Produced by Carrie Ching/California Watch?
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With the steady rise of prescription drug abuse across the state, young pill addicts are succumbing in increasing numbers to another vice: heroin.
For young people who otherwise might have been turned off by the needles and track marks associated with intravenous drug use, switching from abusing pills perceived as ?clean? and ?safe? to snorting or smoking heroin isn?t a major leap, according to treatment specialists and public health officials.
The switch from prescription opioids to heroin swept up people like Evan Macphee, a 23-year-old Orange County resident who said he turned to heroin after a seven-pills-a-day addiction to prescription drugs like OxyContin and Opana became too expensive.
?You get more bang for your buck,? Macphee said in an interview in his hometown of San Juan Capistrano, where he gives surfing lessons.
Experts say California has followed in the path of states like Massachusetts and Ohio, which were among the first in the late 1990s to be ravaged by the painkiller epidemic and where heroin addiction began to take hold in the mid-2000s.
With the rise of prescription drug addiction, heroin dealers realized they were facing an untapped pool of customers desperate for cheaper opiates. The phenomenon swept westward, with California one of the last holdouts.
Few hard statistics are available on the number of people moving from prescription drugs to cheaper heroin. But interviews with drug treatment experts and public health officials suggest a marked increase in heroin use that is accompanying the steady and dramatic rise in prescription opioid abuse among young people.
Daniel A. Anderson/California Watch Evan Macphee (center) attends a memorial for friend Joey Whynaught, who died Apri 5. Macphee, 23, said he turned to heroin after a seven-pills-a-day addiction to prescription drugs.?
In the Central Valley, heroin has replaced methamphetamine as the drug of choice for addicts younger than 25, drug treatment experts said. Most of these people became addicted to pills like OxyContin and are now IV heroin users, according to Dale White, president of Central California Recovery in Fresno.
?The kids we see addicted to heroin today come from neighborhoods and communities of resources and affluence,? White said. ?Where there is employment, there is health insurance and therefore increased access to prescription medication. Heroin enters the picture when they?ve run out of resources.?
The street price of one 80-milligram OxyContin pill runs as high as $100, while an equally powerful high withheroin can be bought for as little as $10 a bag.
The increased use of heroin appears to follow the introduction two years ago of an abuse-resistant OxyContin pill, researchers say. This new version, which is harder to crush and dissolve, has sent opioid abusers to other products, such as fentanyl, hydromorphone and heroin, according to a letter from researchers at Washington University in St. Louis that appeared in the July 12 issue of The New England Journal of Medicine. Heroin use, they said, nearly doubled.
Douglas Bodin, a Bay Area treatment specialist with clients around the state, said pills and heroin used to be an issue for 1 out of every 20 of his patients; these days, he says it?s 1 out of every 2 or 3.
Drug abuse experts said the phenomenon appears to be particularly pronounced in Orange County. For young men and women between age 13 and 26, deaths from heroin overdoses nearly doubled from nine in 2007 to 16 in 2011, according to data compiled by Dr. Robert Winokur, medical director of emergency room services at Mission Hospital in Mission Viejo.
?Our kids are dying,? Winokur said during a recent interview at the emergency room, surrounded by the metal gurneys that transport many young victims.
Opiate overdoses have become so common, Winokur said, that ER staff have coined the term ?positive screech sign? to indicate the sound of a car peeling away after dropping off a young overdose victim whose friends don?t want to deal with the authorities. Often, they are brought to the emergency room following overdoses that happened after periods of sobriety that lowered their tolerance.
?Most of the kids we see who are not dead, they?ve overdosed five, six, seven, eight, nine times,? he said. ?And these are good kids, good parents. These are athletes, cheerleaders, college students.?
The reformulation of OxyContin ? one of the most popularly abused opiates ? is one reason behind the uptick in heroin overdoses, Winokur said.
