Editor's Note: This story has been updated to correct the proper name of Narcan, a drug used to reverse the effects of narcotics.
Data from state and local resources shows heroin use is on the rise, and local responders say the solution to mitigating it will not be immediate or simple.
The Alaska Department of Health and Social Services released a report on July 14 titled Health Impacts of Heroin Use in Alaska. The report detailed the steady rise of both heroin users as hospital patients and heroin-related deaths in the state, and their impact on the health system and community.
The study found that from 2008 to 2012 in Alaska, there were 51 hospital admissions and 201 out-patient evaluations for “heroin poisoning.” The rate of hospitalizations coded for heroin poisoning rose from 2.4 per 10,000 people in 2008 to 4.7 per 10,000 people in 2012. From 2008 to 2013, 72 people died, with heroin listed as either the main or contributing cause.
Heroin-related in-patient and out-patient hospital costs exceeded $2 million, the study found.
Increased heroin use has been documented at the law enforcement level as well.
In 2008, there were 99 heroin-related charges and arrests made by the state, according to the 2008 Alaska Department of Public Safety SDEU Drug Report. In 2014, there were 209.
“No one’s immune from substance use,” said Shari Conner, intake coordinator and prevention grant coordinator for the Central Peninsula Hospital Behavioral Health Department. “It hits every single walk of life and every parent structure.”
The rise of heroin use in the Last Frontier is not an isolated phenomenon. Drug reports from the SDEU from 2008-2014 show the state’s crackdowns on prescription drug and methamphetamine abuse have created unintended consequences.
2008’s Senate Bill 196 required the Alaska Board of Pharmacy to “establish and maintain a controlled substances prescription database … for the reporting of dispensed prescriptions,” according to the Alaska Prescription Drug Monitoring Program’s website. In theory, this would make it more difficult for prescription drug abusers to cheat the system by “doctor shopping,” or getting prescriptions for the same drug from multiple pharmacies.
The crackdown appears to be working. Charges and arrests made by the state related to prescription drug use dropped by 31 percent from 2013 to 2014, according to the most recent SDEU drug report. Conversely, heroin charges and arrests rose by nearly 28 percent during the same time period.
Since heroin was included on the SDEU’s list of “drugs of choice” in 2010, state law enforcement has seized 93.5 pounds of it, the majority in the last two years. In 2014 alone, the heroin seized by the SDEU was valued at more than $3.6 million, compared to about $94,800 worth of prescription drugs seized the same year.
Conner said the rise in heroin abuse in Alaska is part of a larger picture created by fighting other problem drugs.
“If you look at the cycle, we cracked down on prescription narcotics … and then it went into a huge meth spring-up,” Conner said.
To tackle the methamphetamine problem, Alaska tightened restrictions when it came to buying over-the-counter medications like Sudafed. According to House Bill 149, signed into law in 2006, it is illegal to purchase more than 6 grams of pseudoephedrine in a one-month period.
When the path to one drug is cut off by stricter law enforcement or policy change, Conner said it does nothing to stop an individual’s dependency on it. Rather, the path to another drug is created.
“Those individuals now have moved on to heroin, which is much easier to get, (and) lasts longer,” Conner said.
“It’s supply and demand,” said Kenai Peninsula Borough Central Emergency Services staff member Jake Ohms. “They’re going to get high either way. It’s hard to get prescriptions now, but it’s also hard to make meth. You show up to the counter with Sudafed and matches and kerosene, they’re like ‘Hmm, you’re cooking something.’”
CES has responded to about 36 substance abuse or poisoning-related calls in the last year, said Captain Terry Bookey.
Bookey said that because members of CES are given little initial information in a call for service, it’s hard to differentiate between service calls related directly to heroin and those for general substance abuse. However, heroin use is discovered upon the initial review of a patient on scene.
“There’s very few cases where it’s very clear cut,” Bookey said. “We’re not doing a lot of fact searching, if you will, to ‘this is the precise drug or toxin that has caused a problem.’ Now, we’ve got medications that we deliver if we suspect that somebody’s having a narcotic overdose. That being said, that narcotic overdose could be recreational prescriptions, it could be prescribed prescriptions, it could be heroin, any of those opioids.”
