PHOENIX (AP) -- Some states, including Arizona, are reporting a rise in heroin use as many addicts shift from more costly and harder-to-get prescription opiates to this cheaper alternative. A look at what's happening in Arizona:
Arizona has seen the number of heroin overdose deaths rise by more than 90 percent in the past decade. The deaths coincided with a rise in abuse of prescription opioids as well, according to Sheila Sjolander, assistant director at the Arizona Health Services Department. Substance abuse in general is one of the department's priorities.
"We consider it a winnable battle," Sjolander said. "In our perspective, one of the bigger issues we've been working on very strategically is prescription drug overdose deaths."
Deaths from prescription drugs far outnumber heroin deaths, she said. But the department is aware that heroin deaths nationally have been on the rise as prescription opioids become more difficult to obtain.
"We also understand that prescription drugs are often a gateway to heroin - and heroin is cheaper," she said.
Heroin-related deaths rose from 65 in 2003 to 126 in 2013, according to death certificate data collected by the Health Services Department. A large number of the deaths also involved other drugs.
Arizona is focused on increasing awareness of prescription painkiller use, primarily through the medical community, by developing better guidelines for prescribing the drugs. State health officials are also urging providers to use the state's prescription drug monitoring program to identify doctor-shopping patients.
At the community level, drop-boxes for people to dispose of unwanted medication are being installed.
'We're all paying:' Heroin spreads misery in US
On a beautiful Sunday last October, Detective Dan Douglas stood in a suburban Minnesota home and looked down at a lifeless 20-year-old - a needle mark in his arm, a syringe in his pocket. It didn't take long for Douglas to realize that the man, fresh out of treatment, was his second heroin overdose that day.
"You just drive away and go, `Well, here we go again,'" says the veteran cop.
In Butler County, Ohio, heroin overdose calls are so common that the longtime EMS coordinator likens the situation to "coming in and eating breakfast - you just kind of expect it to occur." A local rehab facility has a six-month wait. One school recently referred an 11-year-old boy who was shooting up intravenously.
Sheriff Richard Jones has seen crack, methamphetamine and pills plague his southwestern Ohio community but calls heroin a bigger scourge. Children have been forced into foster care because of addicted parents; shoplifting rings have formed to raise money to buy fixes.
"There are so many residual effects," he says. "And we're all paying for it."
Heroin is spreading its misery across America. And communities everywhere are indeed paying.
The death of actor Philip Seymour Hoffman spotlighted the reality that heroin is no longer limited to the back alleys of American life. Once mainly a city phenomenon, the drug has spread - gripping postcard villages in Vermont, middle-class enclaves outside Chicago, the sleek urban core of Portland, Ore., and places in between and beyond.
Cocaine, painkillers and tranquilizers are all used more than heroin, and the latest federal overdose statistics show that in 2010 the vast majority of drug overdose deaths involved pharmaceuticals, with heroin accounting for less than 10 percent. But heroin's escalation is troubling. Last month, U.S. Attorney General Eric Holder called the 45 percent increase in heroin overdose deaths between 2006 and 2010 an "urgent and growing public health crisis."
In 2007, there were an estimated 373,000 heroin users in the U.S. By 2012, the number was 669,000, with the greatest increases among those 18 to 25. First-time users nearly doubled in a six-year period ending in 2012, from 90,000 to 156,000.
Experts note that many users turned to heroin after a crackdown on prescription drug "pill mills" made painkillers such as OxyContin harder to find and more costly. It's killing because it can be extremely pure or laced with other powerful narcotics. That, coupled with a low tolerance once people start using again after treatment, is catching addicts off guard.
In hard-hit places, police, doctors, parents and former users are struggling to find solutions and save lives.
"I thought my suburban, middle-class family was immune to drugs such as this," says Valerie Pap, who lost her son, Tanner, to heroin in 2012 in Anoka County, Minn., and speaks out to try and help others. "I've come to realize that we are not immune. ... Heroin will welcome anyone into its grasp."
IN MINNESOTA: TAKING THE MESSAGE TO THE MASSES
The night before Valentine's Day, some 250 people filed into a church in Spring Lake Park, Minn. There were moms and dads of addicts, as well as children whose parents brought them in hopes of scaring them away from smack.
