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Pubdate: Mon, 26 Dec 2016
Source: Pittsburgh Post-Gazette (PA)
Copyright: 2016 PG Publishing Co., Inc.
Contact: http://drugsense.org/url/pm4R4dI4
Website: http://www.post-gazette.com/
Details: http://www.mapinc.org/media/341
Author: Rich Lord
ONE DAY IN THE OPIOID EPIDEMIC
The 44-year-old mother who answered the door in Lincoln-Lemington on the evening of Dec. 15 had the “pin point” eyes of “someone who has recently used opioids,” a Pittsburgh police officer wrote.
The officer was responding to a 911 call suggesting child endangerment. “I do suffer from using heroin and I’m trying to stop, but I keep using,” the woman admitted, according to the officer’s affidavit. She led police to the makeup bag under the throw pillow, where they found six stamp bags of heroin and three hypodermic needles, the officer wrote.
Her son, whose age was not indicated, was “in good health,” the officer wrote, and he opted not to arrest her, but to confiscate the contraband and charge her by summons with possession of heroin and paraphernalia.
That encounter is of interest precisely because it is mundane. The epidemic of opioids – including prescription narcotics, heroin and fentanyl – is now part of the Pittsburgh region’s daily grind. A wave of pleasure – or at least relief – draws the user back to the drug, but creates ripples of pain and frustration that course through the lives of family members, medical professionals, police, judges and forensic pathologists.
The Pittsburgh Post-Gazette, which has featured the opioid problem in its series OVERDOSED, asked people and institutions to take special note of the epidemic’s impacts on one ordinary – though brutally cold – day, Dec. 15. But the reverberations from each of that Thursday’s collisions, and the many others not captured here, continue far into the future, as the babies born dependent struggle with the effects, the cops and courts and jails contend with arrested addicts, the grieving families try to regroup. Then add Friday’s rehab admissions, Saturday’s arrests, Sunday’s overdoses, Monday’s orphans, and on and on.
That’s what the region is facing.
Sometimes there are two, other times a dozen, but babies born opioid-dependent are “a constant issue” in the Magee-Womens Hospital of UPMC maternity ward, according to Richard Beigi, the Oakland hospital’s chief medical officer.
On Dec. 15, there were eight such babies, and this year Magee has seen close to 500 pregnant women who were using opioid rehabilitation medicines like methadone or buprenorphine, or actively using painkillers or heroin, Dr. Beigi said. “That’s maybe six or seven percent” of pregnant patients, he said.
Often the dependent babies are irritable, sleep poorly and struggle to coordinate the sucking, swallowing and breathing required to feed. Magee has a corps of volunteer “cuddlers” that carry some of the load. “It’s not that the moms don’t care. It’s just that these babies have so much more needs,” said Dr. Beigi.
At West Penn Hospital on Dec. 15, two newborns suffered from opioid dependence, according to Giovanni Laneri, the nursery’s medical director.
“We just sent home a baby who had been in the hospital for 52 days,” Dr. Laneri said, adding that the mother, while pregnant, had been using heroin, benzodiazepine tranquilizers and buprenorphine. He isn’t blaming her. “Sometimes it’s very sad – sexual abuse, physical abuse, it’s a way to get away from those circumstances.”
West Penn deploys for each dependent baby an array of professionals — doctors and nurses, of course, but also physical therapists and occupational therapists — plus a volunteer cuddling team. The staff also counsels the mother, though sometimes she’s not the baby’s best option. On average, he said, “babies that go home with adoptive parents or foster parents do better than babies that go home with the biological parents.”
Magee’s Pregnancy Recovery Center, which specializes in using buprenorphine to treat pregnant women for opioid addictions, saw five such women, visited two more in the delivery department and took calls from seven potential patients on Dec. 15.
“We welcome them in. We congratulate them for being pregnant,” said Michael England, the center’s director. “I think it stuns the patient,” he said, because they are so used to being scolded.
On Dec. 15, one patient graduated from the program, and no one flunked out.
“Fifty percent of our patients don’t make it through the PRC, in the sense that they fail the drug test or miss their appointments,” said Dr. England. “A lot of those patients tell us, ‘I just can’t do this right now.'”
The city’s first overdose call came at 7:13 a.m., and firefighters arriving at a South Side home shoved a Narcan dispenser into the 21-year-old patient’s nose, administering naloxone, which can reverse an otherwise fatal dose. It didn’t work. They administered a second, and finally the patient revived.
