Heroin and New Canaan, Part 1 of 3: Tracing and Defining a Problem

Editor’s Note: This is the first installment of a three-part series. The final two parts can be found here:

• Heroin and New Canaan, Part 2 of 3: Parenting
• Heroin and New Canaan, Part 3 of 3: ‘Reach Out to a Person’

 

No one died from a heroin overdose in town in 2013, data from state officials tells us, yet the drug for many reasons has become increasingly prevalent in recent years—in New Canaan and most everywhere else around here, officials say.

Rising with an epidemic in prescription drug abuse that’s largely rooted in a critical change in how the medical field started viewing and treating pain—in fact, heroin pharmacologically is identical to legal, prescribed opioids, physicians say—the drug’s availability and use has become one area of focus for professionals here who deal with all aspects of substance abuse.

Though heroin overdoses in New Canaan thankfully haven’t been fatal in the past year, use and even overdoses are occurring, said Jacqueline D’Louhy, assistant director of youth services with the town’s Department of Human Services, an employee in the municipal agency for about nine years.

Asked to characterize what she’s seen in local heroin use, D’Louhy said: “New Canaan does not have a death from heroin per se, but we have gotten close. There have been kids, college age or high school age, that have gotten close [to fatal overdoses], and there have been debilitations.”

Our town’s police, schools and human services providers, public and private both, collaborate so that New Canaan has approachable adults among our youth, trained professionals who may serve as a resource—and as needed, provide a referral—for kids who develop problems with substances, including heroin. The comprehensive network connects adults with teens and offers information and programming to concerned parents, too.

This is the first in a three-part series on New Canaan and heroin that NewCanaanite.com is running over the next three days. In Part I, we offer historical and social context to understand why we’re dealing with heroin in town, among other equally addictive opioids. We hear from New Canaan police, human services providers and medical professionals about the drug’s prevalence—for example, how New Canaan youth get their hands on it—and the process of opioid addiction, physical and otherwise.

Parts II and III of the series will appear on Thursday and Friday. In them, we hear from parents about their concerns and from experts with useful information and suggestions for caregivers. We also will hear from service providers about preempting and addressing substance abuse, and discuss some of what residents here, including state legislators, are doing to help address the problem.

 

‘Medications That They Get from Their Parents’

Here’s how clinical psychiatrist Dr. Eric D. Collins—physician-in-chief at Silver Hill Hospital, the psychiatric facility out on Valley Road, and an associate clinical professor at Columbia University—describes the relationship, beyond strictly physical addiction, between an opioid such as heroin and its users: “It becomes very special to them.”

Collins recalled one patient he’d worked with for years, a man struggling with addictions to painkillers and opioids (not heroin, in this case) as well as cocaine. The patient was “sort of on the fence about alcohol, but he didn’t identify that as a problem,” Collins recalled.

“I remember early on he had gone on a date, and he said, ‘I don’t really understand this thing about people with not drinking.’ And so I said, ‘What do you mean?’ He said that on his date, she [the date] had ordered a glass of wine, and she only drank half of it. And I said, ‘Well that’s hard for you because alcohol is very special to you.’ If I had said painkillers or cocaine were very special, he would have got what I meant exactly. But he said, ‘Well, what do you mean?’ I said, ‘How much of her salad did she eat?’ ‘I don’t know.’ I said, ‘How much of her dessert did she eat?’ He said, ‘I don’t know.’ But he knew exactly how much of her wine she drank. There is something ‘special’ about it. You pay attention to it. It gets your attention.”

With addiction to an opioid like heroin, Collins said, it’s important to think beyond strictly physical addiction (which includes developing tolerance as well as powerful though not life-threatening withdrawal). In fact, the vast majority of people who use opioids—say, through a prescription for pain—are able to get off of them. Using the drugs as prescribed, these are people weren’t trying to get more of it, or use the drugs to deal with the stress of life, or hiding their use.

“The drugs weren’t special to them,” Collins said.

