar drugs that have shown up recently include U47700, U50488, both opioid powders, furanyl fentanyl, and carfentanil – which is 10,000 times more potent than morphine and typically administered by veterinarians to tranquilize large animals such as elephants. 

“The (testing) labs are being overwhelmed. They’re seeing what they call designer opioids,” said Cindi Arfken, professor at Wayne State University in the department of psychiatry and behavioral neurosciences. “Most of the opioids being seized are testing for fentanyl, (but) very few are (identified as) carfentanil.” Part of the problem in accurately identifying which opioid is in a substance is simply the logistics of conducting tests for substances not usually seen by medical examiners. But despite the challenges with testing, the Michigan Department of Health and Human Services declared in October that in the four months prior there had been 19 overdose deaths in Wayne County presumed to be linked to carfentanil. 

Facing a growing danger, many law enforcement officers are instructed to err on the side of caution when approaching the scene of an overdose, as coming into contact with a trace amount of carfentanil can send a person into hypoxia, a state of labored breathing consistent with drug overdose. 

“In the drug diversion training last week, we learned about fentanyl and safety for officers,” said Noel Clason, detective with Bloomfield Hills Public Safety. “Our officers aren’t allowed to touch (carfentanil) because a tiny expose could pose serious risk to officers. If you suspect that it could be, we treat it as it is, like a hazard… We won’t do a field test, we’ll send it to Oakland County or Michigan State Police. There’s no way in powder form to tell (the difference). But we can expect that if someone is taking more than one dose of Narcan to revive them, we will treat it as fentanyl,” referring to the popular brand of the opioid antagonist drug, naloxone hydrochloride, which can revive a user from an overdose. 

What the antidote does is essentially wipe clear the Mu receptors in the brain dangerously inundated with opioids, and naloxone can bring heroin users back from the brink of death. Administered intravenously by paramedics for decades, Michigan Act 462 of 2014 granted police officers the authority to administer naloxone via nasal spray to suspected overdose victims. The bill took effect in January of 2015, and requires officers to undergo training.

“Each officer was trained in it about five months ago, and each officer has (naloxone) with them,” said detective John Weise of the Bloomfield Township Police Department. “It’s a pretty simple thing to use. There are no risks, even if someone is not overdosing. If you put it in your nose right now it would do absolutely nothing to you. We don’t see a lot of heroin in Bloomfield. It will show up here and there, but is not an epidemic in our town. There’s a lot more prescription drugs.”

From 2010 to the present, annual heroin arrests in Bloomfield Township ranged from two to five, with drug overdoses primarily due to prescription drugs peaking at eight in 2015. However, the police department data does not account for the number of runs made by emergency medical services in response to calls for overdose emergencies. 

This year in Birmingham so far, the police department made three arrests for heroin possession, said detective Scott Grewe. Twice, the police were dispatched in response to a possible overdose of a 23-year-old Birmingham man. The other arrest was made in August, after police were dispatched to the corner of Maple Road and Woodward Avenue in response to a 37-year-old Royal Oak man. “We got a call for an unresponsive male, and after we investigated we believed he possibly overdosed on heroin,” said Grewe. “He had a pill vial on him, with some pills prescribed to him, and told the officer that he snorted heroin.”

The Birmingham Fire Department had an additional two cases they responded to this year that were confirmed as heroin overdoses, said Grewe. However, because of the availability of the opioid antagonist naloxone, not all heroin overdoses result in death.

Bloomfield Hills' Clason said “We’ve had Narcan rolled out for about two years, but haven’t used it yet. We had two (situations) when we could have, but we contract with an ambulance service, Star (Ambulance), and they were able to administer it and revive the person that was going through the overdose. One of them was a repeat customer, a frequent flyer.” 

After Bouchard took an active role in getting the law passed to allow police to administer naloxone, the Oakland County Sheriff's Office was the first major agency in the state to deploy the naloxone program, he said. It launched in March of 2015, after deputies were trained in surveying the scene, identifying key physical symptoms of an opioid, and educated on the reality that some users become fearful and potentially violent when they find themselves suddenly conscious with an officer standing by. 

