Heroin overdose deaths at epidemic levels in Allegheny County

EXCHANGE CENTER—Ronald Johnson gathering supplies for people who come in and trade their dirty needles for clean needles and supplies. The old supplies, used needles, condoms, alcohol, tourniquets, cookers and alcohol pads, are then properly disposed of. (Photos by J.L. Martello)
EXCHANGE CENTER—Ronald Johnson gathering supplies for people who come in and trade their dirty needles for clean needles and supplies. The old supplies, used needles, condoms, alcohol, tourniquets, cookers and alcohol pads, are then properly disposed of. (Photos by J.L. Martello)

There were 300 overdose deaths in Allegheny County in 2014, more than ever before. With 75 percent involving opioids.
“There has been a 150 percent increase in HIV and Hepatitis C since 2010 and that is mostly through shared needle contact. The question isn’t why don’t people stop using drugs but why do people use them,” said Alice Bell of Preventive Point Pittsburgh. “Look at all of the people who are dependent on pain medication. We just need to realize the drug addict and the pain patient are the same people.”
“Opioids are being prescribed in such proliferate numbers that in 2012 259 million prescriptions were given, almost one for every person in the country,” said U.S. Attorney for the Western District of Pennsylvania David “Jack” Hickton.
Hickton, who was appointed by President Obama in 2011, believes the opioid problem in the United States and especially in western Pennsylvania where-by law enforcement is trying to decapitate a two-headed monster.
“What we have done recently is being more aggressive with street heroin dealers, we also have increased our healthcare fraud work because many of the people that are trafficking in pills are violating the healthcare laws.” He said they have done so in recognition of the connection between the two, because, often times, people who start out taking prescribed Vicodin work up to a habit that spirals into Percocet and Oxycodone abuse. Eventually, as an individual’s livelihood is overtaken with addiction, heroin becomes the cheaper, more readily available substitute.
A public perception nationwide is to look at drug abuse racially, categorizing crack as a drug abused by African Americans and drugs such as heroin and crystal methamphetamine as drugs abused by White Americans. In reality, according to federal statistics, African Americans make up 13 percent of the population and are 13 percent of overdoses nationwide and 14 percent of overdoses in Allegheny County.
When asked about the new heroin that has been reported to be so strong  that people collapse to the ground before the needle can be removed from the arm, Hickton sounded resigned as he discussed recent events.
“When you talk about the new heroin, what you’re talking about is the fentanyl. We had overdoses this past week with what medical examiners said was one hundred percent fentanyl.”
Fentanyl is a synthetic opiate that is so powerful it is used as anesthesia for surgery. “It should never be used without a doctor’s supervision and certainly not used unknowingly because it will kill you. And that’s what we see happening,” said Hickton.
Another problem for law enforcement is the versatility of fentanyl; it can be smoked like opium, snorted, injected or used topically in a patch. Hickton said reforms are being made accordingly.
“One of the problems that we are dealing with right now is that these opioids and synthetics can be used in a variety of ways. Some of the reforms put in place have been to change the packaging on some of the pill version of opioids to reduce that ability for how they can be used. If it can be ground from pills to a powder and snorted or as a pill swallowed, the easier it is to take the more likely it is to be abused,” Hickton said. Which is why he is going beyond conventional methods to attack the multidimensional problem, he said.
“The first part works on the supply side,” he continued. “The second works on the demand side by recognizing addiction is an illness that we need to illuminate the stigma of the addiction/illness and we need to get a voice to people and families of people struggling with addiction because we can’t prosecute or incarcerate our way out of the heroin or opioid problem.”
READY FOR SALE—Herion stamp bags called “Top Five,” pictured here in bundles of 10, go for $10 a bag.
READY FOR SALE—Herion stamp bags called “Top Five,” pictured here in bundles of 10, go for $10 a bag.

Bell and Ronald Johnson are two Prevention Point Pittsburgh workers who have given the last 20 years of their lives to rescuing addicts from overdosing and fighting the spread of blood borne illnesses. PPP is the only county-approved syringe exchange program in Southwestern Pennsylvania and considers needle exchange as a foundation for addressing a broader set of injection drug users’ needs.
Bell, who started volunteering in 1997 and became staff in 2000, said she joined because “Lots of people were dying of AIDS and, disproportionately, it was affecting drug users. It was a social justice interest more than a personal story. Prevention Point is a place where people get treated with respect,” she said.
Johnson is with Bell every Sunday in Oakland from 12-2:50 p.m. He gives every person a sheet that asks their neighborhood, gender, and needs, everything from syringes, cotton, cookers, condoms, tourniquets, filters to bleach containers for disposal, Hep C tests, HIV Chlamydia, gonorrhea and wound care as well. “Some people who come in are diabetic and they don’t have the ability to keep enough 25-29 gauge needles. Some people go through 8 needles a day,” said Johnson.
After receiving their sheet, he has them report where they have seen people overdose and he writes it on a board that everyone who walks in can see so that people can be warned where the bad stuff is.
“They might come in and say it’s bad in Clairton. And say they were taking Sand Bag, Joe Boat, or Top Five. What date it was found and how bad it was,” said Johnson. “For somebody who might need further assistance, like getting treatment, I’m a case manager so I will see what type of help they need, they will let me know, whether shelter, food, need assistance getting social security or S.S.I.” No using happens in the facility. “On Wednesday I’m on the Hill in a van (with) no markings on Addison Terrace. You can come in get your supplies and it’s quicker,” he said
Finally, and just as importantly, there is Narcan training in the back. Narcan has been used for 50 years by paramedics. Respiratory distress is what causes people to die from overdoses so Narcan blocks the opioid effects and gets them breathing again.
As Bell explained, “It takes four minutes without oxygen before brain death starts to occur. That is why it’s so important to have it on site. With the new laws that allow police, firefighters and EMTs to carry it, that’s great, they can save a lot of lives, but people who are using drugs are with other people who are using drugs, they are the ones that really need to have it.”
The Naloxone, also known as Narcan, program started in 2005. “To this point we have reports of over 1300 overdose reversals due to narcan. 1300 times someone said I need more Narcan because they used what they had,” said Bell, who also does trainings in the county jail and said she hopes Allegheny Health Network, which is taking over healthcare services for the jail, will allow her to administer it there as well.
“I had a man come to me after a session and said if I would’ve had this a year ago my daughter would be alive today. It takes 10 minutes to learn how,” she said.
“A few months back everyone was allowed to get it. They are going to start giving it out at Giant Eagle. That’s big man. You will need a prescription and you will have to pay for it without insurance. But hey, that’s showing you that people are aware of if you can’t stop the problem but you can save someone’s life. But here it’s free,” said Johnson
Narcan has no psychoactive effects. The cost of generic Narcan is cheap. A few years ago 10 doses were $3 but Bell said it has gone up a lot since then. No matter, the fight will continue, as Hickton puts it, “There is no question that we are in an epidemic it’s everywhere and it’s touching all groups and that’s why we are working so hard on it.”
Currently, Pittsburgh and Philadelphia are the only areas in the state that have needle transfer.
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