“It might take two, three, four doses,” depending on the potency of the heroin and the presence of fentanyl, said city Emergency Medical Services Chief Robert Farrow.
On that cold, slow day, city medics responded to non-fatal overdoses involving a 60-year-old in Overbrook and a 46-year-old in Mount Washington, and found a 30-year-old dead amid stamp bags in Lawrenceville.
In much smaller Washington, Pa., medics also responded to four overdoses on Dec. 15.
The overdoses come in waves, said Chief Farrow. “If it’s a strong version of heroin laced with anything, people tend to overdose rather quickly,” he said. “We can get four or five of them in an hour.”
The city has responded by deploying naloxone – previously handled only by medics – to firefighters and to around 80 percent of police vehicles, said Public Safety Director Wendell Hissrich. The medics still bear the brunt of the epidemic.
“It’s very taxing on paramedics,” said Mr. Hissrich. “In some cases you’re responding to the same person the second, third and fourth time. … You’ve saved their life, but at the same time they’re very upset at you” for nixing their high.
Once they’re revived, the medics can’t force patients to a hospital or treatment. If the patient doesn’t wake up, though, off they go.
On Dec. 15, just one heroin overdose patient made it to Allegheny General Hospital’s Emergency Department, which averages around three per day, according to Paul Porter, a physician. That person needed naloxone and respiratory resuscitation, without which “they would not have survived,” he said.
Dr. Porter has gotten to know some of the patients who repeatedly overdose or come in with questionable complaints, trying to convince doctors to prescribe pain pills. “It’s 6 degrees outside. People are not going out to buy milk,” he said. “But they’re going out for this.”
Maintaining that emergency doctors were “always well under 5 percent of that problem,” Dr. Porter puts much of the blame on federal regulators who, 15 years ago, approved the concept that pain was a “fifth vital sign” and must be alleviated. Patients rated pain on a 1 to 10 scale, or using a continuum of line-drawn faces, from grinning to weepy. Opioid prescribing surged. “This year, I successfully lobbied to have the pain scale taken out of our department,” he said.
The opioids created an expectation that can’t be met by other drugs that don’t “give you that warm glow that feels like a mother’s embrace to some people,” he said. Like Frodo in the “Lord of the Rings,” “Once you put on that ring, it just calls you.”
The ER is devising a system for nudging people toward rehab, he said, but “successes are much fewer than the failures right now.”
City medics, too, provide overdose patients with lists of agencies. But many addicts scoff.
“A lot of the times,” said Chief Farrow, “they’re like, ‘Been there, done that.'”
When Neil Capretto arrived at work at 8 a.m. on Dec. 15, the detox unit on the Aliquippa campus of Gateway Rehab was full, and all but one patient was a heroin or opioid user.
“Twenty years ago, probably less than 10 percent of our patients were on opioids,” Dr. Capretto recounted. On Dec. 15, though, just 13 percent of Gateway’s inpatient clientele were there for problems other than heroin or opioids, and two-thirds of the residents in its halfway houses were trying to recover from those drugs.
At least he’s got new tools. On Dec. 15, Dr. Capretto put around 8 patients on Vivitrol, one shot of which blocks the effects of opioids for a month. He put another three on buprenorphine, always accompanied by holistic therapy.
There was no waiting list to get into Gateway. This is the slow time. People postpone the decision to go into treatment, or to nudge a loved-one into rehab, until after the holidays. By the second week of January, if history is any guide, demand will surge.
Southwestern Pennsylvania Human Services, which provides drug and behavioral health case management in Westmoreland County, served 128 people with opioid problems on Dec. 15. More are on the way.
SPHS, with the Westmoreland Drug and Alcohol Commission, did 15 assessments in which the subject’s drug of choice was heroin or opioids, referred three such people to treatment, and did 24 phone screenings related to those drugs on Dec. 15, said Elizabeth Comer, the commission’s director of clinical and case management services.
“That’s an average day,” she said. She spent the down time working on a training program in naloxone administration, and the new online training request form.
Dr. Capretto said the interplay between prescriptions and the heroin problem was evident Dec. 15. He advised a physician whose pain patient was “getting out of control.” Cut them off of opioids, and they might turn to heroin. He urged rehab.
