John Boyle

jboyle@citizen-times.com

In describing Mexican drug cartels, the usual adjectives takes precedence - ruthless, powerful, brutal.

Jill Westmoreland Rose, U.S. Attorney for the Western District of North Carolina, puts another at the top of the list: efficient.

"The Mexican cartels have done a really effective job at getting heroin in the United States," Rose said, adding that Charlotte, where her office is based, has become one of the cartels' "trans-shipment points. Heroin is cheap and it’s plentiful — and it’s more potent, more potent than what we saw in the streets decades ago."

It also creates devastating impacts on the addicted, their families, law enforcement officers, school personnel, emergency service workers, counselors and many others. Often, addicts start out taking strong opioid painkillers such as oxycodone, but then they shift to heroin once the prescriptions run out and they can't get a supply. Once addicted, they become less productive and sometimes turn to crime to get their fix

And some die — Buncombe County recorded 12 unintentional heroin poisoning deaths in 2014, up from three the year before and none the year before that, according to state statistics.

With these factors in mind, Rose and U.S. Department of Justice are spearheading "The Heroin Summit," a day-long discussion of the heroin and prescription drug problem in North Carolina. The event will take place Wednesday at UNC Asheville.

Penny McElroy, whose company, Watauga Recovery Center, had two clinics nearly four years ago, now has seven, including their latest, which just opened in Fletcher. The others are in Virginia and Tennessee.

"It really has exploded," McElroy said of the heroin/opioid problem, citing a statistic that one person overdoses every four hours in the United States."I think it’s the public health issue of our time, to tell you the truth, because it affects everybody. It affects the addicts, their children, law enforcement, hospitals. A hospitalization for a heroin overdose can be upwards of $30,000, $40,000, even $50,000 if it involves ICU treatment."

Buncombe County Sheriff Van Duncan makes no bones about it, saying heroin "has become Buncombe County’s most deadly drug issue.

"We’ve seen more overdoses, we’ve seen more arrests and we've seen more people trafficking in it," Duncan said. "It was probably about three years ago when we really started to see heroin, which we never saw before. Before that, we saw a case here, a case there. After that, about a year ago, we started to see some overdose deaths occurring at a pretty alarming rate."

Exacerbating the problem is the purity of the drug and some dealers' practice of adding powerful narcotics such as Fentanyl to heroin.

Rose said that while she's a diehard prosecutor, she knows "we can't prosecute our way out" of this epidemic. It will require a collaborative effort between law enforcement, schools, counselors and families to gain the upper hand.

Duncan agrees.

"(Rose) will be quick to tell you locking people up is not a solution for everything," Duncan said. "We have to have things that impact people at an earlier stage and really try to deter them from going down a bad path."

Heroin Summit

Federal and local experts will gather from 9 a.m.-4:30 p.m. Wednesday at UNCA's Wilma M. Sherrill Center to discuss the heroin and prescription drug problem in North Carolina. Co-sponsors are: U.S. Attorney's Office (Western District of North Carolina), U.S. Drug Enforcement Agency, Buncombe Co. Sheriff's Office, Asheville Police Department, Smoky Mountain LME/NCO. The audience and participants will consist of law enforcement, service providers, interested members of the community, school system people, etc.

• The Centers for Disease Control reported that 2014 was the first year in which the number of deaths caused by heroin nationwide surpassed 10,000, totaling 10,754. That's more than the years 2008-10, combined.

Unintentional heroin poisoning deaths by county, North Carolina

County, 2012, 2013, 2014

Western North Carolina

Buncombe, 0, 3, 12

Haywood, 0, 1, 0

Henderson, 0, 2, 2

Madison, 0, 1,1

Rutherford, 0, 0, 1

Highest totals statewide

Mecklenburg, 24, 22, 31

Wake, 8, 16, 26

Guilford, 9, 9, 24

Forsyth, 8, 8, 20

New Hanover, 12, 9, 11

Durham, 6, 6, 11

Cumberland, 10, 4, 11

State totals, 147, 179, 246

Source: North Carolina Injury & Violence Prevention Branch, North Carolina Public Health

Part of a larger substance abuse problem

• Nearly all people who used heroin also used at least one other drug, and most used at least three others.

• People who are addicted to alcohol are two times more likely to be addicted to heroin, while people who use marijuana are three times more likely. For cocaine users, that number jumps to 15 times more likely.

• The most striking indicator of future heroin use is opioid painkillers usage. These people are 40 times more likely to be addicted to heroin.

Source: U.S. Centers for Disease Control & Prevention

Troubling statistics

• The United States makes up only 4.6 percent of the world's population, but consumes 80 percent of its opioids, such as Oxycodone and Hydrocodone, according to ABC News.

• Opioid prescriptions per capita increased 7.3 percent from 2007 to 2012.

• In 2012, medical providers wrote 259 million prescriptions for opioid painkillers.

• More and more people have been trying heroin for the first time each year: In 2002, 117,000 people tried it, but in 2014, the number was 212,000, an 81 percent jump. That's an average of 600 new people trying heroin every day.

• As heroin use has increased, so have heroin-related overdose deaths. Between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled, and more than 8,200 people died in 2013.

• Heroin use more than doubled among young adults ages 18–25 in the past decade.

• 45 percent of people who used heroin were also addicted to prescription opioid painkillers.

Sources: heroin.net, Centers for Disease Control & Prevention,

New guidelines for prescribing painkillers

In a response to overdoses, the Centers for Disease Control and Prevention earlier this month issued new recommendations for doctors prescribing opioid medications for chronic pain, excluding cancer, palliative, and end-of-life care, according to a press release. The release stated the United States "is currently experiencing an epidemic of prescription opioid overdose. Increased prescribing and sales of opioids — a quadrupling since 1999 — helped create and fuel this epidemic," according to the release.

“More than 40 Americans die each day from prescription opioid overdoses; we must act now,” said CDC Director Tom Frieden. “Overprescribing opioids — largely for chronic pain — is a key driver of America’s drug-overdose epidemic."

The new guidelines will help primary care physicians to determine if and when to start opioids to treat chronic pain, the release stated. The guideline also offers specific information on medication selection, dosage, duration, and when and how to reassess progress and discontinue medication if needed.

NARCAN usage

Smoky Mountain MCO announced last week it will provide $100,000 to help distribute 2,600 doses of the drug NARCAN in Western North Carolina. NARCAN nasal spray, which contains naloxone, can reverse opioid-related overdoses, and Smoky Mountain believes the donation could save between 200 and 300 lives.

As first responders to medical emergencies, the Asheville Fire Department uses NARCAN frequently. Spokeswoman Kelley Klope said since January 2015 the AFD has documented 65 uses of NARCAN.

"We started using NARCAN in October of 2014 and its seems to be on average about five per month," Klope said. "The calls don’t always come in as drug overdose, but these 65 are calls in which we successfully used NARCAN on narcotic overdoses."

Many of the calls come in as “person unresponsive” and not as “possible overdose," so it's hard to know how many are heroin related.

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