The stories you want. The opinions that matter.
No, thanks
Tag: opiates
Sounding The Alarm As Prescription Drug Abusers Turn To Heroin

Sounding The Alarm As Prescription Drug Abusers Turn To Heroin

By Lisa Girion, Los Angeles Times (TNS)

LOS ANGELES — Standing in the pulpit above Austin Klimusko’s casket three years ago, his mother used his death to draw the connection between pills from a pharmacy and drugs from the street.

“When his prescriptions dried up, he turned to heroin,” Susan Klimusko said in a frank eulogy meant as a warning to the young mourners at Simi Valley’s Cornerstone Church.

Last week, the nation’s top public health official used the bully pulpit to sound the same alarm. The prescription drug epidemic is stoking the nation’s appetite for heroin with disastrous results, Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, told reporters in a teleconference.

“We are priming people to addiction to heroin with overuse of prescription opiates, which are, after all, essentially the same chemical with the same impact on the brain,” he said.

Frieden made his comments as he announced that heroin use had increased 62 percent and related deaths had nearly quadrupled since 2002.

The biggest increases were among groups associated with a parallel rise in the use of prescription painkillers, such as OxyContin and Vicodin. Today’s heroin user is increasingly likely to be wealthy, privately insured and between the ages of 18 and 25, according to the study by researchers at the CDC and the U.S. Food and Drug Administration.

heroin use on the rise

Graphic showing the rise in heroin use and that overdose deaths have quadrupled from 2002-2013.

It is a phenomenon familiar to people on the front lines of the crisis from Simi Valley to San Diego.

“The face of the heroin addict has changed very much to that of an 18- to 25-year-old surfer kind of guy,” said Susan Bower, a San Diego County health official who noted the shift there a few years ago.

And the prescription painkiller has become the new gateway drug to heroin use, eclipsing marijuana, cocaine and alcohol, the study found. People addicted to narcotic painkillers are 40 times more likely to misuse heroin, it reported.

At the same time, Frieden said, the flow of cheap heroin from Mexico has surged, offering users a ready supply of an inexpensive substitute to prescription painkillers.

Continue reading

“It’s really a one-two punch,” he said. “Those two factors are driving the increase and will drive the strategies we need to turn this around.”

Frieden called for a series of responses, including a crackdown on heroin, more treatment and more judicious prescribing. “For prescription opiates, the risks are very palpable,” he said. “A few doses and someone can have a life of addiction. A few pills too many and someone can die of an overdose.”

The findings offer a glimpse into the “real devastation the epidemic is causing to communities across the country,” Frieden said.

One affected area is Ventura County, where heroin-involved deaths more than doubled between 2009 and 2012 to 43. But in 2013, heroin deaths retreated, while deaths involving prescription painkillers jumped to 69. The shift coincided with a law enforcement push against heroin trafficking and may be further evidence of the interchangeability of legal and illegal drugs.

“You work one side of the problem, but then you see a ballooning on the other side,” said Patrick Zarate, who manages alcohol and drug programs for Ventura County. “We will probably continue to see a bit of back and forth over time.”

Simi Valley, on Ventura County’s eastern edge, is emblematic of the tandem crisis of pills and heroin. Austin Klimusko was one of several young overdose victims whose deaths brought the community to Cornerstone Church in 2012. Less than a week after his funeral, another family was planning a service for a daughter. And Austin, 23, was buried in the same cemetery as another victim who died at 21.

At his funeral, the Rev. Pat McCoy summed up the devastation.

“All of us, everyone sitting in this room has been affected by what happened,” McCoy said. “We don’t want that to keep happening. This is the fourth time I’ve done this in the last eight months. And I don’t want to do it anymore.”

Austin’s death illustrates heroin’s new reach. He grew up in a comfortable ranch home with a swimming pool and three dogs. He hung out with his older brother and the boys in the neighborhood. He liked to make them laugh. He loved Harry Potter books. He was enrolled in gifted classes. His mother is a hospital nurse; his father owned an electronics manufacturing plant. The family traveled to Mexico and Europe, and enjoyed skiing and fishing.