“I got a call from a patient that I had treated three years ago who had been doing well up until about three months ago, who had an operation, was put on pain pills and relapsed,” he said. “I said, ‘You’ve got to come back in.’
“I didn’t leave there until close to 7 at night.”
A Carnegie Mellon University student, age 20, spent Dec. 15 in custody for drug delivery counts.
The afternoon before, CMU police responded to a medical assistance call, and found a different student, referred to as John Doe, suffering “abdominal pains” after taking five oxycodone pills, according to an affidavit. “John Doe” revealed that the pills came from the 20-year-old student, that they’d arranged the purchase via text messages, made the payments through PayPal and done the handoff on Margaret Morrison Street.
The accused student told police that he was selling pills he’d gotten after surgery, according to the police affidavit.
That was one of 10 criminal complaints police filed on Dec. 15 that included heroin or opioids.
A Pleasant Hills woman, age 26, was arrested in Spring Hill with three stamp bags of heroin, police wrote. A Fineview woman, 34, was picked up with a hypodermic needle trying to buy heroin near Sandusky Court, according to another affidavit.
A Westwood man, 37, whose truck crashed into a house was “under the influence of narcotic analgesics,” police wrote. A traffic stop in Garfield yielded three men and one juvenile with bundles of heroin marked Hess, 7 Eleven and Stampede.
Officers serving an arrest warrant in Chartiers found heroin, cocaine, marijuana, a Taurus .40 caliber pistol, eight cell phones and $5,954, they wrote. Three men were jailed.
In the Allegheny County Jail, 30 people were in detox for opioids on Dec. 15, and five pregnant inmates were on medication to prevent opioid withdrawal. Another 33 people were offered naloxone as they left the jail, because it’s common for freed inmates with a lowered tolerances to promptly “party” themselves to an overdose.
Police Officer Paul Abel stood a few feet from Terrell B. Campbell, 29, of Perry South, during the latter’s preliminary hearing at Pittsburgh Municipal Court, Downtown, on Dec. 15. The two met previously in October, when Officer Abel stopped Mr. Campbell’s BMW near Allegheny Commons for a burned out brake light.
Officer Abel testified that as he approached, Mr. Campbell raised and then lowered his window and shifted his weight around. Officer Abel peered in. “There was a Dorito bag stuffed, between the seats, in the center console, containing heroin,” the officer testified. Stamp bags, marked with the word Panda, “were sitting on top of the chips.”
The powder “tested positive for heroin and fentanyl,” he added.
District Judge James J. Hanley, Jr. held the case for trial. The hearing was one of 26 scheduled that day which centered on heroin, comprising nearly one-fifth of the regular preliminary docket.
The heroin defendants’ ages ranged from 19 to 62. Nine were women. All were arrested in the city. Their home addresses included Atlasburg in Washington County, Beechview, Bloomfield, Brackenridge, Bridgeville, Carnegie, Carrick, Castle Shannon, Duquesne, Ford City, the Hill District, Lawrenceville, Leechburg, McKees Rocks, McKeesport, Millvale, Perry South, Ross, Sheraden and Spring Hill.
The stamp bags police reported seizing from those 26 defendants were branded with the names A+, Ass Up, Black Jack, Bobby Brown, Dope Boyz, Gucci, Horse Power, K.O., Killing Time, Love, Old School, Panda, Passion, Power, PS4, Quick Stop, Real G4 Life, Scorpion, Tuff Stuff and Zip Em Up. Some were decorated with images of footballs, boxing gloves or a thumbs-up.
Judge Hanley noted that many of the retail thefts, burglaries, car break-ins and simple assaults he heard are also driven by heroin. “The pills lead to the heroin, and it just destroys people,” he said. “The addiction is just so powerful, they don’t use common sense. It’s not a normal brain making the decisions – it’s an addicted brain.”
He postponed around six of his preliminary hearings because the defendants were in rehab. He’ll watch their progress and hope for an ending that doesn’t leave them with a serious criminal record. “Sometimes it’s a wake-up call. And other folks just never get it.”
From throughout Western Pennsylvania, overdose victims’ names, photos of stamp bags, chemical analyses, dealers’ phone data and more flow into the computers manned by Keith Essig, the first investigative analyst hired by the U.S. Attorney’s Office for the Western District of Pennsylvania, at the year-old federal Fusion Center in Cranberry.
