The Heroin Project

An Ordinary Hoosiers Special Report

Families are often the hardest hit by addiction. Here’s one family’s journey and how they’ve dealt with their daughter’s addiction. Names have been changed to protect the family’s privacy, because the stigma of heroin addiction keeps loved ones silent about the battle they face. (OH Audio Slideshow/Linda B. Margison)

Communities and Agencies Battle Indiana’s Heroin Epidemic

SOUTHERN INDIANA – Indiana’s Clark County Sheriff Jamey Noel said when he worked undercover, “You could not buy heroin,” but now he and fellow officers see it “constantly.” He never dreamed of a day when the county would consider a syringe-exchange program or when first responders and police officers would be carrying Narcan, an opiate-antidote drug used to reverse overdoses.

“But I think it’s a good thing we are,” Noel said. “We realize how big of a problem this is and the only way we’re going to solve it is to solve it together and talk about it and explore all our options.”

Noel and other leaders are trying to be proactive after watching neighboring Scott County thrust into the media spotlight as the face of the heroin problem.

In 2015, the small town of Austin, Ind., brought national attention to a declared heroin epidemic spreading rapidly across the state and nation, reaching into affluent and poor neighborhoods alike and stressing community and social resources.

Community leaders, social services and citizens are learning what they can do to save lives and stop the spread of infectious diseases like Hepatitis C and HIV due to the intravenous use of heroin in what government officials are calling an epidemic.

“My heart goes out to the people who are addicts,” Noel said. “The successful drug dealers are the ones that don’t use drugs themselves, they take full advantage of the addicts that they’re making money off of.”

Carolyn King, a Jeffersonville resident, lost her granddaughter a year ago to a heroin overdose.

“When I grew up, we all knew the addicts and junkies were in the back alley and we all knew it was awful, but it didn’t relate to us,” King said. “It relates to all of us now.”

King said her family thought the granddaughter might be having problems, “but there’s a stigma attached to it and you don’t talk to family.” The overdose happened after the young woman exited her third treatment program, which is when many overdoses happen. Addicts return to using the same amount as before treatment and it’s too much.

The National Center for Biotechnology Information released a report that stated, “People who inject drugs with a history of incarceration appear to have a higher risk of opioid overdose than those never incarcerated, and are more willing to utilize naloxone as an overdose prevention strategy.”

Dr. Kevin Burke, Clark County’s health commissioner, said, “We have to make people aware of the problem, convince them there is a problem and also educate them about the resources available to help their friend or family member and themselves deal with this addiction.”

Burke has seen an increase in overdose deaths in the past few years. He said 32 people died of a drug overdose in his county in 2013, 58 in 2014, and more than 70 in 2015. However, this isn’t an accurate count, because toxicology results take several months.

“We may even have as many as 80 or more deaths,” Burke said. “There’s a disturbing trend in overdose deaths suggesting the problem is getting worse.”

This is a problem that has the state in action.

“We are really dealing with a crisis… It’s happening all across the state,” said Greg Zoeller, Indiana attorney general, who has been proactive in targeting the cause of increased heroin addiction and working to get state approval for efforts to keep people safe, like emergency syringe exchange programs.

In the past year, Zoeller’s office has closed down nine pill mills across the state and gone after 130 doctors’ licenses for over-prescribing opiates.

“We’re trying to shrink the front end where people get addicted,” Zoeller said, explaining that his office is trying to reduce the supply chain and teach the medical community not to prescribe an abundance of opiates.

Zoeller added that problems arise when patients are unable to get opiates from their doctors, they end up robbing their local pharmacies trying to get needed drugs. He noted that Indiana ranks first in the nation for pharmacy robberies.

And when that doesn’t work, addicts turn to heroin, and the risk for overdose deaths radically increases.

“We’re trying to save as many lives as we can,” Zoeller said.

Part of those efforts include being awarded $1.3 million in a lawsuit against pharmaceutical companies, which is being used to create a program for law enforcement officers and first responders to carry Narcan, or naloxone, an opiate-overdose reversal drug.