From the stage, Dan Douglas gripped a microphone as a photograph appeared overhead on a screen: A woman in the fetal position on a bathroom floor. Then another: A woman "on the nod" - passed out with drug paraphernalia and a shoe near her face.
"You just don't win with heroin," Douglas told the crowd. "You die or you go to jail."
It was the third such forum held over two weeks in Anoka County, home to 335,000 people north of Minneapolis. Since 1999, 55 Anoka County residents have died from heroin-related causes. Only one other Minnesota county reported more heroin-related deaths - 58 - and it has a population three-and-a-half times greater than Anoka's.
Five years ago, county officials were focused on stamping out meth labs. Then investigators noticed a climb in pharmacy robberies, and started finding Percocet and OxyContin during routine marijuana busts.
As prescription drug abuse rose, so, too, did crackdowns aimed at shutting down pill mills and increasing tracking of prescriptions and pharmacy-hopping pill seekers. Users turned to heroin. "It hit us in the face in the form of dead bodies," says Douglas.
Authorities are working to educate doctors about the dangers of overprescribing painkillers and are fighting to get heroin off the streets. The idea for the forums came not from police but rather from Pap, a third-grade teacher whose youngest son died of a heroin overdose.
Tanner graduated from high school with honors. In the fall of 2012, he was pursuing a psychology degree at the University of Minnesota, and dreamed of becoming a drug counselor. He had not, to his mother's knowledge, ever used drugs - and certainly not heroin.
Then one day Tanner's roommates found the 21-year-old unconscious in his bedroom.
Amid her grief, Pap realized something needed to be done to educate others. She met with county officials, and soon after the community forums were developed. At each, Pap shared her family's story.
"Our lives have been forever changed," she told the crowd in Spring Lake Park. "Heroin took it all away,"
IN OHIO: OD ANTIDOTE HELPS SAVE SOME
Brakes screech. The hospital door flies open. A panicked voice shouts: "Help my friend!" An unconscious young man, in the throes of a heroin overdose, is lifted onto a gurney.
It's known as a "drive-up, drop-off," and it's happened repeatedly at Ohio's Fort Hamilton Hospital. The staff's quick response and a dose of naloxone, an opiate-reversing drug, bring most patients back. Some are put on ventilators. A few never revive.
"We've certainly had our share of deaths," says Dr. Marcus Romanello, head of the ER. "At least five died that I am acutely aware of ... because I personally cared for them."
Romanello joined the hospital about two years ago, just as the rise of heroin was becoming noticeable in Hamilton, a blue-collar city of 60,000 people. Now it seems to be reaching into nearly every part of daily life.
"If you stood next to somebody and just started a conversation about heroin, you'd hear: `Oh yeah, my nephew's on heroin. My next-door neighbor's on heroin,'" says Candy Murray Abbott, who helped her own 27-year-old son through withdrawal.
Heroin-related deaths have more than tripled in Butler County, where Hamilton is the county seat. There were 55 deaths last year, and within one two-week period, the city's emergency paramedic units responded to 18 heroin overdoses.
Users run the gamut, says EMS veteran Jennifer Mason - from streetwalkers to business executives. They die in cars, public parks, restaurant bathrooms.
Romanello's hospital saw 200 heroin overdose cases last year. Overdose patients usually bounce back quickly after given naloxone, or Narcan. It works by blocking the brain receptors that opiates latch onto and helping the body "remember" to take in air.
At least 17 states and the District of Columbia allow Narcan to be distributed to the public, and bills are pending in some states to increase access to it. In Ohio, a new law allows a user's friends or relatives to administer Narcan, on condition that they call 911.
Romanello says his patients are usually relieved and grateful by the time they leave his hospital. "They say, `Thank you for saving my life,' and walk out the door. But then, the withdrawal symptoms start to kick in."
"You would think that stopping breathing is hitting rock bottom," adds Mason. "They don't remember that. ... You've blocked the heroin, and they have to have it. They go back out to get more."
IN OREGON: A FORMER ADDICT FIGHTS BACK
They smile down from photos: recovering addicts holding plates of food at a group picnic last year. From inside Central City Concern in downtown Portland, Ore., David Fitzgerald looks over the faces.
Are they all still sober? Are they all still alive?
"Most of them," says Fitzgerald, a former addict who leads the mentor program at the rehab clinic. "Not all."
