Heroin, opiates behind more than half of fatal overdoses
JANESVILLE Rock County medical professionals and law enforcement agents would like you to stop reading for a moment.
Set down the paper or step away from the computer. Go directly into the bathroom—now, while you're thinking about it—and remove all opiate-based medications from the cabinet. Take the old ones to the nearest police station and drop them in the prescription collection box.
If someone in your family is using such a prescription, put the pills in a locked cabinet or safe in your home.
When you're done, please come back and resume reading.
In 2011, eight people fatally overdosed on heroin in Rock County. That is the greatest number of heroin fatalities since the drug burst onto the scene in 2008, according to Rock County Coroner's Office data.
Another 10 people fatally overdosed on opiate-based medication in 2011. Since 2007, more than half the overdose deaths in Rock County each year have been attributed to heroin or other opiates.
That's a sharp reversal from 2005 and 2006, when opiates were blamed for fewer than half of the overdose deaths in the county, according to coroner's office data.
Data about overdose deaths in 2012 is not yet available.
Statements such as "eight people fatally overdosed on heroin" are eye-catching, but professionals will say again and again that heroin use often starts with prescription medication abuse.
Commonly, people develop an addiction to pain medication such as Vicodin or Percocet, said Sgt. Aaron Burdick with the Rock County Sheriff's Office.
"A lot of arrestees that are heroin users, they told us they got their start with prescription medications," Burdick said. "That works for a little while until you need a better high."
As the addiction advances, they are likely to start taking more pills more often. When it becomes too difficult or expensive to take the pills, they might switch to heroin, Burdick said.
People often start out by snorting heroin, he said.
"Needles kind of scare people," Burdick said.
As the addiction advances, users again find they can't keep up with the cost of the heroin. Users might start to inject heroin to get a richer high for less money, he said.
"It becomes a balance between economics and high," Burdick said.
Prescription abuse more common
Heroin use in Rock County does not seem to be increasing from the high point reached in 2010, Burdick said. Maybe some households are getting the message about keeping prescription opiates under lock and key, Coroner Jenifer Keach said.
The advent of prescription medication roundups and drop boxes at police stations are two examples of the ways Rock County is working to reduce the risk of addiction to prescription opiates, Keach said.
More will need to be done if the trend is going to be reversed, she said.
"I don't know if they're aware that kids are still having a pretty easy time of accessing this stuff," Keach said.
On a day-to-day basis, deputies find more illegal prescription medication than heroin, said Rock County sheriff's Capt. Jude Maurer.
"We deal more with people with prescription medications that aren't theirs than we do with heroin," Maurer said. "We find that more often on the street than we do heroin, easily."
Heroin use is difficult to track for a few reasons, Burdick said.
Heroin isn't a social drug, Burdick said. Users often take the drug and stay put, he said. The heroin high is so incapacitating that users are not likely to go to bars or public places where they would be more likely to run into police, Burdick said.
In addition, heroin is sold in tiny amounts. The most common amount sold is 0.2 gram, Burdick said. That would cost $40. A person who injects heroin might use multiple bags per day, he said.
When Janesville police officers or Rock County sheriff's deputies find drug paraphernalia or prescription medications in the hands of people without a prescription, they take it seriously, said Sgt. James Holford of the Janesville Police Department Street Crimes Unit.
Activities such as pill abuse, drinking and poor supervision are not guarantees that teens will develop addictions, but they certainly make it more likely Holford said.
Such activities shouldn't be brushed off as "kids just being kids," he said.
"When these activities lead to law enforcement contact, they should be considered a warning sign and not a juvenile indiscretion that should be dismissed or ignored," Holford wrote in an email to The Gazette. "Some accountability must be achieved early on to strip away some potential future victims of drug abuse."
Holford thinks people who commit crimes related to their addictions should be held accountable for their crimes before they get access to treatment. So should people or organizations who provide the location or the means for illegal drug use, Holford said.
People shouldn't be lulled into thinking that some kinds of drug use are safe or that one or two pills won't hurt them, said Glenn Milos, medical director and emergency medical physician with Mercy Hospital and Trauma Center, Janesville.
Street drugs are not monitored, and buyers could get more than they paid for, Milos said. For example, marijuana could be laced with another more physically addictive drug, he said.
Prescription drugs are dangerous if they are used in ways other than prescribed, said Milos, who has written pain-management guidelines for Mercy physicians to help them avoid prescribing unneeded opiate-based medications.
"I would beg of young people not to use any street drugs. Be very judicious in the use of pain medications," Milos said. "It's most devastating when a young person comes in dead and stays dead."
'Finding the signs'
Of the 34 overdose deaths in the county in 2011, Keach's office determined 11 were suicides. That is a sharp increase in the annual percentage of suicide by overdose, according to the data.
The number of suicides of any kind in Rock County in 2011 did not increase so sharply. In 2011, Keach's office reported 33 suicides in the county, up from 28 in 2010.
One reason for the increased incidence of reported suicidal overdoses could be better investigation and reporting by coroner's office staff, Keach said.
"It's more likely we weren't catching them in the early years," Keach said about suicidal overdoses.
Testing for toxic levels of drugs is more routine during death investigations than it once was, she said. What once might have been considered a heart attack now could be better investigated and eventually attributed to a cocaine overdose, for example.
Sometimes, family members hide the signs of addiction after a loved one has died, she said.
"We've gotten better at finding the signs," she said.
Determining whether an overdose was suicidal or accidental often depends on the circumstances surrounding the death, Keach said. Indicators of suicide include previous suicide attempts or sudden, negative life changes such as the loss of a job or a loved one, she said.
"We're really looking for someone who is in crisis in their social life," Keach said.
Toxicity levels are another indicator, she said. Suicidal people tend to take far more of a drug than the amount used by a routine drug abuser, Keach said.
"Maybe the person used just a little too much of one or the other (drug) that's combined into a recipe for respiratory suppression or cardiac arrest," Keach said. "They didn't intend to die. They were just doing their usual drug-abuse routine, but this was the time their body couldn't handle it."
'Could have been prevented'
Keach recently was shocked and concerned by a national drug abuse trend that seems to be echoed in Rock County.
"The incidence of drug abuse, substance abuse, has always been high with young adults in the 18-to-25 age group," Keach said. "I was shocked to learn the instance of substance abuse has been increasing in the 50-to-59-year-old group. Every year that number is going up and up."
Among the slice of drug abusers who died as a result of overdose in 2011, Rock County is following that national trend, Keach said.
Of the people whose 2011 deaths were determined accidental overdoses, the median age was 44, Keach said. Almost half the accidental overdose victims were 50 or older; nine of the 24 were between 50 and 59 years old, Keach said.
Statistics aside, all the overdose deaths have one thing in common, Keach said.
"Every single one of them is preventable," Keach said. "Every single overdose, period, could have been prevented."