“The amount of pain and suffering for all involved is significant,” said Burke. “Imagine the grief, the loss of someone in the prime of life with their future ahead of them, snuffed out by this narcotic, which puts them to sleep. They quit breathing and, uh, they’re gone.”

A study by Corey S. Davis of Network for Public Health Law, reported that engaging law enforcement in carrying and using naloxone for opioid overdoses will help curb the growing mortality problem, which he states is “a solvable public health problem.”

In January 2016, Clark County CARES organized a panel of community leaders to open a conversation about the heroin epidemic and come together to find solutions. (OH Video/Linda B. Margison)

Challenges in Recovery

While officials and law enforcement offers are dealing with a strain on their resources, community and social programs have had to create programs and re-target services to help with the influx of IV-drug users and heroin addicts.

Ninetta “Niki” Angelaki is clinical director of Amethyst House in Bloomington, a program that operates three transitional houses (halfway and three-quarter programs) serving 21 men and 10 women and dependent children up to age 6, and a full-service outpatient program. Outpatient services include intensive treatment; individual, group and family therapy; evaluation, case management and referral services; intervention and education classes; and problem gambling treatment and education.

“In the past couple of years, we have seen an increase of clients requesting treatment from opiates in general,” she said about her organization’s response to the heroin epidemic. “It seemed like there was an increase in use of prescribed medications that turned to heroin use.”

Although data collection isn’t a priority for Amethyst House, Angelaki said one empirical way Amethyst House has been able to realize the increase is that they give priority to IV-drug users, “and while we were assessing our applicants’ needs trying to prioritize, it seemed at times like everyone on our applicants list would be an opiate IV user.”

Angelaki said Amethyst House’s greatest need is “getting funding and support, and lifting the stigma of addiction, issues that we believe are related.”

Treatment is expensive and she often finds it difficult to get funding, although the organization recently received a Recovery Works grant that is helping people with felony charges or histories pay for treatment or other supporting services they need.

“But – like with any other chronic disease – staying in treatment, following the suggested regime, and not relapsing… is not easy,” Angelaki said. “When a patient with asthma or diabetes falls back to one of their behaviors that is not helpful to their condition, or forgets their medication, no one withdraws treatment or penalizes them for their behaviors; but this does not happen with patients recovering from substance abuse.”

She said patients, their families and supporters get frustrated with “failures” like that, “but, in fact, relapse is a common characteristic in the treatment of any disease, and the rates of relapse in drug dependence are very similar to those in hypertension, asthma and diabetes. Addiction is a treatable disease – not curable – so it’s a lifelong journey, and when one approach is not working, the treatment plan changes, another intervention is applied until the right combination is found that works.”

Angelaki added that she was surprised that recovery has such a long way to go, since alcoholism was recognized as a disease 60 years ago.

Addiction is a pretty tricky disease,” she said. “It’s complicated and has a lot of challenges for the person trying to recover. So, I would say that – apart from administrative challenges with funding and keeping the agency running, and so on – our greatest challenge would be keeping our clients motivated to keep fighting for their recovery, to keep coming back and trying to maintain abstinence.

“It is really hard to stay clean, especially for the first 30 days, because of the chemical changes in the brain. Even later on, due to various stimuli – e.g., emotions, sounds, smells, social interaction – a person’s desire to use is triggered and a number of coping skills needs to have been learned in order to avoid that,” she adds. “Nobody likes to change, and nobody is just ready to jump right in and start changing things in themselves, no matter what the issue is.”

Above all, though, is ending the silence and stopping the stigma.

“We believe that a lot of steps have been taken in the right direction lately,” Angelaki said. “We see a lot of people that are sensitive to this issue and open-minded, often because they have been impacted by addiction. More and more celebrities are opening up, and this is always helpful, as people need to know that there is no shame to addiction or mental illness in general.

“So, speaking up – really – discussing any issues with loved ones openly, educating ourselves and one another, getting involved. Knowledge is key, obviously,” she said.

Dr. Emma McGinty, an assistant professor at Johns Hopkins Bloomberg School of Public Health, co-wrote a paper grouping drug addiction in with treatable health conditions, and that by doing so, it would reduce the stigma associated with the disease.