Heroin cut a gash through the Pacific Northwest in the 1990s. Then prescription pills took over until prices rose. Now the percentage of those in treatment for heroin in Oregon is back up to levels not seen since the `90s - nearly 8,000 people last year - and the addicts are getting younger.
Central City's clients reflect that. In 2008, 25 percent of them were younger than 35. Last year the number went to 40 percent.
The crop of younger addicts presents a new problem - finding appropriately aged mentors to match them with. But Fitzgerald has hope in 26-year-old Felecia Padgett. Before sobriety, Padgett found herself selling heroin to people younger than herself, suburban kids rolling up in their parents' cars. Using heroin, she says, was like "getting to touch heaven."
Fitzgerald doesn't yet have money to pay her, and Padgett herself is still in recovery. But she, and others like her, may play a crucial role in confronting the problem as the face of Portland's heroin addiction gets younger.
"A lot of them aren't ready at a younger age," Fitzgerald says. "The drug scene, it's fast ... it's different. It's harder than it was."
A look at heroin use, deaths in some US states
By ANDREW WELSH-HUGGINS
In and around Cleveland, heroin-related overdoses killed 195 people last year, shattering the previous record. Some Ohio police chiefs say heroin is easier for kids to get than beer. In Missouri, admissions to treatment programs for heroin addiction rose 700 percent in the past two decades. In Massachusetts, state police say at least 185 people have died from suspected heroin overdoses in the state since Nov. 1, and the governor has declared a public health emergency.
With heroin use rising across the U.S., The Associated Press queried state health departments, medical examiner's offices and law enforcement agencies across the nation for statistics related to use, overdoses and treatment to obtain a more detailed picture of the problem on the ground. While some states reported few changes, others pointed to heroin as a significant public health concern. A look at some state-specific findings:
- CALIFORNIA: California has seen an increase in heroin addicts seeking treatment since fiscal year 2006-2007, as a proportion of addicts seeking treatment for all drugs including alcohol. Despite that, heroin has generally been overshadowed by methamphetamine use over the last 20 years.
- COLORADO: Heroin deaths are increasing sharply among people in their 20s and 30s, but most age groups are affected. While six teens died of heroin overdoses in the past dozen years, five teenage boys died of heroin overdoses in the state in 2012 alone.
- CONNECTICUT: The state reports 10,183 people admitted for treatment for heroin last year at licensed programs, up from 8,954 in 2012 and the highest total in eight years. Heroin-related overdose deaths went from 174 in 2012 to 257 last year, a 48 percent increase. The figures include heroin alone and heroin with other drugs.
- FLORIDA: The number of heroin-related deaths statewide nearly doubled between 2011 and 2012, from 57 to 108, with an increase from 15 to 33 deaths in the Miami area. Admissions for drug treatment where heroin was the primary drug rose from 4 percent of all substance abuse admissions around Miami in 2012 to 8 percent in the first half of 2013.
- ILLINOIS: Heroin's impact is felt from the suburbs of Chicago to those near St. Louis. In DuPage County, the number of heroin deaths stayed in the 20s each year from 2007 through 2011, then rose to 43 in 2012 and 46 last year. Last year's youngest victim was 15 years old. Madison County, northeast of St. Louis, tallied 23 heroin deaths last year, more than two-thirds greater than the seven in 2009.
- INDIANA: Heroin use reported by addicts getting treatment rose from 2.6 percent in 2001 to 6.6 percent in 2010, the most recent year for which statistics were available.
- LOUISIANA: Heroin overdose deaths rose from five in 2008 to 110 in 2012.
- MASSACHUSETTS: In March, Gov. Deval Patrick declared a public health emergency in response to heroin overdoses and opioid addiction. State police say at least 185 people have died from suspected heroin overdoses in the state since Nov. 1, a figure that does not even include overdose deaths in the state's three largest cities. The number of people dying from opiate overdose, which could include heroin but also painkillers such as oxycodone, has nearly doubled from 2000, with 642 deaths reported for 2011.
- MICHIGAN: Heroin overdose deaths increased from 271 from the four-year period of 1999-2002 to 728 from 2010-2012. Admissions to publicly funded programs for heroin treatment nearly doubled from 7,300 in 2000 to about 13,600 in 2013.
- MINNESOTA: In 1993, 450 people were admitted for treatment for heroin abuse in the state. That grew to 4,519 for just part of 2013, with final data for that year still being tallied. The state recorded three heroin-related deaths in 1999 compared with 50 in 2011 and 49 in 2012. According to preliminary data, the number of heroin-related deaths rose to 98 in 2013.