Of course, that doesn’t always turn out to be the case, and in a town such as New Canaan, the path to use of an opioid like heroin—which eventually becomes a practical option because it’s relatively cheap—likely often starts with recreational use of painkillers found in medicine cabinets at home, he said.

“I will bet you that in New Canaan, more kids, more adolescents are trying medications that they get from their parents or grandparents or aunts or uncles, or that some of their friends got from those sources,” Collins told NewCanaanite.com.

There’s a huge “supply” of such opioids for young people to try, and in experimenting, youth probably mix them with alcohol, which can be dangerous.

But how does that experimentation become heroin use?

Some percentage of those kids—Collins said it could be as high as 25 percent—may not instantly be addicted to an opioid in the sense that they “have fallen in love with it and feel like it’s the best thing ever.”

“For some people that’s true,” he said. “But for others it’s a nice enough feeling that they go back to it, they return to it,” and that becomes what medical professionals call ‘reinforcing behavior.’

“I would say the vast majority of adolescents who try an opioid in New Canaan, try a pill first,” he said. “Basically, what happens is some percentage of these kids will like it and they will start to use it regularly, and without realizing it—it’s insidious—they will use it for a day or a week or so in a row, and then they are physically dependent. They liked it, that’s why they kept doing it, repeatedly, and then they find if they don’t do it, they are uncomfortable.”

Often, a new drug user isn’t conscious of the physical dependence at that point, he said.

“Then they take another one and it [the discomfort] goes away, and then that adds a level of reinforcement,” he said. “It’s not just that it feels good intrinsically, on its own: Now it relieves a physical state that the regular use of the drug created.”

 

‘There Has Always Been Some Heroin’

Heroin is an opioid that breaks down into morphine, and in places such as England, it’s used to treat pain—for example, in cancer patients.

In the United States, it’s been illegal for exactly 100 years, since the Harrison Narcotics Tax Act of 1914.

“There has always been some heroin, throughout the country, for more than 100 years,” Collins said. “The main thing is: This all starts with an epidemic in the prescriptions of opioids.”

“There was a group of pain physicians in the 1980s who were very influential in arguing the position that patients with chronic pain needed better treatment and there was no reason, they argued—now some of them admit that they were mistaken, but they believed this, they were zealous, well-meaning—they said there was no reason patients should not have their pain managed with opioids if it gave relief,” Collins said.

Those physicians assumed that since opioids worked for short-term pain, they also could work for long-term pain. They argued that patients had a right to be free from pain, and that pain assessment should be counted, in doctor-speak, as the fifth “vital sign,” after heart rate, blood pressure, temperature and respiratory rate. The physicians made a case that hospitals must make an assessment of patient pain and adhere to a specific standard to relieve it.

“The whole landscape changed,” Collins said. “These doctors—very influential academics and good people by and large—they argued that addiction risk was extremely low. They argued that it was almost unheard-of, at least sometimes they argued that.”

Pharmaceutical companies followed suit—most notably Purdue Pharma in neighboring Stamford—and though eventually that company would pay hundreds of millions in fines for violating rules that govern marketing practices in doctors’ offices—a pattern of prescribing drugs for pain had been triggered.

 

Heroin in New Canaan

On the black market in our area, an OxyContin pill may cost $80, whereas a bag of heroin can be purchased for something closer to $4, “but then your addiction sets in, and you might need 20 bags,” D’Louhy said.

Said Collins: “It [an opioid other than heroin] is a lot more expensive [than heroin]. Even in a rich town like New Canaan, still the kids do not have access to unlimited funds, and it becomes much more expensive to maintain a physical habit with the painkillers.”

As a result, some switch over to heroin—a drug that is transported up, in many cases, from New York City and is distributed into New Canaan through larger municipalities nearby, such as Norwalk or Stamford, according to New Canaan Police Capt. Vincent DeMaio.

“We are starting to see a resurgence of heroin use in the town, across a wide spectrum of contacts we have from younger to older, and I can directly attribute that to the rise in abuse of prescription drugs which became prevalent a few years back with OxyContin and Oxycodone,” DeMaio said.

