National Association of Counties
Washington, D.C.

 County social services battle increased heroin use

By Charlie Ban

It’s pure, cheap and out of control.

As they’re seeing heroin overdose deaths rise, many counties are focusing on trying to reduce demand for the drug, more than trying to control the supply.

Ocean County, N.J. saw nine deaths in eight days in April, and the county is on pace to more than double its 53 overdose deaths during 2012. Immediately to the north, Monmouth County overtook Essex County for drug reporting, which prompted the Acting Prosecutor Christopher Gramiccioni to take a different approach to combating the drug use.

“We’re right off of I-95, between Philadelphia and New York, the supply is going to be a problem,” said Charlie Webster, the office spokesman. “We can’t do as much to stop the supply as we can to try to prevent our citizens from getting hooked. And it’s so pure, this is a dozen times more potent than we saw in the ’70s.”

A study by the British Medical Association subsidiary MBJ Group found the average inflation-adjusted and purity-adjusted price of heroin in the United States decreased by 81 percent between 1990 and 2007, and average purity increased by 60 percent.

For Monmouth, that means hitting the schools. Gramiccioni is in the middle of a swing through the county schools’ back-to-school nights to recruit parents to help the fight.

“You get a lot of denial from parents; they don’t want to hear there’s a problem,” Webster said. “We have to use a shock-and-awe presentation to let them know how bad it is. They think, ‘It could never be our kids.’ It has been their kids.”

Given the 34-percent increase in use among 18–25 year-olds in New Jersey over the course of one year, the high school age group seems to be a sweet spot. Between 2011 and 2012, the number of 18–25 year-olds who took heroin intravenously increased by 30 percent, according to the National Survey on Drug Use and Health. Smoking the drug saw a 23 percent increase and snorting it an 18 percent increase.

“For the most part, we’re the second wealthiest county in the state,” Webster said. “We’re talking about an affluent suburban county; we have two urban areas, and it shows you how this problem affects all people.”

Boredom? Ease of access? Extra spending money? They all contribute to introductions to heroin, he said.

The overdose deaths of two children of local police chiefs and the near-death of another in Monmouth further demonstrated the drug’s pervasiveness.

Down I-95 from New Jersey, Cecil County, Md. is also seeing major problems because of its location, on the interstate corridor.

County Executive Tari Moore admittedly didn’t know much about the drug before, but became much more familiar when her county saw the highest drug use in the state at 27.5 per 100,000 people, narrowly edging Baltimore City. More people died because of heroin overdoses in Maryland in 2012 than by homicide.

Moore appointed the director of the county’s alcohol and drug recovery center to serve as her special assistant to develop a comprehensive plan to manage the county’s drug problem. That includes improving treatment options and access.

“We don’t have any detox facilities here,” she said. “Addicts are stuck waiting in jails for four to six weeks, and if someone is ready to change their life, you want to be able to take advantage of that immediately.”

She still plans to focus on trying to affect the supply, in addition to reducing demand.

“I think we have to do both, stop how much is available, it’s too easy to get,” she said.

In addition to prior drug users trying heroin out, many transition to the drug from prescription painkillers, and they have been nudged, in part, by stricter regulations on opiate prescriptions. Jefferson County, Wis. saw a shift in the last six years. The stretch from 2008 to 2010 saw higher incidences of opiate abuse, which Margo Gray, a detective sergeant for Jefferson County Drug Task Force said resulted from overprescription of oxycodone for sports and occupational injuries.

“Doctors would give it to a football player with a bad back, a worker with a bad shoulder; it seemed like the right fix for people,” she said. “Now pharmacies are more strict and these patients are finding a new way to feed their addictions.”

Midway through 2013, Jefferson County authorities had seized five grams of heroin, more than all of 2012. Though five grams seems insignificant, Gray said a typical dosage amounts to between one-hundreth and four-hundreths of a gram, each fetching $20 on the street.

“It’s actually cheaper than oxycontin,” Gray said, “so it makes more sense, especially when their tolerance builds up and they have to buy higher quantities to get the same high.”

Jefferson County authorities are opening their ears and listening to whatever users can tell them about their heroin habits, to reverse-engineer the addiction.

“We get them to educate us, any way they’re willing,” Gray said. “How does it make them feel? How did they wind up in this situation. We’ll pick anybody’s brain to get some insight.”

Jackson County, Ore. is going to the source of some of the gateways to opiate abuse — the doctors who prescribe them — to prevent people from being hooked in the first place.

Jim Shames, medical director for Jackson County Health and Human Services, gathered doctors and other health care providers and put more responsibility to physicians to level with patients on the risks of painkiller addiction.

“If they don’t prescribe them properly, they’re being irresponsible,” said Michele Morales, addiction services manager for Jackson County. “Opiates only work for chronic pain in a small population, for everyone else there are more appropriate treatments.”

Shames and the county produced a booklet on opiate prescription guidelines. The county’s law enforcement agencies are also doing prescriber postmortems, for which a drug overdose death is reported to the doctor who prescribed medicine to the victim, if a medication bottle is found in their home, so the doctor can look into the patient’s history.

A federal grant of nearly $400,000 will help Jackson County address several aspects of opiate abuse.

It will connect physicians to the state’s prescription drug monitoring program, pay for public education campaigns and crisis intervention training for law enforcement.

Many Florida counties have cracked down on “pill mill” pain management centers, where prescriptions for painkillers could be easily obtained. And doctors have been prosecuted.

Jefferson County’s Gray said beyond the people addicted, heroin use affects the entire community.

“When people have a $200–$300 a day habit, they need money,” she said. “We see an increase in property crimes, scrap metal thefts, car break-ins. They’ll steal, pawn everything.”

That also means stress on landlords not getting rent payments, human services agencies caring for children of addicts and worries about people who drive under the influence.

“Everything law enforcement-related is affected when drug addictions are involved,” she said.