After high school, Austin moved to San Diego with friends. Susan Klimusko realized that her son had a serious drug problem when he accidentally “pocket dialed” her one night and she overheard him pressuring a friend to take drugs. She demanded he move back home in the belief that she could help him stop. Instead, he found a new supplier for his oxycodone habit, a medical clinic in Reseda.

“It just got worse and worse and worse,” she recalled. “He was a walking zombie.”

His parents convinced him to check into the Malibu Beach Recovery Center on his 21st birthday. He stayed sober, working in his father’s plant, for more than a year. But then, he slipped. Before long, Susan Klimusko said, he was spending his entire paycheck on prescriptions for oxycodone and other pills. At some point, he switched to heroin, pawning family valuables for cash. His parents locked their wallets in a safe when they went to bed.

His parents pleaded with Austin to give rehab another try. He agreed, driving himself to a facility in Bakersfield. “We were so hopeful,” Susan Klimusko said.

Sober for almost 90 days, Austin came home for Christmas, hung out and exchanged gifts. His parents gave him a purple and gold Lakers’ Snuggie. Austin headed back to Bakersfield, where he had a new job and a new girlfriend. It looked like a fresh start. But a few days later, he was dead of a heroin overdose.

Charts showing number of overdose deaths from various drugs. Tribune News Service

Charts showing number of overdose deaths from various drugs. Tribune News Service

Susan Klimusko viewed her son’s addiction as a battle that she lost. But she hasn’t stopped fighting a bigger war. Beginning with her son’s eulogy, she has been working to help other families struggling with addiction. She consoles grieving mothers and she counsels addicts who end up in the hospital where she works.

“Healing from heroin is a very long process,” she tells them. “I say, ‘I’m a mom. I lost my kid. I understand.'”

Photo: Susan Klimusko spent hours pouring through her son Austin’s phone logs and texts following his final moves before dying of a heroin overdose. This self-portrait is one of the last he took before passing away. He was 23. His opiate addiction began with prescription narcotics, according to his mother. Originally sent to his girlfriend, his mother says this picture now serves as a symbolic goodbye kiss to all his friends, family and loved ones.  (Liz O. Baylen/Los Angeles Times/TNS)

Book Review: ‘Dreamland: The True Tale Of America’s Opiate Epidemic’

Book Review: ‘Dreamland: The True Tale Of America’s Opiate Epidemic’

Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones; Bloomsbury (384 pages, $28.00)

—

First declared by President Nixon, the war on drugs was always already political. Nixon aide John Erlichman later commented on its origins:

The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black. But by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.

A decade later, President Reagan announced that illicit drugs were a national security threat. “We’re making no excuses for drugs—hard, soft, or otherwise. Drugs are bad, and we’re going after them. As I’ve said before, we’ve taken down the surrender flag and run up the battle flag. And we’re going to win the war on drugs.” Announced three weeks before the 1982 midterm elections, Reagan’s initiative both intensified and militarized the drug war.

Not all drugs were bad, of course. The Reagan administration lavished benefits on Big Pharma, and Congress passed laws that extended patent protections and monopoly rights for brand-name drugs. But even with illegal narcotics, the Reagan administration applied a double standard. As we know from the Kerry Committee report of 1989, CIA officials knew that Nicaraguan drug dealers were selling powder and crack cocaine in Los Angeles during the 1980s. Nobody lifted a finger to stop it. They also knew that the profits supported the Nicaraguan contras, whom the Reagan administration actively (and illegally) aided in their efforts to overthrow the leftist Sandinista government.

As the drug war dragged on, it netted users who didn’t fit Erlichman’s description. A decade ago, we learned that Rush Limbaugh abused Oxycontin, a prescription painkiller also known as hillbilly heroin. He was arrested but served no jail time; Palm Beach prosecutors dropped the charge after Limbaugh agreed to continue his treatment. “I actually thank God for my addiction to pain pills,” he told Fox News in 2009, “because I learned more about myself in rehab than I would have ever learned otherwise.” In particular, he realized he had been trying too hard to be liked in his personal life. But after seven weeks of treatment, he emerged with “zero feelings of inadequacy.” Limbaugh’s skirmish in the drug war turned out to be a voyage of personal growth and self-discovery.

