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An opiate emergency
In Clallam County, what started as a surge in prescription drug abuse in the early 2000s is turning to heroin addiction and death.
Statistics released by the University of Washington Alcohol and Drug Abuse Institute indicate Clallam County holds the highest rate of opiate-related deaths in the state as of 2010. According to the 2008-2010 data, the average annual rate of opiate-related deaths, both from prescription drugs and heroin, was 11.7 per 100,000.
Opiates are a class of drugs that originate from opium, produced in the sap of the opium poppy, or are semi-synthetic or synthetic derivatives of opium. The group includes morphine, heroin, opium and prescription narcotic painkillers such as hydrocodone, oxycodone and methadone.
From 2005-2011, substance abuse treatment admissions for pharmaceuticals and heroin jumped from 0.05 percent of total admissions to 15 percent of total admissions, according to Clallam County data.
Jude Anderson, a human planner with Clallam County Health and Human Services, said while nicotine and alcohol addictions still are the most common, opiates are extremely dangerous and when used in excess or in combination with other drugs can be deadly.
“I think we haven’t seen the worst yet,” said Patrick Graham, a chemical dependency counselor at Olympic Personal Growth Center in Sequim.
Dr. Ronald Bergman, director of integrated pain management at the Lower Elwha Clinic in Port Angeles, said the reason opiates are so addictive is simple — they hit specific receptors in the brain that “make you feel good.”
“We do things that make us feel good,” he said.
Problems arise when the body becomes dependent on the opiate, which is possible even when used as prescribed; when people become addicted to the high and abuse the drug; and when people take too much or mix the drugs and die, he said.
Anderson said opiates interfere with the brain’s natural release of endorphins. It can take a long time for the brain to re-learn how to produce proper amounts of the feel-good hormone on its own, she said.
Bergman said opiates have the side effect of suppressing the respiratory system, which is the most common cause of fatal overdoses.
When opiates are taken with benzodiazepines such as alprazolam (Xanax), lorazepam (Ativan) and diazepam (Valium), the combination adds to the respiratory suppression. If alcohol, which acts as a depressant, is added to such a mix it is a “pretty good indication they’ll die,” Bergman said.
Teenagers attending “pharm parties,” where prescription pills are placed in a bowl and taken at random, are in danger because they often don’t understand the potentially deadly implications of mixing substances, he said.
Abusing prescription painkillers — as a patient or not — is often only the beginning. According to UW’s Alcohol and Drug Abuse Institute, 40 percent of heroin users in 2009 reported being hooked on prescription opiates before trying heroin.
Graham said some people addicted to the prescription painkiller OxyContin were smoking up to 240 mg per day. At a cost of $1 per mg, it was a very expensive habit and they began committing crimes to pay for the pills, he said.
When drug manufacturers made the pill into a gel form that can’t be smoked, users turned to the cheaper alternative — heroin, he said.
The summer of 2011 brought a string of nonfatal heroin overdoses largely involving Sequim’s young adults and teens. Five people — a 16-year-old, a 17-year-old, two people in their 20s and one 60-year-old — overdosed after shooting up black tar heroin in incidents ranging from July 27 to Aug. 19, 2011.
Sequim Police Sgt. Shawn Madison said the department has seen fewer overdoses since the summer months, which he hopes is the result of reducing the supply by arresting heroin dealers.
While the overdoses may be less frequent than six months ago, Graham expects to see a spike in opiate-related health issues next.
Hepatitis C and HIV/AIDS are spread easily by intravenous drug users sharing needles, he said.
Statistics from the Clallam County Syringe Exchange show the number of needles exchanged has increased dramatically in four years from 60,850 in 2008 to 115,900 in 2011.
Anderson said she believes the increase is due to more people shooting up drugs as well as increased awareness of the program, which aims to help prevent the spread of HIV/AIDS and Hepatitis C and protect the public from needles lying around.
“People who use the exchange tell the people they’re using with about it so they use it, too,” she said.
Part of Anderson’s job is to make sure high-risk populations, such as pregnant women, teens and IV drug users, receive substance abuse treatment through state funding.
The prescription narcotic methadone was developed to be used as a substitute for heroin, she said.
There are methadone clinics on the east side of the Puget Sound where heroin users can go each day for methadone maintenance.
Iva Burks, director of Clallam County Health and Human Services, said the purpose of methadone maintenance is to maintain a certain amount of opioids in the body so the user can live a normal life and not seek the drug.
Bergman said methadone was well developed and acts as an effective painkiller but is potentially lethal because it builds up in the body over time, easily leading to an accidental overdose.
There also are detox facilities, which will get users through the initial withdrawal period, Anderson said.
But following detox, which isn’t offered at any facilities in Clallam or Jefferson counties, patients still may need methadone maintenance or Suboxone, she said.
Suboxone is a prescription drug that relieves withdrawal symptoms without producing a high and blocks the euphoric effects of opiates, she said. Doctors must receive special training before they can prescribe the drug to patients, she said.
Abstinence and education
Graham said the Olympic Personal Growth Center has an abstinence approach to drug treatment.
Patients are connected with support systems, recovery activities and services in an effort to prevent them from relapsing on drugs, he said.
People often come in after court orders, family or other outside forces intervene, but it isn’t until they want sobriety for themselves that they are successful, he said.
“You can definitely tell when someone gets it,” Graham said. “Their lives change in a positive way quickly.”
One patient, who started using drugs and alcohol in grade school, was doing “everything” from acid to methamphetamine when he lost his children to Child Protective Services, Graham said.
The man struggled through drug court, quitting before getting help for his anger and trying again. He went back to school, got a job and got his children back, Graham said.
“You can just see the change in their eyes,” he said of patients in recovery. “Those are the things that make our job worth it.”
Bergman, who leads the Clallam County Medication Abuse Work Group, said it is time to look for solutions on a communitywide level.
“As health care providers, we need to look at how we’re prescribing,” he said.
Since 70 percent of prescription drug abusers get the medication from family or friends, people need to make sure their prescriptions are secured and disposed of properly. Parents need to watch their children and know what they’re doing and who they’re hanging out with.
Community awareness, drug demand reduction, prevention, treatment and outreach, and educating youth and families are ways to create solutions to the problem, Bergman said.
“Get involved,” he said. “Be aware.”
Reach Amanda Winters at firstname.lastname@example.org.
OPNET investigations net three arrests
Sequim Gazette staff
Law enforcement cracked down on heroin and pill distributors over the past year, with about 10 from Sequim and Port Angeles arrested and charged.
Most recently, Ronald Charles Critchfield, 40, listed by the court as a transient, was charged with three counts of delivery of a controlled substance, heroin.
According to a probable cause statement filed in Clallam County Superior Court, Critchfield sold heroin to a confidential informant working with the Olympic Peninsula Narcotics Enforcement Team on three separate occasions.
Twice in August 2011 and once in September 2011, Critchfield acquired heroin from a supplier to sell to the confidential informant, OPNET detectives said.
The drugs were tested by the Washington State Patrol crime lab and found to be heroin, according to the report.
Detectives arrested Critchfield on Feb. 3 and placed him in custody at the Clallam County jail.
Critchfield posted $5,000 bail Feb. 6 and was arraigned Feb. 12. He pleaded guilty to all three charges and has a trial date of April 23.
Critchfield is the third person in less than a month to be arrested following an OPNET investigation and charged with delivering heroin. Ralph Omer Needham and Cheryl Ann King were arrested and charged in separate cases earlier this year.