Heroin’s Death Row: How Families, Arizona, & the Nation are dealing with Fatalities in Epidemic Proportions

How to identify signs and symptoms of use and abuse; New National CDC statistics; Narcan lifesaving drug legislation; Arizona heroin laws, penalties, and criminal defense.

Tragedy Strikes Home: “This Drug Wants to Kill You”23-year-old suspect stood before a district court judge after his first arrest the night before, on heroin possession charges.

The young man made an impression on the judge that he would not soon forget.

The suspect was a respectful, polite, and receptive to the judges orders. The judge looked at him and said firmly, “This drug wants to kill you”.  He told the suspect that his desk was stacked with death certificates of defendants who died as a result of heroin or other opiates. The youth stood there listening intently with tears in his eyes. The judge assigned him an attorney, ordered random drug testing. The suspect thanked the judge on the way out.

Two days later, the suspect died of a heroin overdose.

When the judge was notified of the defendant’s death, he was badly shaken. “It’s an incredible feeling of powerlessness. We have no mechanism to identify who’s going to keep using. Nothing would indicate this kid had a heroin problem. The new opiate addict is virtually undetectable, until he dies. We’re all frustrated by this and we want people to know what we’re up against. This is the new breed of people afflicted with opiate addiction…I liked this kid. He was a good kid with a bad problem.”

The suspect’s father wanted other parents to hear his family’s grieved message: “Words can’t describe our pain. He was a beautiful, beautiful kid…with everything in the world going for him. No one wants to be a drug addict. So many other families we know have children struggling with the same thing. It’s an epidemic right now. We made a conscious decision that we weren’t going to hide from it. The reality is, someone died yesterday and someone is going to die today. There are parents out there who have no idea…Talk to your kids. Just talk to your kids.”

Today, the parents hope their story would spare other families with such anguish and heartbreak.

Third Heroin Epidemic

The National Centers for Disease Control (CDC) released their most recent national statistics in March 2015. They reported that drug poisoning is still the number one cause of injury-related deaths in the United States. Of those, heroin deaths have tripled, illustrating a spike in use, abuse and addiction of the drug, and a marked resurgence of heroin use.

The new CDC statistics revealed that the death rate from heroin overdose nearly quadrupled over 2000 to 2013, from 0.7 deaths for every 100,000 people to 2.7 deaths. According to the report, persons of non-Hispanic white origin between the ages of 18 and 44, are the most vulnerable, with the highest death rate: 7 deaths per 100,000, nearly three times the rate for the population at large. While the Midwest United States had the largest increase in death rate, the West, which includes Arizona, began in 2000 tied with the Northeast for the highest death rate, a number that doubled by the time the study ended in 2013.

Examining the CDC data reveals the possibility that we may be in another epidemic. Many believe that the current spike in heroin deaths may be related to an earlier dramatic increase in the abuse of prescription drugs.  Another contributing factor to the drug’s increased popularity and use is that the cost of heroin has decreased, while its potency has increased.

Heroin is classified as a narcotic. It is an opium derivative which is closely related to many prescription painkillers, called opioid analgesics. This category includes morphine, codeine, oxycodone, fentanyl and hydromorphone. According to the CDC, unintentional overdose deaths from opioid analgesics increased dramatically in the early 2000s. From 1999, the number of deaths had doubled by 2004 and tripled by 2007.

A 2011 study by Drexel University found that four out of five users of injected drugs – heroin being the most popular – has abused some form of prescription opioid before turning to an illegal substance. One of four injected drug users reported a prescription opioid as the first controlled substance they ever used.

The recent CDC data also supports the notion that prescription drug abuse has led to increases in the amount of heroin abuse. The same report includes information on overdose deaths from opioid analgesics. The death rate for these substances increased, as well, though at a more rapid pace. In 2000, the death rate was 1.5 per 100,000. By 2006, it had tripled, while the heroin death rate remained the same as it was in 2000.

However, while the death rate for opioid analgesics increased slightly and then even dropped in 2012, the heroin death rate soon took off. Between 2006 and 2011, the rate from heroin doubled, and by 2013 it had nearly doubled from that.

Immediate Adverse Effects of Heroin Use and Overdose

According to the National Institute on Drug Abuse users reported, immediately effects including a “rush”; then dry mouth, skin flushing, heaviness of extremities, nausea vomiting, delirium, severe itching, drowsiness and cloudiness in mental function.

The primary risk of danger on the bodily systems with heroin use is the respiratory system. Opioids depress breathing functions by altering the brain’s neurochemical activity in the area of the brain that controls automatic bodily functions like breathing and heart rate.  It can depress the heart rate and reduce oxygen enough to cause fluid in the lungs, deprivation of oxygen to the body, seizures, coma, brain damage, or death.