Since opioid narcotics like heroin cause respiratory depression of the user, those who overdose will often stop breathing and lose consciousness. The drug to counteract that reaction is Naloxone, commonly called Narcan, and is made available to first responders to buy patients time on their way to receive treatment, Bookey said.
The Department of Health and Social Services’ study recommends making Narcan kits available to all law enforcement officers who might deal with heroin users. CES Deputy Chief Roy Browning said many narcotic users and dealers are already aware of the anti-drug.
“I don’t know how common it is in Alaska, but I know … where I worked in Denver, the availability of Narcan — which is pretty cheap (when) pharmaceutically made and readily available — street value of Narcan went up because of drug dealers.”
Browning said whenever a particularly potent batch of heroin would come through town, drug dealers would capitalize on the availability of Narcan in an attempt to ensure their clients did not overdose and would come back for more.
When it comes to a heroin-induced overdose, Bookey said it is not always as simple as taking too much.
“When you’re taking a pill, and melting that down and injecting it, you pretty much know what the dosage of that pill is,” Bookey said. “The thing with heroin is, you might get your supply this time that’s this strength that’s been cut this much, and the next time you’re getting something different.”
It is heroin’s unpredictability that makes it easier for a user to overdose without intending to.
“They might be injecting the same dose as far as quantity as they’ve done before, but it’s got more narcotic in it than the previous dose … so now they’ve overdosed,” Bookey said.
Bookey also emphasized that heroin and other narcotic users do not set out to be users.
“It’s just one of the bad parts of society, and not the people, but the kinds of addictions,” he said. “Whether it’s brain chemicals for addictions, or whether it’s you made one bad choice because you were in one tight spot in your life, or whatever the case may be. You can’t wake up in a pile of your own feces, and urine and puke and be like, ‘Hey, I should do this again,’ but they do, over and over and over again.”
In Kenai, heroin use is following the same trend as the rest of the peninsula. Data provided by Kenai Police Department shows arrests involving seizures of heroin are climbing as arrests involving seizures of methamphetamine are beginning to decline.
In 2008, Kenai saw only one arrest involving heroin seizure. By 2014, there were 18 such arrests, and the department has made another eight so far this year. Meanwhile, arrests involving methamphetamine seizures, of which there were 26 in 2013, declined to 14 in 2014 and 10 so far this year.
Kenai Sgt. Ben Langham said the solution to getting a handle on heroin abuse will be multi-faceted. Drug abuse education through programs like DARE is always important, he said. Working to target the avenues through which heroin enters the state will continue to be a major goal for investigation departments in law enforcement, he said.
“On an issue where it’s being produced locally, then we have a greater impact,” Langham said. “When it’s being produced somewhere else, we need to focus our efforts on stopping it from coming into our communities and addressing it when it’s in the community.”
While state or federal action similar to that which stifled prescription and methamphetamine abuse is out of law enforcement’s hands, he said the Kenai Police Department will continue to tackle heroin use on an individual level.
The Department of Health and Social Services study was limited in the fact that its patient discharge data came from only ten Alaskan hospitals that consistently recorded information from 2008-2013. Conner said the Serenity House Treatment Center, under the Behavioral Health Department, has been conducting its own research on substance abuse and its effect on the local health community for about a year.
“We’re looking to see what the problem looks like,” Conner said. “It’s a financial cost, but it’s also a cost of lives and families. We’re seeing the destruction of parents (no longer) being able to parent their children.”
Conner said research is focusing on emergency room records, costs of services and data on repeat patients to discern how substance abuse affects the local health care system. She said the research might be ready for presentation in October.
In addition, Browning pointed out that hospital data can’t account for the total number of heroin users who don’t seek or need medical treatment.
“When we’re getting calls, that’s because something has gone wrong,” Browning said. “So when we’re going on more (calls), then you know that it’s happening a lot more, to where obviously they’re not calling us. That puts it in perspective.”
“People try everything before they’ll call us,” Bookey said. “Down to the stereotypical. They’ll throw them into the shower to wake them up. By the way, that doesn’t work.”
Reach Megan Pacer at firstname.lastname@example.org.