The slippery slope

How overuse of painkillers becomes a heroin crisis

By Jennifer Eisenbart

Staff Writer

When Aurora Health Care Dr. Lance Longo first came to Wisconsin to practice in 1996, opiates and heroin were issues for the east coast – not for Wisconsin.

“Wisconsin was still the land of beer and cheese,” said Longo, whose early years as a board-certified psychologist and addictionologist were spent treating alcohol addiction.

But things changed in the early 2000s, as medical mandates by the American Medical Association and other oversight organizations made it a priority to start treating pain as more than just a symptom.

“At the same time,” Longo said, “the pharmaceutical industry began producing a greater quantity of medications and the potency of the medications (went up).”

Most Wisconsinites can name at least one high-profile opioid addict – Brett Favre, the former Green Bay Packers quarterback. The details Favre revealed in his autobiography regarding his addiction to Vicodin, a painkiller, are not unusual, Longo said.

And as access to those medications became more readily available, so did the problem of getting people hooked on those medications.

“It really only takes a couple of weeks of taking (the drug) around the clock to develop (an addiction),” Longo said.

Those drugs – familiar names like Vicodin and Percocet – are the gateway to heroin.

A single 30-milligram pill of Percocet has a street value of about $30 per pill, said Longo.

When a $10 bag of heroin has twice the potency as two Percocet pills, heroin suddenly becomes a cheaper, easier alternative.

“A couple of weeks of using heroin a couple times a day, they can’t stop,” Longo said.

The drugs are tied at their base to the chemical compound found in the poppy plant. Opiates refer to naturally occurring drugs like heroin and morphine. Opioids are the synthetic chemicals.

And opioids can be relatively easy for people to get their hands on. Many people who get a prescription don’t take all of it – and then leave their leftover medication in the medicine cabinet.

Those pills then become the target of people who know to look for them. It can be relatives, it can be children – or it can be a relative stranger who just happens to be visiting your home.

Add in 24/7 online pharmacies and access to the medication skyrocketed in the 2000s.

Once those avenues become exhausted, users typically turn to heroin as a cheap, readily available alternative.

Christina McNichol, a special agent with the Wisconsin Department of Justice’s Milwaukee office, said Wisconsin has seen a 400 percent increase in the number of heroin cases sent to the state crime lab in the period from 2008 to 2013.

The reason is simple math, she said.

In the 1980s, heroin was about 3-8 percent pure and had a street value of $300-$400 per gram. In 2012, the purity averaged 15-26 percent and the price had fallen to $100-$150 per gram.

That purity makes it possible to snort the drug and get high, which eliminates the initial reluctance to inject the drug that many first-time users have.

McNichol said, globally, more heroin is being produced that can be consumed – which means the price won’t be going up any time soon.

While Afghanistan is still the largest producer of heroin in the world, most of the heroin in this area comes from Mexico or South America, McNichol said. Production in Mexico has doubled in recent years.

The combination of purity, low price and availability – combined with heroin’s highly addictive effect – means many people get hooked almost immediately.

And because the addiction is so powerful they don’t attempt to get clean until they’ve lost jobs, ruined relationships, committed crimes and hit rock bottom.

By the time heroin users get treatment, their stories are usually tragic, said Dr. David Galbis-Reig, an addiction specialist with Wheaton Franciscan Health Care in Racine.

“Most of the people I see don’t want to be addicts – they just don’t know how to get out of it,” Galbis-Reig said during the Racine County Heroin Summit May 6 in Burlington.

And even when they get treatment, relapse is highly prevalent – 90-95 percent for those in treatment for the first time, according to national statistics.

“It’s like a malware that’s active in their brain and they can’t get it out.”

 Editor in Chief Ed Nadolski contributed to this story.