The Journal Gazette
Sunday, July 10, 2016 9:35 am

We're hooked on a killer

Rebecca S. Green | The Journal Gazette

Northeast Indiana has a drug problem.

We’re not alone, for the rest of America, in one way or another, is caught in the throes of addiction to prescription opioid painkillers and their illicit street cousin, heroin.

Federal officials have been calling attention to the problem for almost a decade, but in northeast Indiana the volume of the discussion has increased over the past year.

We pop it, crush it, snort it, inject it. We wear it in patches. We get it by prescription from well-intentioned physicians in legitimate ways. We get it passed from hand-to-hand in school hallways, or we pilfer it from the medicine closets of parents or relatives. Sometimes, when we’re really desperate, we buy it on the street.

And it’s killing us. It’s putting us into respiratory arrest, slowing our breathing until we drift away. Sometimes we kill ourselves on purpose, but a lot of times we mix it with other drugs, or we drink with it, or we take too much and we die by accident, leaving loved ones to pick up the pieces.

Civic leaders, elected officials, police officers and drug treatment providers are scrambling to try to solve the problem. But first we have to identify it, so we can fix it together.

We are addicted.

Numbers rising quickly in county

Opioid analgesic painkillers are a class of drug that includes oxycodone (such as brand names OxyContin, Percocet), hydrocodone (Vicodin), codeine, morphine, synthetic opioid fentanyl, and a host of others, including heroin.

Chemically related, the drugs bond to receptors in the brain, reducing the intensity of pain signals and affecting areas of the brain that control emotion. In some people, but not all, the drugs can cause a euphoric response, making them more desirable.

Used properly, they are powerful weapons to attack everything from dental pain (hydrocodone) to bone cancer (oxycodone). Used improperly or illicitly, they can cause debilitating addiction and death.

Poisoning is now America’s leading cause of injury death, with opioids making up a substantial chunk of those fatalities.

From 2000 to 2014, the drug-poisoning death rate has doubled nationwide, from 6.2 deaths per 100,000 population to 14.7 per 100,000. The number involving opioids went from 1.5 per 100,000 in 2000, to nearly 6 per 100,000 by 2014.

In 2014, Allen County beat the national average for fatal drug overdoses with 17 per 100,000. In 2015, the numbers jumped again, up from 46 total deaths in 2014 to 54.

And Indiana has been a pacesetter in opioid prescriptions.

After a federal Drug Enforcement Administration raid earlier this year, it was revealed that a local pain-management doctor, Michael Cozzi, through his clinic, was responsible for the most controlled substance prescriptions in the state.

He handed out opioids with shocking frequency. His license is under an emergency suspension, which won’t expire until October 2017.

Before Cozzi, former Fort Wayne pain-management doctor William Hedrick made headlines for his prescribing practices. He now faces criminal charges in Delaware County and a handful of wrongful death cases there and in Allen County. His license is also under an emergency suspension.

And one merely has to look at the map of overdose responses by the Three Rivers Ambulance Authority (see Page 9A) to see how large this problem has become. Officials said the majority of those overdose responses are due to opioids, including heroin.

In 2015, the map was nearly completely purple with dots showing where paramedics responded, from Aboite Township to southeast to north of Coliseum Boulevard.

The 2016 map is filling in even faster.

Different kinds of dependency

Not everyone who uses opioid painkillers ­abuses them or will become an addict. Not everyone who is dependent on the drug will become an addict. And not everyone who is addicted to an opioid painkiller is going to head to their local heroin dealer in lieu of a prescription.

Dr. Daniel Roth operates Summit Pain Management in Fort Wayne, and since the closure of Cozzi’s and Hed­rick’s practices, he’s been very busy. He also serves on Indiana’s Prescription Drug Abuse Prevention Task Force.

Opioid dependence is when the body’s physiology requires the medication, and if it doesn’t get it, goes through withdrawal. It is involuntary. It is chemistry, he said.

It is, in theory, similar to caffeine dependence. Try going without your morning coffee and not have a headache by noon.

Opioid dependence is not a good thing or a bad thing, said Roth. And if you are prescribed an extended-release opioid, such as OxyContin, for a period of time after having been on the more short-acting drugs such as Percocet, your body is likely to develop a dependence.

If you stop taking it, you are not going to feel good for a period of time.

The question, Roth said, is what kind of dependent are you?

Are you functionally dependent – able to carry on with your daily life, feeling diminished pain and none of the negative side effects of the drug?

Or are you dysfunctionally dependent? You’ve been prescribed the drug legitimately, but it is now in your way. Your pain may be diminished, but so is your energy level and your participation in life.

"The key to any pain management should be function," Roth said. "What are you doing with your life?"

Addiction arises when someone begins using the drug for non-medicinal purposes. The medication, maybe having once been prescribed legitimately, causes spikes in dopamine levels and the user begins to seek it, to chase it and to crave it.

It moves one down what is called the "addiction pathway," Roth said.

And a lack of access to the prescription opioids can cause one to turn to the king of street drugs, heroin. Though the prescription painkillers are much stronger, in their absence, heroin becomes a choice.

When opioids run out, heroin’s next

Allen Superior Court Judge Fran Gull has been on the bench for nearly 20 years, and has run Allen County’s Drug Court program since the early 2000s.

She had seen heroin wane, and she’s seen it come roaring back over the past four or five years.

"It is far more widespread, and touching lives that it has never touched before," Gull said.

An increase in opioid prescriptions by physicians, Gull said, combined with poor monitoring of those patients, can produce patients who shop around for doctors to give them their opioids.

When they run out of doctors, she said, they turn to street drugs.

Street heroin is much more potent than it ever was, laced with other opioids like Fentanyl, Gull said.

One of Gull’s recent Drug Court participant’s struggle with opioids led to heroin and, now, time behind bars.

Fifty-one-year-old Antonio Vasquez Jr. was recently sentenced to a year in the Allen County Jail after he was arrested in January on a charge of possession of heroin following a traffic stop.

Unable to stay clean during his time in Drug Court, in spite of sanctions such as two nights in jail, Vasquez failed the program and was sentenced in June, according to court records.

Before his sentencing he wrote a letter to Gull, explaining how he ended up there.

"I got addicted to pain pills from my two surgeries and my lower back pain," he wrote.

He was prescribed suboxone, another opioid used to wean individuals with dependency off harder opioids.

"When my insurance stopped, so did (the) suboxone," he wrote. "Then came the heroin."

Community must feel the fear

The problem will not be solved without a functional collaboration between the medical community, public health community, mental health community and criminal justice system, Allen County Health Commissioner Dr. Deb McMahan said.

She believes the infrastructure for that system is starting to come together after years of a very fragmented approach to the problem.

"Our goal is to have our policies and our practices reflect research," she said. "We have our act together. We’re all on the same page … coming together to create that sort of approach.

"That’s really important when you’re dealing with complex issues," McMahan said.

To adequately confront the threat and scope of the problem, that infrastructure is going to have to be self-sustaining for the next decade. Or more.

"This affects every aspect of the community," McMahan said. "People need to begin to feel the fear that I feel. I want them to feel that. It’s not for me. I have grandchildren.

"I have a lot of faith in our community. I hope at that end of this they are saying ‘what can I do?’ "


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