Author’s note: Anecdotes and statistics agree, Wilmington is suffering an epidemic of opioid drug use. What remains unclear –– and what this series hopes to clarify –– are fundamental questions about the epidemic.
The epidemic does not have one single narrative but, instead, intertwining threads. Street heroin has a different, but related, story to prescription drugs. Likewise, there is not a stereotypical opioid user. Rather, users come from varied backgrounds. To this complicated mix of people and drugs is added the different relationships among law enforcement, health care, and treatment and recovery.
This is not to say there are no answers, only that there are no easy answers. This series will present those intertwining threads of the epidemic in an effort to help area residents to better engage with the crisis going on around them, to understand its origins, and to better understand the current state of affairs and what can be done about it.
Part II – Opioids: from heroin to prescription pills to and ‘psycho synthetics’
To understand the current opioid crisis, one must first understand the different members of the opioid family.
Historically, that starts with heroin, according to Wayne Ray, director and co-founder of Launch Pad, a recovery center with facilities all over the downtown Wilmington area.
“Wilmington is a heroin town, it’s always been a heroin town,” said Ray, who has worked in recovery for nearly two decades. “Before anything else. Before crystal meth or crack or pills. People come here because they know it’s here. That’s built over time. They come because they know there’s heroin here. And, because there’s heroin here, there’s help here. So that brings people looking to recover.”
After years of representation – and misrepresentation – in popular culture, most people are familiar with heroin and its claims of euphoria, mind-erasing bliss. But while many users, especially IV users, may shoot large doses and drop into semi-conscious states, “nodding off” for long periods of time, Ray said many users administer smaller doses throughout the day.
Mike Page, a former opioid user an current outreach worker for North Carolina Harm Reduction Coalition, described the common misconception.
“Yeah, some people get high, like really high,” Page said. “But a lot of people wake up, and they shoot just enough to take the edge off.”
Page said managing withdrawal from the drug plays as large a part for heroin users as the high itself. The powerful physical symptoms of opioid withdraw can be extremely painful, Page said, though unlike alcohol withdrawal those symptoms are not fatal.
“These people are managing, maintaining,” Page said. “It’s not like being drunk. These people can be working next to you and seem focused, as long as they’re keeping their doses right.”
Heroin users will frequently use a variety of opioids to ‘maintain,’ including methadone, which users can get from clinics like New Hanover Metro.
Ray said the irony of methadone, a lab-created synthetic designed to mimic heroin, is that it was often more powerful than street heroin.
‘Often (methadone) was stronger than heroin. It wasn’t helping you sober up, it was making you a more ravenous addict.’ — Wayne Ray, director and co-founder of Launch Pad.
“People were getting heroin that was cut in fifths, in tenths, with all kinds of nasty stuff, rat poison, or crushed drywall,” Ray said. “That’s often what killed you, whatever the dealer cut it with. Methadone – and there were all these bogus myths that it didn’t get you high, that it would just ween you off of heroin – that stuff was a lab product, it was exactly as strong as it was supposed to be. Often it was stronger than heroin. It wasn’t helping you sober up, it was making you a more ravenous addict.”
Over the years, heroin has gotten consistently more powerful. It’s a two-part story: purer heroin and synthetic additives. The average heroin bought on the streets was about 10 percent pure in 1981. By 1999 it was about 40 percent, according to the Depart of Justice’s 2015 Heroin Task Force Report.
As heroin purity increased, so did overdoses, but a different opioid crisis was also growing.
In 1999, New Hanover County had three prescription opioid deaths, in 2011 the number had grown by a factor of 10.
District Attorney Ben David said, “every Friday in drug court, for 18 years I’ve heard the stories. They’re tragic, but also very similar. ‘I had a caesarian,’ or ‘I broke my ankle,’ they say, ‘they gave me so many pills,’ or ‘the pills were so strong.’ They say ‘they’re just so easy to get.’”
For painkiller abusers in the 1960s, more than 80 percent were introduced to opioids through heroin; by the 2000s, that relationship had flipped, 75 percent of opioid users said they had first used a prescription drug.
These numbers, published in a 2014 study in Journal of the American Medical Association Psychiatry, have been linked to aggressive marketing and potential negligence on behalf of pharmaceutical companies, including Purdue, the manufacturer of Oxycodone. That includes a 2009 study in the American Journal of Public Health.
By 2012, there were 97 opioid prescriptions for every 100 people in North Carolina, according to the Centers for Disease Control (CDC). Many of those prescriptions were for drugs like oxycodone, which could be twice as strong as street heroin. The reaction in the medical and pharmaceutical communities were slow, but when they came they had unintentional consequences.
Robert Childs, director of the North Carolina Harm Reduction Coalition, said:
“It took a long time. Eventually, pharmaceutical companies backed off, a little, and the FDA started cracking down, the CDC came out with new guidelines for prescription. Health care groups started putting their doctors through pain management training. There were – there are – still pill mills, still doctors over-prescribing out of negligence or even criminally, but the real story is that a lot of good doctors who were simply ignorant about addiction started cutting back. And a lot of people who were already hooked suddenly were left in the lurch.”
The result? Those people turned to heroin. Over-prescription didn’t stop, in fact, deaths from prescription pills was more than double that of heroin in 2015, according to the CDC. But enough prescription pill users saw their supply dry up that they turned en masse to the illegal heroin market.
The rise of synthetics
Now opioid users, whether they got hooked on oxycodone in an upper-middle class community in Wrightsville Beach or on heroin downtown at Chesnut and 14th Street, face a new threat: extremely powerful synthetic opioids like fentanyl and carfentanil, which can be hundreds, even hundreds of thousands of times stronger than the purest heroin.
The issue of these synthetics has ratcheted the crisis up another level. For Mike Page, who has seen synthetics kill multiple people in a single night, it is a terrifying phenomenon.
“I’ve heard this [expletive] comes from China, but who knows,” Page said. “We’re focused on the people. We’ll see a batch come out, and within hours people are overdosing. Fentanyl will kill you stone cold dead, immediately. The carfentanil that carved through that town in Ohio, psycho synthetics like that are a nightmare.”
Page referred to a recent tragedy in Colerain Township, Ohio, where Fentanyl and carfentanil were responsible for a string of deaths. Public health officials from Colerain recently visited Wilmington, according to Olivia Herndon, director of public and mental health at the South East Area Health Education Center (SEAHEC) at New Hanover Regional Medical Center.
David, who works with SEAHEC on Mayor Bill Saffo’s opioid task force, said he could not speculate where the synthetics were coming from, only that he works to prosecute those who traffic in them as vigorously as possible.
Coming next week: the changing face of the opioid crisis. Who’s being affected and how? Port City Daily will look at the social and economic impact of heroin.