Some addicts turned to other powerful painkillers instead. In Orange County that year, 15 people younger than 26 died of Opana overdoses; three deaths were attributed to Opana in 2009. Others used heroin, which accounted for nearly 40 percent of accidental overdoses in that age group in 2011, up from 25 percent in 2007, according to Winokur?s data.
From addiction to overdose
Many parents fight desperately to help their children overcome opiate addiction, but some lose the battle. Alice and Ted Whynaught of San Juan Capistrano found their 23-year-old son, Joey, in bed at 5:30 a.m. April 5, dead of a heroin overdose after years of being addicted to painkillers.
?He was blue in the face, but I kept telling him, ?Get back in your body now, just come back,? ? Joey?s mother said as she sat with her husband before an altar awash in lilies at Saddleback Church in Lake Forest.
Some older members at the memorial service shook their heads at the loss of the young man known as ?Joe Bug,? who surfed unimaginably high waves and was shown cuddling with his niece in the pictures at the front of the church. But many friends who attended the memorial, like Macphee, seemed more defeated than shocked.
In just two years, Macphee said he?s attended more than a dozen funerals for friends younger than 25 who overdosed on pills or heroin. He?d seen Joey Whynaught ? a friend since childhood ? at recovery meetings in the weeks and days prior to his death. The day Whynaught died, the pair had planned to go surfing at a local beach.
?It hurts to see someone so young and full of life pass away,? Macphee said. ?But it?s happened so often lately that it?s expected, and it?s going to happen to someone else next, and it?s going to be soon.?
Macphee said Joey Whynaught?s path to heroin was similar to his own. Macphee started using prescription pills, including Soma, Xanax, Norco and OxyContin, at 14 and then turned to heroin. Last July, he overdosed so severely on OxyContin and heroin that he was in a coma and nearly died. Within 45 minutes of his release from the hospital, he said he was high again.
Some teens are introduced to painkillers when doctors and dentists issue prescriptions for sports injuries or wisdom tooth surgery.
That was the case for another friend of Joey Whynaught?s, Blake Kinsey, who was prescribed Vicodin at 14 for a broken finger. Heroin was something he promised himself that he would never do, but by 17, he was spending hundreds of dollars a day to ease the wrenching physical symptoms of painkiller withdrawal that would set in every few hours.
After Kinsey, now 22, became sober two years ago, he began working as a resident adviser at Able to Change Recovery, a residential treatment center in San Juan Capistrano. There, he estimates that 80 percent of those in treatment are opiate users younger than 30, that most of the opiate users are addicted to heroin and that most of those heroin addicts got started by abusing painkillers.
At the Center for Discovery, an adolescent treatment center in Long Beach where he is now an intake coordinator, Kinsey says he sees the groundwork for the trend in its infancy: The majority of the young teens being treated for substance abuse are experimenting with pills.
?It?s basically the earlier stages of what ends up being heroin addiction,? he said.
Early in their addiction, Kinsey said, many young painkiller addicts attach a stigma to using needles, clinging to the stereotypical image of a ?junkie? as a homeless person with a needle hanging out of his arm in a gutter. But for many, the expense of pill addiction quickly becomes unmanageable.
?You find something that is stronger and cheaper,? he said. ?It?s a perfect recipe for going up the food chain of drugs.?
Daniel A. Anderson/California Watch For 22-year-old Anna Taylor from Dana Point, the path to heroin addiction began by pilfering through a family member?s medicine cabinet. She became sober this year.?
Drugs come from friends, family
For 22-year-old Anna Taylor from Dana Point, the path to heroin addiction began by pilfering a family member?s medicine cabinet. More than 70 percent of first-time abusers of prescription pain relievers obtain the drugs from friends or relatives for free, according to a recent federal analysis of data from the National Survey on Drug Use and Health.
In Taylor?s case, her father was dying of cancer and the family?s house ?was like a pharmacy,? so it was easy for the then-15-year-old to sneak pills when no one was looking. Heroin followed a few years later.
