This article was produced in partnership with students at the University of Minnesota School of Journalism and Mass Communication.
Heroin, one of the most addictive and dangerous of drugs, has flooded the Twin Cities and Minnesota in the past five years, a trend that links closely with a steady rise in prescription opioid abuse.
Heroin-related deaths in Hennepin County have surged since 2008, when six people died from overdoses. The number for last year: 54.
In 2011, there were an estimated 3,493 emergency room visits related to heroin in the Twin Cities metro area, more than triple the number in 2005 and almost double the number in 2009.
Estimates of drug-related emergency department visits in Minneapolis/St. Paul/Bloomington, MN-WI Metropolitan Statistical Area
Reeling from overdose deaths, communities, law enforcement and treatment centers are grappling with how to curb the growing problem. St. Francis parents and school officials, for example, are working to educate parents and students.
At the state level, legislators are preparing bills to counter overdose deaths. Similar proposals are getting attention in Hudson, Wis., in the wake of overdose deaths of three recent high school graduates.
And police departments across the state are addressing the gateway-drug issue by setting up drug take-back boxes to get prescription drugs off the streets or out of medicine cabinets.
The rise in heroin use reflects a national trend. In 2012, an estimated 669,000 people age 12 or older used heroin, compared with 373,000 in 2007, according to the U.S. Substance Abuse and Mental Health Services Administration.
But Minneapolis has among the cheapest and purest heroin in the country, most of which comes from Mexico via I-35 or Chicago, according to local and national law enforcement officials.
Heroin price vs. purity in selected cities
Of cities with Mexican heroin, Minneapolis had the highest-purity, lowest-cost heroin in 2007 and 2009, the latest year the Drug Enforcement Administration collected data for Minneapolis. When other sources of heroin were included, from regions such as South America and Southwest Asia, Minneapolis was second only to Los Angeles.
“People want to establish a marketplace here,” Hennepin County Sheriff Richard Stanek said. It’s “simply the law of economics — business strategy. You get people hooked and addicted, it’s good for the business.”
DEA Assistant Special Agent Dan Moren agreed, adding that cartels likely identified a pre-existing market: prescription drug abusers who switch to heroin as a cheaper, more available alternative.
Prescription drugs gateway to addiction
Kallan, who asked that his last name not be used, started his addiction as a 14-year-old football player with Vicodin and Percocet.
“I was told it gave you energy and made you like Superman, and you couldn’t feel pain,” he said as he sat in a meeting room at a Minneapolis treatment center. “And it worked.”
Kallan said about a dozen players on his high school team in Milwaukee used prescription pain-killers illegally. “You didn’t get tired,” said Kallan, now 25 and living in Minneapolis. “You didn’t get exhausted, and the lack of feeling pain was ideal for football.”
He got the drugs from a buddy who altered orders at a family-owned pharmacy. Others “doctor shop,” buy surplus meds or take them from family or friends.
The number of prescription painkillers available nationwide has increased substantially over the past 15 years. Four times more opioid pain relievers were prescribed in 2010 than in 1999, paralleled by the death rate from overdoses. (Opioids, which can contain synthetic drugs, are a broader form of drug than the more commonly known “opiates,” which are derived only from the opium poppy.)
The prescription increase in the mid-’90s stemmed from a push to treat chronic pain with opioids, which were formerly reserved for acute pain, and the release of OxyContin, which offered a more powerful, longer-lasting drug than any previous oral pain medication, said Hazelden Chief Medical Officer Marvin Seppala.
“All of the sudden, there was a huge difference in the medications available for pain treatment orally,” Seppala said. “So they became very popular.”
Though pharmaceutical companies described the long-release pills as preventing addiction, Seppala said, people quickly figured out alternative ways to consume them — snorting crushed pills or shooting up to achieve an immediate high.
In 2010, however, drug companies made OxyContin more difficult to crush into a powder and, therefore, abuse. That resulted in more abusers switching to other painkillers. And some switched to heroin.
Switching to heroin
Kallan was one who progressed from lower-dose painkillers to higher-milligram OxyContin and Percocet. Then, heroin.
“I was going through withdrawals, couldn’t find pharmaceuticals anywhere, opted to buy some heroin to get the same results,” he said.
Kallan went to his oxy dealer’s house, where the dealer’s roommate gave him some heroin to try while Kallan’s buddy sat in the car. “I snorted a little, and I liked what he had to offer,” Kallan said. “I negotiated a price and I went on my merry way.”
It took all of 10 minutes and a few messages and phone calls.
“What we’ve seen is people becoming addicted to those opiate prescription painkillers, and then when those pills are no longer available ... the alternative that can be offered by drug dealers in the community is heroin,” said Pati McConeghey, spokeswoman for Minnesota Adult and Teen Challenge Treatment Center.
“You can get a similar high for a less expensive price,” she said.
The drug also has become easier to use, making it more accessible to a younger crowd.
“It is more of an attractive prospect to know that you can snort or smoke heroin and not have the stigma of being a true heroin addict with a needle sticking out of your arm,” Moren said.
The problem with heroin, Kallan said, is you never know what’s in it until you try it. He overdosed twice.
It is such a strong central nervous system depressant that just a bit too much can suppress breathing and cause an overdose.
“What distinguishes heroin and opiates from other drugs is that it has high abuse potential, high addictive potential and high overdose potential,” said Carol Falkowski, a former drug-abuse expert for the state Department of Human Services who now runs her own abuse education company. “This is a drug that is so rewarding that the brain wants to repeat the experience.”