Since its inception, deputies with the Oakland County Sheriff’s Office have administered Narcan 42 times, and saved the lives of 41, confirmed Megan Noland, state and federal coordinator for the agency. Nearly 60 percent, or 25 of the 42 times that the deputies administered Narcan, took place in Pontiac, where the program was first rolled out. The remainder were scattered through other municipalities served by the sheriff’s office, including once in Rochester Hills. 

“I’m still working on getting all of my people trained,” said Michael Johnson, commander at the Rochester Hills substation. “Unfortunately, we’re getting a small amount of Narcan in, and it’s great for first responders. They’ve been using Narcan at the (Rochester Hills) fire department for a while.”

In October, the Rochester Police Department began training and implementing the use of the naloxone, which was provided to the department though a grant. “Heroin is present, it comes up in reports such as ‘heroin was suspected,’ or ‘the person is a known heroin user.’ It’s something we’re coming across in a variety of different ways. It’s in the community and it does have an impact,” said Steve Schettenhelm, chief of police in Rochester, who cited two young residents who died of heroin overdoses in the last two years – a 21-year-old man who died in 2015, and a 26-year-old woman who died in February of this year.

“With some of these (cases), there’s a combination of things on board, but those were clearly heroin,” said Schettenhelm, who responded to the apartment on Terry Avenue, northeast of Main Street and Romeo Road, in the February overdose. 

“There were a number of needles in a trash can there, so it appeared that they had been using for some time.

“What was so tragic in most cases, is the age of the victims. They have their entire life ahead of them, and because of bad choices they’re making, they find their life ended when it should be at the best years of their life. When fathers and mothers should be planning for weddings and births of grandchildren, they find themselves planning for funerals.”

Schettenhelm also recalled a time when someone was found overdosing as they attempted to drive out of the Rochester Hills Public Library parking lot. “These things can happen anywhere,” he noted.

The prevalence of deaths resulting from heroin overdoses have skyrocketed across the U.S. since the late 1990s. The Centers for Disease Control and Prevention (CDC) reported less than 2,000 deaths by heroin nationwide in 1999, compared to a five-fold increase in 2014 of over 10,500 deaths. The majority of that jump has occurred in just the last five or six years. However, proving that the substance responsible for a person’s death was an opiate, derived from the seedpod of the poppy plant, versus an opioid, a synthetic substance that has the same effect, makes statistical analysis of trends regarding heroin and opioids somewhat tenuous because it is often difficult to determine what has caused the death. And to confound the opiate problem, the CDC reported a nationwide four-fold increase from 1999 to 2014 of deaths caused by opioid pain relievers, for a total of nearly 19,000 in 2014.

Although many people turn to heroin after first being introduced to pain pills such as Vicodin, OxyContin, Percocet, or other opioids, some users initially seek out heroin. Synthesized from morphine, which is found in the sap of the seedpod of the opium poppy plant, heroin is typically sold as a powder or sticky substance that can be injected intravenously, smoked or snorted. As it enters the brain, heroin is converted back to morphine, which is chemically structured like endorphins, the euphoric chemicals that are released through exercise and other pleasurable situations. A relatively cheap street drug, heroin makes addicts out of an estimated 23 percent of people who try it, according to the National Institute on Drug Abuse. 

“It’s not a drug that takes a long time to become addicted to. It happens very quickly, and a lot of times it comes through these relationships where it’s supplied or given to them,” said Kent Runyon, vice president of communications at Novus Medical Detox in Florida. “There’s dealers out there who give free samples. For a drug dealer it’s part of the game. If I hand out samples and you become addicted, you become a customer.” 

A similar exchange can happen between teenage friends.