“The whole goal is to ID the dealers who are killing people and get them off the streets for as long as possible,” said Mr. Essig, as he sat behind his monitors on Dec. 15. Most of the region’s bigger police departments are sending reports of drug deaths to the Fusion Center, by email, fax or phone. ( Mr. Essig wants to develop a phone app. ) The center got 11 overdose reports on Dec. 15.
The road from the overdoses to the judge’s final gavel strike can be long. The case that served as the prototype for the Fusion Center’s work started with two overdoses in March 2015. It ended Dec. 15, with the sentencing of Andre Higgs, 33, of Wilkinsburg, to 15 years in federal prison.
Higgs and two accomplices sold fentanyl-laced heroin. Stacey Shaw, 38, of Altoona, Pa., a mother of two, died after using it in the bathroom of a Sheetz store – the end of a descent that started with prescriptions for OxyContin in relation to injuries. Ray Smith, 43, of Munhall, a father of two, went on and off drugs until he used the spiked heroin and was found in the bathroom of his home.
When Mr. Essig sees a pattern, he’ll alert one of the FBI and Drug Enforcement Administration agents who pass in and out of the small office suite: “I think there’s something that we can expand on here.”
The agents then work with some or all of five outside task force members – — one each from Pittsburgh, West Mifflin, Munhall, the Port Authority and the Allegheny County Sheriff’s Office. Or they partner with municipal police.
Of nine federal court criminal hearings on Dec. 15, three, including the Higgs sentencing, dealt with heroin. More are in the pipeline.
Len Piccini, an FBI special agent with the Fusion Center, outlined a case investigated earlier, on which he was working Dec. 15.
“Multiple ODs in Penn Hills on a certain stamp bag,” said. “Then there were some ODs in Monroeville a day later. Then there was a fatal in the city.”
He put out the word: “Have you guys seen anything of this stamp bag?” He built a crew to interview survivors of non-fatal overdoses, do surveillance and execute search warrants.
He’s been chasing drug dealers for 14 years. Talking with overdose survivors, though, is new to him.
“You catch these people right after they overdosed,” he said. “Just for a very brief period there’s some sort of clarity.” They want to get better.
“And then it’s gone,” he said. “I go back and they’re high when I go and talk to them. They’re right back.”
Nine autopsies were conducted at the Allegheny County Medical Examiner’s Office on Dec. 15, and the initial assessment was that eight appeared to be drug overdoses and four showed chemical indications of fentanyl, according to Karl Williams, the medical examiner.
Dr. Williams can’t issue a final cause and manner of death until the toxicology reports come in, but often it’s obvious. “They come in with stamp bags from the scene,” he said. “They come in with needle marks.”
Usually a body contains multiple drugs. Of the first 300 drug deaths in Allegheny County this year, 56 percent contained heroin, 48 percent fentanyl and 10 percent oxycodone. Other prescription drugs were present in well over 20 percent of the bodies.
Once found only in painkiller patches like duragesic, fentanyl is now manufactured abroad, in many variants linked by one trait: a few salt grains’ worth can kill. Dealers mix it with heroin, cocaine or even bath salts to give their offerings a marketing edge. If they don’t mix it well, “hot spots” appear in the batch. Picture lumps of dry flour in pancake batter, but invisible, and deadly.
Theresa Blatz spent Dec. 15 making arrangements for the cremation of her son, Robert Lee Frank, 36, who died two days earlier.
“When I went up to find him, he was between his bed and his coffee table face down, cold,” the McKees Rocks woman said.
Learning disabled, he had no job and received Supplemental Security Income. “He was on pills for a while, and after the pills he went to the heroin and he just stayed with it,” Ms. Blatz said. “He was basically a decent kid. … But this drug got a hold of him and that was it.
“I kept beating it into his head, your buddies are dying, don’t do this, please,” she said. Rehab worked for a while, and he attended group meetings at the nearby C.A.S.H. Club. “He quit shooting up for the longest time. … I checked his arms and his hands and that, and he was starting to look good.”
But he was suffering from depression, barely leaving the apartment in which he lived, just above hers. “The one friend came around,” she said, and her son, his tolerance lowered, said yes.
“He was so stiff and cold,” she said. Medics tried naloxone, but it was too late. “I expected him to bury me, not me bury him.”
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