And the potential for overdose can be particularly high when an addict relapses after treatment.
“You can’t just go back to what you were doing before you’ve been clean for a year and a half, because that will kill you,” said Jenna Olson, a recovered addict from River Falls, Wis. “I did a half-gram and it almost killed me.”
When users relapse after sobriety periods, their body can’t tolerate the same amount of drugs they had taken before, leading to overdose or death. “Treatment centers need to tell people that if you return to use, you can’t take as much as you used to,” Falkowski said.
Treatment admissions on the rise
In 2012, treatment centers in the Twin Cities metro area admitted almost twice as many people — 2,724 — primarily for heroin abuse, compared with five years earlier. The admissions were higher than for other opiates or for methamphetamine or cocaine.
Admissions to MSP addiction treatment programs by primary substance problem
The rise in admissions and the tendency to relapse have led some treatment centers to develop alternative treatment methods. Centers such as Hazelden recently have started to employ drugs like buprenorphine, a partial opioid with low overdose potential whose effect plateaus, creating a limited high. Another drug called naltrexone is sometimes used to block the high that comes with opioid abuse.
Seppala said that Hazelden historically had opposed using such medications but found that they helped encourage patients to engage in and continue treatment.
“We have gotten a lot of grief from other treatment programs saying we’re doing the wrong thing because we’re using buprenorphine, which is an opioid,” Seppala said.
But he said the medications have proven effective, and after seeing poor treatment success with opioid addicts, the center had to consider alternatives.
“They weren’t completing treatment in the way that other people were — detox and leave,” Seppala said. “Or kind of grouping together in a negative way in the treatment program, rather than in a positive way. These people were banding together trying to figure out how to bring drugs onto [the treatment center] campus, scheming. And then we noticed people dying shortly after treatment. Not large numbers, but even a few is just a huge tragedy ... With that, we had to take alternative treatments really seriously.”
Other treatment centers, such as Minnesota Adult and Teen Challenge, opt not to use medications, choosing to focus on lifestyle choices, the organization’s McConeghey said. The nonprofit, which has long- and short-term treatment programs, has seen a “drastic increase” in opioid use over the past decade, she said.
“People use for lots of different reasons, and our goal is to identify for people why they started using,” McConeghey said. “We want them to learn how to have a different kind of life.”
Said Falkowski: “We’ve never really had a heroin and opiate problem of this magnitude, and our treatment system is on a learning curve of how to best treat opiate addiction.”
Olson and Kallan both attributed their recovery to family tragedy.
Olson said she found the will to stay sober after her mother suffered a stroke in 2012 and needed her to be a full-time caregiver. “If I was high, I could not do this. This is the hardest job I’ve ever had, and I’m not getting paid for it.” She said she hasn’t used heroin in about a year and a half.
Kallan didn’t seek treatment until he saw his older step-brother suffer a drug overdose.
“I found him pretty much lifeless, pretty much just hanging on, barely breathing, and that kind of got the ball rolling,” he said. “I had never seen anyone overdose before.”
About a month later, Kallan enrolled in long-term treatment at the Minnesota Adult and Teen Challenge in Minneapolis. He has about six months left in the program.
The region responds
With overdose deaths continuing to rise, communities across the state and region are considering ways to address the growing problem.
To prevent addiction to and abuse of prescription painkillers, the Minnesota Board of Pharmacy is working to strengthen the Prescription Monitoring Program, which aims to curb “doctor-shopping.” The board also is evaluating how to set up drug take-back systems at pharmacies, which currently isn’t allowed. Law enforcement agencies, state lawmakers and others also have called for more training of physicians on issues such as overprescribing of such drugs.
The DEA, meanwhile, is targeting the organizations that are bringing heroin and other drugs into the country and the Midwest. A task force that includes representatives from 20 Minnesota agencies shares intelligence
Aiming to reduce opioid overdose deaths, Sen. Chris Eaton, DFL-Brooklyn Center, plans to introduce a bill that would provide amnesty for people who call 911 in order to save a life, and would increase access for law enforcement and the public to naloxone, or Narcan, a drug that can counteract an overdose.
“We need to get this in the hands of first-responders and lay people, because this is the antidote for death,” said Lexi Reed Holtum, whose fiancé died of a heroin overdose after becoming addicted to prescription painkillers he had used for chronic pain. The legislation, “Steve’s Law,” is named after him.
“To the best of our knowledge, [there were] three people there, and they left him when he overdosed,” said Holtum, vice president of the Steve Rummler Hope Foundation. “We see, time after time, that witnesses walk away out of fear.”
In Hudson, Wis., Republican Rep. Dean Knudson is co-sponsoring similar legislation, in addition to a separate bill that would require people to present a photo ID when picking up prescriptions for opiates. A two-hour community meeting was held there last week to discuss the measures.
When overdose deaths do occur, the Hennepin County Attorney’s Office is now tracing them back to the dealers and charging them with third-degree murder. The office has filed six such cases in the past two years, compared with none in the prior three.
“We want these dealers to have some sense of responsibility,” said Hennepin County Attorney Mike Freeman.
Falkowski said tougher law enforcement isn’t the sole answer, however.
“I think we need to do as much education of the public as possible, because there’s really no part of the state that is immune,” she said. “When it comes to heroin, many communities think it can’t happen here. Many parents think it can’t happen to my child, until it does. And sometimes when it does, it’s too late.”
Colleen Case and Bryna Godar are students at the University of Minnesota School of Journalism and Mass Communication.