“As far as what we’re finding, and this is even shocking to me, is that high schoolers, the 18 to 25 range, the first thing they've tried instead of alcohol or marijuana is opiates,” said Dr. Elizabeth Bulat, service chief of addiction medicine at Henry Ford Maplegrove Center, located in West Bloomfield. “I meet a lot of people in their late teens, and some said their first drug was heroin, or cocaine. This is much different than the ‘gateway’ thinking (of) people trying a wine cooler or whatever.”

Experimenting together, they sometimes have “pill parties,” for lack of a better term, said Bulat. 

“They get a basket and take whatever they can from their parents’ drawers and pass around the adults’ pills. That’s why any nerve or anxiety medications need to be locked up, because if they’re not locked up, even if your child isn’t taking them, a friend could find it. People know what’s available. Younger people are abusing opioids so I think people know what opioids are, and know what to use to get high – the norcos, the hydrocodones. It’s becoming more prominent,” said Bulat, noting that the most effective way to beat addiction is to prevent it from taking ahold of the person in the first place.

In an effort to thwart heroin and other drug use, Oakland County officials, including Sheriff Bouchard and Prosecutor Jessica Cooper, visit local schools to discuss the legal, emotional and physical suffering heroin users may face, including the likelihood of death. 

“I tell them how deadly it is, and tell them some stories from the community, and try to make them relate to the facts of this epidemic,” said Bouchard. “My daughter, who’s not very old, knows three girls that she played soccer with that are dead from drug overdoses.” 

According to the Michigan Department of Community Health, more than a quarter of all Michigan drug poisoning deaths in 2013 were related to heroin use, with men accounting for a large portion of those deaths, as men are three times more likely to die of heroin and prescription drug overdoes than women. From 2004 to 2013, there was a nearly ten-fold increase of heroin-related mortality for people aged 21 to 34 years, with the second most common age group to die from heroin between the ages of 35 and 54. 

Oakland County data from the Michigan Resident Death Files, published by the Michigan Department of Health and Human Services, indicated that unintentional deaths due to poisoning, which include exposure to noxious substances such as drugs, jumped from just 13 in 2003, to 45 in 2014. Nearly half of those who died in 2014 were between the ages of 25 to 44, and 26 percent were between the ages of 45 and 64. 

“When you’re looking at use, you can see the progression,” said Lisa McKay-Chaisson, administrator with the Oakland County Health Department. “Using increased, and overdose deaths from it (increased, as well).”

But, said McKay-Chaisson, “It’s not just a heroin problem. Forty-five percent of heroin users also use prescription drugs. The biggest risk factor for being a heroin user is prescription drug use. (Nationally), three-quarters of new heroin users report they abused prescription opioids prior to using heroin. Heroin is much cheaper and easier to attain… If you can stop the prescription misuse, or the non-medical use, you will help to reduce the heroin use and overdose risk.”

Officials at local, state and national levels continue to take action to fight against the growing issue and increase awareness, including President Barack Obama, who declared the first Prescription Opioid and Heroin Epidemic Awareness Week in September, and Michigan Governor Rick Snyder, who created the bi-partisan Prescription Drug and Opioid Abuse Task Force in June of 2015.

Chaired by Lt. Governor Brian Calley, the task force was charged with reviewing trends, evaluating strategic options aimed at addressing the issue, and making recommendations for policy and regulation changes.

“Two areas that have moved forward address two different sides of the scope of the issue were trying to deal with,” said Calley, mentioning the areas of prevention and overdose treatment. 

“We’ve taken steps to improve the Good Samaritan exception for people that report to 911 when a person is experiencing overdose, without fear of getting prosecuted (for drug-related charges),” Calley said.

Expanding on a 2015 law that initiated criminal exemptions for people aged 21 and under who call police for help with an overdose, the new law was signed by Snyder in October, and provides exemptions for anyone in the situation, regardless of age. 

“While we made a lot of good headway in terms of first responders and police, and even some schools that keep naloxone on site to be used to save people,” said Calley. “What I want to have is a system where people can have, family members can have, access to naloxone even when they have a family member who hasn’t gotten to the point of seeking treatment.”

