“Heroin: It’s time for the talk”

(This is one of a dozen stories that were part of an award-winning series, Heroin: It’s Time for the Talk. The full PDF version can be found here.)

Heroin turned her into “a monster,” she said, the kind of person who would steal money and jewelry from her parents and tell so many lies that the lines between what was real and what was fiction began to blur.

Jennifer, now a Central Bucks West senior, recalls one night in a Doylestown parking lot when she sat and watched as her friend’s face turned blue. That night, a dealer had agreed to shoot them up with heroin. While her friend was overdosing, Jennifer could think only about the trouble they’d be in if they got caught. Her friend survived, but later, Jennifer recalled resenting her friend for spoiling her high.

“Heroin turned me into a devil,” said Jennifer, who in a span of two years went from being an “A” student and a high school athlete to an addict — a person she hardly recognized.

Jennifer, like so many young users, had her first taste of opiate addiction from the medicine cabinet. The teen, whose real name isn’t being disclosed, was in ninth grade then.

Her story reflects a scary, but growing, trend in the Philadelphia suburbs, where teens and young adults are getting addicted to prescription medicines and then turning to heroin for a cheaper and increasingly accessible product.

Heroin, once considered an urban street drug, continues to seep into the suburban landscape, where teens are using or selling from neighborhood coffee shops, schools, parks and other popular hangouts.

Prevention specialist David Fialko, with The Council of Southeast Pennsylvania, said suburban dealers aren’t your stereotypical shady characters peddling products on street corners. Pushers are often peers, he said, minors who buy enough drugs to sell to friends while supporting their own habit.

“They don’t need to go out of their social circle,” Fialko said. “They may not even really consider themselves as dealers. They may be seeing themselves as a friend who is hooking up other friends.”

Making Matters Worse

The heroin market is flooded, prices are plummeting, and purity is up, treatment advocates and police say. As a growing number of opiate addicts run low on cash for pills, the demand for heroin skyrockets.

“This past year, for 2011-12, for the first time, heroin was the primary drug of use, surpassing alcohol for those seeking county-funded treatment,” said Diane Rosati, acting executive director of the Bucks County Drug and Alcohol Commission. “Heroin is not new to the suburbs. But it has become more available, less expensive and more acceptable.”

Heroin and opiate-related accidental drug deaths are also on the rise in Bucks County, from 56 in 2008 to 97 in 2011, the last full year of data available from the coroner’s office. In Montgomery County, those numbers have gone from 50 in 2008 to 79 in 2012. Those increases mirror state and national trends. And among those deaths are teens as young as 17.

Over the last two years, opioid-related overdose deaths exceeded the number of motor vehicle deaths in Pennsylvania, Rosati said.

“Those are pretty startling statistics,” she said. “It’s really a wake-up.”

Nationally, drug overdose deaths increased for the 11th consecutive year in 2010, the latest year information was gathered, according to a study by the Centers for Disease Control that was published in February’s Journal of the American Medical Association. The study shows that pharmaceuticals, especially opiates, are driving the hike. Painkillers such as OxyContin and Vicodin were the biggest problem, according to the study.

In the past five years, opiates have played a role in 365 drug deaths in Bucks County. And Oxycodone, by far the most commonly abused opioid painkiller, played a role in at least 15 accidental drug deaths in 2007, 21 in 2008, 22 in 2009, 27 in 2010, and 39 in 2011, according to the Bucks County coroner’s statistics.

The Council of Southeast Pennsylvania formed a Drug Overdose and Prevention and Education Advisory Board recently, responding to area drug use trends reflected in hospital and coroner reports.

The Drug Abuse Warning Network, also known as DAWN, tracks drug-related deaths investigated by medical examiners and coroners. DAWN found that Bucks County had 136 drug-related deaths in 2009, the most recent year for which statistics are available.

“In that group, (opiates) were the number one cause of death, and more than half of those deaths were individuals under the age of 34,” according to the council.

Another survey compiled by the Bucks County Drug and Alcohol Commission found that heroin was the most reported primary drug of use for hospital detoxification admissions in 2011-12 in Bucks.

