Heroin, suspected of killing actor Philip Seymour Hoffman this weekend, has for years been a forgotten drug, overtaken by abuse of prescription painkillers.
Now it's back, and in a big way.
Heroin-related deaths jumped 84 percent in New York City from 2010 to 2012, according to a September 2013 report, while the number of heroin users seeking help on New York's Long Island in January rose to 767, far from the average 100 a month seen just five years ago by a local treatment center. Officials in Pennsylvania, Vermont and Ohio report similar increases.
While inner cities have long battled heroin, law enforcement officials say they are seeing increasing seizures in suburban areas, and that in some communities the highest rate of overdose deaths are among older users, ages 45 to 54. This age group has long been tied to abuse of prescription painkillers. The dynamic, though, may be changing as tough, new federal laws have tightened access to those drugs.
“As people have less and less access to prescription opioids, heroin is the most viable alternative,” said Sharon Stancliff, medical director of New York-based advocacy group Harm Reduction Coalition.
Hoffman, 46, who won an Oscar for his portrayal of Truman Capote in 2005, was found dead in the bathroom of his New York City apartment with a needle in his arm, law-enforcement officials have said. The medical examiner is investigating the death as a possible drug overdose.
“The theory, demonstrated well with Philip Seymour Hoffman, is that when you have a period of forced abstinence through rehab, or when you go sober for a period of time, your body chemistry has changed and you can't handle it,” said Jeffrey Reynolds, executive director of the Long Island Council on Alcoholism and Drug Dependence.
Heroin today is cheaper and more easily obtained than prescription painkillers whose use has been limited by federal and state laws that tighten doctor and patient access. A bag of heroin sells for about $10 on Long Island, while the equivalent amount of Vicodin costs $30, Reynolds said.
“If you shut down the supply and don't deal with demand, people turn to heroin,” he said by telephone.
Nationally, heroin use increased 79 percent from 2007 to 2012, with 669,000 people in the United States reporting they used the drug, according to the National Survey on Drug Use and Health released in 2013.
The rate of heroin-related deaths for New Yorkers rose to 5.7 per 100,000 from 3.1 between 2010 and 2012, according to the September report by the New York City Department of Health and Mental Hygiene.
New York is not the only state wrestling with the problem. In the last two months, emergency room doctors at the Allegheny Health Network in Pennsylvania have seen visits related to heroin overdose more than double, said Thomas Campbell, chairman of emergency medicine for the Pittsburgh-based network, that includes five hospitals.
“We usually see no more than seven to 10 visits per month,” Campbell said in a telephone interview. “In this past month, we've had 22.”
Maryland and Vermont have also recorded increases in heroin use, officials there say. Vermont is facing “a full-blown heroin crisis,” Gov. Peter Shumlin said in his Jan. 8 State of the State address, noting there were twice as many heroin overdose deaths in 2013 as in 2012.
While cities such as Baltimore have long battled heroin. police and DEA agents say they are seeing increasing seizures in small towns and suburbs nationally. In suburban Anne Arundel County, Md., police say they are seizing more drugs from what have traditionally been quieter quadrants of the county.
“We are seeing this in the central and southern parts of our county, and it's being used by middle class and upper middle class residents,” said Kevin Davis, Anne Arundel's police chief. “It's coming out of Annapolis, not Baltimore.”
Davis said he could tell that the heroin markets have changed because the deals are not going down in the traditional places, such as city street corners. Instead, he said, they're buying it at strip malls.
“It's everywhere,” said James Hunt, special agent in charge of the DEA's New York field office, in a telephone interview. “It shows no prejudices and is being used by the young, middle aged, even cops' kids and soccer moms. It's the No. 1 threat here in New York City. It's also more pure. You take it once, and you are hooked.”
Tests by federal health officials on today's heroin have shown the drug now being peddled on the street is 60-70 percent pure, up from the 5 percent seen in the 1970s.
Part of the reason for the rise may be a rise in production from countries that produce the drug, officials at the Drug Enforcement Administration have said. Southwest border seizures more than tripled from 559 kilograms to 1,855 kilograms in 2012, with heroin from Mexico found primarily in the western U.S. and from Colombia primarily on the East Coast, according to the agency.
Heroin is made from morphine, which is extracted from the seed pod of poppy plants grown in parts of Asia, Mexico and Colombia. Users report a feeling of euphoria, followed by a mixed state of sleep and wakefulness. Over time, a user develops tolerance to the drug, requiring higher doses to achieve the same effect, leading to increased dependence.
As heroin is a street drug, users can't know the strength of what they buy, putting them at risk for overdose. Emergency overdose treatment includes the drug Naloxone, which is injected or given through a syringe to deliver the drug through the nose. Naloxone works by counteracting the life-threatening depression of the central nervous system and respiratory system that leads to death.
The nation's crackdown on prescription drug abuse is another factor driving the uptick in heroin use, said Reynolds of the Long Island abuse council. The New York Legislature passed a bill in June 2012, known as the I-STOP Bill, which creates a digital database allowing doctors and pharmacists to track narcotics prescriptions.
“Some high-profile drug-dealing physicians were taken off the street, and patients are being literally tossed out doctor's offices,” Reynolds said. He supports the legislation for restricting the availability of prescription opiates, but says lawmakers haven't done enough.
The recent surge in heroin deaths has also caught the attention of doctors and enforcement officers, as they believe it may be made worse by a more lethal version of the drug that combines heroin and fentanyl, a painkiller for cancer patients.
Fentanyl is “very, very potent,” said Stancliff, at the Harm Reduction Coalition, in a telephone interview. While addicts never really know what they're getting when they buy heroin, the addition of fentanyl in some areas of the U.S. makes the act “really risky,” she said.
Twenty-two deaths in Pennsylvania are attributed to the combination of heroin and fentanyl, said Kathleen Kane, Pennsylvania's attorney general, in a statement.
In Long Island, the Nassau County Police Department issued an advisory last week warning of the contaminated heroin, after several deaths were found to involve fentanyl.
The New York Police Department started a pilot program in Staten Island in December, equipping 180 officers with a nasal spray version of naloxone to use in opioid overdose cases. Two Staten Island neighborhoods, Willowbrook and South Beach- Tottenville, were among the five New York City neighborhoods with the highest rate of heroin poisoning deaths, according to the Health Department report.