Opiate overdoses spike to alarming levels

By Amanda Waldroupe, Staff Writer

Oregon’s Medical Examiner office released its annual report of drug overdoses deaths in early April, showing that 127 people died from heroin overdoses in 2009, 63 of which were in Multnomah County. There were a total of 213 drug related deaths in Oregon, 2009, 94 of which were in Multnomah County.

Last year, heroin killed more people than meth and cocaine combined. This is the third year in a row heroin overdose deaths have increased. Since 2001, heroin fatalities have increased by 34 percent.

“It appears that the problem may be increasing,” says Mary Ellen Glynn, the executive director of the state’s Alcohol and Drug Policy Commission.

Everyone interviewed for this article hesitated to say, based upon 2009’s overdose numbers, whether Oregon is experiencing a heroin epidemic akin to what it experienced in the late 1990s when 195 people died from heroin overdoses in 1999. Gary Oxman, the director of Multnomah County’s Public Health department says that while Multnomah County has a “substantial proportion” of heroin overdoses in Oregon, he says that “the local situation has gotten somewhat better,” and “the state has gotten worse.”

According to Oregon Medical Examiner Dr. Karen Gunson, the problem may be twice as worse.

Gunson says “way more people are dying” due to overdosing on prescription opiates — drugs such as OxyContin and methadone belong to the same chemical family as heroin that are just as powerful and addictive.

The Medical Examiner released a separate, 2008 report showing 131 people died from methadone overdose deaths in Oregon — slightly more than the number of heroin overdose deaths in 2009. The Medical Examiner does not track overdoses of other prescription opiate overdose deaths. Gunson cites staff and financial constraints, and also says those deaths traditionally have not been something the Medical Examiner’s office has encountered.

Gunson expects to release a separate report of methadone overdose deaths for 2009 in the coming weeks.
Sources say it is undeniable that heroin abuse is on the rise, and that it is not a singular occurrence, but an increasing trend.

As much was said on Monday, May 10 when the Alcohol and Drug Policy Commission received a briefing from the Department of Justice on heroin.

It was the first time in the commission’s existence that it had received a briefing about a particular drug. The commission was formed by the State Legislature in 2009 to monitor and improve Oregon’s drug treatment and recovery systems. The presentation noted that last year, heroin represented the second highest number of admissions to drug treatment and recovery programs, the first was alcohol.

The presentation also noted that heroin is more available in Oregon than in the past. That is a direct effect, say authorities interviewed for this article, of making drugs with psuedophredine, which is also a main ingredient for meth, behind-the-counter medications. The availability of meth decreased, causing drug users to turn to heroin.

Heroin is also one of the cheapest, if not the cheapest, of illicit drugs in Portland. Officer Mike Jones, working the Portland Police Bureau’s drugs and vice division, said the price has risen slightly since last fall (see “Return of the Dragon,” September 18, 2009). At that time, Jones says, a hit, or what a heroin addict needs to get a high, cost between $70 and $80. Now, the same amount of heroin costs between $90 and $100.

He thinks the increased price may result in an increase in crime. “If (the price) went from $100 to $140, you might have to steal an extra $40 a day,” he says.

Another trend noted at the briefing was drug users are turning to heroin after a long history of abusing other drugs, such as prescription opiates or meth. “Part of what we’re seeing now is that they burn out on stimulants,” says Julie Sutton with the Department of Justice.

“There is risk of individuals using opioids to begin using heroin, because it may be more available and less expensive,” says Dr. Dennis McCarty, a member of the Alcohol and Drug Policy Commission and a professor in the Department of Health and Preventive Medicine. Because it is harder to control heroin’s quality, “naïve” opiate users are more likely to overdose.

Oxman says the Public Health Department conducted a pilot study for the National Institute for Drug Abuse related to meth abuse. The full results have not been published, but Oxman says the report found that there is “quite a bit of crossover” between using stimulant drugs, such as meth or cocaine, and depressants, such as heroin. “We thought if they were using stimulants, they stuck with stimulants,” Oxman says.

In conclusion, Sutton said of the increase of heroin use, “we’ve seen it happen before and it is happening again.”
But what is being done?