Countywide, the number of Bucks County residents admitted to publicly funded addiction treatment centers for outpatient admissions for heroin addiction rose by more than 40 percent, up from 347 in 2008-09 to 536 in 2011-12, the last year for which data is available. The overall increase, which includes all levels of care for heroin and synthetic opiates, is up 54 percent, rising from 460 in 2008-09 to 645 in 2011-12.

“We’ve seen an upsurge nationwide as well as in Pennsylvania with heroin overdoses,” said Jonathan Duecker, special agent with the Bureau of Narcotics Investigation and Drug Control for the state’s Office of the Attorney General. “We believe that overdoses are occurring more frequently because heroin is purer and more available, and the people using heroin today often do not have an established pedigree for using heroin.”

Today’s heroin users likely started with prescription pills, which are perceived to be generally safe for consumption because it’s in a dosage regulated by law, he said.

“Heroin on the street, however, is, of course, not regulated and there is a fine line between a dose of heroin being strong enough to bring back customers and too strong to kill some of those customers,” he said.

Though more lethal, higher purity also translates into a bigger profit for dealers and a better quality of “high” for users, Duecker said. Higher purity level means the heroin can be smoked or snorted. That makes it a drug of choice for teens, in particular, who think it’s safe because they don’t need a needle. The higher potency makes it more addictive and easier to overdose.

So, a high school student who switches from pills to heroin will likely not know how pure the heroin is or whether it’s been adulterated or “cut” with toxic substances. Moreover, that user’s tolerance for heroin, especially heroin of high purity, may be low enough to cause the user to become unconscious or die, he said.

Why the rise in heroin?

Heroin is plentiful, according to drug enforcement officials. It makes its way into the suburbs through Philadelphia, which has become a major gateway for drugs being smuggled into the Northeast.

With a major port, a sprawling highway network and several airports nearby, the region has the infrastructure to support a booming market, said John Hamrick spokesman for the Philadelphia regional office of the Drug Enforcement Agency.

The DEA’s latest quarterly report, he said, shows heroin continuing to increase in availability — especially in the suburbs — and ranges in purity from 40 percent to 90 percent.

The price for a gram of heroin ranges from $60 to $70, down from an average of $75 to $300 a gram more than a decade ago.

Higher purity and lower prices can be blamed on a shorter journey from the poppy fields of South America to the streets of Philadelphia and its suburbs, he said. Hamrick said smugglers are finding more direct routes to the region, though air travel, car travel and shipping ports.

Philadelphia’s heroin supply then makes its way to Allentown, Scranton, Washington, D.C., and Baltimore, coming primarily from Mexican and Colombian drug trafficking organizations.

“Mexican cartels have flooded the marketplace with heroin,” said Duecker.

There is so much heroin in Philadelphia that a .03 ounce bag — essentially satisfying one hit (less than half a teaspoon) — can be purchased for less than $10, he said.

Area teens, who initially picked up their habit in the suburbs, say prices rise the farther one gets from the city, costing $15 for the same amount in places like Doylestown and Perkasie.

Some youths, like Jennifer, started in the suburbs but eventually ended up traveling to Philadelphia to buy in bulk, scoring 12 bags for $60.

“Dealers around here upped the prices, trying to rip us off,” Jennifer said. “The city was scary but, because of the drugs, I didn’t care.”

The suburbs, the agents say, are becoming a more lucrative market because of the high number of teens and young adults who can no longer afford to feed their addiction to prescription medicines — and are reluctant, at first, to go into the city.

“Many suburbanites get their hands on (pills) first, get hooked and once the prescriptions are gone, they still need the high, which explains the increase in heroin use in the suburbs,” Hamrick said.

Heroin and other opiates are perceived by many users as less risky today than they were 20 years ago.

“We’ve become accepting of things like OxyContin, Vicodin and Percocet,” said Fialko, the prevention specialist with The Council of Southeast Pennsylvania Inc. “When a youth sees doctors give it to a parent for a bad back, he or she doesn’t believe a doctor would give out anything unsafe.”

So kids abuse the drugs stolen from their parents’ medicine cabinet or bought on the street. They swallow as many pills as they need to get a high.

Television advertisements only exacerbate the acceptance of prescription medications, Fialko said.