DeMaio said police started to see the rise in those prescription drugs hit a critical level here about five years ago.

“When most people think of heroin, they think of a junkie shooting up on a street corner,” DeMaio said. “That’s really not the case. Most of the time it’s snorted.”

When investigators receive information about the sale of heroin in New Canaan itself, “we concentrate our efforts fully,” DeMaio said.

“That’s basically where we want to go at this point, to eradicate the source of sale here in New Canaan,” he said.

He added that the police officer in place within New Canaan High School—the school resource officer or “SRO”—is a critical piece of how the department combats the problem of increased heroin availability and use, as well as opioids that are legal and prescribed.

“Part of their duties involves educating the kids to the true dangers of using these drugs,” DeMaio said. “We regularly run into a mindset with prescription drugs—‘Hey they’re prescribed, they’re safe, they’re made in a laboratory’—people don’t realize the potency and how strong these really are in terms of narcotics, that overdose is a very real possibility.”

 

Quantifying Heroin Use

A 2009 New Canaan High School graduate, Griffin Conway, last October died in Wilton from a heroin overdose, state officials have confirmed.

Police in Greenwich last month attributed two deaths in town to heroin. Teens in nearby Ridgefield have died from heroin overdoses and this month, a teen there was arrested for trying to trade a handgun for heroin.

Ginger Katz, Norwalk mom who lost her son to the drug in 1996 launched an organization, Courage to Speak, shortly after his death that’s based on a promise she made to him. As her website says: “She promised to do everything in her power to prevent this tragedy from happening to another family.”

Though heroin deaths are reported by the state Office of the Chief Medical Examiner—see the table below—it can be difficult to quantify the prevalence of the drug itself. Part of the reason for that is, on a national level, heroin often is not isolated statistically from other opioids.

The federal Centers for Disease Control and Prevention reports that the nation is seeing an “unprecedented rise in overdose deaths” due to prescription painkillers. Specifically, drug overdose death rates have more than tripled since 1990.

Heroin use has increased “in lockstep” with overall opioid addiction problems, Collins said.

“The issue with heroin is that it is a white powder and if you are selling it, you can make more profit if you cut it with some other white powder,” he said.

That’s caused it’s own problems, with widely reported recent deaths, including in Connecticut, among people snorting heroin that’s been mixed with Fentanyl, a powerful opioid, he said.

From 1979 to 2010, the drug overdose mortality rate in Connecticut has jumped from 1.1 to 10.1 per 100,000, according to a report from the Trust for America’s Health, a nonprofit organization.

Sparked in part by wide publicity following the death last month by heroin overdose of actor Philip Seymour Hoffman, many news outlets are reporting on the drug’s rising popularity.

This part of Connecticut, relative to the rest of the state, in 2013 saw fewer deaths from the drug. Using data from the state medical examiner, the New Haven Register reported that Connecticut had seen 189 heroin deaths in 2013 through the final two weeks of December—the figure includes seven in Fairfield County.

Again, and thankfully for residents here, New Canaan at least in that time span has not had a reported death by heroin overdose.

Still, the drug is in New Canaan—as are resources for education, treatment and prevention.

As Dr. Bryan Luizzi, principal at New Canaan High School told NewCanaanite.com: “Nobody should feel helpless in this kind of situation.”

“Nobody ever expects it, nobody ever thinks it’s going to be them or their family or kids or themselves, but when that realization hits, the school can certainly help,” Luizzi said. “And in truth, the town of New Canaan has excellent resources available, people like Meg [Domino, of New Canaan CARES], Jacqui [D’Louhy], Kate [Boyle, a youth and family services specialist with the town], and others, people who really do care about the welfare of the kids and community. Individuals who will do what they can to help.”

Part II of this series will include more from Luizzi, as well as Katz, and runs tomorrow. To keep abreast of local news in New Canaan, please consider signing up for the New Canaanite newsletter—it’s free and you can opt out any time.