While the Limbaugh story played out, many American cities were experiencing large increases in the use of black tar heroin imported from Mexico. These weren’t cities previously associated with that drug; rather, they were places like Salt Lake City, Boise, Charlotte, Portland, and Columbus. For years, local law enforcement noticed unarmed dealers making home deliveries in small quantities. Even when they made arrests, the cases were minor and often led to deportation. And because police officers rarely communicated with their counterparts in other mid-size cities, they failed to see the larger pattern.

Continue reading

As Sam Quinones shows in Dreamland, the Oxycontin and heroin stories were closely linked. A Los Angeles Times reporter, Quinones learned that black tar heroin wasn’t produced or distributed by violent Mexican cartels; rather, he traced it to the tiny state of Nayarit and its ranchero culture. The opium was grown locally, and tight-knit families sent wave after wave of polite farm boys to deliver balloons of heroin to white suburbanites in the United States. The service was excellent, and users learned that they could maintain a daily heroin habit for the price of a six-pack of premium beer.

The Xalisco Boys, as law enforcement called the Nayarit operators, spread quickly across the American west. They thrived, it seemed, in every city serviced by US Air out of Phoenix. In reading about them, I was reminded of an ironic passage from T.C. Boyle’s 1995 novel, The Tortilla Curtain. In describing coyotes, a nature writer also commented on the influx of Mexican immigrants:

The coyote is not to blame—he is only trying to survive, to make a living, to take advantage of opportunities available to him … The coyotes keep coming, breeding up to fill in the gaps, moving in where life is easy. They are cunning, versatile, hungry and unstoppable.

Eventually the Xalisco Boys moved east across the Mississippi River. By that time, Big Pharma had aggressively marketed OxyContin for chronic pain relief. Its campaign hinged on industrious self-delusion. Distorting a stray remark in a prestigious medical journal, one pharmaceutical firm persuaded American doctors that Oxycontin and other opiates weren’t addictive. That claim contradicted everything those doctors learned in medical school, but many went along with the program. Between 1997 and 2002, OxyContin prescriptions soared from 670,000 to 6.2 million. One 2004 survey indicated that 2.4 million Americans used a prescription pain reliever non-medically for the first time within the previous year; that was more than the estimated number of Americans who tried marijuana for the first time. Once patients were well and truly hooked on opiates, many switched to black tar heroin, which was cheap and easy to acquire. In effect, American pharmaceutical firms opened up new markets for the Xalisco Boys, who delivered heroin like pizza to America’s suburbs.

Dreamland is a tale of two artificial and highly permeable membranes. One separates legal and illegal drugs, the other Mexico and the United States. Quinones is perfectly positioned to tell that double story. After graduating from the University of California, Berkeley, he became a crime reporter in Stockton, a mid-size city in the Central Valley that was struggling with gangs and a crack cocaine epidemic. (After Stockton became Ground Zero for the subprime mortgage crisis, Forbes magazine described it as “one of America’s most miserable cities.”) In 1994, Quinones traveled to Mexico, where he planned to study Spanish for three months. He stayed for a decade working as a freelance reporter. What Quinones learned there informed his first two books about immigration, the border, ranchero culture, and the drug trade. He eventually returned to California and worked for the Los Angeles Times until last year.

Quinones brings all of his considerable talent and experience to bear on this sprawling story. Few American journalists can match his narrative skills or crime chops, which he combines with an ever rarer understanding of Mexican culture. His description of Nayarit is especially evocative; you can see practically hear the bandas playing at the feria, taste the cerveza, and feel the crisp new Levis the drug operatives brought home by the dozens.

Toward the end of Dreamland, Quinones shows how some American communities began enforcing their drug laws differently when they realized that their white, middle-class neighbors and family members were the perps. It was a reminder, if any were needed, that the war on drugs has always been a civil war. When will we bind up the nation’s wounds and care for those who have borne the battle?