The advocates, policy makers and government officials interviewed for this story did not have a strong answer, and made it sound like there will be a lot of talk before there is any action.

“We’re trying to get to the bottom of where the problem is and what policy recommendations we can make to really affect this problem,” says Glynn.

The Alcohol and Drug Policy Commission released a report on May 1 giving an overview of Oregon’s drug treatment system. The report called for a complete overhaul of the system, which is “fragmented” with “significant gaps in coverage.”

McCarty, says that Oregon’s treatment system continues to reflect what the need was 20 or 30 years ago, when treatment programs were developed to serve a population of “public inebriates.” Now, he says, there is growing demand to provide treatment for women, youth, and other groups who are addicted to drugs other than alcohol — such as heroin.

“This is about catching up to the year 2010,” he says.

The Alcohol and Drug Policy Commission will be creating legislative concepts to present to the Oregon Legislature when it begins the 2011 session in January. It is also assembling a subcommittee to look at funding options. When asked what possible concepts would be presented, Glynn refused to answer. The commission will also opportunities to make policy changes through executive order. But nothing, she says, will be done until “we figure out what the facts are.”

“What we don’t understand and what no one understands is what is the situation with the prescription opiates,” Oxman says.

“Prescription opiate use is probably one of the more concerning issues that we’re working on and we’re faced with,” says Therese Hutchinson, who works on opiate issues at the Department of Human Services.

Gunson says one reason why prescription opiate abuse has for so long gone unnoticed is pretty simple—it’s not sexy. Heroin is one of those darkly glamorous kind of things and methadone and OxyCodone are not so exciting,” Gunson says.

According to a 2009 report released by the Office of Disease Prevention and Epidemiology of Oregon’s Public Health office, the hospitalization rate related to prescription opiate overdoses has increased by 500 percent. The report also found that nearly 4,000 hospitalizations in the last five years were related to prescription opiate abuse.

Gunson says autopsies show that those dying from prescription opiate overdoses are not, like those dying from heroin overdoses, addicts. “The vast majority is from pain medication,” she says.

The Prescription Drug Interagency Task Force, a new state-wide task force that was formed last year and met for the first time on May 6, is looking into creating electronic records of people who have prescribed  opiates. The records would track what their prescription is for, the prescription’s duration, where the prescription was last filled, and what doctor prescribed it. Hutchinson says the hope for the records is that it will catch addicts trying to fill illegal prescriptions, or prescriptions indicating the drug is not being used responsibly.

Jessica Guernsey, Multnomah County’s community health services operations manager and a force in designing the county’s four needle exchange programs in the late 1990s, says meetings are being held between private and public stakeholders to look at what other jurisdictions have done. Broadly speaking, she says, Multnomah County’s “intervention strategy has to be a little more sophisticated,” than in the past. She describes that strategy as more individual-based, working on an individual-by-individual basis in drug treatment programs. What is needed this time around are bigger scale policy changes and reforms in treatment models.

McCarty says treatment programs for heroin addicts and those addicted to prescription opiates needs to be different. “They represent different patient populations and different intervention strategies,” McCarty says.

“Ten years ago, we were in this same situation,” Cobb says.

A number of proactive measures were taken, Cobb remembers, by Multnomah County’s public health department and other stakeholders. Multnomah County’s syringe exchange programs were developed, allowing addicts to exchange used needles for new ones and access services. An agreement was made with the Portland  Police Bureau that if an addict called 911 to report an overdose, that person or the overdosing person, would not be arrested. That, Cobb says, has helped save lives. Treatment programs began to change their services in order to better serve people with heroin addictions.

Cobb says the same proactive approach is needed this time. “We need to pick up where we left off 10 years ago,” he says.

Guernsey mentioned making Naloxone, a drug which can revive people who have passed out from heroin overdoses, more available in harm reduction programs. Guernsey also said lowering the barriers for access to drug treatment programs was a possibility. “There are a lot of different things that can be done,” Guernsey says. “We’re not advocating for any specific interventions at this point.”

Patty Katz was addicted to heroin for 14 years before getting into Central City Concern’s recovery program in 2000. She thinks there is a very deep-seated social stigma about drug addicts that needs to be remedied before addicts begin to access treatment programs more willingly. It’s the mentality that “an addict is a bad person trying to be good,” she says. “[But] we’re sick people trying to get better.”

