More potent heroin makes it easier to start—and easier to OD
JANESVILLE—Here's a story that probably sounds familiar in the business world: International supply routes are becoming more efficient at bringing an in-demand product to a growing group of consumers in the United States.
Once it gets here, it encounters a competitive market that forces sellers to keep its quality high while offering it at lower prices.
This product isn't a cellphone or a TV, though.
It's heroin—increasingly pure, cheaper and more readily available than ever in Wisconsin, particularly in smaller cities such as Janesville.
Heroin once was loaded with filler, but officers today come across street-level heroin that is upwards of 50 percent pure, officials said.
Meanwhile, the drug has stayed appealing to users, and competition has kept it cheap.
“With the increase in the availability of heroin, I think the quality is staying up and the price is staying down,” said Dave Spakowicz, eastern region field operations director for the state Department of Justice.
Greater purity has become a double-whammy in communities affected by the drug: Heroin today carries less of a stigma as younger users find it easier to pick up, while its fluctuating strength can make users more vulnerable to overdoses.
“The heroin just keeps getting purer and purer,” said Scott Stokes, who coordinates a statewide needle exchange program that comes to Rock County twice a week. “The overdose potential is huge.”
FEWER STOPS, STRONGER DRUGS
Back in the 1970s and 80s, heroin often was 3 percent to 8 percent pure and was used by a small group of addicts, Spakowicz said. Because it was of such low strength, the only way for users to get high was to inject the drug—one reason it was stigmatized even in circles of other drug users, he said.
But purity has been on the rise, Spakowicz said, especially in smaller towns seen as relatively untapped markets.
In Janesville, Sgt. Jim Holford said his drug unit has seen quality upwards of 70 percent.
“It's much more pure than what historically we had seen a few years ago,” Holford said.
That tells authorities the route that brings the drug here has gotten more efficient, he said.
Heroin that comes to Janesville enters the United States through the border with Mexico, and from there travels north along the Interstate system to Chicago—the distribution hub for the upper Midwest, Holford said.
From there, it moves to what Spakowicz calls “secondary markets” in cities such as Beloit and Rockford, Ill. Users in smaller towns such as Janesville then drive to those cities to buy their drugs, he said, often pooling money between a few friends to get the most they can.
Each link in that chain sees someone reduce the drug's quality—middlemen “step on it” with filler powders such as citric acid so they can sell a greater weight than they bought, Holford said.
“Nobody's passing it on for no benefit,” he said.
So when police find heroin that's 70 percent pure, they know there haven't been many middlemen.
“If it's of higher purity, it's made fewer stops,” he said.
That quality also means users can avoid something that once made heroin unappealing: the needle.
'JUMPING OVER YEARS OF DRUG USE'
When the AIDS Resource Center of Wisconsin in the 1990s started its Lifepoint Needle Exchange program targeting heroin users, the people it served were “at the end of a spectrum of drug use,” said Stokes, the center's director of prevention services.
If someone was hooked on heroin, Spakowicz said, they usually got there after 15-20 years of abusing other drugs.
With heroin today being as pure as it is, though, users can snort the drug instead of injecting it, reducing the stigma that came from needles and track marks.
“I don't think anybody likes sticking a needs in their arm,” Spakowicz said. “If they can snort a substance, they look at it and say, 'That's relatively clean.'”
At the same time, prescription medications such as oxycodone (an opiate like heroin) have become more readily available. Users might start by snorting those pills, later find themselves needing a cheaper way to get the same fix and turn to heroin, Holford said.
He estimates that's how 90 percent of heroin users in Janesville get started.
Combine those factors, and you see younger users—Spakowicz estimates between 18 and 26 years old—getting started with heroin far earlier than previous generations of addicts. It's a group of young adults “jumping over years of drug use,” Stokes said.
As the drug becomes an easier habit to pick up, its greater purity also means users face more unknowns when they snort or shoot up—uncertainty that could prove fatal.
OVERDOSES RISING STATEWIDE
A pretty strong batch of heroin must have come through Wisconsin a few weeks ago, Stokes said. He can guess that because his organization heard about a rash of overdoses.
Paramedics see the same thing, Janesville Deputy Fire Chief Gerry Luiting said. When heroin gets to town that's particularly pure, he said, overdose calls start coming in groups.
“It kind of ebbs and flows,” Stokes said. “You never know what you're going to get with the next batch.”
That might be the most dangerous aspect of increasingly potent heroin: A street drug isn't like a bottle of liquor with a label on the side telling the user how strong it is. And when someone who can handle a certain amount of heroin does that size dose—but from a batch that's twice as pure as what he's used to—he can quickly get into trouble, Holford said.
“You don't know what you're getting. You're just taking your dealer's word for it,” Holford said. “It's not an exact science—you're trusting your drug dealer's word and your own experience on how much you can tolerate, and frequently those calculations are incorrect.”
As the drug becomes readily available and its quality fluctuates depending on who's selling it or when, overdoses are happening more frequently.
Janesville police investigated three heroin overdoses in 2009, Holford said. The number of investigations has steadily grown, reaching 16 last year and 13 this year through Aug. 15.
That puts the department on pace to top 20 heroin overdose investigations by year's end.
Not all of those overdoses are deadly, Holford notes, and police statistics only count the relatively small percentage of incidents that are reported to cops.
Still, the rate of fatal overdoses statewide nearly quadrupled between 2000 and 2013, according to Wisconsin's Department of Health Services. The rate in Rock County has fluctuated far more.
Authorities warn that more people would be dying if not for naloxone, a drug that can stop an overdose in seconds.
Paramedics carry naloxone—also known by its brand name Narcan—and Stokes' needle exchange organization distributes it directly to users who watch a short training video.
The Janesville Fire Department didn't have statistics on how frequently its paramedics use naloxone. But statistics kept by Lifepoint show “peer saves," in which one heroin user injects another with naloxone to stop an overdose, have grown from fewer than 200 in 2008 to nearly 800 in Wisconsin last year.
Distributing naloxone to users is not without controversy, of course, from critics who say it provides addicts with a false sense of security.
Stokes understands that issue. As more people get hooked on heroin and more of them run the risk of a fatal overdose, though, naloxone has become “another tool in the toolbox to keep these people alive,” he said.
“I can appreciate consequences,” Stokes said. “Here the consequence is death.
“There's just no way that we can not provide that (naloxone) and just let those people die.”