- MISSOURI: The upturn in heroin problems in St. Louis County has prompted police to hold town hall meetings in high school gyms to alert parents to warning signs. In 2001, state records listed 18 heroin overdose deaths. By 2011, the number reached 245.
- NEW HAMPSHIRE: In 2013, 68 people died of heroin-related overdoses, compared with 38 the previous year and 16 in 2008. Also rising are burglaries, robberies and assaults associated with drug-seeking. State police say 13 percent of traffic stops and arrests that led to blood or urine tests in 2013 involved heroin.
- NEW JERSEY: State officials are seeing a jump in those seeking treatment who live in suburban areas versus cities. Overall, the number of people seeking treatment for heroin abuse hit a five-year high of 25,442 in 2012, the latest year for which statistics were available. In 2012, 591 people died of heroin overdoses statewide, up from 443 the previous year.
- NEW YORK: Heroin and prescription painkiller investigations have doubled in Rockland County northwest of Manhattan, where a bag of heroin can cost as little as $5 and the drug is being abused by people of all ages and income levels. Treatment facilities also report a rise in numbers: Five years ago, the Long Island Council on Alcoholism and Drug Dependence was serving just under 100 families a month. Last month, the council helped more than 850 families; 80 percent of that increase was due to opiate and heroin addiction.
- NORTH CAROLINA: There were between 40 and 50 heroin deaths a year during the 2000s, then spikes of 77 in 2011 and 148 in 2012, the most recent year for which numbers were available. A chunk of the increases occurred in the Charlotte area, which saw 15 deaths in 2011 and 24 deaths in 2012.
- NORTH DAKOTA: The number of federal charges related to heroin, but also other drugs, has soared in the past few years, coinciding with the explosion of development in the state's oil patch.
- OHIO: The number of heroin-related overdose deaths went to 426 in 2011, up from 338 the previous year, part of a trend that police and counseling agencies have been warning about for several years. In 2004, 5.8 percent of Ohio drug users named heroin as their drug of choice; that rose to 12.5 percent in 2011.
- OREGON: Heroin overdose deaths in the state have grown from a couple of dozen a year beginning in 2000 to an average of more than 100 a year for the past five years.
- RHODE ISLAND: Admissions for heroin addiction went from 5,454 in 2009 to 7,642 in 2013, with growth highest in the 31- to 45-year-old age group.
- TEXAS: Heroin deaths increased from 111 in 1999 to 364 in 2011, the last year for which statistics were available, with the biggest jumps among whites and Hispanics.
- UTAH: Treatment admission figures indicate use of heroin spiked in the past 20 years, with 346 heroin admissions in 1993, or about 2 percent of all drug admissions, compared with 2,606 admissions in 2013, or about 15 percent of admissions.
- VERMONT: Heroin deaths jumped to 21 in 2013 in Vermont, up from single digits over the previous decade. Treatment for heroin or painkiller abuse rose from 399 people in 2000 to 3,479 in 2012, a per capita rate now second in the nation. This year the governor dedicated his entire State of the State speech to the heroin problem.
- VIRGINIA: Heroin overdoses went from 101 in 2011 to 135 in 2012 to 197 in 2013. The increase is hitting both urban areas and rural counties.
- WASHINGTON: Overdose deaths specifically attributable to heroin have risen in the past two decades, from 16 in 1995 to 182 in 2012, with the increase in heroin driven by young adults outside the Seattle area.
- WEST VIRGINIA: West Virginia has seen an increase in overdose deaths over the past few years where heroin was either the primary drug or one in a combination. Seventy people died of heroin-related overdoses in 2012, according to preliminary data, compared with 22 in 2007.
- WISCONSIN: Crime involving heroin is growing, according to data showing that state crime labs processed 1,056 heroin cases in 57 of Wisconsin's 72 counties in 2013, up from 648 cases in 56 counties in 2012 and 579 cases in 37 counties in 2011. The number of heroin-related arrests across the state rose from 267 in 2008 to 673 in 2012.
Associated Press National Writer Sharon Cohen contributed to this story. Forliti reported from Minnesota; Sewell from Ohio; Duara from Oregon.
© 2014 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
© 2014 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.