Long –Term and Other Effects of Heroin

The long term effects of heroin use solely from a medical stand point, can include, but are not limited to: addiction, withdrawal, deterioration of teeth, periodontal disease, and weakened immune system, breathing problems, liver disease, loss of memory, reduction in mental capacity, facial pustules, gastrointestinal problems, depression, sleep dysfunctions and other mental disturbances. Chronic use and shared needles can also lead to AIDS, hepatitis, and other infectious diseases.

Related Dangers: Heroin Laced with Fentanyl Overdose Warnings

Last week the Federal Drug Enforcement Agency issued a nationwide warning about a surge in overdoses resulting from Fentanyl-Laced Heroin. It is being described as a “significant threat to public health and safety”. Drug overdoses due to heroin laced with Fentanyl are occurring at an alarming rate. Fentanyl is said to be 100 times stronger than morphine, and is the most powerful opioid available to doctors. It’s a drug intended to be used to suppress extreme pain due to advanced staged disease such as bone cancer. But it’s being sold on the streets as heroin. Most users have no idea what’s in the heroin they are buying or using, making it far more lethal, than it’s already inherent risks.

Arizona’s Heroin Arrests Statistics

Recently it was reported Arizona ranks as being the sixth highest state in the nation experiencing an increase of heroin use and abuse among teens, and that officials have seen a disturbing trend of increased use. Officials of the Drug Enforcement Agency Phoenix division reported that that drug seizures at the border increased by 300 percent in recent years.

It was reported that in Gilbert, AZ, alone arrests had also increased by 300 percent, with the rise in teen use being a significant contributing factor. Cities across the state are struggling with the rise of its use. Deaths have reportedly doubled in the last decade in Arizona. In Tempe Arizona it was reported that the DEA and Attorney General recently completed a 2.5 year investigation which resulted in dismantling an extensive drug trafficking network that covered three states, as well as Mexico.

Narcan the Life Saving Drug for Heroin Overdose Reversal

In our prior discussion we explored the uses, and trends of an injectable lifesaving drug called Narcan (Trade name) or Naloxone.  This is an opiate antagonist, meaning it has the capability of preventing death if administered to a person suffering from an overdose of opiates, including heroin. It is administered with a hand-held auto-injector “Evizo” (Naloxone hydrochloride injection), approved by the U.S. Food and Drug Administration (FDA) in April 2014.

The injector provides an emergency lifesaving dose of Narcan for potentially fatal overdoses of heroin.  The drug had proven highly effective in reversing otherwise fatal effects of heroin overdoses.

The Federal Drug Enforcement Agency reported that since 2001, Narcan has been credited with reducing over 10,000 otherwise fatal heroin overdoses.

Narcan was traditionally used in Emergency Rooms and by first response paramedics. However, since first responders to the scene were an overdose is often the police or immediate care givers, many states have passed laws allowing police and other qualified first responders to be trained to administer the drug and equipped with it. As a result, police and care givers in some states are now allowed to carry lifesaving drug Narcan which is proving to save more lives.

Administration of Narcan

Lori Combs, BS, RN, Clinical Nurse Consultant an experienced clinician in ER, Trauma, Cardiology Forensic Nursing, and Death Investigations training, had this insight to share about the actual administration of Narcan:

Naloxone or Narcan (Trade Name) is an opioid antagonist which means the Narcan molecules compete for the opioid receptor sites in the central nervous system. Narcan is usually given by medical personnel such as Paramedics, Physicians and Registered Nurses via an intravenous access site. The reversal effects of the Narcan can occur within a couple of minute given in this method. If intravenous access is not available this drug can be given in the deep muscle of the buttock, upper arm or outer thigh area. Or it can be given into the fat of the abdomen or the back of the upper arms. If given in the deep muscle or fat, the mechanism of action will be slower compared to the intravenous access. One word of caution, these patients that experience the reversal effects of Narcan can then exhibit withdrawal symptoms from the opioid within minutes and need to be medically treated immediately.

Expansion of Laws for Police to be Trained and Equipped to Administer Narcan

Last March 2014, the United States Attorney General publically urged all law enforcement agencies in the US to train and equip their officers to administer Narcan. A total of 17 states currently have laws that allow for police to administer Narcan as first responders.

The state and government’s response to Narcan has been favorable, and many states have either passed laws or are in the process of expanding laws to allow other first responders to be equipped and trained to administer Narcan.

The Arizona Legislature is currently poised to pass new laws aimed to curb deaths from heroin overdose.