Katz tried to access treatment a number of times during her addiction, and remembers being told that there were 350 people ahead of her on the wait list.  “That shows me there aren’t enough treatment beds,” she says. “We don’t have treatment on demand. We have jails or prisons on demand.”

Cobb agrees that there needs to be more treatment and supportive housing programs available.

“It takes more than a cookie cutter approach,” she says. Katz, who now works for the Partnerships for Safety and Justice, was homeless at times during her addiction, and says treatment programs cannot work if they do not provide addicts with “a safe place to sleep.”

“I felt like I had a hole in my soul I was trying to fix,” Katz says. Without having a safe place to sleep, entering a 12-step program, going to counseling multiple times a day, having a mentor helping her through the process in an individualized way, and “learning how to use my time during the day,” Katz doesn’t think she would have made it.

Oxman and Gunson say the demographic of people dying from heroin overdoses are white men in their thirties and forties who have been using heroin for anywhere from 10 to 20 years. But, that demographic is beginning to shift. Younger people are beginning to use heroin, as evidenced by the fatal heroin overdose of 22-year old Sam Tepper, a student at Reed College who’s death prompted Oregon’s U.S. Attorney to sharply reprimand the college and demand it crack down on its drug culture.

Oxman says that when considering implementing new programs, public health officials need to ask “can you implement it in this country in a practical sense?” and “does our legal framework allow you to do it?” He says that there are political concerns as well, and it would not be practical to create a program that would be unpopular or dismantled after an election cycle.

“Our society is set up where you don’t get a lot of broad support from the general population to improve the lives of people who are very disenfranchised,” Oxman says. “It’s tricky for advocates and elected officials and agencies to step forward on this.”

Oxman says harm reduction programs, such as needle exchange clinics, are useful because they are able to work with individuals at whatever stage they are at and slowly but surely convince many to seek treatment. Without such programs, relationships and trust are not built between addicts and providers.

McCarty says putting pseudoephedrine behind the counter as part of the meth crackdown does not offer any lessons for how Oregon can deal with heroin. “What was unique about meth was that the primary (ingredient) was an over-the-counter medication. Heroin is already illegal,” McCarty says.

But what it does do is send a clear message to those crafting drug treatment programs and policy on what is and what is not effective. “Society can’t address this piecemeal,” McCarty says.

3 responses to “Opiate overdoses spike to alarming levels

  1. People will always do drugs. Not having safe ones, and not pursuing a “harm reduction” model, is akin to treating VD with abstinence only education. If you really care about this, then support initiative 28.

  2. Studies show that the majority of OxyContin overdoses occur when people take the drug as prescribed. Purdue Pharma lied about the addictive properties of this legal-heroin and pushed it through the FDA. At Novus medical detox we hear stories everyday from people whose lives are being ruined by this widely over-prescribed drug.
    http://www.novusdetox.com

  3. sick of the propaganda

    Detoxer, what are you talking about? What “studies”? Only time I was ever in danger of an OD is when I didn’t have health care and was desperate for pain relief. Someone gave me methadone. I didn’t understand that methadone takes much longer to leave your system than other opiates, and over two days, I took too much. If I had been able to get oxycodone from a doctor, my normal painkiller, that never would have happened. I take issue to the idea that “methadone is as addictive as heroin.” What??? You don’t get “high” from methadone. It may create physical dependence, just as anti-depressants and tramadol and benzos and a million other drugs do, but methadone is not something people abuse to get “high” from. Why do you think opiate addicts access legally regulated methadone maintenance programs? Now all the docs are afraid of oxycodone and trying to get pain patients to take new antidepressants like Cymbalta. It’s like a giant lab experiment. When used properly opiate painkillers are not addictive and they do not cause kidney and liver damage like Tylenol, Ibuprofin, and Cymbalta. The demonization of useful drugs is causing problems for pain patients. If you take away the medications that work, we will go to the streets trying to get pain relief, and that is when you will see the overdoses. Law enforcement will call it “addiction” but trying to get out of pain and being an addict are two very different things.

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