?I don?t want to be the 90 percent that relapse,? said Taylor, who said she?s been sober for nearly three months. She is living at home with her mom, working at the local Vons supermarket and focusing on raising her two young children, ages 2 and 3. ?I want to be the 10 percent where I make it. I want to remember my life,? she said.
In many households, it?s not uncommon for parents to have a stockpile of prescription opioids ? middle age brings health issues, back and knee pain and surgeries. Many people like to hold onto their drugs in case of a ?rainy day,? and so access to these medications can be easy.
But some physicians continue to overprescribe painkillers, according to law enforcement agents and addiction specialists. That angers recovering addicts and those working in the addiction field who believe, like Kinsey, that such physicians should be treated as criminal drug dealers.
?They are no different than that shady guy in the alley,? Kinsey said. ?They look different, they have a much different salary, they have way more important friends, some of those friends being pharmaceutical companies. But it?s the same thing.?
Meanwhile, the recent influx in California of a stronger-than-usual form of heroin has upped the survival stakes for overdose victims, according to Eliza Wheeler, project manager at the Drug Overdose Prevention and Education Project in the Bay Area.
Drug abuse experts also have noticed an increase in the use of naloxone, a drug, often in nasal spray form, that counteracts the effects of opiates and is available at some needle exchanges and treatment centers.
Since January, the DOPE Project has received 99 reports of people using the antidote to revive an overdosing friend, and the number of reports of naloxone use in May alone almost tripled from the numbers reported the year before.
?Purity and strength of heroin changes all the time, and the result is that our friends, family and community members die when the drugs are stronger,? Wheeler said.
Addressing addiction?s stigma
Still, the growing tide of overdose deaths has not acted as a deterrent for some young adults whose tragedies are often closely connected.
When Laguna Niguel mom Jodi Barber?s 19-year-old son, Jarrod, overdosed on a cocktail of clonazepam, Seroquel and Opana in January 2010, his friend John McGinley returned from the U.S. Army on a two-week leave to attend the funeral. McGinley relapsed and died of a heroin overdose. Six months later, another friend, Ryan Winter, died; 11 months later, Jarrod Barber?s friend Riley Russo also was dead, according to Jodi Barber.
The shame surrounding addiction to prescription drugs ? not to mention the lingering stigma of heroin ? has been a major factor in stymieing efforts to educate the public about the problem. For the most part, Jodi Barber said, parents are reluctant to admit that their children are struggling, even after their deaths.
?If we all keep quiet, the problem will only get worse,? she said. ?Parents need to stop trying to protect their image and help fight this battle. They need to start trying to save another family from going through the devastation that so many are experiencing.?
Jodi Barber has tried to chip away at the code of silence by producing ?Overtaken,? a short documentary aimed at educating young adults about prescription drug addiction. But she says she has faced pushback from some parents and school officials who are opposed to bringing up the topic in an explicit manner.
Daniel A. Anderson Friends and family attend a memorial for Joey Whynaught, who died April?5.
And along with members of a group called Mothers Against Prescription Drug Abuse, Jodi Barber is calling for federal legislative action. At a June 10 meeting with White House drug czar Gil Kerlikowske and U.S. Rep. Mary Bono Mack, R-Calif., the group urged the passage of legislation to require doctors to undergo education related to abuse and addiction of the substances they prescribe and to limit the use of the opiate oxycodone to ?severe pain? only.
At the state level, the ?911 Good Samaritan? bill by Assemblyman Tom Ammiano, D-San Francisco, aims to reduce overdose deaths by providing immunity from prosecution for people who call for medical help for overdose victims.
But for many of those in the trenches, political remedies offer little immediate help. Since Joey Whynaught?s memorial service in April, Evan Macphee has lost two more friends to addiction, his 15th and 16th funerals since his 20th birthday. Often these days, he retreats to the ocean, where he can lose himself in the surf and try to focus on staying sober.
?I?ve become numb to it,? he said. ?It?s super depressing and it?s upsetting, but it?s become so normal. It shouldn?t be that way for a 23-year-old kid.?
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