“We are the only country in the world that direct-markets prescription medications to consumers,” he said. “When we get a direct message that says they’re OK, we tend to trust them — sometimes too much, and we don’t read the fine print messages of how harmful these substances can be.”

Whenever a drug’s perceived harm is low, the level of use will increase, Fialko said.

“Heroin, in the 1980s, was perceived to be a killer drug,” he said. “Today, it’s more of a next-step drug, a choice that teens turn to once their supply of prescription opiates runs out.”

Jennifer’s fight

This is where Jennifer said she fell into a trap.

“I completely wiped out my parents’ medicine cabinets,” she said. “It was the opiates that drew me in — the OxyContin, Vicodin and Percocets. “I felt like I was on a cloud.”

Her habit grew expensive.

Jennifer, was paying $50 to $60 on the streets for her daily dose of two 30-milligram pills of OxyContin or Percocet. She would crush them and snort them to get the most immediate and “euphoric high,” she said.

But, as many addicts agree, one never gets the same high twice. Chasing that high meant using more, buying more, and seeking stronger drugs. “It was my choice to do opiates, and once you start doing that, you’ll turn to the cheapest way possible to get high,” she said.

She recalled a student from a neighboring school who introduced her to something called “Smooth.” She was told it was a mixture of OxyContin and morphine and it could be snorted. It wasn’t until that supplier was picked up for a DUI and tested positive for heroin that she realized what she had been putting in her body.

“I had been taking heroin and I didn’t even know it, but by that time it was too late,” she said. “The big drug dealers didn’t want to call it heroin. Who would buy heroin? We looked it at as a big scary powerful drug. But that’s what we were doing. After a while I didn’t care. All I knew is that I wanted it all the time.”

Heroin, she said, made her feel invincible.

“I fell in love with it. It made me feel like nothing could ever harm me,” she said.

Somehow, Jennifer said she was able to keep her habit hidden from her parents, from teachers, and from supervisors at the market where she worked.

But others thought something was up.

“I was barely functional,” said Jennifer, who recalled vomiting at work and getting suspicious glances from friends and coworkers.

In the summer between her junior and senior year, her addiction intensified and she began driving with a group of local users to the Kensington neighborhood of Philadelphia, where drugs were cheaper to buy in bulk.

Soon after, she reached for the needle for a faster high.

“I couldn’t do it myself; I was terrified of needles. I had my dealer shoot me up, but once you go to a needle, you never went back to snorting,” Jennifer said.

What she saw in this new world was hard to stomach. People prostituting themselves for drugs. People living out of their cars and on the streets. People hurting everyone around them for a high.

“I met people like that. I thought, ‘I come from a really good family with good morals,’ ” she said. “I felt like I was better. But I realized later: An addict is an addict. You can’t justify what you’re doing. It’s all the same.”

She then reflected on her own behavior: the time she stole from her parents; the time she made her best friend drive to the city to watch her shoot up; the time she worried more about getting in trouble than the well-being of a friend who was overdosing.

“Seeing my friend turn blue was really scary, and at first I only cared that she ruined my high. I didn’t care about her dying. That was a big wake-up call for me. What had I become?”

Weeks later, her father discovered needles in her car. Though she denied a problem, she could no longer hide it.

“Seeing how upset and broken my parents were over me really hurt me and got to me,” she said. “I had to come clean at that point.”

In a few weeks, Jennifer will graduate from high school.

She’s been clean for several months, and plans to go to college and study business. Thoughts about her future, her goals and her love for her family keep her strong, she said. Outpatient treatment, along with regular shots of a medicine called Vivitrol helped control her urges. Vivitrol blocks pleasure receptors, so users can’t experience the “high” from the drug.

Her fears and memories of hitting what she calls “rock bottom” also help keep her clean.

Looking back, she never would have imagined that a curious impulse to feel something different — and dip into her parents’ medicine cabinet — would entrap her in a lifelong disease. But, at 18, she’s determined to stay clean.

“I don’t want to die,” she said. “So I have learned from myself. I got caught up in a disease that is extremely cunning and powerful. It sucks you in and takes you down. It waits for you. And when you have a moment it will suck you back in. I can’t think that way anymore.

“I refuse to be that person, that monster I was.”

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