Opiod Addiction — Opioids are chemically related and interact with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain. — Addiction is a primary, chronic and relapsing brain disease characterized by an individual pathologically pursuing reward and/or relief by substance use and other behaviors. — Drug overdose is the leading cause of accidental death in the U.S., with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015. — From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate. — Four in five new heroin users started out misusing prescription painkillers. Information provided by the American Society of Addiction Medicine.

Editor’s note: This is the second in a four-part series examining the impacts of heroin on individuals and on the community.

The number of heroin-related deaths in Fremont County is on the rise in recent years.

Heroin use and addiction can stem from individuals using prescription opioids simply to find relief for common ailments, but it eventually can lead to death.

“We have seen this at St. Thomas More,” said Dr. Rob Lins of the hospital’s Emergency Department. “The increase and dramatic number of deaths related to the use of medicine that has never saved a life is hard to watch.”

Opioids are a class of drugs that include the illicit drug heroin, as well as the licit prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others.

Fremont County Coroner Randy Keller said there were four accidental heroin deaths in 2016, one of which was heroin and methamphetamines combined. In addition, two people died of methamphetamine intoxication; three people died by prescription drug intoxication, and three people died by prescription drug/ethanol intoxication.

“We are seeing more and more problems in our community with heroin and methamphetamines,” Keller said. “We are seeing a rise in heroin; heroin-involved deaths — full blown heroin, not prescription opiates — doubled last year from the previous year.”

There were two fatal heroin overdoses in 2015, compared to four in 2016.

“As a lot of the counties in Colorado have seen over the last couple of years, these numbers are tending to almost double,” Keller said. “It is a very inherent problem in our community at this time.”

The use of Narcan, a nasal spray that works as a reversal agent for heroin and prescription opioid overdoses, by law enforcement and first responders has saved lives in this community, Keller said.

“Without it, the (number of deaths in Fremont County) would have been much higher,” he said.

Use of prescription opioid use has quadrupled since 1999, and there have been more than 183,000 deaths from 1999 to 2015, Lins said. Each year sees a dramatic increase from the past. Because of this, the surgeon general, Dr. Viveck Murthy, sent a letter to every physician in the U.S. asking every physician to “please work together to help solve this problem of unnecessary deaths.”

“We have seen a recent epidemic and exponential increase in deaths related to opioid use over the past few years,” Lins said. “Prescription opioid use is a big reason for this.”

The community also is seeing somewhat of a rise in prescription drug and alcohol intoxication.

“That’s typically prescription opiates and alcohol intoxication,” Keller said. “It’s a very bad combination.”

Keller said the accidental heroin overdoses are not restricted to just young people.

“Part of the problem that is being seen nationwide is individuals who are getting addicted to prescription opiate medication, and their doctors are either trying to wean them off of it, or they get so addicted to it that the next step is heroin,” he said. “Heroin also is less expensive.”

With the massive influx of heroin coming into the U.S., Keller said, it’s much more accessible. Fremont County Sheriff Jim Beicker said the drug is coming from Mexico through the I-25 corridor to Pueblo, then here to Fremont County.

“It’s a problem that’s here, and it’s a problem that’s not going to go away very soon,” Keller said.

Addicts often find it difficult to experience feelings of happiness without the effects of heroin after they’ve become used to it.

Lins said heroin induces sleep but also creates a powerful euphoria caused by a massive surge of dopamine in the brain. He said addicts soon begin to feel there is little in the world that causes happiness, except heroin.

“Worse yet, tolerance develops quickly,” he said. “Therefore, to get the same high, larger and larger doses are needed. This leads to a very dangerous situation where it becomes difficult to judge a dose that is not fatal. People typically die from overdosing and respiratory depression.”

Dependence also develops quickly. Without it in your system, Lins said, withdrawal symptoms develop, including pain, sweating, vomiting and involuntary twitching.

The term “kicking the habit” was coined in reference to opiate withdrawals, he said.

“This can lead to stealing, violence, gambling and prostitution to pay for the habit,” Lins said. “I recall when I was a resident physician, doing a medical clearance exam on a man who had raped and murdered his grandmother to steal $500 to buy more heroin. He struck me as a very gentle and cooperative person as I examined him to go to jail.”

Other complications from drug use that are common include infected heart valves, abscesses and hepatitis.

Sometimes, people don’t want to stop using heroin because the withdrawal symptoms are miserable.

“Unlike alcohol withdrawals though, narcotic withdrawals are not considered life-threatening,” Lins said. “Deathly ill is a good description though.”

Information provided by Rick Miklich, the director at Fremont County Department of Public Health & Environment, states based on initial findings from a recent community health assessment, substance abuse, particularly heroin, is the community’s No. 1 health concern.

“I am glad that there is some public awareness out there of this issue,” he said. “I am glad people are starting to become aware of what is going on and know there are some things we need to be doing. That will help us down the road once we get our improvement plan going and develop some strategies, which we are doing right now, to work on some innovative approaches to curbing what’s going on.”

Based on a statewide survey for years 2012-2014, out of 36 Colorado counties responding, Fremont County ranked seventh for visits to emergency departments for opioid use. Fremont County also ranked seventh out of 45 responding counties for hospitalizations due to prescription opioid overdoses.

“We really need to start to get innovative on how we are addressing opioid use,” Miklich said. “We’ve really got to get going because it just keeps getting worse.”

Fremont County Department of Public Health and Environment started giving out Narcan and Naloxen earlier this year, free of charge to the community.

“We had a big flurry when we first started, now it’s kind of dropped off a little,” Miklich said.

They have given out about 20 doses, including giving some to agencies who house users so they have it on hand, social services and private citizens.

“What we need is treatment,” Miklich said. “Naloxen is great, it will bring someone back from the brink of death, but we need to get more treatment programs so we can get people treated — it is an extremely addictive substance.”

Carie Canterbury: 719-276-7643, canterburyc@canoncitydailyrecord.com