Bloomington, Ind., social worker Chris Abert founded and runs The Indiana Recovery Alliance, which focuses on harm reduction that includes syringe exchange, naloxone training, teaching safe drug use and providing supplies like coats, socks and other necessities. (OH Video/Linda B. Margison)

Reducing Harm

While recovery may be the ultimate goal, community members are focusing on keeping addicts alive to give them the potential to someday enter recovery.

Chris Abert is a social worker who started Indiana Recovery Alliance, a harm reduction program in Bloomington, with just five people about a year ago. After the donation of a large mobile harm-reduction command center, Abert and volunteers now travel to neighboring counties to educate people on using clean syringes and naloxone to save lives.

Abert held a community discussion and naloxone training session in neighboring Brown County on March 5, joined by Emma Roberts from the national Harm Reduction Coalition.

Roberts said that harm reduction is about reconnecting people to services and helping figure out what’s best for them. It often means meeting the addicts where they are and addressing their immediate needs first.

“We meet people where they’re at, but we don’t leave them there,” Roberts said, stressing that harm reduction volunteers don’t enter communities and force recovery on people or tell them, “This is what you should do.”

When Abert takes the IRA van into the community, he not only offers a syringe exchange, but also blankets, socks, clothes, condoms, tampons and other items people need, as well as information on safer drug use.

He said he often encounters people who insist he is enabling a person’s addiction by giving clean syringes, and his response is, “I am enabling them to be alive.”

Abert enters the addicts’ world and offers help with no conditions, no strings attached, with respect and dignity.

There are many reasons why addicts don’t go into recovery – having no one to watch children while they’re gone, being on probation and afraid to ask for help, not having time to take off work, or being on the varsity squad and afraid of getting kicked off – but he doesn’t care about those reasons. Abert’s goal is to keep them alive, because “dead people don’t recover.”

According to the National Institutes of Health, as of September 2015, 43 states and the District of Columbia had passed laws allowing naloxone access without a prescription, thereby making it easier for family and friends to save lives.

Since Indiana passed a law allowing residents to possess naloxone without a prescription, Abert strives to train those first on the scene of an overdose – parents, friends or fellow addicts – how to recognize the signs of overdose and use the reversal drug and keep people alive.

Abert says signs of an overdose include:

  • awake but unable to talk;
  • body is very limp;
  • face is pale, clammy;
  • lips, fingernails are blue for lighter-skinned people;
  • lips, fingernails turn gray for darker-skinned people;
  • breathing is very slow, shallow, erratic or has stopped;
  • choking or gurgling sounds;
  • vomiting, foaming from the mouth;
  • loss of consciousness;
  • unresponsive to outside stimuli, such as yelling, “The cops are here” or “Narcan”;
  • unresponsive to sternal or lip rub.

While Abert acknowledged the benefit of having medical first responders and police officers carrying naloxone, he said family members and friends need to carry and be trained, because they’re the ones that find the person initially.

Also, naloxone is harmless, so Abert said it is better to use it than not if there is a possibility the person could have taken opiates, which include heroin, Opana, Vicodin, Tylenol 3, Percocet, fentanyl, Demerol, morphine, Suboxone, Oxycontin, methadone and hydrocodone.

The Drug and Alcohol Dependence journal stated in a report that basic training, such as that provided by Abert, is sufficient for laypeople to administer naloxone.

Even if naloxone isn’t available, Abert stressed that rescue breathing will keep an overdose victim alive until help arrives. Heroin and opiates depress breathing because they fill up opiate receptors in the brain. The more drugs consumed, the more breathing becomes depressed until breathing stops. Even without naloxone, if breathing resumes, even by artificial means, it can keep the person alive.

For those who have a family member or friend who is at risk for opiate overdose, or for those who use opiates or heroin, the reversal drug naloxone is available in southern Indiana at: Indiana Recovery Alliance; Lucky’s Market in Bloomington; CVS Pharmacy; Walgreen’s; Williams Brothers; and Overdose Lifeline.

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