Under House Bill 2489, a police officer or emergency medical technician would be permitted to administer Narcan.

If passed, Arizona’s police and other eligible first responders would join at least 18 states that have passed laws nationwide allowing police to be trained, and equipped to use Narcan for an otherwise fatal heroin overdose.

HB 2489 passed the House of Representatives by a vote of 59-1, and is currently awaiting a vote in the Senate.

Signs and Symptoms of Heroin Use

All too often after tragedy strikes, a loved one including parents are stunned due to the fact they were unaware their child or loved one was using or abusing heroin. Early detection and intervention is crucial. Here are some signs and symptoms that may reveal someone is using or abusing heroin:

• Frequent nausea or vomiting;
• Chronic drowsiness;
• Scratches on skin due to uncontrollable itching;
• Flushed face, tiny pupils and no response of pupils to light;
• Slow breathing; coughing, runny nose, respiratory disturbance;
• Remnants of brown powder , dark sticky residue or crumbling substances;
• Syringes, glass or metal pipes;
• Belts or rubber tubing for injections;
• Baggies, burnt spoons,
• Loss of appetite;
• Sweating, twitching or tremors;
• Fully covering skin, especially on arms to hide needle marks

What to do if you Suspect a Loved one is using or abusing Heroin

According to HelpGuide.org, it is natural for parents to feel angry, and sometimes blame themselves. Parents and guardians are urged to resist the urge to punish, preach, or threaten the youth.

Instead it is recommended that the parent or loved one try their best to do the following:

• Speak up, and reach out to the person about their concerns;
• Remain calm; and only discuss the concerns under sobriety of both parties;
• Be prepared for denials with a list of behavior problems and concerns noted:
• Take care of yourself, and your health needs;
• Let the person accept responsibility for their actions;
• Institute rules and be prepared to execute the consequences if the rules are broken;
• Monitor your teens, or loved one’s activities, including knowing with whom they are with;
• Encourage healthy interests and participation of extracurricular activities;
• Explore underlying issues such as pain, stress, or other causes;
• Seek professional help, education, counseling and treatment

Why Heroin Use and Arrests are on the Rise in Arizona and throughout the United States

The most recent statistics reported for heroin and other opiate arrests in Arizona by the Arizona Department of Highway Safety were in 2013. Heroin and other opium related crimes include possession, trafficking and sales. The total arrest related to these crimes were 3,549, a 7 percent increase over 2012, totaling 3,315.

On a national level the Drug Enforcement Agency reported in its 2014 National Drug Threat Assessment Summary that the greatest increasing threat facing our country in 2014 was posed by heroin. Heroin seizures at borders were 4 times higher in 2013 over 2009. Increase in use was second only to methamphetamine.  Reasons cited included the following:

• Increased demand;
• Controlled prescription drug users who switched from prescription drugs to heroin.
• Controlled prescription drug users switched to heroin due to the decreased availability of prescriptions resulting from law enforcement and legislative efforts to thwart operation of illicit pill mills, doctor shopping, and unethical physician practices.
• Price of heroin is relatively low as compared to the cost of prescription drugs.

Arizona Laws and Criminal Penalties for Heroin Convictions

In addition to the highly dangerous health and medical risks of use and abuse of heroin are the criminal consequences of use, possession, transport, sale or distribution.

Narcotics crimes including heroin, carry some of the most serious penalties under Arizona Drug Law. Under both the federal Controlled Substances Act and the Arizona Uniform Controlled Substance Acts, it is listed as a Schedule I substance, meaning it has no accepted medical use and a high potential for abuse. It is classified as a “narcotic drug” in Arizona Revised Statutes 13-3401(21).

Under Arizona Revised Statutes 13-3408, heroin charges can include:

• Possession or use, a class 4 felony, with a range of punishment from four to eight years in prison;
• Possession with intent to sell, a class 2 felony, with a sentence ranging from seven to 21 years in prison;
• Possession of equipment or chemicals for the manufacture of heroin, a class 3 felony, punishable by five to 15 years in prison;
• Manufacturing heroin, a class 2 felony, with a seven to 21 year range of imprisonment;
• Administering heroin to another person, a class 2 felony, with a seven to 21 year range of imprisonment; and
• Transporting or importing, or offering to transport or import, heroin into the state, a class 2 felony, with a seven to 21 year range of imprisonment.

All heroin charges result in felony convictions, which have broad implications. Penalties for convictions include expensive fines, fees, and costs of assessments; participation in a substance abuse counseling and treatment programs; loss of some civil rights associated with felony records which include loss of the privilege of possessing a firearm; and loss of voting rights.