Public Act 311, which went into effect in October of 2014, allows a prescriber to issue a prescription for naloxone to an individual at risk of opioid overdose; to a family member of a person at risk; or to a person who is in position to assist a person at risk; according to Laura Biehl, senior communications advisor in the executive office.

Although one dose of naloxone is intended to stabilize a person who perhaps started to turn blue from lack of oxygen, it’s not uncommon for two, three, or even four doses of naloxone to be required for revival. As more and more heroin is laced with extremely potent synthetic opioids like fentanyl, taking a hit is like playing Russian roulette, where the user can’t predict the outcome. 

“You don’t have a heroin dealer saying, ‘This is so many milligrams potency, and given your body weight, I would only suggest you take this much to achieve this type of high,’” said Paul Walton, chief assistant to Oakland County prosecutor Cooper. “You have no idea what they put in there, no idea of the purity, no idea if it’s being cut with something else. The analogy the prosecutor gives students is, ‘Would you walk down the street and find a sandwich, pick it up and eat it? But you’re going to walk down the street and find some person and trust them to put something in your blood system?’” 

Although the illicit fentanyl that’s being mixed with heroin is reportedly coming from clandestine labs outside of the U.S., prescription fentanyl appears to be increasing, as well. According to data from the Michigan Automated Prescription System, a drug monitoring system, the number of fentanyl prescriptions increased by 137 percent from 2012 to 2013, jumping from slightly over 2 million in 2012, to 4.87 million in 2013. 

“(Fentanyl) is being found on the street. We’re finding that unfortunately it's in the drug dealers hands, just like they get hydrocodone or OxyContin,” said Bulat, of Maplegrove Center. “We’re seeing that in conjunction with heroin and street drugs. “Fentanyl-laced heroin is obviously a crisis for overdoses, but people are at risk of abusing prescription medications, and that one, (fentanyl), is also a prescription medicine. Usually things with a short-acting (effect) have a higher abuse potential. Fentanyl, if it’s in patch form, it’s more long-acting, but people can divert that – take it not as prescribed or mix it with other narcotics.”

Opioid use, heroin or otherwise, can get very expensive, very quickly.

Eric Noll, chief probation officer at 51-1 District Court in Novi, said once the addiction gets ahold of the individual, the habit can run between $100 or $200 a day.

“Once they’re in full-blown addiction and using everyday, they can be extremely cunning, very resourceful,” said Noll, formerly the drug court’s probation officer. “They find a way to get that money, and most of the time it comes down to stealing.”

Wealth, in this case, can be a curse said Runyon of Novus Detox Center, which has a spa-like atmosphere that’s treated professional athletes and their wives, lawyers, and other successful members of society. 

Far from being confined to high-crime areas, heroin use continues to turn up in bucolic suburbs with good schools, tailored lawns and involved parents. While the neighborhoods where users live may differ, the scene of a heroin overdose appears shockingly predictable.

“I didn’t know the suburbs were hit so bad as well, but my first month out there (in Orion Township), we had a Narcan save,” said sergeant Darrin Zehnphfennig, who has been with the Oakland County Sheriff’s Office since 2004. “His mom found him. It's always a loved one. Usually there’s very shallow breathing, sometimes gurgling noises that sound almost like they’re choking on snot or vomit. 

“Sometimes, they don’t fall out right away (after taking heroin). They may cook it in one room, shoot it in another, and then make it to the bathroom. But there’s always a needle somewhere that I’ve seen.”

Zehnphfennig has personally administered naloxone three times, including once to a 28-year-old Lake Orion man found in a Kroger bathroom at 11 p.m. in August. 

“Typically, the fire department beats us there, but in this (case), my partner was the first on scene and found him, unconscious. He dug his body out of the stall, (and we) saw narcotic paraphernalia around him,” said Zehnphfennig. 

“I administered one dose, one milligram of Narcan. Then when EMS arrived, they pushed two more doses. Then he began shallow breathing. He was transported to McLaren Hospital in Pontiac.”

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